The URL can be used to link to this page

Item C44 .. D N�-�-TY I yorGeorge te : as t y rol"eorHWher ®thstrsatTjo '�MONROEDanny Whage, DIsAnd'1. „t mD a m'•' Daawd Pice,D tract 4 District 4 Office: RorWa KeVs Marathon Airport SWte 210 Kwaithon,FL 33050 Ph:305 2 3- �C Fx0 305 289 4 10 Em.( g alu t ta��u .@.@".�wm�m. P1� f�i't„u a➢( f Interoffice Memorandum October , 2013 ® Amy Heavilin, Clerk From: Commissioner DavidRice,District *REVISED* Notice of Voting Conflict Per Florida Statute 12.3 s l hereby disclose by written rrnernorandaorre that I will abstain fro the Grote on certain issues that are brought before the Monroe County Board of Commissioners with entities that I am involved with. 1 will abstain from the vote on issues concenfing the Guidance(mare Center„Inc.,a rivak% snot-for-tnrolit entity,which receives sore e of its operational funding from the County, as l am currently a member oluthe Board of Directors, of the Care Center. At e October 16,2013 BOCC meeting, I will abstain ro the vote on ie (s)c ('43:Approval of a rrree aent„s wieh Monroe Cdou ned of the Arts Corpora don on d(bla Florida Key,s Council of 1he Ails and rite Historic Florida KeYS F ou ndlaatia rat Inc,for BOCC direct line- item aaanalion Y'.. 014:Approval of agreements with Guidance Care Ce neer cor the unit lot-fleouse Program,ra m, the Baker Act Transportation Services and Community nity raaonsportatiaorno aor the Disfulvapiraged and the Substance Abuse Mental Health local onantchfu ndin for FY 2014, BOARD OF COUNTII COMMISSIONERS Mayor George Neugent,District 2 -� Mayor Pro Tem Heather Carruthers,District 3 UNTYjo 'MONROE Danny Kolhage,District 1KEY WESTFLORIDA 33040 Sylvia 1.Murphy,District 5O5 t3051 29a-4s4i David Rice,District 4 District 4 Office: 9400 Overseas Highway Florida Keys Marathon Airport,Suite 210 Marathon,FL 33050 Ph: 305 289-6000 Fx: 305 289-4610 Ern: boccdis4 Inonrtx:county-II.L,(iv Interoffice Memorandum Date: October 9,2013 To: Amy Heavilin, Clerk of the Court From: Commissioner David Rice, District 4 Re: Notice of Voting Conflict Per Florida Statute 112.3143,1 hereby disclose by written memorandum that I will abstain from the vote on certain issues that are brought before the Monroe County Board of Commissioners with entities that I am involved with. I will abstain from the vote on issues concerning the Guidance Care Center, Inc.,a private, not-for-profit entity, which receives some of its operational funding from the County, as I am currently a member of the Board of Directors of the Care Center. At the October 16,2013 BOCC meeting,I will abstain from the vote on item(s): #C44: Approval of agreements with Guidance Care Center for the Jail In-House Program, the Baker Act Transportation Services and Community Transportation for the Disadvantaged and the Substance Abuse Mental Health local match funding for FY 2014. BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: October 16, 2013 Division: OMB Bulk Item: X No Department: Grants Staff Contact/Phone 4: Laura deLoach-Hartle x4482 AGENDA ITEM WORDING: Approval of agreements with Guidance Care Center for the Jail In- House Program, the Baker Act Transportation Services and Community Transportation for the Disadvantaged and the Substance Abuse Mental Health local match funding for FY 2014. ITEM BACKGROUND: The Jail In-House Program (JIP) direct program cost for FY14 is $201,070. The program will be funded in part by a FDLE Byrne JAG grant in the amount of$27,040 and a FDLE RSAT grant, including required match, of $66,667. The balance remaining necessary to support the direct program is $107,363. The full program budget is attached. (Additional indirect program costs will be funded by the Guidance Care Center(GCC)). The Baker Act Transportation funding remains the same as prior year in the amount of$146,000, 'The Community Transportation for Disadvantaged Program has a slight increase due to an increase in funding to GCC from the State for which the County's funding is a local match in the amount of $41,151. The Substance Abuse Mental Health funding remains the same as prior year in the amount of $657,066, A copy of the SAMH services agreement between Florida Dept. of Children and Families (DCF) and the South Florida Behavioral Health Network (SFBHN) is attached along with the agreements between SFBFIN and GCC. PREVIOUS RELEVANT BOCC ACTION: For FY 13, the BOCC funded the JIP in the amount Of $118,726, the Baker Act Transportation in the amount of$146,000 and Community Transportation for Disadvantaged in the amount of $32,290 and the SAMH local match funding in the amount of $657,066. For FY14, the BOCC agreed to the funding amounts during the budget process. CONTRACT/AGREEMENT CHANGES: STAFF RECOMMENDATIONS: Approval TOTAL COST: JIP $107,363 Baker Act $146,000 Trnsp. Disadv. $41,151 SAMH $657,066 INDIRECT COST: BUDGETED: Yes X No DIFFERENTIAL OF LOCAL PREFERENCE: NA COST TO COUNTY: $951,580 SOURCE OF FUNDS: Ad Valorem REVENUE PRODUCING: Yes_ No X AMOUNT PER MONTH Year APPROVED BY: County At8tyt � 1111 /Purchasing Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM # Revised 7/09 Monroe County Funded Services Substance Abuse& Mental Health Services,Transportation &Jail In-House Programs Agency: Guidance Care Center PROGRAM SOURCE FY13 FY14 Direct County Funding SAMH 001045905 657,066 657,066 Baker Act Transportation-SAMH Funding 001 045903 146,000 146,000 Community Transportation Coordinator-Direct Line-Item Funding 001 01509 32,290 41,151 *Jail In-House Program(JIP)-Discretionary Funding 001 045906 118,726 107,363 Total Ad Valorem 954,082 951,580 Jail In-House Program RSAT Grant Match (25%required) 101 Fine&Forfeiture(match) 16,667 968,247 FDLE JAG&RSAT Grant Funding FDLE JAG Women's JIP 125 06049 GG1302/GG1402 16,500 27,040 FDLE JAG (formerly RSAT)Men's JIP 125 06054 GG1317 67,000 - FDLE RSAT Men's JIP(25%match rqmt-fm 101) 125 06019 GG1409/101 - 50,000 83,500 77,040 Total Funding (lessWWTP): 1,037,582 1,045,287 *JAIL IN-HOUSE PROGRAM SOURCE FY13 FY14 Guidance/Care Center,Inc. Jail Staff 171,728 176,111 Fringe Benefits @ 10% 17,173 17,609 Workbooks,Drug Tests 3,750 3,750 Office/Program Supplies 9,575 3,600 JIP Total Direct Expenses: 202,226 201,070 Additional Fringe Benefits GCC 18,890 19,374 Indirect Costs GCC 65,964 65,744 JIP Add'I Expenses: Not included in County calc. 84,854 85,118 JIP Total Program Costs: 287,080 286,188 FDLE JAG&RSAT Grant Funding FDLE JAG Women's Jail In-House Program 125 06049 GG1302/GG1402 16,500 27,040 FDLE JAG (formerly RSAT)Men's Jail In-House Program 125 06054 GG1317 67,000 - FDLE RSAT Men's JIP(50,00 Grant;25%match rqmt 16,667-fm 101) 125 06019 GG1409/101 - 66,667 Total FDLE Grant Funding: 83,500 93,707 SUMMARY GCC JIP Total Direct Expenses: 202,226 201,070 Less FDLE JAG/RSAT Grants: -83,500 -93,707 Monroe County Esti.Discretionary Funding of Direct JIP Expenses: 001 045906 118,726 107,363 FY14 Note: 1). FY14 RSAT grant funding from the State is pending. The grant estimate provided is between$50,000-$75,000. 2). Actual RSAT grant will be$50,000 with a required match of$16,667 for a total of$66,667. NOT INCLUDED: Marathon Detention Center WWTP(Estimated Figures) 101 20505 15,000 15,000 GCC FY14 Funding, FY14 Funding 10/1/2013 SUBSTANCE ABUSE MENTAL HEALTH SERVICES MATCH DETERMINATION Substance Abuse and Mental Health Services Actual Cost Center Operating and Capital Budget Agency:Guidance Care Center Period:07/10/2010 to 06/30/2011 and 07/2011 to 06/2012 PART I:ACTUAL FUNDING SOURCES AND REVENUES FY13 FY14 COLUMN F MATCH COLUMN F APPLICABLE Total for all State- Applicable Match Total for all State- Applicable Designated Cost Designated Cost Match Funding Sources and Revenues Centers Centers 1A.Total State SAMH Funding (1a)Direct from DCF District 16 $ - $ - (2a)Managing Entity(SFBHN)Main Contract $ 3,804,397 NA $ 3,923,946 NA (2b)Managing Entity(SFBHN)Other Contract $ 80,879 NA $ 80,510 NA (2c)Managing Entity(SFBHN)Prior Year Adjustment $ 12,999 NA $ - NA Total SAMH Funding $ 3,897,575 NA $ 4,004,456 NA IB.Other Government Funding (1)Other state funding $ 166,703 NA $ 47,080 NA (2)Medicaid $ 449,077 NA $ 682,196 NA (3)Local Government (This is a bulk figure with no specificity as to sources;but extrapolating from current contracts and amounts,applicable match sources/amounts included in this bulk figure,other than MC,would be) $ 1,162,511 $ 1,181,518 Monroe County Sheriffs Office* $ 50,000 Applicable 50,000 $ 60,000 A $ 60,000 Monroe County Sheriffs Fine and Forfeiture* $ 4,500 Applicable 4,500 $ 4,400 A 1$ 4,400 Monroe County School District* $ 86,373 Applicable 86,373 $ 86,373 A $ 86,373 City of Key West* $ 19,600 Applicable 19,600 $ 19,600 A $ 19,600 City of Marathon* $ 2,200 Applicable 2,200 $ 2,200 A $ 2,200 $ 162,673 $ 162,673 $ 172,573 $ 172,573 (4)Federal Grants and Contracts $ 378,106 NA $ 472,237 NA $ - (5)In-kind from Local Government only (amount listed is zero,however,MC pays sewer at GCC Marathon facility,approx$580 per mo.) $ 6,960 Not Applicable $ $ - N $ IC.ALL OTHER REVENUES (1)1st and 2nd party payments $ 69,814 Applicable $ 69,814 $ 78,143 A $ 78,143 (2)3rd party payments $ 68,182 Applicable $ 68,182 $ 30,764 A $ 30,764 (3)Medicare $ 22,215 Applicable $ 22,215 $ 3,700 A $ 3,700 (4)Contributions and Donations $ 2,133 Applicable $ 2,133 $ 1,485 A $ 1,485 (5)Other $ 137,421 Part Applicable $ 20,000 $ 5,156 A $ 5,156 (6)In-Kind $ 133,884 Not Applicable $ - $ 1,471 A $ 1,471 $ 433,649 $ 182,344 $ 120,719 $ 120,719 Total Applicable Match $ 345,017 $ 293,292 Required Local Match ME225-3-27 $ 915,809 ME225-4-27 $ 939,008 Required Local Match(PPG-1-06-Prevention Partnership Grant) $ - PPG-1-06 $ 36,112 Total Required Local Match $ 915,809 $ 975,120 Total Applicable Local Match $ 345,017 $ 293,292 County Portion of Local Match $ 570,792 $ 681,828 SAMH Local Match Requested $ 657,066 $ 657,066 FY13 Notes: 1.This spreadsheet is a copy of the most relevant portion of GCC's required special audit schedule,"Actual Cost Center Operating and Capital Budget,Part 1:Actual Funding Sources and Revenues",required by DFC,and part of the GCC 2011 Audit.The actual schedule showing totals in Column F is the next exhibit(Exhibit 3).The entire schedule is several pages long,and is included in its entirety in the GCC 2011 audit,which is attached as Exhibit 8 in the back-up. 2.Except for the asterisked figures,all other figures are as they appear on the audited schedule lie,they are audited figures). 3.The"local government"figure is listed on the audited schedule as a bulk amount,with no indication of the individual sources that make up the amount.The asterisked figures in IB(3)are extrapolations,made by staff, based on current contract information from provider,in order to indicate specific individual local government sources/amounts that are likely included within the"Local Government"bulk figure listed on schedule and applicable to match. 4.The asterisked figure in IB(5)is based on additional information,that wasn't included on schedule,but is applicable to match. 5.Per County Attorney Memo dated May 2,2012,the figures in Column F,for sections 1B(3)extrapolating for the specific,local governmental entities and amounts,1B(5),and 1C are applicable toward match. 6.County Attorney opined that the amount listed in IB(5)was incorrectly applied.The County's sewer payment is not for GCC,but is a reimbursement for the County's expense. 7.County Attorney opined that the amount listed in IC(6)should not be applied to the match,in this case,due to the specific nature of this in-kind donation. 8.County Attorney opined that portions of the amount listed in IC(5)should not be applied to the match,due to the nature of some of the items included in this category,such as a federal pass thru grant to another entity. 9.Shaded areas represent changes,per county attorney opinion,from spreadsheet provided with last month's agenda item(G-1). FY14 Note: 1.GCC is no longer participating in the client perscription program therefore is a reduction in in-kind. 2.GCC received a Prevention Partnership Grant 11/01/12-06/30/15. Per Pg 29 of 121,'The services provided under this contract are community-based SAMH services for a consumer- centered and family-focused coordinated system of care." A complete copy of the grant(PPG-1-06)was provided including Ex.H Funding Detail. GCC SAMH Match Calc FY14 10/1/2013 a a � v � a a - E v u u sO O a v 0 a 5 o v, `w O s v ° - o o N V v y u V - a O v m 0 o m o o � E U� 00 o n N v v a Oj W N ry 0 N ul ul ul O - ut W N l0 l0 N N 00 V V I� b➢'" b➢ o a O v _ m - 0� Q to v� v� v�v� v� QE Qa >. v v v v v U v v v v Mu u r a c 3 a r90 r90 r90 r90 r90 " r90 r90 r90 r90 " u a O a `0 c Q Q Q Q Q Q u u u u u Q u u u `0 °1 v .Q.Q.Q.Q .Q.Q.Q Q Q m nn m a .. u° - Q Q Q a v u Q Q Q Q Q o Q Q Q Q r o m °' t o a Z a Z — v °_ > o ° Y ° A u v E a a c y « m 0 of L' n o in o Ln m ko m w a w is o a o ry i6 of o a m ry ri m N ry m�.i ac v v Y > E > u, w w N a m ,-i v ra v t o z v v ^ ^ ba ba E - as `0 u c " o o 0 o" O O 0 v E o E U ti V m M } N N 9 W U}U}U}U}U} U}U} U} U}U}U}U}U}Vf U} U} U}U}U}U}U}U}Vf N v a ? UUV' C 0 Z v a s Q o c O = �— v v a ° - Q o E a 0 a t 9 a E 9 g >O ai n E a— -moo 0 ui o v o ` WO o ba c u9 . — Xo '0 m aL E .� m c o ai m s = a x ° O V o a s a +, '�-' a - o 3 o c 5 v ° _ u > v o w_ - u ° H o vai M. O w V a w $ y c w a 0 s y o v E o 9 3 LL o s oo v s ` u ? H Q a 0 v U Q a o ° Q L a `o c > _ O F v V � io v a o 0 J w g V O t L N E v U Q -fl Y O a W y3°; n v au0ao O O 0 a c r N o of o ~ v Z E 0 i > c v >0 a N o `O ° � a as a u v v t E - -a v a g a o o > 7 c W vvi " a Z o 0 `ti `� c O .,v, v c c o o M n_.v� W v u y �, p h o LL E .„ L o a o 0 � � to c t a o v L u° ° 'oo ° `0 v W ba v O _ 0 a` c a t t s + c ` o o s �- V 'v E v O as _ _ _ u ° v N E m o_..� a _ Z v 0 u z LL m m m LL 3 c c c ° O 'o w o a fl Y E a Q v N v"i m i > > > a u l7 - °_p V ro N Z v = > > > 0�i - ` a, u u u v a a v z > a u m J � u E - c c CO v v u m ¢ o E a z a o 0 0 o o 0 _ w E '° 46 v o 9 m u :b° o 0 0 0 E Y � o H o ubna unun v s E ry " aJ a v O y E Lc E E E N v o ' m 7 � a u ou o c U E , 0 t - O O hnI uuuW u Q a u N ¢ V N Z N n_ r�o N m r0o a ui ro m FY 2013-2014 EXHIBIT H:FUNDING DETAIL 07/01/2013 r......,_...................__-.,_,.-.-._,,,,m....._.-..-_,._-___--.__ ._._.____.,.-...,m,---_.._.....-___..� .... _ Pmvrdu Nmne-'Gwdaneo/Ctne Contcr,hrc. ______ Contract#:: ME2 5 4 27 ! Revision# - MENTAL HEALTHHm Budget Entity 60910506-Adult's Mental Health OCA AMOUNT Budget Entity 60910506-Children'S Mental Health OCA AMOUNT 502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION GIA-ADULT COMM.MENTAL HEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435) ADAMHRe Trust Fund (OQO32G)*TF 7005)* AESSI tkSSl l $-�-.. i General Revenue(0032Trusa Fund TF6*7005)* t65St $ C ) Si $ IS(77 TSTF(122023)* IJ P.1 411 $_ FGTF-Title XXI(261013) S.)Q01 t $ i ".,..._..,..�.d Gri—I Revenue(000326)* 3MHA I G/A-BAKER ACT SERVICES (100611) G/A-CHILDREN'S BAKER ACT (104257) _._.-.._ .. I ..,_w... Ge�ral Revenue(000326)* A 7S $ 1 112 303 I General Revenue(000326)* t I SS i $ - _...__ ..... ..� Social Services Block Grant(639022) Emergency Stabilization Total= $ 1,112,903 Emergency Stabilization Total= $ 15,677 Uncompensated Units $ 222.581 Uncompensated Units $ 3,135 502018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY GIA-ADULT COMM.MENTAL HEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund TF(027005) .4KR4 $ _ ADAMH Trust Fund TF(027005)* CR.RS 1 $ 7 53 7,-2 Geta:ral Rcvcru,(000326) ARRS $ 1 028 348? General Revenue(000326)* i'RR91 E$ 286 248 GR/AGAPE Fmn Matsu),(000326)* APIMD $ I General Revenue-Children At Risk of ED(000326} CARED $ ..-...._.. __s GR/Comm Forensic Beds-Adult Svc(000326) CL 3 4) $ 160,000 FGTF-MIAMI-DADS Wrap Around Pg-(261015) 6111DA3 I I $ i GDAM RcvcnuF id FACT CT Adra (On(027005) F I A $ a Federal Grant Trust Fund(261015) C:RRS I ($ 30 000' ._„ e Trust enera FGTF-Title XXI(261015) R9Q13 ; $ FGTF-FMGPMA-Medicaid Adman(261015) FI)x 19 $ - �r Gereml Revee-FACT Svcs(000326) F'T$14 $nu - ! F'G`IF-FGGGPT-Trans From Homelessness(261015) GV0 i 8 ,,,__ 90-827 t General Revenue(000320) SMHA2 $ •^•i G/A-PURCHASED RESIDENTIAL WTFF TANP(40100p 39AI* $ TREATMENT SERVICES (102780) Getwrat Rcvonue(000326) LPnAtf $ GRIMCAID&Non-MCAID MOE(000326)* 9PR.Nh1 Tobacco Settlement Trust Fund(122023) ARRSi $ ? Federal Grant Trust Fund(261015) ARR.S i G/A-INDIGENT PSYCH MEDS PROGRAM (101350) _,.,_„_......_......_--... General Revenue(000326)* ARRSi i$ --„--5,945 Total Non-TANF $ 1,295,120 Total Non-TANF $ 470,000 Recovery&Resiliency Total= $ 1,295,120 Recovery&Resiliency Total= $ 470,000 Uncompensated Units $ 259,024 Uncompensated Units $ 94,000 TOTAL ADULT'S MENTAL HEALTH= $ 2,4(18,023 TOTAL CHILDREN'S MENTAL HEALTH= $ 485,677 SUBSTANCE ABUSE Budget Entity 60910604-Adult's Substance Abuse OCA AMOUNT Budget Entity 60910604-Children's Substance Abuse OCA AMOUNT 603005-DETOXIFICATION 602001-DETOXIFICATION/ARF GIA-COMM SUBSTANCE ABUSE SVCS (100618) " G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS (100420) ADAMH Trust Fund TF(027005)*** D 1 XAS $ 84 ,) ADAMH Trust Fund TF(027005)*** Im"s $ - GeucYal Rexeme,(000326)** D XAS $ 102,284 General Revenue(000326)** - --- TSTF(122023)** Detoxification Total= S 186,643 Detoxification Total= S Uncompensated Units S 37.329 Uncompensated Units S - 603006-PREVENTION SERVICES 602002-PREVENTION SERVICES G/A-COMM SUBSTANCE ABUSE SVCS (100618) _ G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS(100420) Gelural Revenue(000326)** PI'LAAi $ - ADAMH Trust Fund TF(027005)*** PRVC'� ($ I7 262L ADAMH"Cost Ford'FF(027005)**** PRVAS .�$ - General Revenue(000326)** PIIv- $ - Prevention Services Total= $ Prevention Services Total= S 172.262 Uncompensated Units $ - Uncompensated Units $ 34,452 603IXI7-TREATMENT&AFTERCARE 602003-TREATMENT&AFTERCARE G/A-COMM SUBSTANCE ABUSE SVCS (100618) _ G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS(100420) ADAMH Tried Fund TF(027005)*** "fF iS $ 3719�R ADAMH Trust Fund TF'(027005)*** TEZT(e $ ..a,..�_ .../ General Revenue(000326)** TR Aa General Revenue(000326)** TRTCS i$ O&M TF(516015) 1 R i AS $ t TSTF(122023)** 'I"RaC S' $ 279,139 ADAMH'Frust Food TF(027005)*** I114 $ 3600 O&MTF(516015)** '1"RFIS $ ADAMH Trust Fund TF(027005)*** 2 V,(', ,$ ADAMH Trust Fund TF(02700>)*** 27C`H+ n$ WTTF TANF(401001) 31,10 $ WTI F`I"ANT General Revenue 100 1)00 I vl $ General Revenue(000326)** SPJCs $ - GR-IndlgentDu 1 )FF Drug Pro MOE(000326)** DI C CS - $ ADAMH lost Fund TF(027005)*** SPICS $ General Revenue(000326)** Sf 1.+5 $ SSBG TF(639002) IRKS. $ i ADAMH Trust Fund TF(027005)*** Si 114 $� TotalNon=TANF $ 390,133 TmaINon-TANF $ 279,139 Treatment&Aftercare Total= $ 390,133 Treatment&Aftercare Total= $ 279,139 Uncompensated Units $ 78,027 Uncompensated Units $ 55,828 TOTAL ADULT'S SUBSTANCE ABUSE= $ 57G,776 TOTAL CHILDREN'S SUBSTANCE ABUSE= $ 451,401 TOTAL ALL PROGRAMS= $ 3.921,877 TOTAL ALL UNCOMPENSATED UNITS= $ 784,375 FUNDS NOT REQUIRING MATCH: GRAND TOTAL OF PROGRAMS&UNCOMPENSATED UNITS= $ 4,706,252 Dru" Abuse Setvices $ 518 SR2' TOTAL FUNDS REQUIRING MATCH= DoinsUudlonvlul6on Project $ 210000, LOCAL MATCH REQUIRED= $ 9,39008 ,CMH Program $ 375,970 ADDITIONAL LOCAL MATCH=[ f,.,.. ,.....K ,..-..., ,.....e.2 Vik Block Grant -- - $ _. TOTAL FUNDS NOT REQUIRING-MATCH= $ 1.104,852" GRAND TOTAL LOCAL,MATCH= S 939.008 'fbmnnmtity Manful Itwlih Block Gant "'F_xFn^ndimro inusl be$ubstmtan AN—Pmvamion u,W r—i—t Brwk Grunt aliglblc '^Sctxsmn«Abusu Pravnntiai-dice 1-1 nl«k Gran-Funding AsIll—It-RLSt'Ric rIONS APPLY Guidance/Care Center,Inc. Exhibit Contract No.ME225-4-27 Page 1 of 1 07/01/2012 EXHIBIT H FUNDING DETAIL 2013-2014 FY 2013-2014 IXERBTc IT.FUNDE'IG DECAIL Pma�Ae.x Nnine k�tl tee t'n+w;C ttet lu4 ConO aet K ,PP61-06 'In—on AIFNTAL HEALTH Bualget EkOdty 609I 0506-Adult's W1W Health OCA AMOUNT BudgetEdty60910a06-ChiiJraua'S Mentnl}kn1Ur OCA AMOUNT 5020ii4-FAiFRGF1VCY STABILIZATION 503001-EMERGENCY STABILIZATION UA-ADULT CY)MNt MENTAL HEALTH (1006-d _ GfA-CHRAREN'S MFNTA L HEALTH H00435) A DAMH Ttvst Fund TP((127005)* _.tst ADAMHTrust Fund TF(027005). ci5S: Cicncrul Rev<nuc(00032f)` A t.SSI ., General Rcvcnuc(00032(d- U,,; I S1.F(I-)T3)• SSI _,- } FGTF-Tall XNT(261015) O:.nerd R-l—(000326). 114UII , CEuerai Rcx anua(000326)* 111HIA G/A-I AKER ACTSERVICES (1OO611) G/A-CHB.DREISS BARER ACT (--57) Ci -11 Rcvenue(t10032O- A SSI t......... G 0-1 Re.cnua(000320- <FJ.S' j I"S"PF(122U23)" AfSS! Emergency SLaHlizatlan Tntals J Emergency SLr.HBsuU nn'I'utui- S - llncortrycnantcd Units A - Unconapcns atcd Uaits .S 50201#-RECOVF.RY.Y RESILIENCY 503O13-RECOVERY.RESILIENCY GA-ADULT COMM.MENTALHFALTH (IOU61o) GIA-CHII.3REN'S MENTAL HEALTH (I00435) AD A MHTmst Fnnd TF(027005) RR*I A DAMH Truaa Fund TF 1027005)" C' os, O.4MTF(027005) .4RP.sF Gonerni Resennc(000i26)• IRR1T a."crai Re.em.c(000326) .1RR'.I General Rca c�xuc-Gtild+mv At Ris4 of ETJ(000326) CARED GR/AGAPEF:uuM" n'(U00326)' AFN111t FGTF-MIAMI-DADEWrPAlnund Pto YR-1(261015) MI-2 HE nvn Fomnsic Bcds-Adele Ss'c(000326) CFRhf _ Federal Groot Ttust Fund(261015) }i<4i AT)AMH Trust Fnnd-FA[_'C Adnun(027(iU5) Iq G0-1 TO,--(1100321) F \1A Geiaerul It.,enne-FACC Adnxin 000326) I"),i"1 _ _T GR-TV Rcsmrhxcomp T.Pro(000326)' /L\++ FGTT-FMGPMA-Medicaid Aduun(2(,1011) FT FGTF-TiOi N'XI(261015) t'Ica<mtRcvomto-FA('T.,es(000326) 11s1/ FITP-FUCTUT)-lid Diversion lho(361015) 1,0111 G!A-PLIRCHASFTI RESIDENTIAL FGTF-FGG('...RT-Trnns Fro+v Honacbssncss(261015) \ ,. TREATMFT S FRVICES 0-7N0) OBxM'TF I0 7005) MHbIN Gi2/MCAID&Non-MCA ID MOE(00032(,)- 1f1i1;M C.,tncrni Rcv enuc(000326) �SAHa) _ GR/Porch R.cs 1"rcatmcna-Medicaid St'cs(1.0-6) -11S WTT FTANF(401001) iJv --I Rcve—(000326) Tobacco Seltlontcnt TO-Fund(122023) .ARRSI Fndcrat Gvnt Trust Fun d(261 OI s) APRSI G"A-IND[GENT PS YCIT MEDS PROGRAM (I o1350) ..... General Rou<n uo(W(!32G)* _i 1.R�1 Tot al Non-TANF .S - Total Non-I'ANF A - Reena¢ry Sc Res Biency Toth- S Reco5 y @Resiliency T.-- S UnconxPons aced L'nns Unus $ - TOTAL ADULT'S MEVT.AL HEALTH- .S TOTAL CHILDREN'S MENTAL HEALTH e S SUBSTANCEABUSE BudgedF.0-0-1604-Adali s S a hctancc Abuse OCA AMOUNT Budget Entity 60910604-Chlld,-ens Subntunce Atntne UCA AMOUNT 603605-DETOXIFICATION 602001-DETOX-CATION/ARF G/A-CO;NM SUBSTANCEABUSESVCS (1)O61 A) _ O/A-CHILD/ADOL S IMSTANCEA USE SVCS MITn (t o11430)r ADAItet Fund TF(O27005)... x ., A GAMHTInsl Fnnd TF(027005)- C t\<'S _qy Fn,al R.V GE—I RcS'onuc(D0032W iryi Y<S TSTF(122023)- r'1'4:XC_1 DetoxiBcntinn Tntui v $ Eh.Grxf t)cuB un Totul S EbcumPeneutad Unit. $ - Uincompnns u«J Units $ - 6-006-PREVENTION SERVICES 6020O2-PREVENTION SERVICES G/w-COMMSUBSTANCEABUSESVCS (IU061S) GJA-CHILD/ADOL S UBSTANCE ABC6E SVCS(100420) Gcucrat Rovcnnc(0t10326)' ADAM14 Trust Fund TF(027005)- V'ltS.Cy i$ tl9701t A DAMH Trust Pund TF(027003)^^'* WRY.\6 Gcnex:+l Rc.rntuo(000126)•x.• IF\GCS i$ 34-678� Generui Ru.'unuo(000326) It-S 1 Prear...flan 6er5ic<s Toth- $ 144,447 Uncotupc--d Units $ - Uncontpcns ztcd Units $ - 603007-TREAT74E7NT&AFTERCARE 6(120O3-TREATMEIVF&AFTERCARE G/A-COMMSUBSTANCEABESESVCS (I O06tn) __ G1A-CHILD/ADOLS UBSTANCE AEITS E SVCS(100420) ADA M H us T lt Fund TF(027(A)5)"' TIT- ust�.. ADAMHT� Fund T1(027005)--- .RI15 <bnverui Ra�enuo(OOUi2G)'x IK'i q4 Ccni.ul Revenue(U01772ti)" it a'.. OlkM IF(516015) TRrFia TSTF(I22O2 IT CS ? ADAMH 10-Fund TF(027005)'"' 11% O.StMTF(5160111- ;RI cl t ADAM111'i tFnnd TF(O27OOi)'^' 7.7..'St•t)'vi � t ADAMHTrust Fund TF(027W5)'*" Gcncrdl-- 0.(000326) 1':i L'0 £ �_ WTTFTANF(40it101) tYi c': WTTF TANI(401001) ',TIT, _ --I R--e ite(O00326)"* OR-Ind iyent D.g Pm MOE(000326)" 1 � ADAMHTrust Fund TF(027005)... PTC'S FGTF-IT Accss to Rcx-(2611115) F 2n , „j SSBGTF(-)002) FGPP M dcaid Adm(261015) *v t'I FGTP S--hx--,Treat R.(2661015) Ccncral Revcnu< A D:1MHTmst Fvnd TF(027005)•" Sf J'ti I r Total Non-TANF $ - Total Non-TANF $ - I}e annent ds ABercur<T.u+rl T+e..nc ARa+<earar T.rtui- Uncn�nPensnieaU-O s - n Unc.OmPcnsntcd Units $ - TOTA L ADULT'S S UBSTANCE.ABUSE- S TO'CALCHILDREN'SSUBSTANCEABItSE- S 144,447 TOTAL ALL PROGRANIN- S 144,447 TO'i'ALALLUNCOMPENSATEDUNCCS A FUNDS NOT REQUIRING MATCH. GRAND TOTAL OF PROGRAMS&UNCOMPENS ATM UNE'S-_I_I44 447 i'hvg Abuse Sen gees $ TOTALFUND.S REQUIRINGMATILI S 144,447 -Dc nai' xn PtnJcct i$ LOCAL MA'1CTI REQUIRED- S 36.I12 0 - CMITP g— _ _ $ ADDITIONAL LOCAL MATCH [ MH Bloch C1 ant 7_�, _„ TOTAL FUNDS NOT REQUIRING MATCH= A - GRAND TOTAL LOCAL MATCH A 36.112 y M<ntei Hon�eh W .+ur the SL a rca c rnn R;:S Guidance/Care Center,Inc. Page 105 of 121 Contract#PPG-1-06 I i 41 �L c S S 1 � 2 g i n E M _- N� N $ B = 8ee ul uj CL B A J fill 6 mu fl GUIDANCE/CARE CENTER, INC. FINANCIAL STATEMENTS AND SUPPLEMENTAL INFORMATION FOR THE YEAR ENDED JUNE 30, 2012 TABLE OF CONTENTS Independent Auditors' Report 1 - 2 Financial Statements : Statement of Financial Position 3 - 4 Statement of Activities 5 Statement of Cash Flows 6 Statement of Functional Expenses 7 - 9 Notes to the Financial Statements 10 - 14 Supplemental Information: Report of Independent Certified Public Accountants on Supplemental Information 15 Schedule of State Earnings 16 Schedule of Program/Cost Center Actual Expenses and Revenues 17 - 20 Schedule of Bed-Day Availability Payments 21 Schedule of Related Party Adjustments 22 Independent Auditors' Report on Schedule of Expenditures of Federal Awards and State Financial Assistance 23 - 24 Schedule of Expenditures of Federal Awards and State Financial Assistance 25 Notes to Schedule of Expenditures of Federal Awards And State Financial Assistance 26 TABLE OF CONTENTS Report of Independent Certified Public Accountants On Compliance and Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Stands 27 - 28 Report of Independent Certified Public Accountants on Compliance and Internal Control Over Compliance in Accordance with OMB Circular A-133 and Applicable to Each Major State Projects 29 - 31 Schedule of Findings and Questioned Costs 32 - 33 Summary of Auditors' Results - Data Collection Form 34 - 3B CALLAGHAN GLASSMAN & MARGOLIS,L.L.C. CERTIFIED PUBLIC ACCOUNTANTS 7369 SHERIDAN STREET, SUITE 201 HOLLYWOOD, FLORIDA 33024 TELEPHONE(954)99647ED TELEFAX(954)991-7912 To the Board of Directors Guidance/Care Center, Inc. 3000 41 Street, Ocean Marathon, Florida 33050 INDEPENDENT AUDITORS' REPORT We have audited the accompanying Statement of Financial Position of Guidance/Care Center, Inc. , as of June 30, 2012, and the related Statements of Activities; Functional Expenses; and Cash Flows for the year then ended. These Financial Statements are- the responsibility of the Organization' s Management . Our responsibility is to express an opinion on these Financial Statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and Government Auditing Standards issued by the Comptroller General of the United States . Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the Financial Statements are free of material misstatement. Our audit included consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion' of the effectiveness of the Organi,zation' s internal control over financial reporting. Accordingly, we express no such opinion. An audit includes examining, on a test basis, evidence supporting the amounts and - disclosures in the Financial Statements . An ' audit also includes assessing the accounting principles used and significant estimates made by Management, as well as evaluating the overall Financial Statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion the Financial Statements referred to in the first paragraph presents fairly, in all material respects, the financial position of Guidance/Care Center, Inc. as of June 30, 2012 and the changes in its net assets and cash flows for the year then ended, in conformity with accounting principles generally accepted in the United States of America. 1 To the Board of Directors Guidance/Care Center, Inc. In accordance with Government Auditing Standards, we have also issued a report dated January 3, 2013, on our consideration of Guidance/Care Center, Inc. ' s internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements and other matters . The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of testing, and not to provide an opinion on the internal control over financial reporting or on compliance . That report is an integral part of an audit performed in accordance with Governmental Auditing Standards and should be considered in assessing the results of our audit . Certified Public Accountants January 3, 2013 2 GUIDANCE/CARE CENTER, INC. STATEMENT OF FINANCIAL POSITION JUNE 30, 2012 ASSETS CURRENT ASSETS Cash and Cash Equivalents (NOTE 1) $ 385,327 Patient Accounts Receivable, Net of Allowance for Uncollectable Accounts of $90,161 (NOTE 1) 106,073 Grants, Contracts and Other Receivables 839,057 Prepaid Expenses 208,776 TOTAL CURRENT ASSETS $ 1,539,233 FIXED ASSETS (NOTE 1) Land 643,122 Buildings and Improvements 4,598,809 Construction in Progress 9,744 Furniture; Fixtures and Equipment 459,191 Transportation Equipment 578,448 6,2B9,314 Less:Accumulated Depreciation 3, 614,098 NET BOOI{ VALUE 2,675,216 OTHER ASSETS (NOTE 1) Security Deposit 5,900 Due to Related Party 66,156 Bond Issuance Costs, Net of Amortization of $41,225. 48,117 TOTAL OTHER ASSETS 120,173 TOTAL ASSETS $ 4,334, 622 Please Read the Accompanying Independent Auditors' Report and Notes to the Financial Statements 3 GUIDANCE/CARE CENTER, INC. STATEMENT OF FINANCIAL POSITION JUNE 30, 2012 LIABILITIES AND NET ASSETS CURRENT LIABILITIES Accounts Payable and Accrued Expenses $ 192, 531 Accrued Salaries and Related Expenses 2B1, 180 Current Portion of Long-Term Debt 171, 057 TOTAL CURRENT LIABILITIES $ 644, 768 LONG-TERM DEBT (NOTE 2) Long-Term Debt 1, 636, 756 Deferred Revenue 41, 629 Less : Current Portion of Long-Term Debt 171, 057 TOTAL LONG-TERM DEBT 1, 507, 328 TOTAL LIABILITIES 2, 152, 096 NET ASSETS - UNRESTRICTED 2, 182, 526 TOTAL LIABILITIES AND NET ASSETS $ 4, 334, 622 Please Read the Accompanying Independent Auditors ' Report and Notes to the Financial Statements 4 GUIDANCE/CARE CENTER, INC. STATEMENT OF ACTIVITIES FOR THE YEAR ENDED TUNE 30, 2011 CHANGES IN NET ASSETS - UNRESTRICTED PUBLIC SUPPORT AND REVENUES PROGRAM SERVICE FEES: Grants and Contracts $ 6, 774, 988 Client Fees and Other Third Party Payors - Net 797, 466 Contributions 2, 956 TOTAL PROGRAM SERVICE FEES 7,575, 410 OTHER REVENUES: Interest Income 1, 038 Gain on Sale of Assets 2, 961 Other Revenues 22, 390 TOTAL OTHER REVENUES 26, 389 TOTAL PUBLIC SUPPORT AND REVENUE - UNRESTRICTED 7, 601, 799 EXPENSES PROGRAM SERVICE EXPENSES: State of Florida Department of Children and Families 4, 976, 500 Other Grants 1, 262, 673 TOTAL PROGRAM SERVICE EXPENSES 6, 239, 173 SUPPORTING SERVICES: General Support 536, 547 Administration 941, 307 TOTAL SUPPORTING SERVICES 1, 477, 854 TOTAL EXPENSES 7,717, 027 INCREASE IN NET ASSETS - UNRESTRICTED (115, 228) NET ASSETS - UNRESTRICTED JULY 1, 2011 2, 297,754 JUNE 30, 2012 2, 182, 526 Please Read the Accompanying Independent Auditors' Report and Notes to the Financial Statements 5 GUIDANCE/CARE CENTER, INC. STATEMENT OF CASH FLOWS JUNE 30, 2012 CASH FLOWS FROM OPERATING ACTIVITIES (Decrease) in Net Assets $ (115,228) Adjustments to Reconciliation Change in Net Asset to Cash Provided (Used) By Operating Activities: Depreciation and Amortization 205,081 (Increase) Decrease in Assets: Patient Accounts Receivable (8,706) Grant Contracts and Other Receivables (7,781) Other Receivables 407 Prepaid Expenses (4,644) Increase (Decrease) in Liabilities: Accounts Payable 7,394 Accrued Salaries and Related Expenses (91,205) Deferred Revenue (32,227) NET CASH FLOWS PROVIDED (USED) BY OPERATING ACTIVITIES $ (46,909) CASH FLOWS FROM INVESTING ACTIVITIES Acquisition of Faxed Assets (20,524) Disposal of Fixed Assets 8,817 NET CASH FLOWS PROVIDED BY INVESTING ACTIVITIES (11,707) CASH FLOWS FROM FINANCING ACTIVITIES Investments 12,930 Due to Related Parties 10,798 Repayments of Line of Credit (288,992) Repayments of Long-Term Debt (404,619) Acquisition of New Loan 525,000 Loan Fees 110,700) NET CASH FLOWS PROVIDED (USED) BY FINANCING ACTIVITIES (155,575) NET (DECREASE) IN CASH AND CASH EQUIVALENTS (214,191) CASH AND CASH EQUIVALENTS - JULY 1, 2011 599,518 CASH AND CASH EQUIVALENTS - JUNE 30, 2012 $ 385,327 Interest paid for the year ended June 30, 2012 was $86,366. Please Read the Accompanying Independent Auditors' Report and Notes to the Financial Statements 6 00 4 rl h � Nh ' ' ' y- NC h h •r t � UJ M —M V 2 Nto mC] �} hN h Lo h w Q1 r7 N a h ![] �['] O7 v N �- w rn �] t U U rn 'Q0, M Ci N 04 �` tF V3 rl� UT cu rn w � � to m N to co Co - :,- m O N ' ' M h C3 d] 117 V' to OI CV m m CO to n N CIS h O m C to N LO 7 N co Q. N h r CI 03 bs bs O N e- mm Om Mm ' vN Ql �D [O tl' N Cry P7 N P] P) h 00 cn �[] e- to co "I. (O C1 O N cm uj th O R N(O C] Oi ri N Q ce7 N PNj N u7 Pm m j Z O b9 bg �- h m Ln {`7 ' tF M N ' M m 1* N O N N Ct (34 Co C] O M N tF N CO h �O m m ll] CIOa 47 L7 — b D) h O LT) N h v- O1 a Fu- N Cy � ri v N ri rl C] C v p U � a Lo d9 O a mwm N m OEDmim er Lo N � N c 47 h N O V �d N h V O h M Q3 cd N in t0 N N N N N Q W F U� Q C) Lu Nca �Z Sao bs � �w a w w'R Fw- j N m m m C] h + h m i- o v, o Z CO h Z' h [S] eF N U] CO 't O [+7 O N m O m t1F v h LU Q Q 7 r- m � m m r] I- N N tF N cd Ili4 tF tF 4 U iti w cot= N ri ui of wi.�ti c Ed N c v ri C d O cn h C'] w P7 +� N N N cn Co i- 6 r clz U ¢ zt C7u � a � Zti Z w Q Qwx Oh m Nvvt- v �- ' R. hC'] O N O N C) ~ C.7w � w 0C' R On � O hlNil C9 � C N g W U Co w ill cF al to N e- N � T' lmD V 0 co co cn to to M M m e� tF 4 P7 h h m tF N w O7 'It' tF — h �- Q Lo 4 QI r7 O7 N to r- Co O) r •- V) coN C O OI 07 co O " m Q w w ^ L rn u)r' N1-7 NN ai cs ri cq CO ul ca z co � w z fn W 4 O LLU 4 xQ U Z W pco W Uca W ¢ W W O ti W ° W W V Z) o¢ � a U o ¢ a [I- Qoow zw w 00 � o � co � � a � U -? W F~ ♦~ �¢ Qo: I� ti 111 U F= J00g4C4a fnu 11 4 a ¢w � awL w � �/im w � 4. 41� � �aOL 1�� 0 O W 4 � O N 0) N i e i i i i ( i i i N 1 N LL, Oh (m7 C O O N (V N a ds 69 ED 4 ED to d d tQ W to wuj z � bs m v h tb LO LO Il- q of h in to tf tF g C9 o - o T Q'ro Ol V h to �} (O (O (`] 41 rl Lo C9 Co T IT to N W Ln *� � Ln N d b two 59 kF3 W (O N (`1 a7 Pi tO tt ( N+ (O 4] d Co (T h d v t(] (O ((1 a3 N EO M (03 N LO tD F d N N V tO V� T d m n tP t7 d h rn to [, n) h cq tS7 Oj I qz ccr 1 C'N N O7 ti K n V N ❑ Co m F V }� w ° o a m o N a] N N (- o v (f1 (•7 tf o P] '7 Ch T N T (V d m N fm N a m O N LO to N h T Ol N 'C' N 4 N w (o; ti w. �m� ui N v ,=er ui � ❑ w �: ciwN ° T oz Ls L9LLJ z Z 0 N N a � � tm (dn CO w rn w W� CO w o Z �I m (V at N T N t>a 4 h (h a 4 Q U F:. U Itc (o vi a ui o(n ni C ,=C ni L Sri tr - W U LLJ4 C) w a r4 N T T (dY] (qS L ❑z w zz o� o w zti >- � zLU O w ~ N F CO I R tb O M N d 10 tO tT d m � ~ c a O1N N NFNN 6dd (V m to T vi h Q 4 N h F V) V tj F N (D ]" m to h Q' Q h 6 N N T d` (h0 't Q w n F T F w Z a W 4 bs b LU T h CO h (O 'q' N CO tF Q1 tih R7 O1 Ih Ol tO (n tT N to (h O h d N an fit] N no F rn F UJ m LA T h o N CO 4 m F td LO LO O w (N(1 c � N ti w=w to vt r C F eo T T Q ti cn Q f* to uj LU llto co LU LU 4 U! w co W a :2 wCL se aW z CO wo ocn LU 93 It z LU a:W I- Ly W z a w 0 V � � � q qo a w w►= o ❑ x 4, U w Lu Zn ❑ � m o ' w o uxax[Ill ¢ 4 yy4�� a U CO z LULU 0 Uj JI��- Fes- co 0) a � mZ Lco uzU3 ti tiUgj U � w ¢aw o z '❑ � � » zo�iaaa o 00 Z _I ti 0 0 4 a O : Lu w 4 Qc�nm wmQELra:LLLL o 0 w 4 d d d M So Co w IZ7 M CC7 M Cr1 h r to CO r h U3 al b d h 1n d N m+- W Co m CO [T Cn C m N CAN h CO V3 N �- t- hObh r- lh Q O C17 O Clj N e lri al�c r=lj N tY al N: Ch � 1Ci C}l R V 4-— m b co Cn 1n d w N CO CO r Q r Ch CO •- .- r N Cn d N h 44JJ Sag tN tf CD N, N C7 CO m ' ' Q1 In O C 1 S 1 !� Cal SO m m O m to m m al Oh ti r N m N La to N C7] to m N N Cn C. Cl7 CV N C CCi C SCi ti N ti m C1[ cd r N 47 M v r h l•1 b a r g F- Sri Sag •- *- N b t- ta7 e+ •t �['] 1 m d Cal N N V' C*1 t. rLO N and CO to Cn Cn dl71 N J ♦< "+ V. CO m O Cn a1 Cn N Cn CO Cn Cn d Cs1 CO �O m t. V d d h CT d N b N o1 C*y wQ r N h 1f1 a co CO Q CO tF b cn C9 ' N_ O m N_ 1* cm C9 LOQ h N m (n C'7 (A Cp M 1C1 al h 9b Ca h w oltt N CO Cl NO1h NN [') N Cn e- h 4] — [t t+ N'a w cd N 1-: os 1fl Qrn tF N 11 m b T+ co Cn E 0U � O lY � d rm b CO Cl!" N m rn a1 � w u 111 N w ui N ai N ui C co 1u ¢ �( Ln N C'7F- uJLu }^ w Q Z Q C, LU Q ER A U� LU w� zZ QcaO tr xrmm m al i. 1n I cn h N m (n rn CO ¢ Qw Lucr Ctio v rt. m rn oom 0 m m UQ- qw cnt7 a1 rr Ln hhmr CD m CI C7 Cn C7 � �I So C`i Oj L6 cd N V N O (I CCj C1i t, 4i cG Z Q� w ♦, w w m Cn m r N r CO m ,_ m x C tl: FZ w OOWti C1 Ci owx tc qO (Dw � V3 ° +� +e �°,w CIJ 'C N CO [7f 1n ,-1. m m ' ' v m 1. m tr M h h h v C'1 N It h Cn w CO h 2 m NCO e- W SC] a+ h N u) N N Cl) N m to 6 Cn m d co x U ]w+ hLd cn h ryNjfB CCIrNa� CC]F N sM � CN`t d ti 7 Cn r to h ❑ cto% a w d T N N N hCltmNh ' a1Nr v LO I- M w C"3 Ch h a1 N Cal N cO tf ca7 h 7 m C•1 -J b 11 In C7 +- Q N Cn O m d al C7 N CO a SNb'N C(i C'7 CV OI Cli CO *'V lij a b [O r m r Ubs b9 Oco coa co W 4 a 1-:LlixLU 4 4 xw w �` w co w W ¢ Lu Z Co Lill QC) U) W U ? 43 W 4 cn to¢ w z u7 w w J �O Q � �LLI GO CO S CL ❑ 4 w W �- O w ° W W UCL Q -< � ti a U o x o u� w ti ern wU co W�ulti Q ¢4 ¢ O www O C7 � tu-j - � �w o O4 LUII z °Clu l- � plLC7aa � QUEZz � zz =� oo � 4aox - ww a (D aaaaw � Ow � '` a w � p1� m Q Q ♦~ ZIL ILazO Q 4 O GUIDANCE/CARE CENTER, INC. NOTES TO THE FINANCIAL STATEMENTS JUNE 30, 2012 NOTE 1 - NATURE OF THE ORGANIZATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Nature of the Organization The Guidance/Care Center, Inc. and its predecessor organization was formed and incorporated under the laws of the State of Florida as a not-for-profit corporation on May 28, 1973 to provide treatment, counseling and prevention for mental health, drug and alcohol related problems . The Organization is Located in Marathon Key, Florida. Accreditation Funding sources are beginning to require that providers be accredited to continue to receive funding. In addition, Department of Children and Families has adopted policies whereby accredited facilities are subject to less intensive audits by Department of Children and Families staff. During the year ended June 30, 2010, the Clinic applied for accreditation under CARF (Commission on Accreditation of Rehabilitation Facilities) . The process involved completion of a survey document and a three-day site visit by a team of three CARF surveyors . Although the resulting recommendations by the committee could result in no accreditation, a one-year accreditation or a three-year accreditation, the Clinic was awarded the highest recommendation, a three-year accreditation from June 2010 through June 2013 . Financial Statement Presentation The Guidance/Care Center, Inc. reports information regarding its financial position and activities according to three classes of net assets : unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets . Federal, state and local governments and public grants are recorded as support and an increase in net assets when performance occurs under the terms of the grant agreement . Net assets revenues, expenses, gains and losses are classified based on the existence of absence of donor- imposed restrictions . During the year, the Clinic did not have any net assets, which were subject to donor-imposed stipulations . Therefore, there are no temporarily and/or permanently restricted net assets as of June 30, 2012 . 10 GUIDANCE/CARE CENTER, INC. NOTES TO THE FINANCIAL STATEMENTS (CONTINUED) JUNE 30, 2012 NOTE 1 - NATURE OF THE ORGANIZATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED) Tax Status The Organization qualifies as a non-profit organization as described in Section 501 (c) (3) of the Internal Revenue Code, and is tax exempt from federal and state income taxes, therefore no provisions for federal and state income taxes have been made . Management is of the opinion that there is no unrelated business income tax subject to taxation. Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles in the United States of America requires management to make estimates and assumptions that affect the reported amounts and disclosures contained in the financial statements . Actual results could differ from those estimates . Cash and Cash Equivalents Cash and Cash Equivalents consist of cash held in checking accounts and is considered highly liquid. At various times during the fiscal year, the organization' s cash balance exceeded the federally insured limits . At June 30, 2012 cash balance was $385, 979 . Management believes the Organization is not exposed to any significant credit risk on cash and cash equivalents . Patient Account Receivable Accounts receivable related to in-patient services are carried at net realizable amount based upon expected reimbursement rates from Medicaid, Medicare and other third-party payers . Accounts receivable from clients are carried at net realizable amounts after reducing standard fees to a sliding fee schedule based on the individual' s financial ability to pay. 11 GUIDANCE/CARE CENTER, INC. NOTES TO THE FINANCIAL STATEMENTS (CONTINUED) JUNE 30, 2012 NOTE 1 - NATURE OF THE ORGANIZATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED) Fixed Assets Fixed Assets valued in excess of $4, 999 . 99 are capitalized. Fixed Assets are valued at cost when purchased or estimated fair value at date of donation. Depreciation is computed on the straight-line method over the estimated useful lives of the respective assets . Leasehold improvements and capitalized leased assets are amortized on the straight-line method over the term of their respective leases or their useful life, whichever is shorter. Depreciation and amortization expense for the year ended June 30, 2012 amounted to approximately $205, 081 . The estimated useful life range of each assets group is : Years Building 15-40 Leasehold Improvement 5-20 Furniture and Fixtures 3-20 Automobiles 3-5 Bond Issuance Cost The issuance costs associated with the origination of the bond have been deferred and are being amortized over the term of the debt . The amortization related to the loan costs for the year ended June 30, 2012 was $3, 402 . Contributions Contributions, including unconditional promises to give, are recorded as made. All contributions are available for unrestricted use unless specifically restricted by the donor. Conditional promises to give are recognized when the conditions on which they depend are substantially met. 12 GUIDANCE/CARE CENTER, INC. NOTES TO THE FINANCIAL STATEMENTS (CONTINUED) JUNE 30, 2012 NOTE 2 - LONG TERM DEBT Long term debt consists of the following at June 30, 2012 : On July 31, 2003, the Clinic refinanced its mortgage note Borrowed through the Florida Community Provider Pooled Loan Program and its construction loan agreement with iBERIABANK. The Principal with interest at a fixed rate of 5 . 125% is due in monthly installments of $17, 591 to iBERIABANK through August 2018 ; collateralized by substantially all assets of the Clinic; borrowed through the Monroe County Industrial Development Authority. $1, 111, 756 Mortgage payable, collateralized by real property, equipment, accounts receivable, deposits, investments, fixtures, and proceeds of various government contracts, payable in monthly installments of $3, 758 . 08 including interest at 6 . 00%, matures June, 2b27 . 525, 000 1, 636, 756 Less current portion 171, 057 Total long-term portion $ 1, 465, 699 The aggregate maturity of the long-term debt for each of the five Years subsequent to June 30, 2012 and thereafter are as follows : Year Ending June 30, 2013 $ 171, 057 2014 180, 277 2015 189, 995 2016 200, 168 2017 Thereafter 895, 259 $ 1, 636, 756 13 GUIDANCE/CARE CENTER, INC. NOTES TO THE FINANCIAL STATEMENTS (CONTINUED) JUNE 30, 2012 NOTE 3 - PENSION PLAN Westcare Foundation, Inc. and affiliates have retirement plans covering substantially all employees . Under the plans, Westcare contributes, at the discretion of the Board of Directors, an amount up to 15% of the annual salary of employees . NOTE 4 - FUNDING/ECONOMIC DEPENDENCE The Guidance/Care Center, Inc. has received grants and/or contracts to continue providing program service for the June 30, 2012 fiscal year. Funding for program services from the United States Department of Health and Human Services, State of Florida, Department of Children and Families, Monroe County and the South Florida Behavioral Health Network, Inc. represented approximately B8o of the Clinic' s total support and revenues for the year ended June 30, 2012 . A significant reduction in the level of this support, if this were to occur, would have an adverse effect on the Guidance/Care Center, Inc. ' s programs and activities and its ability to satisfy its financial and programmatic obligations and commitments . NOTE 5 -- WESTCARE FOUNDATION, INC . On June 1, 2005, Guidance/Care Center, Inc. entered into an Agreement and Plan of Assumption and an affiliation agreement with WestCare Foundation, Inc. a not-for-profit public benefit corporation as is the Guidance/Care Center, Inc. Management Fees paid to Westcare Foundation, Inc. during the fiscal year ended June 30, 2012, was $693, 557 . NOTE 6 - SUBSEQUENT EVENTS The Organization has evaluated subsequent events through January 3, 2013, the date which the financial statements were available to be issued. 14 CALLAGHAN GLASSMAN & MARGOLIS,L.L.C. CERTIFIED PUBLIC ACCOUNTANTS 736E SHERIDAN STREET, SUITE 209 HOLLYWOOD, FLORIDA 33024 TELEPHONE(954)986-4780 TELEFAX(954)981-7912 REPORT OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS ON SUPPLEMENTAL INFORMATION To the Board of Directors of Guidance/Care Center, Inc. 3000 41 Street, Ocean Marathon, Florida 33050 Our audit was conducted for the purpose of forming an opinion on the basic financial statements taken as a whole. The supplemental information included on pages 16 to 38 is presented for purposes of additional analysis as required by U. S . Office of Management and Budget Circular A-133, "Audits of States, Local Government, and Non-- Profit Organizations", Chapter 10 . 650, the Rules of the Auditor General, and the State of Florida Department of Children and Families and is not a required part of the basic financial statements . Such information has been subjected to the auditing procedures applied in the audit of the basic financial statements and, in our opinion, is fairly stated in all material respects, in relation to the basic financial statements taken as a whole. Certifi Public Accountants January 3, 2013 15 AUDIT SCHEDULE Schedule of State Earnings for Fiscal Year ending 06/30/12 1 Total Expenditures $ 7,717,027 2 Less Other State and Federal Funds $ (909,618) 3 Less Non-Match SAMH Funds $ (1,120,020) 4 Less Unallowable Costs per 6SE-14, F.A.C. $ (71,609) S Total Allowable Expenditures $ 5,615,780 (Sum of lines 1, 2, 3, and 4) 6 Maximum Available Earnings $ 4,211,835 (Line 5 times 75%) 7 Amount of State Funds Requiring Match $ 2,882,367 8 Amount Due to Department $ 1,329,468 (Subtract line 7 from line 6. If negative, funds are due to State) CF-MH 1034,Jul2003 (6117102) 16 Substance Abuse and Mental Health Program p H w I II I i IG' ID x w 1 Ilk N ID O O Id i� N I i � � I � i I III v I � E E w I `E II I I E n w E E i u u M h a .. I rymry v� I 4 v) ri I M N M E u f N w E I I I I C 4 m ni N N i >b I II I n n p ai n NII � III i n � ¢ T O h _ � � I� Gl~i• E r - E Gl O n o b 4 v tr I� I ul LL1 O ul ¢ V m m tr m l n a I ¢ -J 14 F- U a m 3 g I u vi`o i wT w I I F a 0 g m 4 I N v 3 U ~ a W a x G m @ -- U) 6 N N Z Z FF F cv� m O I I J Q CD !If YI 4 w tr i I I II II — 11 cc w m g 9 ¢ z z LLI cc �n lu Q a z z z z ca N z W W ,i O 2 IL U w W p Vr a s In h w r c u a g $ WE m w C3 En E ~ — Q 13 so Z V1 Q Ej I d m u 11 I 141 H-r i hl km A 3I eA� 111 A tl • A v1 N I `� " 1 I 1 I N I EI 1� to Ih'] 1 vl I'i 1[1 0l T m m I ep- I u tV ! lal ! ! I n pj t!S m I I 3 N ([{ N v h� Is tri I *i o ri m N pi a N ti iI I n I I c II fl q M N i'1 Q M I II Il I M II III I p I y II — Ip 41 � rl � � VI Vza II N I I 1 N I I � t II II II II I� II N I N I� A m I N ' — Vl n- Iry 0 • a II m I r TI n I m I I • I 1 I — (y Ip I 1b1 pp R� m th m 1!1 M t • • m I — rqrq�� O I 1N'i 1 N I ' . Wi Omi h i 10 O N R N O N In A EII IA'1 E N o ry EI 1➢ ``!I I y? E I hr 17 rl w T N II A I lif e: w E 11 i i 0j I I m R — n n lE IN N t ' Q w A N ? +� Ifi d I T I p1 I I I n m N N II T II N II I N I II � y I N I I --- � W � 0. Ilk{ 11 I R ♦- t+( ' , O I t N.N Y I N Ii I R I { I I I I I € ZI ~ Im y w II II E II N EI I� I p I y I h I(I R m'? , 'f N •- iY +f m I Il `�] N 3 — u 4 Ili II 1I1 RI A e� R ^ T � i CNi m a 9 y AI T I� — N ! � ' OI A � • i m �! I —� t•� I N � — a'I1 N I -— G mN m m N I A I 1I��1 4i fE t'i R C O h1 K li N A ' m 4 T i[ [p NN N W E � � �A A � II N vi cif EI Itf of Iff ry I R � I i � I m f `t U !. II EE e- I II ^ I Iy III T I I ry I Y m a I m N .d n II i� A T `r� T 1 N I h II T I T Si u '� II I Cn N f% I I II I N � II I N I Ya �p a jj€ t[ kE ^r T pi 4 g IA N N ' ri ri � I � ¢� H I Cc;g G p N R I I ~ 11 A I IE A I ! W ry q II II I II II _ EI II N I M I I N O O lz W11 U N N i iI i E`i `N Ii I i N I N I a -a N m ¢ u �a y '^z N 1•i 'ri Fi .=m o Ip r: •i c +� pi .r I ._^ i vC [— q � 1�• R C'C�1� (� A .1�1. 1� I � e.. n N N 7 , ' ry O v] 1� EI >� iI , 1E i � i IJ' 13 �J,� (Wj [3 Al ItI I I I II � N 't ' T A — a II I a 1� •N I II i I € H>ly u1 1p I 1'f 0.1 � N m I o In W q p❑ � 2 � E m a —_ _- 10 S O .,._ >T ^ EI Vl l n Am •f m Q ..... N I m I IO ni m I Imp II ~ II I Yj I E LIJ V m II R {p O �- Gt m �i N b T O I O 11ii w 1 1 pl II VI Li 2 T . vi I o .- n N I•i , p� i i o 'd nAi E IE E ' IE v I E E SE a I Yj K � T G Z 7- N a tn z ' o uzLl 2 d c uJ 'a w u w ¢ q _ wp G w m o to IL a FW LU Ln oa W a z c w id cni 6 o w ` w E"' cl w a 1 a o i o a In u❑i c = Z u & a q c t x ` U u uue ¢ w w °-� o Q a ~ Z m a. n y vl O w 6 u N u u O a n c Q H ul z In In 5 N 4 �E r Lu Z ❑ i c w LLIu � R F z e a y _ r a ❑ � uM � 0. Z U �i z m r q N a ° i\. p a yy (IJ h m Lw tL H '^�' ❑ ❑ Ly y 0 O d y Q 4 U a ❑ = —L` o C n ti U q u E 16 O � ip — m 16 � • �V�tt— �9 1O 9 4 LL��1� rynry II � I M II If I F' M _ — G _ � m N � • � — N � i I1'1 G I a -- u 2 n I•i Ti w 4 m " o 2`' f If I z if It "3 V" �ti — '.3 • of Itt T o vs N O li w o Q r n I q I!l 41 G I n n R A I N I a 6, —� � + T HI ICI u ho � 9 � ut tens m • s'�s p— raj ry I ——— if ul EE h N� I In a a — � vl c— � r; H I: N o ai � � o I•i F I T f ^I iry � I Iri Ol gE m n n if it c u"i I� sm� O al II `nF O I p II 1W I I if N II I —_— ra m I m b n Y d O if e o ; if I II u a m I w E I J a w l5 t o [7 In 0 in ic3 z _ g Z ��nn • m 2 z w z w o u-1 G z V v t W �? R ? a v = m Ill W 4' LU a by ¢ zO` ! m why m W u1 ° F W W ZLU a u G W� O z 11 li 5 W yzyj 01 .t°. c C O Q h a 0 4 U z�c 7 w e O la 11 Fa 4 w N l7 I N ❑ IU W U O 6 -- - L7 a m •— �° E r n a — r o L7 Z U) Q d r m L7 im K 1��ry! I O M h fQ��i ID O C i 1 M lr N C I m � Ill ,r ti m I ti n ti i I I I I a i �I �i i 11 IE ii it l q h N ve w. n m n m gy m{ Rp a m l 1 A 10h�l fyy: 'n'�}} n 1� c M q ` +- N in A IIII Ypl EI N Yl I Qmi I ❑ I ' ! e O m h IfII ry Le C lt'f O l C❑i II m II 'i Id I 1 1 II U N G h R@ RY �I b Ill >n N N I� w M i[l I T mT+� ThK RAR (] ❑ t-i E 61 F1 N n N n N n A n g s E n { m t m 1 ut I o m w g E m I N O �I I o II I ❑ I �u I i i w l wiE i i � i z w N w W .. In h `- � w ❑ N � � m ` K � P a N W t+l b 4] L�.hJ T A t'I Iry ' 'nV ? 1 lRry I m 1� I Ol I IO I O n I EI G Y b fQ tL i� ID N IIt N S Gi I❑ll C R N m F F- i i ,min ry 6 G Q V + h T w I tri 1 w IE Ip E II � i iE 0 o M u iE i I ii it it � m I 1: m i 1st I o o N m E i i� i! I EI II it II I p R I 1 e 6 rmi N I ao . I 9 — IINi .r.. m I ' e K ry io E w w w IL II II Il 1I I I R I �I II tl II _ N 1111II��]] OI �- K m l] � Lqt] A o N O �I`— ❑ I � m S I S Im-[ O {yI 4 m N K 1❑r ip m RI w Q A m +n+ O R Ill EI R I ❑ h T l A E R II ❑ f`l E[[ N IL t ut ' 1f7 m IR I'1 !f N m 1� b, i F N ti h M F r ui i ld Ili In let l Isi >rr i °' II 0 w u IK'n M rRi A I — 4 ^ � Ill N Yl � IG TN 61 � A I❑4 I 1O II � � b A I t I� I ' I w I I O n n I T n N m �+ ❑ Iq In N R R , E � m ❑ N fA I't 4i IO t 4 Irt � � i T I w N cl E ry IE I N j I l7 w � ' E I I I N li II W I W E I --- . I w � tl mml�� E � i � Ei m IiE Ie rt Y ? A Itf W' E yl I i I it a J m I T E E E IE I Il — A � a `{{E`E`I EaEI N � Iq I � I y + � q w I I i� I h l ii I N I N W I IS I IIi 2 - 2 a J w z r a cif z In o z G Z Q [qi IL a Imo. F aaC i z a r2 OIN R „Wj c orb N m W W O < W z w Uj o o t47 i "l w c4i a o w w aw, [Jj F-Z 7 U N Z N z F Z a O V W C N Z }}� d Irwi I°n �[ •a O w _n r rc a y tY a t m l] W q W m !'i G a' Yya. p LL Q IL �s J N R t! yl 4 a 5 '� V = N u W IL 4 to 93 ma M u I� n a o mJ W e a Z U �- a� o A If p tI} E M trf m h IE o- N n .�... a^ In a .` al m n'^• G to a a F LJ k N a 4 m m x fi v qd'i !� 10"O�O'O�d O'O O. O m 4 N ' Q.'�?' O. I: ti m d d 0 0 0 y zi o k Ty � byum v3 iv3isgs U .u... d" td- Q. bs F 'D to N O aC) w O a d a 3 owe a o too O 7 IO O 1*1 O, O q O O- p 41 a cu to Q 4 0 tC N a. I y � Nnmy Co rn rn ID LU to q T- U ]ti 'Z b Q v ti` N Tt m a pu7 c cm d 7 LL- U t U � E i� E E ,m` :d ) U a o w, M U •M 9.� rom cai cai JE a � lz 0 0 S m o n T LL U 4 k \ £ k k , . \ \ � 4-1 % ] q / k U ° / f c u c c ) ) ® \ / co / j \ C-) � a / N � / 2 ® § Q3 § o / / q q q q e \ 2 2 � k ~ƒ \ � N 4 6 � g 2 \ . . L t N 2 W N L o ro 13 � 3 $ o / § o L2 @ § / k cc to w § @ o Q / / / 6 / E k ca k / k f E q R k { \ a ƒ k / / / q / \ k % k % e � 0 2 / / /t/ / / / � § � \ ( # \ � § \ CALLAGHAN GLASSMAN & MARGOLIS, L.L.C. CERTIFIED PUBLIC ACCOUNTANTS 7369 SHERIDAN STREET, SUITE 201 HOLLYWOOD, FLORIDA 33024 TELEPHONE(954)9854780 TEL.EFAX(954)991-7912 INDEPENDENT AUDITORS' REPORT ON SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS AND STATE FINANCIAL ASSISTANCE The Board of Directors Guidance/Care Center, Inc. 3000 41 Street, Ocean Marathon, Florida 33050 We have audited the Schedule of Expenditures of Federal Awards and State Financial Assistance of the Guidance/Cara Center, Inc. for the year ended June 30, 2012 . The Schedule of Expenditures of Federal Awards and State Financial Assistance is the responsibility of the Organization' s management. Our responsibility is to express an opinion on the Schedule of Expenditures of Federal Awards and State Financial Assistance based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations; and Chapter 10 . 650, Rules of the Auditor General, which require that we plan and perform the audit to obtain reasonable assurance about whether non- compliance with the types of compliance requirements referred to above that could have a direct and material effect on the state project occurred. An audit includes examining, on a test basis, evidence about Guidance/Care Center, Inc. ' s compliance with those requirements and performing such other procedures, as we considered necessary in the circumstances . We believe that our audit provides a reasonable basis for our opinion. Our audit does not provide a legal determination on Guidance/Care Center, Inc. ' s compliance with those requirements . 23 To the Board of Directors Guidance/Care Center, Inc. In our opinion, the Schedule of Expenditures of Federal Awards and State Financial Assistance referred to above presents fairly, in all material respects, the financial position of Guidance/Care Center, Inc. for the year ended June 30, 2012 in conformity with United States of America accounting principles generally accepted. In accordance with Government Auditing Standards, we have also issued a report dated January 3, 2013 on our consideration of Guidance/Care Center, Inc. ' s financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts and grants . This report is an integral part of an audit performed in accordance with Government Auditing Standards and should be read in conjunction with this report in considering the results of our audit . Certif d Public Accountant January 3, 2013 24 GUIDAAICEXARE CENTER,INC. SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS AND STATE FINANCIAL ASSISTANCE FOR THE YEAR ENDED JUNE 30,21112 CFDA CONTRACT FEDERAUSTATE AGENCIES CFSA PASS-THROUGH TRANSFERS TO APRA PASS THROUGH GRANTOR NUMBER AWARD NUMBER EXPENDITURES SUHRECIPfENTS FUNDS p-so fnom lL_1E FEDERAL AWARDS PROGRAMS: U,S DEPARTMENT OF JUSTICE PASSED THROUGH FROM FLORIDA DEPARTMENT OF LAW ENFORCEMENT PASSED THROUGH MONROE COUNTY.' RESIDENTIAL SUBSTANCE ABUSE TREATMENTFOR PRISONERS 1E593 2011-RSAT-MONR-I-A9-004 $ 16,69B $ - RESIDENTIAL SUBSTANCE ABUSE TREATMENT FOR PRISONERS 16,593 Z01Z-RSAT•MONR-I-D1-003 45,468 PASSED THROUGH MONROE COUNTY,' COORDINATEORGANIZELDCAL INIPATIVESISTATE INITIATIVES 16738 2012-JAGC.MONR-5•C4.228 25,002 U.S.DEPARTMENT OFHEALTH AND HUMAN SERVICES OFFENDER RE-ENTRY PROGRAM SUBSTANCEASUSE AND MENTAL HEALTH SERVICES ADMINISTRATION CENTER FOR SUBSTANCEARUSE TREATMENT 93.243 11179T1021624.01 394,588 AFFORDABLE CAREA CT-HEALTH CENTER PLANNING GRANTS HEALTH RESOURCES AND SERVIC95 ADMINISTRATION 93.621 1 PO4CS227E6-07-00 77,648 PASS-THROUGH: SOUTH FLCRIGA BEHAVfORAL HEALTH NETMRK.INC. PROJECTS FOR ASSISTANCE IN TRANSITICN FROM HOMELESSNESS 93.150 ME22527 90,027 BLOCK GRANTS FOR PREVENTION AND TREATMENT OFSUBSTANCEABUSE-ADULT SERVICES 93.959 ME22527 104,337 BLOCK GRANTS FOR COAfAIUNITY MENTAL HEALTH SERVICES-CHILDRENS SERVICES 93.958 ME22527 160,475 BLOCKGRANTS FOR PREVENTIONAND TREATMENT SUBSTANCEASUSE-CHRDREN'S SERVICES 93.067 ME22527 26,747 PREVENTION SERVICES CHiU31ADOLES CENT SUBSTANCE ABUSESERVIC6S 93.959 ME22527 107,1128 BLOCK GRANTS FOR PREVENTION AND TREATMENT SUBSTANCE ABUSE-CHILDREN SERVICES 93.959 ME22527 100,TUB SOCIAL SERVICE BLOCK GRA MT CHILDRENS SUBSTANCE ABUSE 93.667 ME22527 2,764 PREVENTION SERVICES CHfLDIADOLES CENT SUBSTANCE ABUSE SERVICES 93.959 HDZDI 72,099 U.5,DEPARTMENT OFAGRICULTURE FOOD AND NUTRITION SERVICE PASSED THROUGH FRDAf THE FLORIDA DEPARTMENT OF ELDERLY AFFAIRS 10.550 Y2110 6,8Z4 FOOD AND NUTRITION SERVICE PASSED THROUGH FROM THE FLCIRIOA DEPARTMENT OF ELDERLY AFFAIRS 10.556 Y1TT8 4,879 TOTAL EXPENDITURES OF FEDERAL AWARDS 51.954 61�6 S STATE FINANCIAL ASSISTANCE PROJECTS: STATE OF FLORIDA DEPARTMENT OF CORRECTIONS NON-SECURE DRUG TREATMENTPRDGRAAt 70.016 C2546 35,377 STATE OP PLORIOA COMMISSION FOR THE THAMSPORT4I7ON DISADVANTAGED 55,001 ABQ77 266,166 41,835 STATEOF FLORIDA COMMISSION FOR THETRANSPORTATION DISADVANTAGED-MEDICAID NON EMERGENCYTRAN5PORTA VON 55.001 BDM86 61D,853 44,375 STA TE OF FLORIDA DEPARTMENTOF TRANSPORTATION E310 VEHICLE GRANT 20.513 N/A STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES PASSED THROUGH SOUTH FLORID BEHA VIDRAL HEALTH NE WORK.INC. EAKERACT 60.006 ME22527 - COMMUNITY FORENSIC BEDS 612,114 ME22527 160,QOQ - CHILDREN'S AfENTA4 HEALTHCCAfMUNfTY SUPPORT SERVICES 60.055 ME22527 - - ADULT COMMUNITY MENTAL HEALTH COMMUNITY SUPPORTSERVXES 66,053 ME22527 966,938 47,196 INDIGENTPSYCHIATRIC OUTPATIENTSERVICES 60.039 ME22527 5,545 ADULTCDMMUNfTY MENTAL HEALTH EMERGENCY STABILIZATION 60,054 ME22527 90,001 CHILDREN'S MENTAL HEALTH SIPP RTGNON MEDICAL ELIGIBLE 60.046 ME22527 248,530 CHOLDREN'S COMMUNITY MENTAL HEALTH EMERGENCY STABIUZA77GN 60.057 ME22527 12,390 DETOXIFfCATION COMMUNITY SURE rAHCEA6USE SERVICES 60.031 ME22527 78,952 TREATMENT AND APTERCARE COMMUNITY SUBSTANCE ABUSE SERVICES 60,023 ME22527 191,5B2 44,154 TREATMENT AND AFTERCARE CHILWADOL SUBSTANCEASUSE SERVICES 60.030 ME22527 266,143 - SUBSTANCEABUSE PREVENTION SERVICES FOR CHILDREN 00.029 ME22527 6,83E SUBSTANCE ABUSE PREVENTION SERVICES FOR CHILDREN 60.029 KDZOI 7,611 STATE OF fLORIDA DEPARTMENT OF CHILDREN AND FAMILIES OFFICE OF HOMELESSNESS PASSED THROUGH THE S OUTHERNMOST HOMELESS ASSISTANCE LEAGUE 60.014 KPZ52.01 5,000 TOTAL EXPENDITURES OF STATE FINANCIAL ASSISTANCE $4'013,213 S177,560 PLEASEREAD THE INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS ON SUPPLEMENTAL INFORMATION 25 GUIDANCE/CARE CENTER, INC. NOTES TO THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS AND STATE FINANCIAL ASSISTANCE YEAR ENDED JUNE 30, 2012 1 . General The accompanying schedule of expenditures of federal awards and state financial assistance presents the activity of all federal awards and state financial assistance programs of Guidance/Care Center, Inc. for the year ended June 30, 2012 . The Organization' s reporting entity is described in Note 1 to the Organization' s financial statements . Federal awards and State financial assistance expended from federal and state agencies, and federal awards and state financial assistance passed through other government agencies, are included on the schedule. 2 . Basis of Accounting The accompanying schedule of expenditures of federal awards and state financial assistance is presented using the accrual basis of accounting, which is described in Note 1 to the Organization' s financial statements . The information in this schedule is presented in accordance with the requirements of OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations and Chapter 10 . 650 Rules of the Auditor General . Therefore, some amounts presented in this schedule may differ from amounts presented in or used in the preparation of the financial statements . 26 CALLAGHAN GLASSMAN & MARGOLIS,L.L.C. CERTIFIED PUBLIC ACCOUNTANTS 7869 SHERIDAN STREET, SUITE201 HOLLYWOOD, FLORIDA 33024 TELEPHONE(954)986-4780 TELEFAX(954}981-7912 REPORT OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS ON INTERANL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS To the Board of Directors Guidance/Care Center, Inc . 3000 41 Street, Ocean Marathon, Florida 33050 We have audited the financial statements of Guidance/Care Center, Inc. , as of and for the year ended June 30, 2012, and have issued our report thereon dated January 3, 2013 . We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Governmental Auditin Standards, issued by the Comptroller General of the United States . Internal Control Over Financial Reporting Management of Guidance/Care Center, Inc. is responsible for establishing and maintaining effective internal control over financial reporting. In planning and performing our audit, we considered Guidance/Care Center, Inc. ' s internal control over financial reporting as a basis for designing our auditing procedures for the purpose of expressing our opinion on the Financial Statements, but not for the purpose of expressing an opinion on the effectiveness of the Entity' s internal control over financial reporting. Accordingly, we do not express an opinion on the effectiveness of the Entity' s internal control over financial reporting . A deficiency exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect and correct misstatements on a timely basis . A material weakness deficiency is a deficiency or combination of deficiencies in internal control such that there is a reasonable possibility that a misstatement of the entity' s financial statements will not be prevented or detected and corrected on a timely basis . 27 To the Board of Directors of Guidance/Care Center, Inc. Internal Controls over Financial Reporting (continued) Our consideration of internal control over financial reporting was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control over financial reporting that might be significant deficiencies or material weaknesses . We did not identify any deficiencies in internal control over financial reporting that we consider to be a material weakness, as defined above. Compliance and Other Matters As part of obtaining reasonable assurance about whether Guidance/Care Center, Inc. ' s financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts . However, providing an opinion on compliance with those provisions was not an objective of our audit and, accordingly, we do not express such an opinion. The results of our tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards . This report is intended for the information and use of the board of directors, management and federal, state and local awarding agencies and pass-through entities and is not intended to be and should not be used by anyone other than these specified parties . January 3+ 2013 Certift d Public Accountant 28 CALLAGHAN GLASSMAN & MARGOLIS,L.L.C. CERTIFIED PUBLIC ACCOUNTANTS 7369 SHERIDAN STREET, SUITE201 HOLLYWOO€3, FLORIDA 33a24 TELEPHONE(954).986-4780 REPORT OF INDEPENDOFIM?Y�ftbD PUBLIC ACCOUNTANTS ON COMPLIANCE AND INTERNAL CONTROL OVER COMPLIANCE IN ACCORDANCE WITH OMB CIRCULAR A - 133 AND APPLICABLE TO EACH MAJOR STATE PROJECTS To the Board of Directors of Guidance/Care Center, Inc. 3000 41 Street, Ocean Marathon, Florida 33050 We have audited the financial statement of Guidance/Care Center, Inc. as of and for the year ended June 30, 2012, and have issued our report thereon dated January 3, 2013 . We conducted our audit in accordance with auditing standards generally accepted applicable to the financial audits contained in Government Auditing Standards, issued by the Comptroller . General of the United States . Compliance We have audited the compliance of Guidance/Care Center, Inc. with the types of compliance requirements described in the United States Office of Management and Budget (OMB) Circular A-133 Compliance Supplement, and requirements described in the Executive Office of the Governor' s State Projects Compliance Supplement, that are applicable to each of its major federal programs and state projects for the year ended June 30, 2012 . Guidance/Care Center, Ins. ' s major federal programs and state projects are identified in the summary of auditor' s results section of the accompanying Schedule of Findings and Questioned Costs . Compliance with the requirements of laws, regulations, contracts, and grants applicable to each of its major federal programs and state projects is -the responsibility of Guidance/Care Center, Ins. ' s management. Our responsibility is to express an opinion on Guidance/Care Center, Inc. ' s compliance based on our audit . We conducted our audit of compliance in accordance with auditing standards . generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations; and Chapter 10 . 650, Rules of the Auditor General . Those standards, OMB Circular A - 133, and Chapter 10 . 650, Rules of the Auditor General, require that we plan and perform the audit to obtain reasonable assurance about whether non-compliance with the types of compliance requirements referred to above that could have a direct and material effect on a major federal program and a state project occurred. 29 To the Board of directors of Guidance/Care Center, Inc. An audit includes examining, on a test basis, evidence about Guidance/Care Center, Inc. ' s compliance with those requirements and performing such other procedures, as we considered necessary in the circumstances . We believe that our audit provides a reasonable basis for our opinion. Our audit does not provide a legal determination on Guidance/Care center, Inc. ' s compliance with those requirements . In our opinion, Guidance/Care Center, Inc. complied, in all material respects, with the requirements referred to above that are applicable to each of its major federal programs and state projects for the year ended June 30, 2012 . Internal Control Over Compliance The management of Guidance/Care Center, Inc. is responsible for establishing and maintaining effective internal control over compliance with requirements of laws, regulations, contracts, and grants applicable to federal programs and state projects . In planning and performing our audit, we considered the Organization' s internal control over compliance with requirements that could have a direct and material effect on a major federal programs or state projects in order to determine the auditing procedures for the purpose of expressing our opinion on compliance, and to test the report on internal control over compliance in accordance with OMB Circular A - 133, but not for the purpose of expressing an opinion on the effectiveness of internal control over compliance . Accordingly, we do not express an opinion on the effectiveness of the Entity' s internal control over compliance. A deficiency in internal control over compliance exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect and correct noncompliance with a type of compliance requirement of a federal program or state project on a timely basis . A material weakness in internal control over compliance such that there is a reasonable possibility that material noncompliance with a type of compliance requirement of a federal program and state project that is more inconsequential will not be prevented or detected and correct on a timely basis . Our consideration of the internal control over compliance was for the limited purpose described in the first paragraph of this section and would not necessarily identify all deficiencies in internal control over compliance that might be significant deficiencies or material weaknesses . We did not identify any deficiencies in internal control over compliance that we consider to be a material weaknesses, as defined above. 30 To the Board of Directors of Guidance/Care Center, Inc. Guidance/Care Center, Inc. responses to the findings identified in our audit are described in the accompanying Schedule of Findings and Questioned Costs . We did not audit Guidance/Care Center, Inc. ' s responses and accordingly, we express no opinion on such responses . This report is intended solely for the information and use of the Guidance/Care Center, Inc. ' s board of directors, management and federal, state and local awarding agencies and pass-through entities and is not intended to be and should not be used by anyone other that these specified parties . 4rCertifi' ed" Public Accountants January 3, 2013 31 GUIDANCE/CARE CENTER, INC. SCHEDULE OF FINDINGS AND QUESTIONED COSTS FEDERAL PROGRAMS AND STATE PROJECTS YEAR ENDED JUNE 30, 2012 SECTION I -- SUMMARY OF AUDITOR' S RESULTS Financial Statements Unqualified Internal control over financial reporting: Material weakness (es) identified? yes X no Reportable condition (s) identified not Considered to be material weaknesses yes x none reported Noncompliance material to financial statements noted yes x no Federal Awards & State Financial Assistance Internal control over major federal programs and/or state project : Material weakness (es) identified? yes x no Reportable condition (s) identified not considered to be material weaknesses (es) yes x none reported Type of auditor' s report issued on compliance for major federal programs and/or state projects : Unqualified Any audit findings disclosed that are required to be reported in accordance with Circular A-133, Section 510 (a) and/or 10 . 656 yes x no Identification of major federal programs And state projects : CFDA Name of Federal Program of Cluster Number (s) Substance Abuse and Mental Health Service Administration Center 93 . 243 Residential Substance Abuse 16. 593 32 GUIDANCE/CARE CENTER, INC. SCHEDULE OF FINDINGS AND QUESTIONED COSTS FEDERAL PROGRAMS AND STATE PROJECTS YEAR ENDED JUNE 30, 2012 (Continued) C FSA Name of State Project Number (s) Baker Act 60 . 006 Adult Community Mental Health Community Support Services 60 . 053 Treatment and Aftercare Child/Adolescent 60 . 030 Dollar threshold used to distinguish between Type A and Type B programs for federal awards : $ 300, 000 Dollar threshold used to distinguish between Type A and Type B projects for major state Financial assistance : $2, 089, 643 Auditee qualified as low-risk auditee pursuant to OMB Circular A-133 YES x NO SECTION II - FINANCIAL STATEMENT FINDINGS NONE REPORTED SECTION III - FEDERAL AWARDS AND STATE FINANCIAL ASSISTANCE FINDINGS AND RESPONSES NONE REPORTED SECTION IV - FEDERAL AWARDS AND STATE FINANCIAL ASSISTANCE SUMMARY OF PRIOR AUDIT FINDINGS NONE REPORTED SECTION V -- FINANCIAL ASSISTANCE -- MANAGEMENT LETTER THERE IS NO MANAGEMENT LETTER 33 INTERNET REPORT 1D:531702 VERSION:1 2/2112013 11:26:33 AM OMB No.0348-0057 FORM SF- AC DataU.S.DEPT.OF COMM.-Eccn.and 51aL UR Admin.-U.S.CENSUS BEAACTING AS U LLECTING A( {5-18-2010I OFFICE OFMANOAGEMENT AND BUDGETData Collection Form for Reporting on AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS for Fiscal Year Ending Dates in 2010, 2011, or 2012 Complete this form, as required by OMB Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations." PART V GENERAL INFORMATION (To be completed by auditee, except for Items 6, T, and 8) 1. Fiscal period ending date for this submission 2. Type of Circular A-133 audit 3. Audit period covered Month Day Year i®Single audit 10 Annual 3 El Other- Months 06 / 30 / 2012 z❑ Program-specific audit 2❑Biennial 4. Auditee Identification Numbers a. Primary Employer Identification Number (EIN) d. Data Universal Numbering System (DUNS) Number 5 9 _ 1 B 12141 0 8 -- 5 5 6 - 6 4 6 1 b. multiple cov red in this report? i ❑Yes 2®No e. Are multiple DUNS covered in this report? t❑Yes 2®No c. If Part em =" es," complete Part 1, Item 4c f. If Part I, Item 4e="Yes,"complete Part I, Item 4f o the c tin lion bet on Page 4. on the continuation sheet on Page 4, S. AUDIT 90111 ATION 6. PRIMARY AUDITOR INFORMATION (To be completed by auditor) a. Auditee ame a. Primary auditor name GUIDANC CARE ENTER, C. CALLAGHAN,GLASSMAN,&MARGOLIS,LLC b. Auditee d ess NUmbe and eet) b. Primary auditor address(Number and street) 3000 41ST STREET LEAN 7360 SHERIDAN STREET,SUITE 201 City City MARATHON HOLLYWOOD State ZIP+4 C de State ZIP+4 Code _ FL 3 3 0 FL 3 c. Auditee contact c. Primary auditor contact Name Name MARIANNE K.BENVENUTI GARY GLASSMAN Title e REGIONAL CONTROLLER L/PART>R d. 'Auditee contact telephone d./ P ary auditor contact telephone `305 434 '"- 7660 954 ) 9 -' 4780 e. Auditee contact FAX . P " ary a tar c tact FAX 305 434 — 9040 954 98 — 912 f. Auditee contact E-mail f. P ' ay au ' r con ct -mail MARIANNE.BENVENUTI WESTCARE.COM RY 6 N T M A PA.CO g. AUDITEE CERTIFICATION STATEMENT-This is g. DITO STAT EN -T e elements and information to certify that, to the best of my knowledge and belief, the dude n this m are ' ited o tho prescribed by OMB auditee has: (1)engaged an auditor to perform an audit rc r A-13 . he i rmatio inclu ed in Parts II and III of the In accordance with the provisions of OMB Circular A-133 fo ,exce or Par II, Item 7, 8, nd 9a-9g,was transferred for the period described in Part 1, Items 1 and 3; (2) the from the ditor' eport(s)f r the eriod described in Part I, Items auditor has completed such audit and presented a signed 1 and 3, nd i of a Su titu Far such re .The auditor audit report which states that the audit was conducted in has not p ed any au iting ocedure Ce th date of the accordance with the provisions of the Circular;and, (3) auditor's report(s).A cop of th repo r' package uired by the information included in Parts 1, 11, and 111 of this OMB Circular A-133,w ch in u he tom audi data collection farm is accurate and complete. I declare report(s),is available i its a ty from t uditee the dress that the foregoing is true and correct. provided In Part I of€ is form,As re ' ed by OM ircular 33, the information in Pa 11 an of this form s ent d in t form by the auditor bas Information Intl ed in re rting Date c package.The auditor has not performed a additio I au itl Auditeg�er�i�ica 9 ,M I S S 10I�i N 0 1 1-0;-, ., �>�1 I S S I O N procedures in connection with the comp Ion of jhi5 f N C?i F=C, R'SUBMISSIO f--l0 1- I'L0 ', `SUBMiS ,i1 7a. Add Secondary auditor inform ion? ptt a[I' N ELECTRQNICALI�iY'_CER_TiIFIEC t_111=(-)P 2/21120,13;;I S.1 f,.i Na[ne nflc(rtifyfng)offI0bI;S10N NOT FOP P SI.J1,MIS S,III"I 3 ❑Yes z®No r-'iC-) I.. F0P 1;1J 1fJl1c_-f E"J1-� NOT 1 (�F? SUSIMISS10fL b. If"Yes,"complete Part 1,Item 8 on th Conti ation f�J�tiAARIANt�E�K.i ENVE��IUT� N(D [-0 R1 S EJ B,M I' S M-1 sheet on page s. Tide oFcertfjiing�bffciallS` [G(! f!i i I F{_)f ZtilJ1-EMI:)- i, 1 Auditorlcelttflc tion fVlIySIC)PzJ 1�1t::)1 I UP, a[eN3'S` it ii�l R�G OC1AL-COINTRQLLEftJ f lOT F C)�: �ilJ afll�l l )I�1 i�10 EL[ECTRO�VIICAULY-CERTIFIEDi_ f dl� 212 7 013'IOC I f�lC T FUI SUBrAS`_;IU14! flOT I=f1i slil-IMISSIC-N 11101 i ()RI `7 JBIVI15SION NuI 1-01? `_-,tJlslvlls:�iOfJ INTERNET REPORT ID:531702 VERSION:1 Primary EIN: 5 9 1 4 W5 8 3 2 4 PART lIl j FINANCIAL STATEMENTS fro be completed by auditor) 1. Type of audit report Mark either: i I] Unqualified opinion OR any combination of: 2 ❑ Qualified opinion 3❑ Adverse opinion 4❑Disclaimer of opinion 2. Is a "going concern"explanatory paragraph included in the audit report? i ❑Yes 2❑x No 3. Is a significant deficiency disclosed? 1❑Yes 2 I]No 4. Is a material weakness disclosed? 1 ❑Yes 21E No S. Is a material compli ce disclosed? i Cl Yes 2 0 No PA 11: L,�EIDEAAL PROGRAMS (To be completed by auditor) 1. Does th udit 's re ark include a statement that the auditee's financial N ' ude epartments, ncies, or other organizational units e $ 0,00 or more in ed I awards that have separate A-133 ah are t included this au t7 (AICPA Audit Guide, Chapter 13) 1 El Yes 2®No 2. What is t doll r thres id to ' tingu Ty A and Type B programs? 3pp ppp (OMB Ci ular -133 ....._...52 b)) 3. Did the auV if s a to -risk au itee?L.530) 1 ❑Yes 2 FNI No 4. Is a significant deficiency dis osed far any m ' r pragram7 ( .510(a)(1)) 1❑Yes 2❑9 Na 5. Is a material weakness disci ed or any major rogram? (§ 5 0(a)(1}} i ❑Yes 2I]No 6. Are any known questioned costs report d7 ( _.510(a)(3} or ❑Yes 2 X❑No 7. Were Prior Audit Findings related to dir t fu �Iwn in the S m/rychedule of Prior Audit Findings?(5_.315(b)) 1 ❑Yes 2®No a. Indicate which Federal agency(ies) have current year audit dings re ted to dire riding or prior audit findings shown in the Summary Schedule of Prior Audit Findings related t irect ndin (Mark ) all at apply or None) ea❑ U.S. A ency for Inter- 39❑ General Services dmi ' ration ❑ ation Archiv nd 1B❑ U.S. Department national Development e3(� Health and Human vices Rec s Ad ' istr 'on of State io El Agriculture 97 El Homeland Security s❑ ianal dawm f 20 El Transportation 23❑ Appalachian Regional 1e Ar 1 ❑ Treasury PP 9 1�E❑ Housing and Urban Commission Development o Na' al En me for 4❑ Veterans Affairs i i❑ Commerce o3❑ Institute of Museum and t Huma ' es oo® None s�El Corporation for National Library Services 47 ation Science ❑ Other—Specify. Fo and Community Service 15 El anon Interior a7 ice of Natio al Dr g 12 El Defense 18 El Justice ontral Polic as❑ Education 17❑ Labor ss❑ Small Busi ss al❑ Energy a9❑ Legal Services Corporation Administr ion 66❑ Environmental 43❑ National Aeronautics and 96 ElSocial Se rity Protection Agency Space Administration Administrati Page 2 FORM SF-SAC I5.18-7010I a]CD V v C C aj u ry] 41 w N z ¢ ` r a a a a a Q a a Ul oz zz z' z z z z `z In LL c a., Y Ll O t7 to � CCC ❑ -0[ll • g'C ❑ N.� c p Q 0 Q-E O O E tD Q w to uo- 0 a a 0 0 0 a a 0 0 �a u r _ y D -Fu a� Ln tn ePl T q w Q]� t1❑' m uj N Q Lj X ly-V) Lo Z� O C m C = J C Z Q Q. z >" z > Z } Z >- Z Z } Z. ❑ a; E o v �❑ ❑® ❑ x❑ El El El El El a E o 'Cl tll � C7. � ❑] '� tR JR C C U- } 2 } z Z Z z } z z 2! mil- Zfu Ta en .N 0! 0 m r N r N r N r N r N r r N r N r N r N e~j] V C n] U m m C E L" d d d O O O O O C] O O u ❑ u C E u m O O O C? O O C7 C7 O C? C) m E ca Q G N CC] CO [r to r co » ti On N � C 0 to m 00 a N h 0N0 t0 m N m a'�O [i g." r L >n tP m [T u m Lo N C] ti O w N G G ]tn `7 j 'C Q C Q N E to c cq r to r ai 'a C •m a m a I tV ¢ Fn w e- ee- 0 eg ❑ s= a C F] 113 r to ❑— Q M 00 c G7 m d7 a N VY J _E mma7a tL E m m 61 m C C 4 z O a 0 C z m C3 O c.n tEC9 tLo o F W W 7 �2 sz m n Q w N x s z r o Cis c� T� `t3 M f w L7 -1 J w 'o 'C m y c1 t�L9 ~ F F o U o.0 CU (]7 to N ti a z w wS Ej d] ee emu to C} i�tz O .� M O p m 0 u] m 0 V Z rwr] Z W y !n N`_ O¢Ci Qmj m to c❑ T O.O r q ❑ t7 m L.rIl m 7 rm w r w x m N E u J h ¢ tii f w Y �i] �if L ¢ 1 z 1� U f' 7' ° m V �' Q a x (� r Q1 m Q q m U a U u] [] a 0 sZ m�] [n R1 7 N Z 3- z a -- w tk z J a w Ve x m m m 4 r ❑ m ❑ w m ❑ 0 w G7 [0 o C C m m z a q 1,;u LL a m w w LL 'a E it Q T QI O ¢ Ln o w a Nm ° m m m to o E m E *' W J � o wz x s z a z a ❑ a�m �^� t1E o a z w < m m Z O 7, a �] ¢] m n, r U a z a z m U J F w W v Q a]rn m-LtJ I tf :E a ry wU 7 C J [] m U m 0 G m O (f� Mn y ❑ E ts. q ❑ 2 0 a tl 0 m 0 m ' W LL.wm 0 <L a o: ❑ J J w O J 7 J Z ¢ a C IZ ;3 N� a a a. u ? ¢ ° a m m m m m z m m m m W o v m 8 131 ❑� W CY QCYLL ❑® El ❑ ❑ ❑IR ❑® ❑® ❑® El u eS] a r�G m 7 r N r N r N r N r N r r N r N r N r N W ❑ E D O Q C O Mi ❑ C © > U N D ❑ y '° c� o LLJ > E m � m � M J a } Z L , � ❑fU tea.0C3 Z Z >- z N - N� 0 °j ® ® ® El® El® ❑ o • 7 am r- � : o I ❑, w N N cLE M !LLI i m tom+ E O W `.� at N- n o m cr o� a)�uom .� 0 Z a x eq m ti o 0o co h m a] W Q m a m °E Q C) ❑ Z Z Ltl M M N ]n to to to to Ln � rL ti] Wto ti N to r a3 tD a] c] m o '� m Q M U 0 F- ~ W - - - - - - - _ _ _- - - - -- - - - - to E E❑ gQ Q tiL. ? U •- Lt7 err N m Cl) - m F] M In � n:°+�a uW cs � a x „a.. - � �� - - - - - - - - - - - - - - - - F D¢a r -. t- a] rn a] c] rn 01 al 07 FORM SF-SAC(s.ia-znin) Page 3 u� N z Q C 4 Q N Z Z C: M ❑ 0 z 1n Q17 [A D C C _ Q Q y� p O wEm m ❑ ° E m r d ou ¢' o O Q O ei I w rr s CL CL 0Ln U N QJUWCD q `V W N i ca C L m roD u s aLntn2D W O o -�� z0❑ CL m �o ❑� ❑® El E] ❑❑ El El El El El El ❑❑ ° E o 0.` 13� N r N r N r N r N r N r N r N r N Q] o C a V"O } z } z } z } z } z } } } z l L m r N r N r N r N r NnM U '� (!J Sr,u q a1 n C E �N O O O a d O O O O C)1 a U ❑ u a o 0 o a C) 0 o a a o a, c Cm a ❑ E m o 0 m o t� ❑ �n E _ r-i CC W L r3 u aj � Cb N N ❑ m Va p O Q N N 41 r � �� N f7p =L ❑ Q � tf} rft rf} tfy EH tr3 ifl cr7 1ff 4fl ❑ .= M p 2 8 N w v❑" rn X -0 1„-- C N 00 V N j =f ❑ctl ISO 61� W C C'❑ p C', E z z LL in JE Ll to 1`U A uj U °.- yY.❑ CL l� LL M O p ❑ d uNi U ��- ins°. 2 OW al u_ x N O yn- �. ❑ N N N D. IIIm r3[y o �� fV E ¢ U m w � n Q aid w -(D C o �M W q ej u ' ❑ Q N Y] C } Ce w Z Y ^�• u o J w z F w z O �, `� dE w`°.� tp £j f� a r w w a W � ¢ mE F=QMLUZa. z N 0 O LL vs Ula s �[ C N 0-0 v N0.' ,� > z >- ? Z >- z >- z >- z >- z >- z d m ° CC E2u ❑— ❑� O 7 O r N r N r N N r N r r N r N r N r N _ O r a ci c C. ❑ � Cum�q Mp �� o� } z } z } z } z } z } z } z � z � z } z � m > In(D00-=1C- 'O a �; maE ❑® ❑® ❑® ❑❑ ❑❑ ❑❑ ❑❑ ❑❑ ❑❑ a � r N r N r N r NNN r N ? ma w f'- Im Im w j C SSr " � U1 , C W L} N QI ;n L ❑ C7 u C u IL 1� Cla 4 = m ' ❑ w mm { ¢ v X u Ea—2 � E 1 Lu i„ E oc Q U _ ❑ T�L31- �1 ip.' 0 L N z z - z w ti rn W o �� L m Q QUf� 4CD in � d L U p- El < tn 0 < ja LLI V U K I- F N j'i tiT j!] � � �Y FORM SF-SAC(5-18-2010) Page 3 ME ■ ■■:■■■■�■ =■■ ■■� B®88��8®BB�aBB®B®BBBBB - ■■■■�/�■rim■■■■■■■■■■ ■�©©0©00�08®®�8®BBBBB u Lo y y I N b I C C � N7 W co Q3 O s= E CL� m m U- Lu I y In as auli ej m as ro can �s m I E a a C C C E a 'D C C C C tw m U D O O t❑i C C U u U U U L Q p + f O O D O + O O YO O =o =a a apC.n, n a a n v 7 C N ❑ 7 ❑ a 7 N 7 a 7 7 Q Q ¢ ¢LLJm m ( f6 m m (pm ^ ^ ^m ❑ O O Iq u ❑ y D D ❑ O ❑ y DU U lil U U U .T+ u E tll U u u E m (n mr — o (D CD Q 0 m m m acn z (n`• cn V) V) u V) in z i= Ln. tnti Ln to s m � m y y ❑ I mz I o � mro � m x z a+ ¢ LU u LU U u1 cu C1 cUO tU9 tUtl tULn L ti7 [U4 fyU9 t" D N �- u-. D m U 'a 0 ❑ m C C E a C C C C o O o a o ❑ ❑ 0 p y c m U u u u u c m u u u u L b O D 4 ❑ O O C O q O G O O a v a - cm a d n o a 4 4 Q Q Q Q N Q Q Q ¢ (p m t6 m m 0 (a m m !� m m ❑ p ❑ ❑^ 'o v a "o a^a^a C C C C C C C C C C C ❑ ❑ m ❑ D D O ❑ D a) ❑ m ❑ O D u u u u E m u u u u u T u E m u u u 'p w a) 0 m a] m e+ e� a� a1 m m m aJ as 0 tl1 (n in iU U7 z F^ V1 V) V) Ill U u1 V) z M- V)-.0 V) 7 m A }� .!On [V /V� 4 V � E ❑ D E W 0 4 y iq E a CO C O .m ti D X E a) Q E N ❑ a p U U U U 0 N (a (Up .Um IUO CC ¢ E b a3 � c c c E a w c c c c W m a a D ❑ 0 ❑ E^ ' m '❑ P U U DU u C m O u u u U C) Zs m C - L) L - - w-. L I �. tw `❑ ❑ ,� O ❑ _ D O ❑ a D 4 O O W U fl TS - C7 a O O O D ❑ D ❑ a 0 D a m❑ C 0. ❑ ❑ ❑ ❑ D E" Q ¢ N ¢ ¢ Q Q ¢ ¢ N ¢ ¢ Q Q m m m m m m IO (9 m m m EtJ r a7 a Q a C m ❑ Cry O D ❑ m ❑ ❑^ ❑�ti ❑ !- q p o f _ u u u u u y u E a1 u u u z N Y c+ m as m ci w as a) a3 a) m - m ❑ m it V) Z Vl U ill in z Ln in In V) u N in z H V)._.V)� V) FORM SF-SAG(5-19.2010) Page 5 MONRDE COUNTY BOARD OF COUNTY COMMISSIONERS AGREEMENT This Agreement is made and entered into this 16th day of October, 2013, between the BOARD OF COUNTY COMMISSIONERS OF M{}NROE COUNTY FLORIDA, hereinafter referred to as "Board" or"County," and Guidance/Care [enter, hereinafter referred to as "PROVIDER." WHEREAS, the County participates in funding substance abuse and mental health (�AMH\ 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 legitimate public purpose to provide substance abuse and mental health services for individuals, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. GRANT OFFER TO THE PROVIDER. The County hereby agrees to provide local match funding for State funding pursuant to Section 394.76/9\(a), Florida Statutes, and the contracts between the PROVIDER and South Florida Behavioral Health Netvvorh /�4E225-4-27 and PPG-1-06\ attached here in (Attachment [}) to provide substance abuse and 'enta| health services; such ' funds shall be expended for alcohol, drug abuse, or mental health service programs. 2. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and carrying out the duties and obligations of the Board, shall reimburse the Provider for a local match portion of the Provider's expenditures for Substance Abuse and Mental Health services, as billed by the Provider, for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures, for substance abuse treatment. This cost shall not exceed a total reimbursement of SIX HUNDRED FIFTY SEVEN THOUSAND AND SIXTY SIX AND ND/100 DOLLARS /$657,066.0O) in fiscal year 2013-2014. ' 3. TERM. This Agreement shall commence on October 1, 2013, and terminate September 30, 2014, unless earlier terminated pursuant to other provisions herein. 4. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act and BAMH 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 nnonth. 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 organizat|on's final invoice must be received within sixty days after the termination date of this contract shown in Article 3above. 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 tothe funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County [ode of Ordinances, State |avvS and regulations and Attachment A - Expense Reimbursement Requirements. Any funds expended in violation of this Agreement or in violation of appropriate Federal, State, and County requirements shall be refunded in full to the County. Evidence of payment by the PROVIDER shall be in the form of letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as Attachment B. The organizat|on's final invoice must be received within thirty days after the termination date of this contract shown in Article 3 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. 5. AVAILABILITY OF FUNDS. The County reserves the right to withhold/reduce the funds to the Provider in the event that the Department of Children and Families e|irn|nabas/neducesthe 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 of this Agreement; provided that all applications, requests, grant proposals, and funding solicitations shall be approved by each party prior to submission. 7. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING S. RECORDS. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER. 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 tothe County the following (iternsA-M must be provided prior to the payment of any invoices): (a) IRS Letter ofDetermination and (5UI[}ESTAR printout indicating current 5O1(c\(3\ status; /b\ List of the (]rganization'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; Guidance Care CenmrSAMH Contract FY/4;page 2 /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 filed IRS Form 990 from most recent fiscal year with all attached schedules; /f\ Organization's Corporate Bylaws, which must include the onganization'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 y4E225-4-27 and PPG-1-06); (i) All legally required licenses; (j) Any upddtes/a mend[Oents 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 /ME225-3-27and PPF-1-06\; (k) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved; (|) Cooperation with County monitoring visits that the County may request during the contract year; and (rn) 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 2013-2014 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, 2O15. 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 [ to residents of Monroe County, Florida. 13. AQFTORNEY"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'sfees, 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 ofthe 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, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. Guidance Care Centep8AMH Contract FY1+;page 3 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 agnacU 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 |icensure of the PROVIDER'S program and staff. 20. NON-DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and itis expressly understood that upon a determination by 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\ which VI of the Civil Rights Act of 1964 (PL 88-352) hi�h prohibits discrimination on the basis o' race, color or national origin; 2\ Title IX of the Education Amendment of 1972, as amended (20 USC os. 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 of1975, as amended (42 U5[ ss. 6101-6107) which prohibits discrimination on the basis of age; 5\ The [}rug Abuse Office and Treatment Act of 1972 /PL92-255\, as amended, relating to nondiscrimination on the basis of drug abuse; O\ The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL91 616), as amended, relating to nondiscrimination on the basis of alcohol abuse oralcoholism; 7\ The Public Health Service Act of1912, 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 o� housing; 9\ The rner|cans with Disabilities Act of 1990 (42 USC s, 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement, AMENDMENTS, CHANGES, AND DISPUTES Guidance Care Genm,OAMK Contract FY14;page 4 21. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. 22. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. 23. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 24. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict inany manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 25. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 26. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed o waiver ofimmunity 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 to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 29. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including aLtorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors/ or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 30. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 31. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 32. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation ofConstitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 33. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled torely 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 orany 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 A#nsernenL separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 34. Execution in Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be regarded as on original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 35. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand-delivered or mailed, postage pre-paid, by certified rna||, return receipt requested, to the other party asfollows: For L3garcl:. Grants Administrator and Monroe County Attorney 1100Sinnontun Street PO Box 1026 Key West, FL3304O Key West, FL33O41 For PROVIDER Frank Rebb(to, Senior Vice President Guidance/CareCenter 1205 Fourth Street Key West, FL33O4O Guidance Care CentepSAMH Contract FY/4;page 36. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 37. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 38. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as dose 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 TD F{}LU}VVl Guidance Care Cente~SAMf Contract rY/4;page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) BOARD {}F COUNTY COMMISSIONERS ATTEST: AMY HEAVILIN, CLERK OF M{}NRDEC{}UNTY, FLORIDA uy By Deputy Clerk Mayor/Chairman Guidance/Care Center (Federal I[} No. \ Witness &t,0 A I ,' 2 �L WitnessZI Di , C>utreacK& A-vocacy Guidance/[areCenter M(}NROE COUNT`/ ATTORNEY ASSISTANT COUNTY ATTORNEY Gvidsnoe Care{ente,GAMHContract FY/4;page 8 ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community-Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business, These guidelines, as they relate totravel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this onganization. Furthermore, these expenses are in compliance with thisorganizotion's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source," Invoices should be billed to the contracting agency. Third party payments will not beconsidered 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 beconsidered all-inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305-292-3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter-company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary orhourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, dote, payee, and support for applicable paid payroll taxes. Postage, OvernightDeliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy of the rental or )ease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number 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 C*nter-SAM*Contract FY,4;page 9 TeUefax. 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 of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must besubmitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. 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 to the airport for a business trip is not reimbursable. Parking is considered m reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for bytraveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and persona) 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 o point of departure. For example, driving from one's home to the airport fora business trip is not reimbursable expense. Meal reimbursement shall beatthe rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code ofOrdinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after p.m. for dinner reimbursement. Non-allowable Expenses The following expenses are not allowable for reimbursement: capita) outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non-sufficient check charges, penalties and fines. Guidance Care Qm^er-3AMH Contract FY/4;page ,0 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL33O4O Date The ho|!ovvin4 is a summary of the expenses for / \ for the time period to_______. Check # Payee Reason Amount 101 Company Rent $ X,XXX.XX 102 Company Utilities XXX.XX 104 Employee P/R ending O5/14/O1 XXX.XX 105 Employee B P/Rending 05/28/01 ) XC8.KX (A) Total (B) Total prior payments $ X,XXX.XX (C) Total requested and paid (Af B) $ X,XXX,XX (0) Total contract amount $ X,XXX.XX Balance of contract (D-C) I certify that the above checks have been submitted tu the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organizotion's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Chief Executive Officer Attachments (supporting documentation) Sworn to and subscribed before me this day of 20__ by who is personally known tome. Notary Public Notary Stamp Guidance Care CentepGAMf Contract FY/4;page // ATTACHMENT C Services to be provided: Local match portion of State-Funded Substance Abuse Mental Health Services, inclusive of Baker Act services. per Florida Statutes, and contracts between Guidance Care Center and the South Florida Behavioral Health Network (ME225-4-27 and PPG-1-06L. Guidance Care Center-SAMH Contract FY14;page 12 ATTACHMENT D GCC's Contracts with South Florida Behavioral Health Network Contracts (ME225-4-27 and PPG-1-06) Guidance Care Center-SAMt-1 Contract FY14;page 13 South(Florida hayloral Fiealth(Network,Inc. STANDARD CONTRACT THIS CONTRACT is entered into between the South Florida Behavioral Health Network, Inc., (SFBHN) hereinafter referred to as the "Managing Entity"(ME)and Guidance/Care Center, Inc., hereinafter referred to as the"Network Provider." 1. Contract Document The Network provider shall provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, and documents incorporated by reference which constitute the contract document. 2. Requirements of Section 287.058, Florida Statutes(F.S.) The Network Provider shall provide units of deliverables, including reports, findings, and drafts, as specified in this contract. These deliverables must be received and accepted by the ME contract manager and/or designee, in writing prior to payment. The Network Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre-audit and post-audit; where itemized payment for travel expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061, F.S., or at such lower rates as may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the Network Provider in conjunction with this contract except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the Network Provider's failure to comply with this provision shall constitute an immediate breach of contract for which the ME may unilaterally terminate the contract. 3. Provisions of the Prime Contract All provisions,terms and conditions, or amendments, addendum, changes or revisions applicable to the Network Provider made subsequent to the initial execution of the Prime Contract, i.e.,the Contract entered into between the DCF and SFBHN (ME), not in conflict with this Contract, shall be binding upon the Network Provider and the Network Provider agrees to comply with same. The Prime Contract is incorporated by reference in this Contract. In case of conflict with the provisions, terms and conditions of The Prime Contract and this Contract, the provisions, terms and conditions of this Contract will prevail. In the event of a conflict between the provisions of the documents of this contract, the documents shall be interpreted in the order of precedence listed in Paragraph 46, of this Standard Contract. 4. Effective and Ending Dates This contract shall begin on July 1,2013. It shall end at midnight, local time in Miami-Dade County, Florida on June 30,2014. 5. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate state court in Miami-Dade County, Florida. 6. Federal Law a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not limited to, 45 Code of Federal Regulations(CFR), Part 74, 45 CFR, Part 92, and other applicable regulations. b. If this contract contains over$100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations(40 CFR, Part 30). The Network Provider shall report any violations of the above to the ME. c. No federal funds received in connection with this contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of $100,000, the Network Provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment III. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to payment under this contract. d. Unauthorized aliens shall not be employed. The ME shall consider the employment of unauthorized aliens a violation of section 274A(e)of the Immigration and Nationality Act (8 U.S.C. 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be cause for unilateral cancellation of this contract by the ME. Pursuant to Executive Order 11-2 signed on January 4, 2011, the Network Provider, and if applicable all subcontractors for work contemplated under this contract, shall use the E-Verify system established by the U.S. Department of Homeland Security to verify the employment eligibility of its employees and the subcontractors'employees performing under this contract. e. If this contract contains $10,000 or more of federal funds, the Network Provider shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 and 45 CFR, Part 92, if applicable. f. If this contract contains federal funds and provides services to children up to age 18, the Network Provider shall comply with the Pro- Children Act of 1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both. 7. Audits, Inspections, Investigations, Records and Retention a. The Network Provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income and expenditures of funds (to include funds used to meet the local match requirements per 65-E-14 F.A.C., if applicable)provided by the ME under this contract. The network provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect that the Department is the payer of last resort for substance abuse and mental health services. Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 1 of 10 South FloridaI ehaloral Fieallh Network,Inc. b. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract shall be maintained by the Network Provider for a period of seven (7) years after completion of the contract or longer when required by law. In the event an audit is required by this contract, records shall be retained for a minimum period of 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 ME. c. Upon demand, at no additional cost to the ME, the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME, State, and Federal auditors, pursuant to 45 CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment II. g. The Network Provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by The Office of the Inspector General (section 20.055, F.S.). h. The Network Provider shall include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and assignments. 8. Inspections and Corrective Action The Network Provider shall permit all persons who are duly authorized by the ME to inspect and copy any records, papers, documents, facilities, goods and services of the Network Provider which are relevant to this contract,the scope of review being conducted, and to interview any clients, employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the terms and conditions of this contract. Following such review,the ME will deliver to the Network Provider a written report of its findings, and may direct the development, by the Network Provider, of a corrective action plan where appropriate. The Network Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. This provision will not limit the ME's termination rights under Section 40. Failure to implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall be grounds for contract termination. 9. Indemnification a. The Network Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and hold harmless the ME, State and the Florida Department of Children and Families(DCF), and its officers, agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys'fees, arising from or relating to any alleged act or omission by the Network Provider, its agents, employees, partners, or subcontractors, provided, however, that the Network Provider shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or omission of the ME. b. The Network Provider shall fully indemnify, defend and hold harmless the ME, the State and the DCF, from any suits, actions, damages, and costs of every name and description , including attorneys' fees, arising from or relating to violation of infringement of a trademark, copyright, patent, trade secret or intellectual property right, provided, however, that the foregoing obligation shall not apply to the ME's misuse or modification of Network Provider's products or a ME's operation or use of Network Provider's products in a manner not contemplated by the contract or the purchase order. If any product is the subject of an infringement suit or in the Network Provider's opinion is likely to become the subject of such a suit, the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non-infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use,the ME shall not be liable for any royalties. The Network Provider's indemnification for violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this contract or delivered to the ME for the use of the ME, its employees, agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all claims and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or trade secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 34. d. The ME shall not be liable for any cost, expense, or compromise incurred or made by the Network Provider in any legal action without the Network Provider's without the ME's prior written consent, which shall not be unreasonably withheld. The Network Provider's inability to evacuate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the ME negligent shall excuse the Network Provider of performance under this provision, in which case the ME shall have no obligation to reimburse the Network Provider for costs of its defense. If the Network Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the ME shall be to the extent permitted by section 768.28, F.S. or other applicable law, and without waiving the limits of sovereign immunity. 10. Insurance Continuous adequate liability insurance coverage shall be maintained by the Network Provider during the existence of this contract and any renewal(s)and extension(s)and in accordance with the requirements in Attachment I. By execution of this contract, unless it is a state agency or subdivision as defined by subsection 768.28(2), F.S., the Network Provider accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the Network Provider and the clients to be served under this contract. The limits of coverage under each policy maintained by the Network Provider do not limit the Network Provider's liability and obligations under this contract. Upon the execution of this contract, the Network Provider shall furnish the ME written verification supporting both Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 2of10 South Florida e a loraI Health Network,Inc. the determination and existence of such insurance coverage. Such coverage may be provided by a self-insurance program established and operating under the laws of the State of Florida. The ME reserves the right to require additional insurance as specified in this contract. The network provider shall notify the ME's Contract Manager within thirty (30) calendar days if there is a modification to the terms of insurance, to include but not limited to, cancellation or modification to policy limits. 11. Confidentiality of Client Information a. The Network Provider shall only access information concerning a recipient for a permitted purpose and shall abide by all applicable state and federal data privacy laws including, but not limited to HIPAA and 42 CFR Part 2. b. The Network Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 12. Assignments and Subcontracts a. The Network Provider shall not assign the responsibility for this contract to another party without prior written approval of the ME, upon the ME's sole determination that such assignment will not adversely affect the public interest; however, in no event may the Network Provider assign or enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned on full and faithful performance of Network Provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval of the ME shall be null and void. The Network Provider shall not subcontract for any of the work contemplated under this contract without prior written approval of the ME,which shall not be unreasonably withheld. b. The Network Provider shall ensure that all subcontract agreements, at any tier, for work contemplated under this contract, adhere to all of the requirements of the ME's Prime Contract with the department and all the requirements of this contract. A copy of the Prime Contract can be found at the ME's website.www.sfbhn.org. c. To the extent permitted by Florida Law, and in compliance with Section 9. of this Standard Contract, the Network Provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the Network Provider or its subcontractors.Any subcontracts shall be evidenced by a written document. The Network Provider further agrees that the ME shall not be liable to the subcontractor in any way or for any reason. The Network Provider, at its expense, will defend the ME against such claims. d. The Network Provider shall make payments to any subcontractor within seven (7)working days after receipt of full or partial payments from the ME in accordance with section 287.0585, F.S., unless otherwise stated in the contract between the Network Provider and subcontractor. Failure to pay within seven (7)working days will result in a penalty that shall be charged against the Network Provider and paid by the Network Provider to the subcontractor in the amount of one-half of one percent(.005)of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen(15%)percent of the outstanding balance due. e. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under its contract with the ME to another governmental agency in the State of Florida, upon giving prior written notice to the ME. In the event the State of Florida approves transfer of the ME's obligations, the Network Provider remains responsible for all work performed and all expenses incurred in connection with the contract. This contract shall remain binding upon the successors in interest of either the Network Provider or the ME. f. The Network Provider shall include, or cause to be included, in all subcontracts(at any tier)the substance of all clauses contained in this Standard Contract that mention or describe subcontract compliance. 13. Return of Funds a. The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network Provider by the ME and any interest attributable to such funds pursuant to the terms 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 made, the contract manager or designee, on behalf of the ME, will notify the Network Provider by letter of such findings. Should repayment not be made forthwith, the Network Provider will be charged interest on the outstanding balance after the ME notification or Network Provider discovery. Payments made for such services subsequently determined by the ME to be in full compliance with the contract requirements shall be deemed overpayments. b. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utilization and Performance measures monitored by ME. 14. Client Risk Prevention and Incident Reporting If services to clients are to be provided under this contract, the Network Provider and any subcontractors shall, in accordance with the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner prescribed in CFOP 215-6 or circuit or region operating procedures. The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As required by Chapters 39 and 415, F.S.,this provision is binding upon both the Network Provider and its employees. 15. Civil Rights Requirements In accordance with Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, or the Florida Civil Rights Act of 1992, as applicable the Network Provider shall not discriminate against any employee (or applicant for employment) in the performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the Network Provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80, 83, 84, 90, and 91, Title VI of the Civil Rights Act of 1964, or the Florida Civil Rights Act of 1992, as applicable and CFOP 60-16. These requirements shall apply to all contractors, subcontractors, sub-grantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities. The Network Provider shall complete the Civil Rights Compliance Checklist, 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. Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 3of10 South FloridaI ehaloral Fieallh Network,Inc. 16. Independent Capacity of the Contractor a. In performing its obligations under this contract, the Network Provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the ME or the State of Florida, except where the Network Provider is a state agency. Network Provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME unless specifically authorized in writing to do so. This contract does not create any right to state retirement, leave benefits or any other benefits of state employees as a result of performing the duties or obligations of this contract. b. The Network Provider shall take such actions as may be necessary to ensure that each subcontractor of the Network Provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the ME or the State of Florida. The ME will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial or clerical support) to the Network Provider, or its subcontractor or assignee, unless specifically agreed to by the ME in this contract. c. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the Network Provider. 17. Sponsorship As required by section 286.25, F.S., if the Network Provider is a non-governmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program state: "Sponsored by(Network Provider's Name) , Inc., South Florida Behavioral Health Network, and the State of Florida, Department of Children and Families". If the sponsorship reference is in written material, the words "South Florida Behavioral Health Network " and "State of Florida, Department of Children and Families"shall appear in at least the same size letters or type as the name of the organization. 18. Publicity Without limitation, the Network Provider and its employees, agents, and representatives will not, without the ME's prior written consent in each instance, use in advertising, publicity or any other promotional endeavor any ME or State mark, the name of the ME's or State mark,the name of the ME , the State, or any ME or State affiliate or any officer or employee of the ME or the State , or represent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed by the ME, or refer to the existence of this contract in press releases, advertising or materials distributed to the Network Provider's prospective customers. 19. Final Invoice The final invoice for payment shall be submitted to the ME no more than fifteen (15) days, per the requirements stipulated in the Method of Payment section of this Contract, after the contract ends or is terminated. If the Network Provider fails to do so, all rights to payment are forfeited and the ME will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Network Provider and necessary adjustments thereto, have been approved by the ME. 20. Use of Funds for Lobbying Prohibited The Network Provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature,judicial branch, or a state agency. 21. Public Entity Crime Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the discriminatory vendor list. When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, or an entity or affiliate has been placed on the discriminatory vendor list, such person, entity or affiliate may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S., for CATEGORY TWO for a period of thirty-six (36)months from the date of being placed on the convicted vendor list. This provision applies to the Network Provider and all their subcontractors. 22. Gratuities The Network Provider agrees that it will not offer to give or give any gift to any ME employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the ME, any violation of this provision will result in referral of the Network Provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the Network Provider's name on the suspended vendors list for an appropriate period. The Network Provider will ensure that its subcontractors, if any, comply with these provisions. 23. Intellectual Property a. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals, presentations, films, or other copyrightable materials, arising in relation to Network Provider's performance under this contract, and the performance of all of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the ME, fully compensated for by the contract amount, and that neither the Network Provider nor any of its officers, agents nor subcontractors may claim any interest in any intellectual property rights accruing under or in connection with the performance of this contract. It is specifically agreed that the ME shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S.,which arises or is developed in the course of or as a result of work or services performed under this contract, or in any way connected herewith. Notwithstanding the foregoing provision, if the Network Provider is a university and a member of the State University System of Florida,then section 1004.23, F.S., shall apply. b. If the Network Provider uses or delivers to the ME for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 4 of 10 South FloridaI ehaloral Health Network,Inc. this contract. c. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida, then section 1004.23, F.S., shall apply, but the ME shall retain a perpetual, fully-paid, non-exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any state funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the state a security interest in the property at least to the amount of the state funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. As a condition of receipt of state funding for this purpose, the Network Provider agrees that, if it disposes of the property before the ME's interest is vacated,the Network Provider will refund the proportionate share of the state's initial investment, as adjusted by depreciation. 25. Information Security Obligations a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Network Provider employees that request or have access to any ME or DCF data system or information. b. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network Provider employees immediately upon termination of employment. c. The Network Provider shall provide the latest DCF HIPPA and Security Awareness Training to its staff and subcontractors who have access to ME and DCF data system, information and/or who have access to Protected Health Information regardless of format(e.g. electronic,written, audio, video or still image recording)or function. Security and HIPAA requirements extend to non-clinical or non-administrative personnel if such persons can access Protected Health Information.. The Network Provider shall ensure that proof of training is maintained in each employee file. d. All Network Provider employees who have access to ME or DCF data system or information, including but not limited to access to Knight Information Software (KIS), or any data system designated by the ME, Substance Abuse and Mental Health Information System (SAMHIS), Incident Reporting and Analysis System (IRAS), Temporary Assistance for Needy Family (TANF), shall comply with, and be provided a copy of CFOP 50-2, and shall sign the DCF Security Agreement form CF 0114 annually to the ME's contract manager and the ME's Director of Information Technology.A copy of CF 0114 may be obtained from the contract manager. e. The Network Provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data and storage devices are encrypted as prescribed in CFOP 50-2. If encryption of these devices is not possible,then the Network Provider shall assure that unencrypted personal and confidential ME or DCF data will not be stored on unencrypted storage devices. The Network Provider shall require the same of all subcontractors. f. The Network Provider agrees to notify the contract manager as soon as possible, but no later than five (5) business days following the determination of any breach or potential breach of personal and confidential ME or DCF data. The Network Provider shall require the same notification requirements of all subcontractors. g. The Network Provider shall provide notice to affected parties no later than 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. The Network Provider shall also at its own cost implement measures deemed appropriate by the ME to avoid or mitigate potential injury to any person due to a breach of personal and confidential ME and/or DCF data. 26. Accreditation The ME is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the ME has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the ME's Network Providers will either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a reasonable period of time. 27. Network Provider Employment Opportunities a. Agency for Workforce Innovation and Workforce Florida: The Network Provider understands that the DCF, the Agency for Workforce Innovation, and Workforce Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Agency for Workforce Innovation and Workforce Florida. b. Transitioning Young Adults: The Network Provider understands DCF's Operation Full Employment initiative to assist young adults aging out of the dependency system. The ME encourages Network Provider participation with the local Community-Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated thereunder(45 CFR Parts 160, 162, and 164). 29. Emergency Preparedness a. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients,the Network Provider shall,within thirty (30)days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 5of10 South FloridaI ehaloral Fieallh Network,Inc. records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning,the term supervision includes the responsibility of the ME, or its contracted agents to ensure the safety, permanency and well-being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a non-licensed relative/non-relative home, or be placed in a licensed foster care setting. b. The ME agrees to respond in writing within thirty(30) days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the ME may exercise oversight authority over such Network Provider in order to assure implementation of agreed emergency relief provisions. c. An updated emergency preparedness plan shall be submitted by the Network Provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The ME agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME. The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal filing, whichever comes first. 31. Whistleblower's Act Requirements In accordance with subsection 112.3187(2), F.S., the Network Provider and its subcontractors shall not retaliate against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee. The Network Provider and any subcontractor shall inform its employees that they and other persons may file a complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle-blower's Hotline number at 1-800-543-5353. 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or disclosure. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the Network Provider fails to promptly submit a redacted copy,the ME is authorized to produce the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard-of-Hearing a. The Network Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.F.R. Part 84(hereinafter referred to as Section 504),the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35(hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP) 60-10, Chapter 4, entitled"Auxiliary Aids and Services for the Deaf or Hard-of-Hearing." b. If the Network Provider or any of its subcontractors employs fifteen (15) or more employees, the Network Provider shall designate a Single- Point-of- Contact (one per firm) to ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504,the ADA, and CFOP 60-10, Chapter 4. The name and contact information for the Network Provider's Single-Point-of-Contact shall be furnished to the ME's Grant or Contract Manager within fourteen (14)calendar days of the effective date of this requirement. c. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60-10, Chapter 4. The Network Provider's Single Point of Contact and that of its subcontractors will process the compliance data into the Department of Children and Families HHS Compliance reporting database at https://fs16.formsite.com/dcfuser/form3/secure index.html, by the 41h working day of the month, covering the previous month's reporting, and forward the confirmation of submission to the ME's Contract Manager. The name and contact information for the Network Provider's Single Point of Contact shall be furnished to the ME's Contract Manager within fourteen(14)calendar days of the effective date of this requirement. d. The network provider shall contractually require that its subcontractors comply with Section 504, the ADA, and CFOP 60-10, Chapter 4. A Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 6 of 10 South FloridaI ehaloral Fieallh Network,Inc. Single-Point-of-Contact shall be required for each subcontractor that employs fifteen (15) or more employees. This Single-Point-of-Contact will ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the Network Provider's Single-Point-of-Contact. e. The Single-Point-of-Contact shall ensure that employees are aware of the requirements, roles&responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60-10, Chapter 4. Further, employees of Network Providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60-10, Chapter 4. This attestation shall be maintained in the employee's personnel file. f. The Network Provider's Single-Point-of-Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no-cost to the deaf or hard-of-hearing customers or companions are posted near where people enter or are admitted within the agent locations. Such Notices must be posted immediately by Network Providers and subcontractors. The approved Notice can be downloaded through the Internet at: http://www.dcf.state.fl.us/admin/civilrights.html g. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids/services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored. The Network Provider shall distribute Customer Feedback forms to customers or companions, and submission to the Department of Children and Families Office of Civil Rights. . h. If customers or companions are referred to other agencies, the Network Provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids/service needs. i. The network provider's and its subcontractors'direct service employees shall complete the online training: Serving our Customers who are Deaf or Hard of Hearing, (as requested of all Department of Children and Families and ME employees) and sign the Attestation of Understanding. Direct service employees will also print their certificate of completion, attach it to their Attestation of Understanding, and maintain them in their personnel file. 34. Contract Amount The ME shall pay for contracted services according to the terms and conditions of this Contract in an amount not to exceed $4,706,252.00, subject to the availability of funds and satisfactory performance of all terms by the Network Provider. Of the total Contract amount, the ME will be required to pay$3,921,877.00,subject to the delivery and billing for services. The remaining amount of $784,375.00, represents"Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the Network Provider, in whole or in part, or not at all, for Exemplary Performance by the Network Provider. Exemplary Performance will be determined by the Network Provider delivering and billing for services in excess of those units of service the ME will be required to pay. Should the network provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match as it appears on Exhibit H, Funding Detail, will automatically change, utilizing the following formula prescribed in the Method of Payment section of this contract. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. 35. Contract Payment (a)The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this contract, within ten(10)calendar days following the end of the month for which payment is being requested. (b) If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the ME indicating this information within ten (10) calendar days following the end of the month. Should the network provider fail to submit an invoice or written documentation (should no services be due to be invoiced from the preceding month), within thirty (30) calendar days following the end of the month, then the ME at sole discretion will consider these funds as lapse and may reallocate these funds within the network of providers. If the Network Provider fails to submit an invoice or written documentation for two (2)consecutive months within a twelve (12) month period, the ME at its sole discretion can terminate the contract or whole or in part. (c) The ME has ten (10) working days, subject to the availability of funds, to inspect, and approve for goods and services, unless the bid specifications, purchase order, or this contract specify otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if payment is not available within forty (40)days, measured from the latter of the date a properly completed invoice is received by the ME or the goods or services are received, inspected, and approved, a separate interest penalty set by the Chief Financial Officer pursuant to section 55.03, F.S.,will be due and payable in addition to the invoice amount. Payments to health care providers for hospital, medical, or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment is determined. Financial penalties will be calculated at the daily interest rate of.03333%. Invoices returned to a Network Provider due to preparation errors will result in a non-interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment shall be made only upon written acceptance by the ME and shall remain subject to the subsequent audit or review to confirm contract compliance. 36. Financial Consequences for Network Provider's Failure to Perform If the Network Provider fails to meet the minimum level of service or performance identified in this contract, or that is customary for the industry, than the ME will apply financial consequences commensurate with the deficiency. Financial consequences may include but are not limited to refusing payment, withholding payments until deficiency is cured, tendering only partial payments, imposition of penalties per Section 39., and termination of contract in whole or in part and requisition of services form an alternate source. Any payment made in reliance on the Network Provider's evidence of performance which evidence is subsequently determined to be erroneous, will be immediately due as an overpayment in accordance with Section 13. above, entitled"Return of Funds"to the extent of such error. 37. Vendor Ombudsman A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this office are found in section 215.422, Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 7 of 10 South FloridaI ehaloral Fieallh Network,Inc. F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at(850)413-5516. 38. Notice Any notice that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery. Said notice shall be sent to the representative of the Network Provider responsible for administration of the program,to the designated address contained in this contract. 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action a. Corrective action plans may be required for noncompliance, 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. b. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances exist, shall be based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, if imposed, shall not exceed ten percent (10%) of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of a ten percent(10%)penalty of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. c. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five percent (5%) penalty. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent (2%) penalty. The ME at is sole discretion may terminate a contract in whole or in part for failure to comply with requirements for corrective action. d. The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the ME may deduct the amount of the penalty from invoices submitted by the Network Provider. 40. Termination a. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the contract manager or the representative of the Network Provider responsible for administration of the program. This provision shall not limit the ME's ability to terminate this contract for cause according to other provisions herein. b. In the event funds for payment pursuant to this contract become unavailable, the ME may terminate this contract upon no less than twenty-four (24)hour notice in writing to the Network Provider. Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery. The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the Network Provider will be compensated for any work satisfactorily completed. c. In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than twenty-four(24)hours(excluding Saturday, Sunday, and Holidays)notice in writing to the Network Provider after Network Provider's failure to fully cure such noncompliance within the time specified in a written notice of noncompliance issued by the ME specifying the nature of the noncompliance and the actions required to terminate the contract. The ME's failure to demand performance of any provision of this contract shall not be deemed a waiver of performance. The ME's waiver of any one breach of any provision of this contract shall not be deemed to be a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions of this contract. The provisions herein do not limit the ME's right to remedies at law or in equity. d. Failure to have performed any contractual obligations with the ME in a manner satisfactory to the ME will be a sufficient cause for termination. To be terminated as a Network Provider under this provision, the Network Provider must have: (1) previously failed to satisfactorily perform in a contract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the ME; or (2) had a contract terminated by the ME for cause. Termination shall be upon no less than twenty-four (24) hour notice in writing. e. Should the termination of the contract be inevitable, the network provider shall work in collaboration with the ME to develop a transition plan, in accordance with the Network Service Provider Contract Non-Renewal/Termination/Record Transition Plan, incorporated herein by reference, and timeline to ensure the uninterrupted continuum of services to individuals served under this contract, to include but not limited to the transfer client records. A copy of the Network Service Provider Contract Non-Renewal/Termination/Record Transition Plan may be obtained from the ME's website at www.sfbhn.org. 41. Renegotiations or Modifications Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently included in the ME's prime contract with the DCF. 42. Dispute Resolution (a) It is the sole responsibility of the ME to resolve differences with the Network Provider pertaining to this contract. The Network Provider and the ME 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 its representative for dispute resolution purposes, 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 President/Chief Executive Officer of the respective parties. Upon referral to this second step, the President/Chief Executive Officer of the parties Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 8 of 10 South FloridaI ehaloral Health Network,Inc. shall confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, then in that event, the decision of the ME shall prevail subject to any legal rights that the Network Provider may have and/or wish to exercise. Venue for any court action will be in Miami-Dade County, Florida. This provision shall not limit the parties' rights of termination under Section 40. (b) In the event of a dispute as to the ME's determination regarding client eligibility and/or placement into the appropriate level of care, the ME's dispute resolution process, incorporated herein by reference and available upon request from the ME's contract manager, shall be followed. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. (c) In the event of a general dispute arising out of, or relating to this contract the parties mutually agree to resolve the disagreement amicably by following the ME's dispute resolution process. 43. Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (For Contracts Valued at$1,000,000.00(total contract value), or more, awarded, extended, or renewed on or after July 1, 2011). The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described in s.219.473, F.S. Pursuant to section s.287.135(5), F.S., the ME may immediately terminate this contract for cause if the Network Provider is found to have submitted a false certification or if the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List during the term of the contract. 44. Verification of Employment Status(E-Verify) 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 to the contract/grant with the department. "Subcontract"means any contract entered into by a subcontractor 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 a prime provider or another subcontractor. (b)Enrollment and verification requirements. (1)The provider/grantee shall- (i)Enroll. Enroll as a provider/grantee in the E-Verify program within 30 calendar days of contract award; (ii)Verify all new employees.Within 90 calendar days of enrollment in the E-Verify program, begin to use E-Verify to initiate verification of employment eligibility.All new employees assigned by the provider/grantee/subcontractor to perform work pursuant to the contract with the DCF shall be verified as employment eligible within 3 business days after the date of hire;and (2) The provider/grantee shall comply, for the period of performance of this contract,with the requirement of the E-Verify program enrollment. (i) The Department of Homeland Security(DHS)or the Social Security Administration(SSA)may terminate the provider's/grantee's enrollment and deny access to the E-Verify system in accordance with the terms of the enrollment. In such case, the provider/grantee will be referred to a DHS or SSA suspension or debarment official. (ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the provider/grantee is excused from its obligations under paragraph(b)of this clause. If the suspension or debarment official determines not to suspend or debar the provider/grantee,then the provider/grantee 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 of Homeland Security Web site: http://www.dhs.gov/E-Verify. (d)Individuals previously verified. The provider/grantee is not required by this clause to perform additional employment verification using E-Verify for any employee whose employment eligibility was previously verified by the provider/grantee through the E-Verify program. (e)Individuals performing work prior to the E-verify requirement. Employees assigned to and performing work pursuant to this contract prior to February 04,2011do not require employment 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. Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 9of10 ; I South Florida Behavioral Flealth Network,Inc. 45. Official Payee and Representatives(Names,Addresses,Telephone Numbers and E-Mail Addresses) a. The Provider name, as shown on page 1 of this Contract,and b. The name, address, and telephone of the Contract Manager mailing address of the official payee to whom the payment for the ME for this contract is: shall be made is: Guidance/Care Center, Inc, Cara Zuckerman 3000 41 st Street Ocean South Florida Health Network,Inc. Marathon,FL 33050 7205 Corporate Center Drive,Suite 200 Miami, FL 33126 Tel.(786)507-7474 E-Mail: CZuckerrnan@sfbhn.org c, The name of the contact person and street address where the d. The name, address, and telephone number of the Provider's financial and administrative records are maintained representative of the Provider responsible for the is: administration of the Droaram under this contract is: Marianne K,Benvenuti, Regional Controller Frank C.Rabbito,Senior Vice-President 3000 41 st Street Ocean 169 E. Flagler Street, Suite 1300 Marathon,FL 33050 Miami, FL 33131 Tel:(305)434-7660 Ext.31131 Tel:(305)573-3784 Fax:(305)434-9040 Fax:(305)381-7733 Cell:(305)393-0925 Cell:(305)799-1286 E-mail:marianne.benvenuti@westcare.com E-mail:frabbito @westcare.cam Upon change of representatives(names, addresses, telephone numbers and e-mail addresses)by either party, notice shall be provided in writing to the other party and the notification attached to the originals of this contract. 46. All Terms and Conditions Included This contract and it attachments, 1, 11, 111, IV & V and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract(which can be found at http://wvvw.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 hereon, 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; cl,Any documents incorporated herein by reference BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT,AS DESCRIBED IN SECTION 46 .ABOVE. IN WITNESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to be executed by their undersigned officials as duly authorized. PROVIDER: Guidance/Care Center, Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. S I GN 4ED ) SIGNED "2 BY: BY \j NAME: Frank Rabbito /NA ME" John W. Dow TITLE: Senior Vice President TITLE: President and CEO DATE: DATE; Federal Tax ID#(or SSN)59-1458324 Network Provider Fiscal Year Ending Date 6/30 Guidance/Care Center, Inc. Standard Contract Contract No. ME225-4-27 Page 10 of 10 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% 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 ME contract manager. b. Program/Service Specific Terms Additional Program/Service Specific Terms can be found in the South Florida Behavioral Health Network's Glossary of Program/Service Specific Terms, which is incorporated herein by reference, and can be obtained from the following internet location: http://www.sfbhn.ora/R5%2OContractina%2OPaae.htm (1) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397, F.S. which are provided using state and federal funds. (2) "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. (3) "Consolidated Program Description" is the combination of all of the ME network providers' program descriptions and the ME program description organized according to the description provided in 65E- 14.021 (8)(d) 1.d.(III), Florida Administrative Code (F.A.C). (4) "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. (5) "Contract Manager" is the ME employee who is responsible for enforcing the compliance with administrative and programmatic terms and conditions of a contract. The contract manager is the primary point of contact through which all contracting information flows between the ME and the network provider. All actions related to the contract shall be initiated by or coordinated with the contract manager. (6) "Co-occurring Disorder" is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (7) "Co-occurring Disorder Service Capability" is the ability of any program to organize every aspect of its program infrastructure (policies, procedures, practices, documentation, and staff competencies), within its existing resources, to provide appropriately matched, integrated services to the individuals and families with co-occurring disorders that are routinely presenting for care in that program. Should services not be available at the network provider then then the consumer must be linked to an agency with the capability to meet the consumer's needs. (8) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 1 of 39 °iouth Fllo riklaa Bc➢asnr o raall I111csallth Ncbvo rh,lru% allowable, appropriate and reasonable. (9) Cultural and Linguistic Competence" is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professional that enable effective work in cross- cultural situations that provides services that are respectful and/or responsive to cultural and linguistic needs. (10) "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.shtml, and is incorporated herein by reference. (11) "Department" means the State of Florida Department of Children and Families. (12) "Electronic Health Record (EHR)" is defined pursuant to section 408.051, F.S. (13) "Evidence-Based Practices" are those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. For substance abuse prevention services evidence-based prevention practice are prevention programs, practices or strategies in the substance abuse profession that are supported by research. For Evidence-Based Practices, Center for Substance Abuse Prevention (CSAP) Options of the Strength of Evidence upon which this program or strategy was selected provides the definitions of the options below: Option 1) this proposed program or strategy is recognized by a Federal registry of evidence-based prevention programs and environmental strategies as having a strong and consistent positive effect on an outcome that is relevant to the identified intermediate outcome. Federal registries include National Registry of Evidence-Based Programs and Practices (NREPP) with relevant element scores, Blueprints for Violence Prevention, Models of Exemplary, Effective and Promising Alcohol or Other Drug Abuse Prevention Programs on College Campuses. Option 2) this proposed program or strategy is reported in one or more peer-reviewed journals as having positive effect on an outcome that is relevant to the identified intermediate outcome. Provide a detailed description of the evidence of a positive effect on an outcome that is relevant to the identified intermediate outcome and how the relevance was determined, Option 3) this proposed program or strategy is supported by other sources of information, such as unpublished evaluation reports. When claiming this CSAP Option, include a) a description of the theory of change and a logic model, b) a discussion of how the content and structure of this proposed program or strategy is similar to programs or strategies that appear in Federal registries or in the peer-reviewed literature or how it is based on sound scientific principles of community prevention or public health, c) documentation of the program or strategy has being implemented in the past, including the number of times; if any, it was implemented, the fidelity with which it was implemented and the results of any outcome evaluations, d) and documentation of a review by and consent of a Panel of Informed Prevention Experts indicating that the implementation of this proposed program or strategy is appropriate for the community and likely to have a positive effect on the identified intermediate outcome and what evidence their decision was based upon. (14) "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 (15) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (16) "HIPAX is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C. 1320d, and 45 CFR Parts 160, 162, and 164). Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 2 of 39 °iouth Fllo rikl a Behar iwu iraall III Ic allr➢a Ncbvo rh,Iru% (17) "Individual(s) Served" (synonymous with Consumer or Client) is any person who is receiving services in any substance abuse or mental health program whose cost of care is paid, in part or in whole, by the Department or Local Match. (18) "KIT Solutions" is the entity that maintains the database called Performance Based Prevention System (PBPS) and the data system, or other system designated by the ME that substance abuse prevention network providers must utilize to upload prevention data required by this contract. (19) "Knight Information Software Database (KIS)" is the ME's online data system which network providers are required to use to collect and report data and performance outcomes on clients served whose services are paid for, in part or in whole, by the ME's Substance Abuse and Mental Health (SAMH)contract, Medicaid, or local match. The KIS, or other system designated by the ME, shall be utilized to upload client-related data as required by this contract. (20) "Local Match" are funds received from governing bodies of local government, including city commissions, county commissions, district school boards, special tax districts, private hospital funds, private gifts both individual and corporate, bequests and funds received from community drives or any other sources. See section 394.67(14), F.S. and 65E-14.005, F.A.C. (21) "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. (22) "Medicaid Eligibility"The consumer must be enrolled in Medicaid and have a Medicaid number. (a) If the consumer is enrolled in Medicaid and has a Medicaid number, then the following is billable to the ME: I. Services not covered by Medicaid (i.e. peer services, residential services); ii. Medicaid covered services for a consumer whose service limit(s)has (have) been exhausted and an appeal denial is on file. (b) If the consumer is enrolled in Medicaid and has a Medicaid number, then the following Medicaid eligible services are non-billable: I. Services are non-billable to the ME, if providers' staff are not properly credentialed staff as per the applicable Medicaid Handbook credentialing requirements for the identified service(s); ii. Services are non-billable to the ME, if the provider is not a Medicaid provider or approved Provider Service Network (i.e. Magellan, UMBH, etc.) for the consumer seeking the service(s). (23) "Mental Health Services" is defined pursuant to Chapter 394, F.S. (24) "Network Provider" is an entity that Contracts with the ME and receives funding to provide services to clients; in this contract the network provider is synonymous with provider or subcontractor. (25) "Outcome for Individual Service Recipient" is a measure of the quantified result, impact, or benefit of services on the individual service recipient. (26) "Outcome for Managing Entity Performance" is a standard to evaluate performance of the Managing Entity and any Network Service Provider relative to compliance with the contract and the performance and outcome measures therein. (27) "Payer class" Medicare, Medicare HMO, Medicaid, Medicaid HMO, private- pay health insurance, Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 3 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allr➢a Ncbvo rh,Iru% private-pay health maintenance organization, private preferred provider organization, the Department of Children and Family Services, other government programs, self-pay patients, charity care and any other payer class other than the Department. (28) Payer of last resort is a standard that is applied by the network provider to ensure that all options to collect payment for services rendered under this contract from "First party payer" (consumer), "Second Party Payer or Responsible Party", and/or "Third Party Payer", as defined in Rule 65E-14, F.A.C. are pursued prior to billing the ME. The ME is always the payer of last resort. (29) "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/. (30) "Performance Measures" are quantitative indicators, outcomes and outputs that are used by the Department to objectively measure performance and are used by the ME and network providers to improve services. (31) "Program Planning Tool (PPT)" is the data collection module contained in the PBPS 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. (32) "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.). (33) "Prime Contract" is the contract between the Department of Children and Families and the ME. (34) "Program Description" is the document the network provider prepares and submits to the ME for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E-14.021, 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. (35) "Projects for Assistance in Transition from Homelessness (PATH)" is a federal grant to support homeless individuals with mental illnesses, who may also have co-occurring substance abuse and mental health treatment needs. (36) "Protected Health Information" (PHI) relates to any information whether oral or recorded in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. (37) "Provider Network" (subcontractor or network provider) refers to the direct service agencies that are under contract with a ME 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. (38) "Quality Assurance" is a process that measures performance in achieving pre- determined standards, validates internal practice and uses sound principles of evaluation to ensure that data are collected accurately, analyzed appropriately, reported correctly and acted upon in a timely manner. The process may employ peer review, outcomes assessment, and utilization management techniques to assess quality of care. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 4 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allr➢a Ncbvo rh,Iru% (39) "Quality Improvement/Continuous Quality Improvement" is a management technique to assess and improve internal operations and network services. It focuses on organizational systems rather than individual performance and seeks to continuously improve quality. The process involves setting goals implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements. Quality improvement activities will assess compliance with contract requirements, state and Federal law and associated administrative rules, regulations, and operating procedures and validate quality improvement systems and findings. (40) "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. (41) "SAMH"stands for the Substance Abuse and Mental Health Programs within the Department. (42) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVE/VIS Program can and may provide assistance in verifying eligibility in cases where a client does not possess sufficient documentation. (43) "Service Units" means those units of measure specified in Rule 65E-14.021, F.A.C. and in the Substance Abuse Recovery Support Services, and Clinical Supervision for Evidence Based Practices exhibits. (44) "SOAR" stands for Supplemental Security Income/Social Security Disability Insurance (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. (45) "Stakeholder(s)" are individuals/groups with an interest in the provision of treatment services for substance abuse, mental health services, and/or co-occurring disorders in the circuits outlined in Section A.2.c.(2), of this Contract. This includes, but is not limited to, the key community constituents included in section 394.9082(6)(f)5., F.S. (46) "Statewide Inpatient Psychiatric Programs (SIPP)")" are residential inpatient facilities under contract with the Agency for Health Care Administration (AHCA) under the Medicaid Institutes for Mental Disease (IMD) 1915B waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. (47) "Substance abuse" is s a pattern of chronic or harmful use of alcohol, illicit or prescribed drugs that result in adverse physical, psychological, or social consequences. Substance abuse prevention and treatment services, pursuant to Chapter 397, F.S., which are provided using state or federal funding. (48) "Substance Abuse and Mental Health Information System (SAMHIS)" is the Department's online data system which network providers are required to use to collect and report data and performance outcomes on individuals 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 DCF PAM 155-2. (49) "System of Care" is defined pursuant to section 397.311, F.S., and interpreted to include the comprehensive array of Behavioral Health Services per section 394.9082(1)(e), F.S., that includes the following elements: (a) Prevention and early intervention; (b) Emergency care; (c) Acute care; Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 5 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% (d) Residential treatment; (e) Outpatient treatment; (f) Rehabilitation; (g) Supportive intervention; (h) Recovery support; and (i) Consumer support services. Services provided as the SOC must be assessable and responsive to the needs of individuals' substance, their families, and community Stakeholders. (50) "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. (51) "Temporary Assistance to Needy Families (TANF)" are cash assistance for families, including any family receiving cash assistance payments or TANF diversion services from any state program pursuant to the provisions of sections 414.045, and 414.0252(9), F.S. (52) "Unit Measurement" is used in billing the ME for services. The definition of each unit of measure can be found in Rule 65E-14.021, F.A.C. (53) "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. (54) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E-14.021, F.A.C. (55)Wait List" is a list maintained by the ME and each Network Service Provider that shows the number of persons waiting for access to the recommended level of care. 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 and/or children with behavioral health issues as authorized in section 394.9082, F.S., consistent with Chapters 394, 397, 916, section 985.03, F.S. (as applicable), State Behavioral Health Services Plan dated January 2011, or the latest version thereof, and in the Prime Contract (ME's contract with the Department), which is incorporated herein by reference The network provider shall work in partnership with the ME to better meet the needs of individuals with co-occurring substance abuse and mental health disorders, trauma informed care. The partnership process will be open, transparent, dynamic, fluid, and visible. The process shall also serve as an opportunity for collaboration to continuously improve the quality of services provided to the residents of Florida. During the course of the contract period, the ME will require that the network provider participate in the process of improving co-occurring disorder service capability system wide and trauma informed care services. The network provider shall work in collaboration and shall assist, upon request of the ME, in fulfilling its contractual obligations pursuant to the Prime Contract with the Department of Children and Families including but not limited to the following functions: (1) System of Care Development and Management; (2) Utilization Management; (3) Quality Improvement; (4) Data Collection,Reporting,and Analysis; (5) Financial Management; Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 6 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% (6) Disaster Planning and Responsiveness b.Authority Section 394.9082, F.S., and the Prime Contract provides the ME with the authority to contract for these services. C. Scope of Service The following scope of service applies to the contract period and any renewal or extension: (1) The network provider is responsible for the administration and provision of services to the target population(s)indicated in Exhibit A, Clients/Participants to be Served, and in accordance with the tasks outlined in this contract. Services shall also be delivered at the locations specified in, and in accordance with the Program Description, as required by Rule 65E-14.021, F.A.C.,which is herein incorporated by reference, and maintained in the ME's contract manager's file. (2) Services are to be delivered in the following county(ies): Miami-Dade County _X_Monroe County d. Major Program Goals (1) The primary goal of the SAMH Program is to promote the reduction of substance use, abuse, and dependence and improve the mental health and lives of the people of Florida by making substance abuse and mental health treatment and support services available through a comprehensive, integrated community-based System of Care and to engage and encourage persons with or at risk of substance abuse and/or mental illness to live, work, learn, and participate fully in their community. (2) It is the goal of the ME and network provider to improve accountability, ensure quality of care through best practice models and seek to ensure delivery of behavioral health services across the provider network and across systems resulting in systematic access to a full continuum of care for all children, adolescents and adults who enter the publicly-funded behavioral health services systems. (3) It is the goal to improve co-occurring capability, trauma informed care, 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 ME 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:Hkitservices2.kithost.net/. e. Minimum Programmatic Requirements The network provider shall maintain the following minimum programmatic requirements: (1) System of Care The consumer-centered and family-focused system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self-determination and choice; (c) Be ethically,socially, and culturally responsible;and (d) Be dedicated to excellence and quality results. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 7 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% There is a commitment to expand clinical treatment to include the behavioral health Transformation Initiative, evidence-based practices and recovery support services in accordance with priorities established by the ME and the Department for substance abuse, mental health treatment and/or co-occurring disorders, substance abuse prevention services, substance abuse and mental health treatment capacity,children and families,criminal and juvenile justice, HIV and hepatitis. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; (b) Comprehensive - incorporating a broad array of service and supports (e.g. physical, emotional,clinical,social,educational and spiritual); (C) Individualized-meeting the individual's exceptional needs and strengths; (d) Community-based- provided in the least restrictive, clinically appropriate setting; (e) Coordinated-both at the system and service delivery levels to ensure that multiple services are provided and change as seamlessly as possible when warranted; (f) Cultural and linguistic competence, and (g) Gender responsive. 3. Clients to be Served See Exhibit A,Clients/Partici pants to be Served B. Manner of Service Provision 1. Service Tasks The following tasks must be completed for each fiscal year covered in the contract period. a. Task List (1) Based on client needs, the network provider agrees to provide appropriate services from the list of approved programs/activities described in Exhibit G, State Funding by Program and Activity and the description of such services specified in the Program Description as required by Rule 65E-14.021, F.A.C. Any change in the array of services shall be justified in writing and submitted to the ME's contract manager for review and approval. (2) The network provider shall serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes/Outputs within the activities specified in Exhibit G, State Funding by Program and Activity. (3) The network provider shall ensure that EBPs are accessible to children and families who are involved in the Child Welfare System. (4) The network provider shall adhere to treatment group size limitations not to exceed fifteen (15)individuals per group for any clinical therapy service provided. In addition to other programmatic documentation requirements,service documentation to evidence group activities shall include the following: Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 8 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Networh,Iru% (a) Data Elements: I. Service Documentation-Group Sign in Sheet I. Recipient name and identification number; ii. Staff name and identification number iii. Service date; IV. Start time V. Duration; vi. Cost Center; vii. Brief description of type of group; viii. Program(AMH,ASA, CMH, CSA) II. Audit Documentation-Recipient Service or Non-Recipient Chart: I. Recipient name and identification number or if non-recipient, participant's name, address, and relation to recipient; ii. Staff name and identification number iii. Service date IV. 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 Paragraph 25., Information Security Obligations, of the Standard Contract. The network provider shall submit to the Managing Entities Contract manager, by 08/01/2013, verification that all network provider employees and subcontractors who have access to ME and Department information systems have completed the Security Agreement form as identified in Paragraph 25. Information Security Obligations, of the Standard Contract. (6) For licensable services, the network provider shall have and maintain correct and current Department of Children and Families and Agency for Health Care Administration (AHCA) licenses and only bill for services under those licenses. In the event any of the network provider's license(s) are suspended, revoked, expired or terminated, the ME shall suspend payment for services delivered by the network provider under such license(s) until said license(s)are reinstated. (7) By 08/01/2013, the network provider shall submit to the ME's contract manager grievance procedures, which include an appeal process with the ME, should the grievance not be resolved at the network provider level, which applicants for, and recipients of, services being provided under this contract, may use to present grievances to the network provider,or to the ME about contracted services. (8) The network provider shall use the approved assessment tool designated by the ME. Standardized tools and assessments approved by the ME must be used to determine placement and level of care. (9) If the network provider provides medication management services, the network provider shall ensure that clients discharged from state mental health treatment facilities will be maintained on the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676, F.S. Maintenance includes performing required lab tests, providing the medication,and providing appropriate physician oversight. (10)By 08/01/2013, the network provider shall submit to the ME's contract manager a disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard Contract. (11)Should the ME conduct a mock emergency drill, the network provider shall participate by activating their emergency/disaster plan and reporting on preparedness activities, response activities, and post-recovery activities. (12) By 08/01/2013, the network provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 9 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Networh,Iru% (13) Continuous Quality Improvement Programs I. The network provider must maintain a continuous quality improvement program to objectively and systematically monitor and evaluate the appropriateness and quality of care, to ensure that services are rendered consistent with prevailing professional standards, and to identify and resolve problems. Additionally, the program must support activities to ensure that fraud, waste and abuse do not occur. ii. The network provider shall develop a plan,with a copy made available upon request to the ME, which addresses the minimum guidelines for the network provider's continuous quality improvement program, including, but not limited to: (a) Individual care and services standards to include transfers and referrals, co- occurring supportive services, and trauma informed services. (b) Individual records maintenance and compliance. (C) Staff development standards. (d) Service-environment safety and infection control standards. (e) Peer review and utilization management review procedures. (f) Incident reporting policies and procedures that include verification of corrective action and a provision that specifies that a person who files an incident report, in good faith, may not be subjected to any civil action by virtue of that incident report. (g) Fraud, waste, abuse and other potential wrongdoing auditing, monitoring, and remediation procedures. (h) Evidence-based practices (EBPs)utilized by the agency and how these EBPs are monitored to ensure fidelity to the model. iii. The continuous quality improvement program is the responsibility of the director and is subject to review and approval by the governing board of the service network provider. iv. 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. V. The quality improvement program must also: (a) Composition of quality assurance review committees and subcommittees, purpose, scope, and objectives of the continuous quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings. (b) Provide a framework for evaluating outcomes, including: (i) Output measures, such as capacities, technologies, and infrastructure that make up the system of care. (ii) Process measures, such as administrative and clinical components of treatment. (iii) Outcome measures pertaining to the outcomes of services; (C) Provide for a system of analyzing those factors which have an effect on performance; (d) Provide for a system of reporting the results of continuous quality improvement reviews; and, (e) Incorporate best practice models for use in improving performance in those areas which are deficient. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 10 of 39 °iouth Fllo rikl a Behar iwu iraall III Ic allth Ncbvo rh,Iru% (f) For agencies utilizing seclusion and restraint procedures and as required by law (65E-5.180), establishment and utilization of a Seclusion 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) Nature of the de-escalation efforts and alternatives to seclusion and restraint are attempted. (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. (14) By 08/01/2013, the network provider shall submit to the ME's contract 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 served, which is herein incorporated by reference.The network provider shall submit: updates as amended of the Quality Assurance Plan within 30 days of adoption. (15) By 08/01/2013 the network provider shall establish a Quality Improvement Plan, which is herein incorporated by reference, which includes the quality improvement activities for fiscal year 2013-2014 to improve performance. The Quality Improvement Plan may be submitted with the Quality Assurance Plan as one document or separately, but must include, at minimum, the performance measures and activities listed below. The network provider shall submit quarterly reports on the implementation of the plan to the ME's contract manager. (16) Performance Measures for Continuous Quality Improvement Programs The network provider shall track by program, as applicable, the following performance measures and report it quarterly within the QI report and submit the report to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports: i. Mental Health Services (Admission type): Cost Centers 01-Assessment 19-Residential Level 2 03-Crisis Stabilization Unit 20-Residential Level 3 06 Day/Night 21 Residential Level 4 08- In Home/On-Site 34-FACT 09-In atient 35-Outpatient Group 12-Medical Services(psychiatric) 39-Short-term Residential Treatment 14-Out atient Individual 18-Residential Level 1 (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. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 11 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth NebVo rh,Iru% (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. ii. 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) 14-Out atient Individual 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. (17) Trauma Informed 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 a system of care that meets their needs. Network providers will be implementing the Trauma Informed Care initiative through the following: a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the TIC initiative. As part of the plan or component of the plan must include the following: (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. (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 the ME by December 30th 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: Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 12 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% 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) Evidence of the implementation of the Trauma Informed Care initiative throughout the agency, including progress on the implementation of the TIC Commitment Plan shall be documented in quarterly QI Report, and submitted the report to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (18) 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. (19) 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. (20) By 08/01/2013, the network provider shall submit to the ME's contract manager copies of its "no wrong door" policies and procedures as required by the CCISC 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. Such services include, but are not limited to, linkages with community programs such as housing, employment and parenting supports. The network provider is responsible for tracking and ensuring that the proper linkages are made and documented in accordance with the requirements in the Utilization Management Manual (UM). Network providers are required to submit all required Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 13 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allr➢a Ncbvo rh,Iru% documentation for the initiated referral. (21) Linkage and Referral Process: The network provider may only refer a consumer to a provider that offers the service for which the network provider created the referral. If the network provider is a receiving provider then the network provider must inform the referring provider that the consumer was admitted/not admitted within seven (7)calendar days, unless otherwise required by applicable state, federal rules and/or statues. If the network provider is the receiving provider, the network provider will have seventy-two (72) hours to respond to a new referral, unless otherwise required by applicable state,federal rules and/or statues. If the network provider is the receiving provider, and if upon assessing a referred consumer on in-take, determines that the consumer requires a service that is different from the service for which the consumer has been referred, the network provider will admit the consumer for the service that the consumer needs if the network provider offers the service and has availability to offer the service. In the event the network provider does not offer the service nor has availability to offer the service, the network provider will create a referral for the consumer to receive the service at a different provider. (22) The network provider shall perform the following tasks related to the co-occurring disorder service capability initiative: (a) Complete network provider co-occurring disorder service capability as directed by the ME using the COMPASS; (b) Following evaluation of each program using the COMPASS, evaluate clinicians' co-occurring disorder service capabilities as directed by the ME using the CODECAT. (c) Develop and submit to the ME a summary report June 30th of each year of the contract term that details: (i) The types of network provider involvement in state and local co-occurring planning processes; (ii) An overviewof the network provider's co-occurring disorder service capabilities with regard to service structure(assessment,stabilization,treatment,support,and other services); (iii) Networking capacities with local network providers in the community for persons with co- occurring disorders; (iv) Strategies and activities to develop or improve co-occurring disorder service capability; (v) Scope of services and programs to be included in the process; (vi) Any changes to the co-occurring disorder service structure including new programs, training, or changes in policy and procedures(copies of training guidelines or curricula and co- occurring policies should be included); (vii) The number of times the COMPASS was used and the composition of the focus group(s)for each use; (viii) The number of clinicians evaluated using the CODECAT;AND (ix) In addition, the summary report shall include an Action Plan that details the following: Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 14 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% a. Brief narrative detailing the findings from the COMPASS, the action steps developed, and progress made for each action step; b. Brief narrative detailing the findings from the CODECAT and action steps developed to enhance clinicians' co-occurring attitudes, knowledge, values and skills; and c. Overall progress toward co-occurring disorder service capability development in accordance with timeframes specified in the action plan. (x) Evidence of the implementation of co-occurring capabilities, including progress on the implementation of the co-occurring action plan shall be documented in the quarterly QI report, and submitted to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (23) The network provider shall ensure access to services that meet linguistic and cultural needs of recipients. (24) The network provider agrees to provide 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. (25) The network provider, in partnership with the ME, will implement a Cultural and Linguistic Competence Action Plan for developing strategies to increase cultural competence among board members, staff, and family members were appropriate. The network provider shall: (a) Implement standards and document specific strategies, tools and other resources focused on how to improve culturally and linguistically competent service delivery, coaching and training, and evaluation and assessment in a way that can enhance the system of care and achieve positive outcomes for consumers; (b) Collaborate with the ME to identify and utilize the network provider's data to (1) identify sub- populations (i.e., racial, ethnic, LGBTQI-2S, minority groups) vulnerable to disparities and (2) implement strategies to decrease the differences in access, service use, and outcomes among sub-populations. These strategies should include the use of the enhanced National Standards for Culturally and Linguistically Appropriate Services(CLAS)in Health and Health Care; (C) By 10/31/2013, the network provider shall submit the Cultural and Linguistic Competence Action Plan; (d) Implementation of the Cultural and Linguistic Competence will be documented in the quarterly QI Report, and submitted to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (26) The network provider shall assure the delivery of services based on Evidence-Based Practices/Promising Practices Guidelines in accordance with the approved Program Description. (27) Evidence-based practices (EBPs) utilized by the agency and how these EBPs are monitored to ensure fidelity to the model shall be documented in the quarterly QI plan and submitted to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (28) Financial Audit Reports (a) The network provider shall submit quarterly financial statements consisting of Balance Sheet and Statement of Activity (income statement) per the schedule and to the individual(s) identified in the Exhibit C, Required Reports. The network provider agrees to provide the ME with any requests for additional financial statements/documentation. (b) The network provider shall submit a copy of Form 941, Employer's Quarterly Federal Tax Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 15 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% Return, United States Department of the Treasury-Internal Revenue Service (IRS), as completed and submitted to the Internal Revenue Service. The network provider shall also submit copies of the bank statements for each months within the quarter for which the 941 form is prepared, demonstrating proof of payment to the IRS. These reports are due on the dates and to the individual(s)identified in the Exhibit C, Required Reports. (29) The network provider shall implement and maintain fiscal operational procedures. These shall contain but, not be limited to procedures relating to overpayments, charge-backs that directly apply to subcontractors and documentation of cost sharing (match) that comply with state and federal rules, regulations and/or ME policies and procedures. (30) The network provider shall also make available and communicate all plans, policies, procedures, and manuals to ME staff, Department staff, network provider staff, and to clients/stakeholders if applicable and appropriate. (31) 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 hllp://www.dcf.state.fl.us/news/humanresearcL22ILy.ahtml. 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. (32) The network provider shall participate in the State's Peer Review process, when implemented, to assess the quality, appropriateness,and efficacy of services provided to individuals pursuant to 45 CFR 96.136. (33) The network provider shall execute or maintain if executed 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 the due date(s) as specified in Exhibit C, Required Reports. The network provider shall submit copies of any amendment to the MOU, to the ME's contract manager, within thirty (30) days of execution. The MOU provides for integration of primary care services to the medically underserved. Federally Qualified Health Centers are required to submit policies and procedures that explain the access to primary care services to the medically underserved behavioral health client. (34) The network provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (35) The network provider shall ensure that individuals needing treatment services will receive services, depending on the severity of individual need, consistent with industry standards for distance and travel time, and as specified in the Utilization Management Manual (UM), herein incorporated by reference. Non-compliance with timely access to care for services terms will result in a corrective action and may result in a financial penalty as specified in Paragraph 36. of the Standard Contract. (36) The network provider will promote personal self-determination and choice by: I. 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 recipients, family members, and advocates in the design, development, and evaluation of services; iii. Giving consumers a choice of provider and services,whenever possible; iv. Assessing and improving consumer satisfaction. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 16 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% (37)The network provider shall take appropriate steps to obtain or maintain national accreditation during state fiscal year 2013-2014 in order to promote best practices and the highest quality of care. The network provider shall provide the ME with their full accreditation and licensing reports upon request. Providers whose contract or annual service reimbursement amount exceeds $35,000 but is less than $350,000 and serve more than three unrelated persons, must comply with the CARF Standards for Unaccredited Providers. (38) The network provider shall ensure provision of services to clients with special needs The network provider shall ensure the coordination of specialty services including employability skills training and linkage, victimization and trauma services, infant mental health services, the elderly, and services to families in recovery. The network provider shall also ensure the availability of appropriate services to consumers with special needs such as those who are blind, deaf or hard of hearing, developmentally disabled, physically handicap, criminally involved, or forensic clients. The ME reserves the right to modify this list as the needs of the consumers change. I. The network provider shall provide early diagnosis and treatment intervention to enhance recovery and prevent hospitalization. ii. The network provider agrees to comply with provisions of Exhibit L, Assisted Living Facilities with a Limited Mental Health License, if services to such residents are offered. iii. The network provider shall work with the ME, the state, and other stakeholders to reduce the admissions and the length of stay for dependent children and adults with mental illness in residential treatment services. (39) Develop and Disseminate Consumer Manual The network providers shall assist the ME in developing and maintaining a manual for service recipients which includes information about access procedures, recipient rights and responsibilities(including grievance and appeal procedures). This information will be available for use by the consumers within each subcontractor location. (40) Work and Social Opportunities The network provider will employ Peer Services Coordinators to develop work and social opportunities for clients and make recommendations to the ME and subcontractors for a consumer- driven system. (41) Assist Stakeholder Involvement in Planning, Evaluation,and Service Delivery (a) At the ME's request, the network provider will assist the ME in engaging local stakeholders, per section 394.9082 F.S., in its support activities for the Department's local plans. (b) The network provider shall work with the ME to provide performance, utilization, and other information for the Department's Substance Abuse and Mental Health Services Plan, and annual updates thereof, and to provide appropriate information for the Department's Long Range Program Plan and its Annual Business Plan. (42) Develop,Maintain and Improve Reporting The network provider shall submit reports included in Exhibit C, Required Reports. In all cases, the delivery of reports, ad hoc or scheduled, shall not be construed to mean acceptance of those reports. Acceptance, in writing, of required reports shall constitute a separate act and shall be approved by the ME's contract manager. The ME reserves the right to reject reports as incomplete, inadequate or unacceptable. (43) Client Satisfaction Survey Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 17 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allr➢a Ncbvo rh,Iru% The network provider shall conduct satisfaction surveys of individuals served pursuant to DCF PAM 155- 2. The network provider shall utilize a Department- approved satisfaction survey instrument. Failing to provide the required number of satisfaction surveys and/or utilizing a survey instrument other than that approved by the Department will result in a corrective action and an imposed financial penalty. (44) The network provider agrees to assist in the development and implementation of a Utilization Management Predictive Model data system and shall maintain the capacity to perform the following functions including, but not limited to: (a) ME-approved automated, standardized, and evidence-based screening and assessment instruments to improve proper evaluation and placement of individuals; (b) Automated referral and electronic consent for release of confidential information with the ME and other network providers, to the extent permitted by law; (C) Integrated processes for intake, admission, discharge and follow-up; (d) Encounter and progress notes to support all services provided under this contract and that automatically generate state and Medicaid billing and payment in the event Medicaid compensable services are provided to individuals eligible for Medicaid; (e) Utilization management, including but not limited to Wait Lists and capacity management; (f) Determination of financial and clinical eligibility of Individuals Served; (g) Processes to ensure the Department is the payer of last resort; (h) Electronic capability for billing, invoice payment and claims adjudication, and/or Medicaid billing and payment(HIPAA 837 and 835 Transactions); (i) Automated processes for state and federal data analysis and reporting; and (j) Full compliance with federal and state laws, rules and regulations pertaining to security and privacy of protected health information. (45) Client Trust Funds (CTF) (a) The network provider shall submit a letter to the contract manager certifying that they either are or are not the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits on behalf of a client within thirty (30) days of contract/amendment execution or by August 15t of each fiscal year. (b) If the network provider is the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits on behalf of the client, the network provider shall comply with the applicable federal laws including the establishment and management of individual client trust accounts(20 CFR 416 and 31 CFR 240). (C) Any network provider assuming responsibility for administration of the personal property and/or funds of clients shall follow the Department's Accounting Procedures Manual 7 APM, 6, Volume 7, incorporated herein by reference. Department or the ME personnel or their designees upon request may review all records relating to this section. Any shortages of client funds that are attributable to the network provider shall be repaid, plus applicable interest,within one (1)week of the determination. (d) All reports specified in the Department's Accounting Procedures Manual 7 APM, 6, Volume 7 shall be maintained onsite and available for review by Department or ME staff, and shall be submitted to the ME Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 18 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Networh,Iru% 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. b. Task Limits The network provider shall perform services in accordance with applicable, rules, statutes, licensing standards and policies and procedures. The network provider agrees to abide by the approved Program Description, and is not authorized by the ME to perform any tasks related to the project other than those described in the approved Program Description and in this contract, without the express written consent of the ME. The network provider shall ensure that services are performed in accordance with applicable rules, statutes, and licensing standards. 2. Staffing Requirements a.Staffing Levels (1) The network provider shall maintain staffing levels in compliance with applicable rules, statutes, licensing standards and policies and procedures. See Exhibit F, Minimum Service Requirements. (2) The network provider shall engage in recruitment efforts to maintain as much as possible staff with the ethnic and racial composition of the clients served. The ME, at its sole discretion may request documentation evidencing recruitment efforts. b. Professional Qualifications (1) The network provider shall comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications.See Exhibit F, Minimum Service Requirements. (2) The network provider shall provide employment screening for all mental health personnel and all chief executive officers, owners, directors, and chief financial officers of service network providers using the standards for Level II screening set forth in Chapter 435, and s. 408.809 F.S., except as otherwise specified in s. 394.4572(1)(b)-(c), F.S. For the purposes of this contract, "Mental health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct contact with individuals held for examination or admitted for mental health treatment. Additionally, the network provider shall provide employment screening for substance abuse personnel using the standards set forth in Chapter 397, F.S. This includes all owners, directors, and chief financial officers of service network providers and all service network provider personnel who have direct contact with children receiving services or with adults who are developmentally disabled receiving services. c. Staffing Changes The network provider shall notify the ME's contract manager, in writing within (10) calendar days of staffing changes regarding the positions of Chief Executive Officer, Chief Financial Officer, Medical Director, and Clinical Director, IT Director, Dispute Resolution Officer, Data Security Officer, Single Point of Contact in accordance with Section 504 of the Rehabilitation Act of 1973 as required by Paragraph 33. of the Standard Contract, or any individuals with similar functions. Additionally, the network provider will notify the ME's contract manager in writing, of changes in the Executive Director or any senior management position. d.Subcontractors (1) This contract allows the network provider to subcontract for the provision of all services, subject to the provisions of, but not limited to, Paragraph 12. of the Standard Contract. Written requests by the network provider to subcontract for the provision of services under this contract will be routed through the ME's contract manager for approval. The ME is not obligated nor will it pay for any services Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 19 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% delivered prior to its written approval of the act of subcontracting. The act of subcontracting 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 subcontract procurement, development, performance, and management that comply with state and federal rules, regulation, and/or ME policies and procedures, in addition to identifying the ME's pre-approval process for approving the network providers act of subcontracting. (3) The network provider shall maintain individual subcontractor files for each subcontractor and provide a copy of all subcontracts prior to the execution of those subcontracts and any amendments to the ME's contract manager. (4) The network provider shall not subcontract for substance abuse/mental health services with any person,entity,vendor, purchase orders or any like purchasing arrangements which: (a) is barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; (b) is under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services, or which adversely reflects their ability to properly handle public funds; (c) is currently involved, or has been involved within the last 5 years, with any litigation, regardless of whether as a plaintiff or defendant,which might pose a conflict of interest to the department, the state or its subdivisions,or a federal entity providing funds to the department; (d) had a contract terminated by the department or ME for failure to satisfactorily perform or for cause;or, (e)failed to implement a corrective action plan approved to the satisfaction of the ME, the department,and other governmental entities,after having received due notice. (5) All subcontract agreements shall adopt the applicable terms and conditions of the network provider's contract with the ME, which is incorporated herein by reference. Subcontract agreements shall include a detailed scope of work; clear and specific deliverables; and performance standards. The subcontractors will be required to follow the network provider's and the ME's Policies and Procedures, and Contract, which is incorporated herein by reference and may be found on the ME's website www.sfbhn.org. (6) Unless the Department agrees to an alternative payment method as authorized in section 394.9082, F.S., and prior to entering into any subcontract, or an amendment which modifies the previously negotiated unit cost rate or adds additional cost centers, the network provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14.021, F.A.C.. A cost analysis is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. Subcontractors will be required to comply with Rule 65E-14.021, F.A.C., 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. (7) The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title 45 of the Code of Federal Regulations, Part 96.135(a)(5)prohibit States from expending Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services funds "To provide financial assistance to any entity other than a public or non-profit private entity". Ordinarily, the term "financial assistance" is used to describe a grant relationship as distinguished from a procurement relationship, typically funded by contract. While the above-referenced statute and regulations preclude States from providing grants to for-profit entities, procurement contracts may be entered into with for-profit entities. This is the latest interpretation from the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (4/5/2009). [PHS Act, ss. 1931(a)(1)(E), and 1916 (a)(5), Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 20 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth NabVo rh,Iru% and 45 CFR, Part 96.135(a)(5)] Additional guidance for contracting SAPTBG funds can be obtained in the SAMH Funding Restrictions Guide at the following website: [°iflp:((acarww.dcf state tll doc (8) The network provider shall monitor the performance of all subcontractors, and perform follow up actions as necessary. The network provider shall notify the ME within forty-eight (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 of services will be as specified in the approved Program Description required by Rule 65E- 14.021(8)(d)1.d.(III), F.A.C. b. Service Times (1) A continuum of services shall be provided on the days and times as specified in the approved Program Description. (2) The network provider shall notify the ME's contract manager, in writing, at least ten (10) calendar days prior to any changes in days and times where services are being provided pursuant to Rule 65E-14.021(8)(d)5., F.A.C. c. Changes in Location The network provider shall notify the M E's contract manager, in writing, at least ten (10) calendar days prior to any changes in location where services are being provided pursuant to Rule 65E-14.021(8)(d)d(III), F.A.C. d. Equipment The network provider shall furnish all appropriate equipment necessary for the effective delivery of the services purchased. In the event that the network provider is allowed to purchase any non-expendable property with funds under this contract, the network provider will ensure compliance with the Tangible Property Requirements, Department operating Policies and Procedures as outlined in CFOP 40-5, CFOP 80-2, Rule 65E-14, F.A.C., which are incorporated herein by reference and may be obtained from the ME's contract manager. The provider shall submit an inventory report, as specified in the Network Provider Inventory List, incorporated herein by reference, and by the date(s) listed in Exhibit C, Required Reports. The Network Provider Inventory List form may be requested from ME Contract Manager upon request. 4. Deliverables a.Services The network provider shall deliver the services specified in and described in the Program Description submitted by the network provider and as set forth in Exhibit G, State Funding by Program and Activity. b. Records and Documentation The network provider shall protect confidential records from disclosure and protect client confidentiality in accordance with ss. 397.501(7), 394.455(3), 394.4615, and 414.295, F.S., and also the Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2, and any other applicable State, and Federal laws, rules, and regulations. c. Reports Where this contract requires the delivery of reports to the ME, mere receipt by the ME shall not be construed to Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 21 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports shall require a separate act in writing. The ME reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The ME, at its sole option, may allow additional time within which the network provider may remedy the objections noted by the ME or the ME may, after having given the network provider a reasonable opportunity to comply with the report requirements,declare this agreementto be in default. (1) The network provider shall submit to the M E financial and programmatic reports specified in Exhibit C, Required Reports,by the dates specified or as requested by ME staff. (2) 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. and submitted within the timeframes specified in Exhibit C, Required Reports. (3) The network provider shall submit treatment data, as set out in subsection 394.74(3) (e), F.S. and Rule 65E-14.022, F.A.C., and DCF PAM 155-2. (4) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAM 155-2, Appendix 2, the network provider is directed to utilize the following modifiers required for services funded by the following sources,where applicable: Panel Approved Code Short Description 10 27CHV-Children IV 11 27HIV-IV Drug Usage 12 27WOM-Services to Women 15 CFBAS-Community Forensic Beds 18 GX018-PATH (5) In addition to utilizing the modifiers to procedure codes for block grant funds identified in Section B. 4. (4) above, the network provider, upon request by the ME or the Department, shall submit information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and/or the Substance Abuse Prevention and Treatment Block Grant. (6) Data shall be submitted electronically to the ME by the 4ch of each month following the month of service into the Knight Information Software database (KIS), PBPS maintained by KIT Solutions or other data reporting system designated by the ME. Notwithstanding, if the network provider is funded to provide substance abuse prevention services, the network provider shall submit prevention services data to PBPS, or other data reporting system, electronically by the 4ch of each month following the month of service. The network provider shall also: (a) Ensure that the data submitted clearly documents all client admissions and discharges which occurred under this contract. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME, clearly documents all program participants, programs and strategies which occurred under this contract, if applicable; (b) Ensure that all data submitted to the KIS, or other data reporting system designated by the ME is consistent with the data maintained in the network provider's clients' files. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME, is consistent with the data maintained in the network provider files, if applicable; (C) Review the ME's File Upload History screen in SAMHIS to determine the number of records accepted, updated and rejected. Based on this review, 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,or other data reporting system designated by the ME; (d) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the network provider's total monthly submission per data set, which results in a rejection rate of 5%or higher of the number of monthly records submitted will require the network provider to submit a corrective action plan describing how and when the missing data will be submitted or how and Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 22 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth NebVo rh,Iru% when the rejected records will be corrected and resubmitted;and (e) In accordance with the provisions of section 402.73(1), F. S., and Rule 65-29.001, F.A.C., corrective action plans may be required for non-compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. Failure to implement corrective action plans to the satisfaction of the ME and after receiving due notice, shall be grounds for contract termination. (7) A facility designated as a public receiving or treatment facility under this contract shall report the following Payer Class data to the ME, unless such data are currently being submitted into KIS. Public receiving or treatment facilities that do not submit data into KIS, or other data reporting system designated by the ME, shall report these data annually as specified in Exhibit C, Required Reports, even if such data are currently being submitted to the Agency for Health Care Administration: (a) Number of licensed beds available by payer class; (b) Number of contract days by payer class; (C) Number of persons served (unduplicated)in program by payer class and diagnoses; (d) Number of utilized bed days by payer class; (e) Average length of stay by payer class;and (f) Total revenues by payer class. (8) The network provider shall obtain the format and directions for submitting Payer Class data from the ME. (9) The network provider shall submit Payer Class data to the ME no later than 90 days following the end of the ME'sfiscal year and by the date specified in Exhibit C, Required Reports. (10)The network provider must subtract all units which are billable to Medicaid, and all units for SAMH client services paid from other sources, including Social Security, Medicare payments, and funds eligible for local matching which include patient fees from first, second, and third-party payers, from each monthly request for payment. Should an overpayment be detected upon reconciliation of payments, the network provider shall immediately refund any overpayment to the ME. . 5. Performance Specifications a. Performance Measures (1) The network provider shall meet the performance standards and required outcomes as specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs. (2) The network provider agrees that the Knight Information Software (KIS) Data System, PBPS, and SAMHIS, or other data reporting system designated by the ME, will be the source for all data used to determine compliance with performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs or other data system as specified by the ME. Any conflicts will be clarified by the ME and the network provider shall adhere to the ME's resolution. The network provider shall submit all service related data for clients funded in whole or in part by SAMH funds, local match, or Medicaid. (3) 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 B. 1.a. (16), Performance Measures for Continuous Quality Improvement P rog ra ms. b. Performance Measurement Terms Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 23 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% DCF PAM 155-2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the ME to objectively measure a network provider's performance, and contains policies and procedures for submitting the required data. KIT Solutions maintains the procedures for submitting the required prevention data into PBPS. c. Performance Evaluation Methodology (1) The network provider shall collect information and submit performance data and individual client outcomes, to the ME data system in compliance with DCF PAM 155-2 requirements. The specific methodologies for each performance measure may be found at the following we http://dashboard.dcf.state.fl.us (2) The network provider is expected to have the capability to engage in organized performance improvement activities, and to be able to participate in partnership with the department and ME in performance improvement projects that are related to system wide transformation and improvement of services for individuals and families. (3) By execution of this contract the network provider hereby acknowledges and agrees that its performance under the contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the network provider fails to meet these standards, the ME, at its exclusive option, may allow a reasonable period, not to exceed six (6) months, for the network provider to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the ME within the prescribed time and if no extenuating circumstances can be documented by the network provider to the ME's satisfaction, the ME must terminate the contract. The ME has the sole authority to determine whether there are extenuating or mitigating circumstances. (4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs, in Section B. 1.a. (16), Performance Measures for Continuous Quality Improvement Programs. (5) Performance data information may be found on the department's web-based performance Dashboard at: http://dcfdashboard.dcf.state.fl.us/. Additional substance abuse prevention data information may be found on the Exhibit D Report which is transmitted to the ME Director of Prevention Services monthly. 6. Network Provider Responsibilities a. Network Provider Unique Activities (1) In the event of a dispute as to the ME's determination regarding client eligibility and/or placement into the appropriate level of care, the ME's dispute resolution process, incorporated herein by reference and available upon request from the ME's contract manager, shall be followed. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. (2) The network provider is responsible for the satisfactory performance of the tasks referenced in this contract. By executing this contract, the network provider recognizes its responsibility for the tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to be fully accountable for the performance thereof whether performed by the network provider or its subcontractors. (3) The network provider agrees that services other than those set out in this contract will be provided only upon receipt of a written authorization from the ME's contract manager or an authorized ME staff member. The department through the ME has final authority to make any and all determinations that affect the health safety and well-being of the residents of the State of Florida. (4) The network provider shall ensure that the invoices submitted to the ME reconcile with the amount of funding and services specified in this contract, as well as the network provider's agency audit report and client information system and reconciled with KIS, PBPS, or other data reporting system designated by the ME. (5) The network provider shall comply with all other applicable federal laws, state statutes and associated administrative rules as may be promulgated or amended. See Exhibit F, Minimum Service Requirements and Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 24 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Networh,Iru% ME policies and procedures. (6) Pursuant to s. 394.74(3)(e), F.S., the network provider shall maintain data on the performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, for the types of services provided under this contract. (7) A network provider that receives federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants agrees to comply with Subparts I and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x-21 et seq. (as approved September 22, 2000) and the Health and Human Services(HHS)Block Grant regulations(45 CFR Part 96). (8) A network provider that receives funding from the SAPTBG certifies compliance with all of the requirements of the Substance Abuse and Mental Health Services Administration (SAMHSA)Charitable Choice provisions and the implementing regulations of 42 CFR54a. (9) 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. (10) If required by 45 CFR Parts 160, 162, or 164; the following provisions shall apply[45 CFR 164.504(e)(2)(ii)]: (a) The network provider hereby agrees not to use or disclose protected health information (PHI)except as permitted or required by this contract, state 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 to all manual and electronic data. (C) The network provider agrees to report to the Department and the ME 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 ME that if any PHI received from the Department or the ME, or received by the network provider on the Department's or the ME'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 to the network provider with respect to such information. (e) The network provider agrees to make PHI available in accordance with 45 C.F.R. 164.524. (f) The network provider agrees to incorporate any amendments to PHI in accordance with 45 C.F.R. 164.526 into its operating procedures. (g) The network provider agrees to make available the information required to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528. (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 ME or created or received by the network provider on behalf of the Department or the ME 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 retention, it will return or destroy all PHI received from the Department or ME or received by the network provider on behalf of the department and the ME that the network provider still maintains regardless of form. If not feasible, the protections of this contract are hereby extended to that 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 contract. (11) The network provider shall provide performance information or reports other than those required by this agreement at the request of the ME, the Southern Region's SAMH Regional Director, or their designee. For requests that are complex and difficult to address, all parties will develop and implement a mutually viable work Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 25 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Networh,Iru% plan. (12) The network provider shall cooperate with the ME and the Department when investigations are conducted regarding a regulatory complaint of the network provider. (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 by client, and have the ability to provide an audit trail. The network provider's financial management and accounting system must have the capability to generate financial reports on individual service recipient utilization, cost, claims, billing, and collections for the ME. The network provider must maximize all potential sources of revenue to increase services, and institute efficiencies that will consolidate infrastructure and management functions in order to maximize funding. (14) 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 (10) days of receipt by network provider. The network provider shall implement a process for tracking all corrective action plans and submit a copy of the tracking log to the ME upon request. (15) The network provider shall maintain human resource policies and procedures that provide safeguards to ensure compliance with laws, rules and regulations. Integrate current and/or new state/federal requirements and policy initiatives into its operations upon provision by the Department and/or ME of the same. (16) The network provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (17) The network provider shall make available source documentation of units billed by network provider upon request from the ME staff. The network provider shall track all units billed to the ME by program and by Other Cost Accumulator(OCA). (18) 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. (19) The network provider shall maintain in one place for easy accessibility and review by ME and/or Department staff all policies, procedures, tools, and plans adopted by the network provider. The network provider's policies, procedures,and plans, must conform to state and federal laws,the Florida Administrative Code,state and federal regulations, state and federal rules, and minimally meet expectations/ requirements contained in applicable Department of Children and Families and ME operating procedures. (20) The network provider shall maintain a mechanism for monitoring, updating, and disseminating policies and procedures regarding compliance with current government laws, rules, practices, regulations, and the ME's policies and procedures. (21) The network provider agrees to allow the ME and the Department access to all records pertaining to service delivery, to include but not limited to, invoicing, fiscal management, data management, incident reporting, client records, and such documents determined to assure accountability of service provision and the expenditure of state and federal funds. (22) Records relating solely to actions taken in carrying out the requirements of this contract and records obtained by the ME and/or the Department to determine a network provider's compliance with this section are confidential and exempt from s. 119.07(1) and s. 24(a), Access to Public Records and Meetings, Article. I, Constitution of the State of Florida. Such records are not admissible in any civil or administrative action except in disciplinary proceedings by the Department of Health or the appropriate regulatory board, and are not part of the record of investigation and prosecution in disciplinary proceedings made available to the public by the Department of Health or the appropriate regulatory board. Meetings or portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011.F.S. b. Coordination with other Providers/Entities Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 26 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% (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. 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. (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 the ME (b) When indicated by the ME, 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. Priority for behavioral health services shall be given to families with children that have been determined to be "unsafe" by child protective investigators. Such priority is limited to individuals that are not Medicaid eligible, or require services that are not included as reimbursable by Medicaid, as defined in Exhibit A, Clients/Participants to be Served. (3) The failure of other providers or entities does not relieve the network provider of any accountability for tasks or services that the network provider is obligated to perform pursuant to this contract. c. Minimum Service Requirements See Exhibit F, Minimum Service Requirements. 7. Managing Entity Responsibilities a. Managing Entity Obligations (1) The ME shall only subcontract with entities that are fiscally sound, and that can adequately ensure the accountability of public funds. (2) The ME shall assess the network provider's financial stability, using a risk assessment approach; the risk assessment approach will examine the impact of programmatic requirements on the network provider's financial stability. Any issues identified as a result of the financial risk assessment shall be reported to the Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 27 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allr➢a NebVo rh,Iru% Department during the quarterly/monthly reconciliation and performance review identified in the Prime Contract. (3) The ME will provide administrative and programmatic oversight to ensure that network providers comply with all consumer-related services and other requirements of this contract. (4) The ME is solely responsible for the oversight of the network provider and enforcement of all terms and conditions of this contract. Any and all enquiries and/or issues arising under this contract are to be brought solely and directly to the ME for consideration and resolution between the network provider and the ME. In any event, the ME's decision on all issues is final and solely subject to the ME's appeal process and legal rights of the network provider. (5) The ME reserves the right terminate this contract in whole or in part, for non-performance as determined by the ME and to procure the services purchased through this contract to another entity and/or network provider. (6) The ME is responsible for the administration, management, and oversight, and through subcontracts, the provision of behavioral health services in Miami Dade and Monroe Counties and to include statewide beds as specified in the Prime Contract, and in this contract. (7) The ME shall monitor and take action when necessary so that services which meet the standards defined herein will be provided throughout the contract period. (8) The ME will ensure that the network provider utilizes the approved consumer assessment and placement tool designated by the ME. Standardized tools and assessments approved by the ME must be used to determine placement and level of care. (9) The ME shall implement the administrative cost reduction plan developed by the ME and approved by the Department, which is incorporated herein by reference. This plan is designed to achieve administrative and service provision cost savings and efficiencies through, but not limited to; the streamlining of the Subcontractor network; the reduction, elimination, and consolidation of duplicative Subcontractor and ME administrative structures; coordinated procurements with parallel state, local, and private entities; and other reductions to service delivery overhead costs. (10) The ME shall work with the Department to redirect administrative cost savings into improved access to quality care, promotion of service continuity, required implementation of EBPs, the expansion of the services array, and necessary infrastructure development. It acknowledges the benefits to be realized, include improved access to quality care, promotion of service continuity, implementation of EBPs, improved performance and outcomes, expansion of the service array, and necessary infrastructure development. b. Monitoring Requirements (1) The ME will monitor the network provider in accordance with this contract and the ME's Contract Accountability Policies and Procedures which can be obtained from the designated ME contract manager, and is incorporated herein by reference. The network provider shall comply with any coordination or documentation required by the ME's 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 conclusion of the monitoring. If the report indicates corrective action is necessary, the network provider shall have ten (10) calendar days from receipt of the monitoring report to respond in writing to the request. In the sole discretion of the ME, if there is a threat to health, life, safety or well-being of clients, the ME may require immediate corrective action or take such other action as the ME deems appropriate. Failure to implement corrective action plans to the satisfaction of the ME and after receiving due notice, shall be grounds for contract termination in whole or in part. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 28 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth NebVo rh,Iru% C. Training and Technical Assistance (1) The ME's contact manager, or designee, will provide training and technical assistance concerning the terms and conditions of this contract. (2) The ME will provide technical assistance and support to the network provider to ensure the continued integration of services and support for clients, to include but not limited to, quality improvement activities to implement evidenced-based practice treatment protocols, the application of process improvement methods to improve the coordination of access and services that are culturally and linguistically appropriate. (3) The ME will provide technical assistance and support to the network provider for the maintenance and reporting of data on the performance standards that are specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs. In addition, the ME may convene cross- organizational training and assistance to help non-accredited network providers become accredited. (4) The ME implements a training program for its staff and the network provider staff. The trainings assure that staff receives externally mandated and internal training. The ME may coordinate training or directly provide training to network provider staff. d. Review Compliance with Utilization Management Criteria (1) As part of the quality improvement program, the ME will provide or coordinate reviews of service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of clients is appropriate. The ME will take corrective action to resolve situations in which the subcontracted network provider is not following the guidelines or working to help the system meet its utilization goals. (2) Authorization of Services (a)The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Utilization Management Manual (UM) in order to ensure timely access to behavioral health services and eliminate the wait lists.The authorization processes includes: (i) Timeliness standards for authorization review must adhere to timelines standards referenced in the approved Utilization Management Manual for the services provided and departmental, statutory, and judicial regulations or requirements. (ii) Processes for making the criteria on which decisions are made available to practitioners, including any standardized tools and assessments for use in determining placement and/or level of care. (iii) Provisions for providing timely appeals, or second opinions, when a request for authorization for a particular service is denied. (An appeal differs from a grievance in that grievances are used when a recipient or member of the covered population believes that he or she has been treated improperly, whereas an appeal is a request to review a judgment.) The second opinion shall be obtained according to the timeliness standards for the service in question. (3) Upon request, the ME will assist with the development and implementation of client admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. (4) The ME will participate in the collaborative development and implementation of the working agreement with the Community Based Care and substance abuse and mental health network providers to ensure the integration of services and support within the community. The ME will support the development and implementation of the working agreement by providing an example of a policy working agreement, system of care information, data reporting requirements and technical assistance. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 29 of 39 °iouth Fllo riklaa Bchsn o rsall I1111c allth Ncbvo rh,lru% (5) The ME has the right to review the network provider's policies, procedures, and plans. Once reviewed by the ME, the policies and procedures may be amended provided that they conform to state and federal laws, the state Administrative Code, and federal regulations. Substantive amendments to submitted policies, procedures and plans shall be provided to the ME. (6) The ME may request supporting documentation and review source documentation of units billed to the ME. (7) Juvenile Incompetent to Proceed Program The ME will manage the Juvenile Incompetent of Proceed Program as per section 985.19, F.S. and as per the Department of Children and Families operating procedure. In addition, the ME 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. (8) Residential Level 1 Services The ME will insure that Residential Level 1 is available to children in the community. Management of this resource is a complex issue. The ME 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 ME will establish a system of intensive in-home services for the most severely disturbed children and families as an alternative to residential. e. Managing Entity Determinations The ME has exclusive authority to make the following determination(s) and to set the procedures that the network provider shall follow in obtaining the required determination(s): (1) Whether the network provider is meeting the terms and conditions of this contract, to include the Standard Contract, Attachment I, any documents incorporated into any attachment by reference, Program Description, and any documents incorporated by herein by reference. (2) The ME reserves the exclusive right to make certain determinations in these specifications. The absence of the ME setting forth a specific reservation of rights does not mean that all other areas of this contract are subject to mutual agreement. The ME reserves the right to make exclusively any and all determinations that it deems are necessary to protect the best interests of the State of Florida and the health, safety, and welfare of the clients who are served by the ME either directly or through any one of its contracted network providers. (3) In the event of any disputes regarding the eligibility of individuals served, the determination made by the ME is final and binding on all parties. C. Method of Payment Exhibit B, Method of Payment Exhibit E-1, Monthly Payment/Advance Request(Non-TANF Invoice)(Incorporated herein by reference and available at following website: htti?://www.sfbhn.org/R5`/`2OContracting`/`20Page.htm). Exhibit E-2, Monthly Payment/Advance Request (TANF Invoice) (Incorporated herein by reference and available at following website: htti?://www.sfbhn.org/R5`/`2OContracting`/`20Page.htm). Exhibit G, State Funding by Program and Activity Exhibit H, Funding Detail and Local Match D. Special Provisions 1. The network provider is expected to reduce its administration cost to 10.28% or less for Fiscal Year 2013-2014 for SAMH services purchased under this contract. The cost savings shall be reallocated to support the increase of direct services, improved access to quality care, promotion of service continuity, and the implementation and/or expansion in the use of evidence-based practices. The network provider's Projected Cost Center Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 30 of 39 °iouth Fllo rikl a Behar iwu iraall III Ic allr➢a NebVo rh,Iru% 2. Utilization Management Program: The network provider shall assist the ME in the reporting and managing of the Substance Abuse and Mental Health Waiting List for all levels of care (a) The Network Provider agrees to adhere to the utilization management protocols pursuant to the South Florida Behavioral Health Network Utilization Management Manual, herein incorporated by reference and available upon request from the Contract Manager. (b) The network provider will have a data system in place that adequately supports the collection, tracking, and analysis of data necessary to perform utilization management activities, reviews of clinical/administrative performance related to levels of care, clinical outcomes, and adherence to clinical/administrative standards. (C) The goals of utilization management include elimination/management of wait lists, the maximum utilization of treatment resources, and the delivery of clinically appropriate services in the least restrictive setting and most cost effective manner. Utilization management systems include preauthorization for some services as well as retrospective reviews and focused reviews of individuals receiving services and subcontractors whose utilization of services is outside of expected parameters. Utilization management includes methods used to manage the system of care to ensure access to the appropriate level of care, at the right frequency and for the appropriate duration. It also includes financial screening to ensure maximization of fiscal resources including other third party payors such as, but not limited to KidCare, Medicaid, Medicare, and other HMOs. These methods may include programs of intervention and/or diversion. Utilization management includes not only managerial and supervisory strategies, methods and tools to ensure timely access to care, but also includes processes to promote continuous improvement to manage resources. The ME is enhancing its automated utilization management system to include additional treatment services authorization. (d) The network provider will comply with the utilization management protocols pursuant to the South Florida Behavioral Health Network Utilization Management Manual. The network provider will offer clients a multi-level continuum of care services for treatment of behavioral health services. Each level of care as identified below have durations or length of stay as specified in the Utilization Management Manual: (e) The network provider shall obtain written authorization from the ME prior to providing the services as specified in the Utilization Management Manual. A written authorization will also be required, prior to the expiration of the initial length of stay, in order to extend services. The request for an extension must be justified in accordance with the ME approved consumer assessment and placement tool and in accordance with the Utilization Management Manual. (f) When a client has been provided residential services as a non-ME funded client (e.g. paid by insurance), that stay is subtracted from the prescribed length of stay should the client become eligible to receive network provider-funded services. (g) The network provider agrees to: (i) Utilize a transmittal system, which may be a computerized management information system, for submitting/receiving and recording information and documentation required as part of the Utilization Management Program. (ii) Request and receive an authorization number from the ME for all clients requiring admission into a substance abuse and/or mental health service as specified in the Utilization Management Manual prior to the client being admitted to the program for treatment. (iii) Complete all required assessment components outlined in the Utilization Management Manual for all consumers requiring substance abuse and/or mental health treatment services. The information will be submitted to the ME prior to the authorization request. (iv) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies and procedures outlined in the Utilization Management Manual. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 31 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% 3. Waiting List and Interim Services (a) In the event that waiting lists develop, the network provider will collaborate with the ME to implement procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services through utilization management strategies. The authorization of services is specified in Section B. 7., Managing Entity Responsibilities. (b) For children and parents who are not Medicaid eligible or who need services that are not covered by Medicaid, and who are in or placed from households that the Department's Child Protective Investigators determined were "unsafe" without additional services, will have priority for substance abuse and mental health services provided by the network provider. Per section 394.674(a)(2), F.S., eligibility for adult mental health services for the parents is based upon the emotional crisis experienced from the potential removal of children. Substance abuse eligibility is based on parents who put children at risk due to a substance abuse disorder, pursuant to section 394.674(c)3, F.S. These individuals may not be placed on a wait list without receiving interim services for longer than seven (7)calendar days. 4. Pre-Authorization Utilization Management Roster for Services Specified in the Utilization Management Manual The network provider shall submit a request for reimbursement on the approved ME invoices found on Exhibit E-1 and/or Exhibit E-2 of this contract, incorporated herein by reference and available at following website: http://www.sfbhn.ora/R5%20Contracting%20Paae.htm, as applicable. A listing of all prior- authorized clients served including, 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 K, SAMH Pre- Authorization Utilization Management Roster of this contract and attached to the approved ME's invoice, Exhibit E-1 or Exhibit E-2 as a prerequisite for payment. The network provider shall maintain back-up documentation for step-down services for a period of seven (7)years from the expiration date of the contract per Paragraph 7. of the Standard Contract. 5. Incident Reports (a) The network provider shall submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215-6,within 24 hours of receiving notification of a reportable incident. In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee-related incidents of criminal activity, the network provider must notify the ME Risk and Compliance Coordinator as soon as possible, but not to exceed 24 hours. Certain incidents may warrant additional follow-up by the ME. Follow-up may include on-site investigations or requests for additional information or documentation. When additional information or documentation is requested, the network provider will submit the information requested by the ME within 24 hours unless 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 to the Office of the Inspector General and those not reportable in IRAS, with the following information: Consumer's initials, incident report tracking number from IRAS (if applicable), incident report category, date and time of incident, and follow-up action taken. (b) All network providers (inpatient and outpatient)will report seclusion and restraint events in SAMHIS and in accordance with Rule 65E-5.180(7)(g), F.A.C. 6. Mandatory Reporting Requirements (a) The network provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the network provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 32 of 39 °iouth Fllo riklaa @tc h ar iwu iraall III Ic allth Networh,Iru% (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client shall be immediately reported to the contract manager; and (2) Other reportable incidents shall be reported to the ME and Department's Office of Inspector General by completing a Notification/Investigation Request (form CIF 1934)and emailing the request to the Office of Inspector General at ig_complaints@dcf.state.fl.us. The network provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399-0700; or via fax at(850)488-1428. (b) A reportable incident is defined in Children and Families Operating Procedures CFOP 180-4 (CFOP 180-4) Mandatory Reporting Requirements to The Office of The Inspector General, which can be obtained from the contract manager. 7. Contracted Mental Health network providers shall participate in the Department's aftercare referral process for formerly incarcerated individuals with severe and persistent mental illness or serious mental illness who are released to the community or who are determined to be in need of long-term hospitalization is required. Participation shall be as specified in Children and Families Operating Procedure 155-47 (CFOP 155-47), Processing Referrals from the Department Of Corrections which can be obtained at: http://www.dcf.state.fl.us/admin/publications/policies.shtml, and is incorporated herein by reference. 8. Crisis Stabilization Unit Monthly Census The network provider contracted to provide Crisis Stabilization services shall submit a monthly Crisis Stabilization Unit Census report by the date and to the individual(s) identified in Exhibit C, Required Reports. The network provider must utilize the approved ME CSU Monthly Census report format, which is available upon request from the Contract Manager. 9. The network provider shall comply with the provisions of Exhibit I, Family Intervention Services (FIS) and Adult Intervention Services (AIS) Provider Protocols and Exhibit J, Family/Adult Intervention Specialist (FIS/AIS) Treatment Summary Report. 10. Involuntary Outpatient Placements If referred, the Network Provider agrees to provide services to persons who have been court ordered into involuntary outpatient placement in accordance with section 394.4655, F.S. 11. Children's Mental Health Services, including services for Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families, if services to such consumers are offered. (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 2014-2016, or the latest revision thereof, which is incorporated herein by reference, and available at the following website: http://www.dcf.state.fl.us/proa[gp] /i/ mh/publications/2014- 2016%20SAMH%20Services%20PIan.pdf. 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. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 33 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% (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 (i i) 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 traumatic stress, Dyadic Therapy for infants and toddlers, and the Wraparound Approach. (v) Individualized, child focused, and family directed. (vi) Inclusive of early intervention with the child and family. (vii)Coordinated across agencies and time lines (f) The network provider shall 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: (i) Dyadic Therapy for children under 5, (ii) Behavior Analysis services for children with behavior problems, (iii) Life skills and Wellness Recovery Action Plan services to children transitioning to the adult system. 12. Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants, if applicable. (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 be found at: http://www.dcf.state.fl.us/programs/samh/contractingMore.shtmi and which are incorporated herein by reference. (b) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAM 155-2, Appendix 2, the network provider is directed to utilize the following modifiers required for Block Grant funds,where applicable: Panel Approved Code Short Description 10 27CHV-Children IV 11 27HIV-IV Drug Usage 12 27WOM-Services to Women (C) The network provider agrees to comply with applicable data submission requirements outlined Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 34 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% in Exhibit C, Required Reports. This exhibit lists required annual reports for SAPTBG set- 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 Exhibit G, State Funding by Program and Activity. (f) The network provider is required to participate in the peer-based fidelity assessment process to assess the quality, appropriateness, and efficacy of treatment services provided to individuals under this contract pursuant to 45 CFR 96.136. 13. The network provider agrees to maximize the use of state residents, state products, and other Florida- based businesses in fulfilling their contractual duties under this contract. 14. Option for Increased Services The network provider acknowledges and agrees that the contract may be amended to include additional, negotiated, services as deemed necessary by the ME. Additional services can only be increased if the network provider demonstrates competence in the provision of contractual services and meets whatever criteria are established by the ME from time to time. The ME in its sole discretion shall determine at what time and to which network provider and what amounts are to be given to network providers for additional services. 15. Sliding Fee Scale The ME requires the network provider to comply with the provisions of Rule 65E-14.018, F.A.C. A copy of the network provider's sliding fee scale that reflects the uniform schedule of discounts referenced in Rule 65E-14.018(4), F.A.C. shall be furnished to the ME within thirty (30)days of contract execution. 16. Transportation Disadvantaged The network provider agrees to comply with the provisions of chapter 427, F.S., Part I, Transportation Services, and Chapter 41-2, F.A.C., Commission for the Transportation Disadvantaged, if public funds provided under this contract will be used to transport clients. The network provider agrees to comply with the provisions of Children and Families Operating Procedures 40-50 (CFOP 40-5) Acquisition of Vehicles For Transporting Disadvantaged Clients if public funds provided under this contract will be used to purchase vehicles which will be used to transport consumers. 17. Medicaid Enrollment (a) Those network providers with SAMH contracts that meet Medicaid provider criteria and with funding in excess of$500,000 annually shall enroll as a Medicaid provider. This process shall be initiated within ninety (90)days of contract execution. A waiver of the ninety (90) day requirement may be granted, in writing, by the Department's Director of Substance Abuse and Mental Health Program Office, through the ME. (b) All network providers whose contracts are $500,000 or more annually, and enrolled as a 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 (CBMAC)program. The CBMAC program allows participating network providers to claim reimbursement for administrative activities performed while providing eligible Federal Medicaid Title XIX services. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 35 of 39 °iouth Fllo riklaa @tc h ar iwu iraall III Ic allth Ncbvo rh,Iru% (C) Participation in the CBMAC program by Substance Abuse and Mental Health providers who are enrolled as Medicaid providers with contract amounts less than $500,000 annually, and who have the technological capability to participate electronically is optional. 18. National Provider Identifier(NPI) (a) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. (b) An application for an NPI may be submitted online at https://nppes.cros.hhs.gov/NPPES/StaticForward.do?forward=static.npistart. (C) Additional information can be obtained from one of the following websites: (1) The Florida Medicaid HIPAA located at: http://www.fdhc.state.fl.us/hipaa/index.shtmi (2) The National Plan and Provider Enumeration System (NPPES) located at: https://nppes.cros.hhs.gov/NPPES/Welcome.do (3) The CMS NPI located at: http://www.cros.hhs.gov/NationalProvldentStand/ 19. Ethical Conduct The network provider understands that performance under this contract involves the expenditure of public funds from both the state and federal governments, and that the acceptance of such funds obligates the network provider to perform its services in accordance with the very highest standards of ethical conduct. No employee, director, officer, agent of the network provider shall engage in any business, financial or legal relationships that undermine the public trust, whether the conduct is unethical, or lends itself to the appearance of ethical impropriety. Network providers' directors, officers or employees shall not participate in any matter that would inure to their special gain, and shall recuse themselves accordingly. Public funds may not be used for purposes of lobbying, or for political contributions, or for any expense related to such activities, pursuant to Paragraph 20. of the Standard Contract of this contract. The network provider understands that the ME contracts with the department, and as a subcontractor, recognizes that the department is a public agency which is mandated to conduct business in the sunshine, pursuant to section 286.011, F.S., and chapter 119, Florida Law, and that all issues relating to the business of the department, the ME and the network provider are public record and subject to full disclosure. The network provider understands that attempting to exercise undue influence on the ME, the department and its employees to allow deviation or variance from the terms of this contract other than a negotiated, publicly disclosed amendment, is prohibited by the State of Florida, pursuant to section 286.011, F.S. The network provider's conduct is subject to all state and federal laws governing the conduct of entities engaged in the business of providing services to government. 20. Information Technology Resources If applicable, the network providers must receive written approval from the ME prior to purchasing any Information Technology Resource (ITR)with contract funds. The Contract Manager is responsible for serving as the liaison between the network provider and the ME during the completion of the process as instructed by the Contract Manager. The network provider will not be reimbursed for any ITR purchases made prior to obtaining the ME's written approval. 21. Programmatic,Fiscal&Contractual Contract File References All of the documentation submitted by the network provider which may include, but not be limited to the network provider's original proposal, Program Description, Projected Cost Center Operating and Capital Budget, Agency Capacity Report and Personnel Detail Record, are herein incorporated by reference for programmatic, contractual and fiscal assurances of service provision These referenced contractual documents will be part of the contract manager's file. Documents incorporated by reference in this contract are available in the ME contract manager's file. Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 36 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% 22. Employee Loans Funds provided by the ME to the network provider under this contract shall not be used by the network provider to make loans to their employees, officers, directors and/or subcontractors. Violation of this provision shall be considered a breach of contract and the termination of this contract shall be in accordance with the Paragraph 40. of the Standard Contract. A loan is defined as any advancement of money for which the repayment period extends beyond the next scheduled pay period. 23. Travel The network provider's internal procedures will assure that: travel voucher Form DFS-AA-15, State of Florida Voucher for Reimbursement of Traveling Expenses, incorporated herein by reference, be utilized completed and maintained on file by the network provider. Original receipts for expenses incurred during officially authorized travel, items such as car rental and air transportation, parking and lodging, tolls and fares, must be maintained on file by the Network provider. Section 287.058 (1) (b) F.S., requires that bills for any travel expense shall be maintained in accordance with Section 112.061, F.S. governing payments for traveling expenses. CFOP 40-1 (Official Travel of State Employees and Non-Employees) provides further explanation, clarification, and instruction regarding the reimbursement of traveling expenses necessarily incurred during the performance of business. The network provider must retain on file documentation of all travel expenses to include the following data elements: name of the traveler, dates of travel, travel destination, purpose of travel, hours of departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of payee and payee's supervisor. 24. Property and Title to Vehicles a. Property (1) Nonexpendable property is defined as tangible personal property of a non-consumable nature that has an acquisition value or cost of $1,000 or more per unit and an expected useful life of at least one year, and hardback covered bound books that are not circulated to students or the general public, the value or cost of which is $250 or more. Hardback books with a value or cost of$100 or more should be classified as nonexpendable property only if they are circulated to students or to the general public. All computers, including all desktop and laptop computers, regardless of the acquisition cost or value are classified as nonexpendable property. Motor vehicles include any automobile, truck, airplane, boat or other mobile equipment used for transporting persons or cargo. (2)When state property will be assigned to a provider for use in performance of a contract, the title for that property or vehicle shall be immediately transferred to the provider where it shall remain until this contract is terminated or until other disposition instructions are furnished by the ME's contract manager. When property is transferred to the provider, the department shall pay for the title transfer. The provider's responsibility starts when the fully accounted for property or vehicle is assigned to and accepted by the provider. Business arrangements made between the provider and its subcontractors shall not permit the transfer of title of state property to subcontractors. While such business arrangements may provide for subcontractor participation in the use and maintenance of the property under their control, the ME shall hold the provider solely responsible for the use and condition of said property. Provider inventories shall be conducted in accordance with CFOP 80-2. (3) If any property is purchased by the provider with funds provided by this contract, the provider shall inventory all nonexpendable property including all computers. A copy of which shall be submitted to the along with the expenditure report for the period in which it was purchased. At least annually, the provider shall submit a complete inventory of all such property to the ME whether new purchases have been made or not. (4) The Network Provider Inventory List, incorporated herein by reference, and available from the designated ME Contract Manager upon request, shall include, at a minimum, the identification number; year and/or model, a description of the property, its use and condition, current location, the name of the property custodian, class code (use state standard codes for capital assets), if a group, record the number and Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 37 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Ncbvo rh,Iru% description of the components making up the group, name, make, or manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number; acquisition date, original acquisition cost, funding source, information needed to calculate the federal and/or state share of its cost. (5) The ME's contract manager must provide disposition instructions to the provider prior to the end of the contract period. The provider cannot dispose of any property that reverts to the ME or department without the contract manager's approval. The provider shall furnish a Closeout Inventory Form no later than 30 days before the completion or termination of this contract. The Closeout Inventory Form shall include all nonexpendable property including all computers purchased by the provider. The Closeout Inventory Form shall contain, at a minimum,the same information required by the annual inventory. (6)The provider hereby agrees that all inventories required by this contract shall be current and accurate and reflect the date of the inventory. If the original acquisition cost of a property item is not available at the time of inventory,an estimated value shall be agreed upon by both the provider and the ME and shall be used in place of the original acquisition cost. (7) Title (ownership) to and possession of all property purchased by the provider pursuant to this contract shall be vested in the ME upon completion or termination of this contract. During the term of this contract, the provider is responsible for insuring all property purchased by or transferred to the provider is in good working order. The provider hereby agrees to pay the cost of transferring title to and possession of any property for which ownership is evidenced by a certificate of title. The provider shall be responsible for repaying to the ME the replacement cost of any property inventoried and not transferred to the ME upon completion or termination of this contract. When property transfers from the provider to the ME, the provider shall be responsible for paying for the title transfer. (8) If the provider replaces or disposes of property purchased by the provider pursuant to this contract, the provider is required to provide accurate and complete information pertaining to replacement or disposition of the property as required on the provider's annual inventory. (9)The provider hereby agrees to indemnify the ME and the department against any claim or loss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. (10)A formal contract amendment is required prior to the purchase of any property item not specifically listed in the approved contract budget. b.Title to Vehicles (1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract shall be vested in the ME upon completion or termination of the contract. The provider will retain custody and control during the contract period, including extensions and renewals. (2) During the term of this contract, title to vehicles furnished by the state or acquired at the direction of the state (using state or federal funds)shall not be vested in the provider. Subcontractors shall not be assigned or transferred title to these vehicles. The provider hereby agrees to indemnify the ME or the department against any claim or loss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. 25. Business Associate Agreement The network provider shall adhere to the terms and conditions of the Business Associate Agreement, incorporated herein by reference. E. List of Exhibits The network provider agrees to comply with the exhibits listed below. The following exhibits, or the latest revisions thereof,are incorporated in and made a part of the contract. 1. Exhibit A, Clients/Participants to be Served 2. Exhibit B, Method of Payment Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 38 of 39 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,tram% 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E, Monthly Payment/Advance Request (Non-TANF and TANF Invoices) 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 I, Family Intervention Services (FIS)and Adult Intervention Services (AIS) Provider Protocols 10. Exhibit J, Family/Adult Intervention Specialist (FIS/AIS)Treatment Summary Report 11. Exhibit K, SAMH Pre-Authorization Utilization Management Roster 12. Exhibit L, Assisted Living Facilities with Limited Mental Health License 13. Exhibit M, Clinical Supervision for Evidence-Based Practices 14. Exhibit N, Special Provisions for the Indigent Drug Program 15. Exhibit O, Incidental Fund Invoice and Expenditure Log for Adult Mental Health Services 16. Exhibit Q, Missing Children 17. Exhibit R, Our Kids Miami-Dade/Monroe Child Welfare Quarterly Clinical Report 18. Exhibit V, Special Provisions for the Forensic Services Program 19. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH)Services 20. Exhibit AA, Substance Abuse Family Intervention Specialist Services 21. Exhibit AC, Special Provisions for Substance Abuse Prevention Services Guidance/Care Center, Inc. Attachment I HCO2(a) Contract No. ME225-4-27 Page 39 of 39 °iouth Fllo riklaa Behar iwuiraall III Ic allth Networh,Iru% Exhibit A Clients/Participants to be Served A. General Description The network provider shall furnish services funded by this contract to the target population(s) checked below: Non-Prevention Prevention ® Adult Mental Health-Severe&Persistent Mental Illness ❑ Adult Substance Abuse ® Adult Mental Health-Serious&Acute Episodes of Mental ® Children's Substance Abuse Illness ® Adult Mental Health-Mental Health Problems ❑ Substance Abuse Community Coalition ® Adult Mental Health-Forensic Involvement ® Children's Mental Health-Serious Emotional Disturbances ® Children's Mental Health-Emotional Disturbances ❑ Children's Mental Health-At Risk of Emotional Disturbances ® Adult Substance Abuse ® Children's Substance Abuse B. Client/Participant Eligibility (1)The network provider agrees that all persons meeting the target population descriptions in the table above are eligible for services based on the availability of resources. A detailed description of each target population is contained in s. 394.674, Florida Statutes and as described in the Department of Children and Families Pamphlet 155-2 (PAM 155-2), based on the availability of resources. Pamphlet 155-2 is available on the Department's website (www.dcf.state.fl.us/programs/samh/pubs_reports.shtml) and is incorporated herein by reference. (2) This contract precludes the Network Provider from billing the ME for services provided to Medicaid eligible individuals, which are reimbursable by Medicaid. (3) Priority for Behavioral Health Services shall be given to families with children that have been determined to be "unsafe" by child protective investigators. Such priority is limited to individuals that are not Medicaid eligible, or require services that are not included as reimbursable by Medicaid. Eligibility for services is found, pursuant to: (a) section 394.674(a)(2), F.S., for adult mental health services for the parents, based upon the emotional crisis experienced from the potential removal of children. (b) section 394.674(c)3., F.S. Substance abuse eligibility is based on parents who put children at risk due to a substance abuse disorder. (4) Mental health crisis intervention and crisis stabilization facility services, and substance abuse detoxification and addiction receiving facility services, shall be provided to all persons meeting the criteria for admission, subject to the availability of beds and/or funds. C. Client/Participant Determination (1) Determination of client eligibility is the responsibility of the network provider. The network provider shall adhere to the eligibility requirements as specified in Exhibit F, Minimum Services Requirements. The ME reserves the right to review the network Guidance/Care Center, Inc. Exhibit A Contract No. ME225-4-27 Page 1 of 2 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% provider's determination of client eligibility and override the determination of the network provider. When this occurs the network provider will immediately provide services to the consumer until such time the consumer completes his/her treatment, voluntarily leaves the program, or the ME's decision is overturned as a result of the dispute resolution. (2) In the event of a dispute as to the ME's determination regarding eligibility, dispute resolution, as described in Paragraph 42. of the Standard Contract, shall be entered into. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. The determination made by the ME is final and binding on all parties. (3) The ME may delegate the Individuals Served eligibility determinations to the Network Provider, subject to the determination of the Department. (4) Participant eligibility (Direct Prevention) and target population eligibility (Community Prevention) shall also be based upon the community action plan or on the relevant epidemiology data. D. Contract Limits (1)The network provider is not authorized to bill the ME for more units than are specified in Exhibit G, State Funding by Program and Activity, or for more units than can be purchased with the amount of funds specified in Exhibit G, State Funding by Program and Activity, subject to the availability of funds. An exception is granted at the end of the contract term, when the ME at it sole discretion may pay, subject to the availability of funds, the network provider for"Uncompensated Units Reimbursement Funds", in whole or in part, or not at all, for Exemplary Performance by the network provider. Exemplary Performance will be determined by the network provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. (2)The network provider agrees that funds provided in this contract will not be used to serve persons outside the target population(s) specified in the paragraph above. NOTE: Prevention funds allocated to underage drinking programs and activities targeting eighteen (18) to twenty (20) year old individuals may be taken from Adult Substance Abuse Prevention funds. (3)The provision of services required under this contract are limited to eligible residents, children, and adults receiving authorized services within the counties outlined in Attachment I, Section A. 2. c. (2)and limited by the availability of funds. (4)The network provider may not authorize or incur indebtedness on behalf of the ME or the Department. Guidance/Care Center, Inc. Exhibit A Contract No. ME225-4-27 Page 2 of 2 °iouthFllvuu°idaaBehaNIoraall III Icallth Networh,faam% Exhibit B Method of Payment 1. Payment Clauses a. This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, State Funding by Program and Activity. The ME shall pay the network provider for the delivery of service units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed $4,706,252.00, subject to the availability of funds and satisfactory performance of all terms by the network provider. Of the total Contract amount, the ME will be required to pay$3,921,877.00, subject to the delivery and billing for services. The remaining amount of $784,375.00, represents "Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the network provider, in whole or in part, or not at all, for Exemplary Performance by the network provider. Exemplary Performance will be determined by the network provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. b. The network provider is granted the flexibility to shift funds between and among cost centers within a program and activity up to thirty percent (30%) or twenty-five thousand dollars ($25,000.00), whichever is greater, without the need for a contract amendment. Any shift of funds in excess of the aforementioned amount will need a formal contract amendment. c. Aftercare, Intervention, Outpatient, and Recovery Support Services (Substance Abuse) are eligible for special group rates. Group services shall be billed on the basis of a contact hour, at 25% of the contract's established rate for the individual services for the same cost center. Excluding Outpatient, total hourly reimbursement for group services shall not exceed the charges for fifteen individuals per group. Group size limitations outlined in the current Medicaid Handbook apply to Outpatient group services funded under this contract. d. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds in the amount of$939,008.00, as indicated in Exhibit H, Funding Detail and Local Match. Should the network provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match as it appears on Exhibit H, Funding Detail, will automatically change, utilizing the following formula: The additional match required on the uncompensated units = Uncompensated Substance Abuse Services X 16.67% + Uncompensated Mental Health Services that is not exempt from local match requirements X 33.33%* *The following MH services are exempt from local match requirement L Deinstitutionalization Projects 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 Guidance/Care Center, Inc. Exhibit B Contract No. ME225-4-27 Page 1 of 5 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% operated by a public receiving facility) FACT Teams ii. CMH Programs (100435 Category& 102780 (PRTS) Category)that are not grant funded. e. In accordance with the provisions of s. 402.73(1), F.S., and Rule 65-29.001, Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed, to include contract termination in whole or in part, for failures to implement or to make acceptable progress on such corrective action plans. f. The ME shall reduce or withhold funds pursuant to Rule 65-29.001, F.A.C., if the network provider fails to comply with the terms of the contract and/or fails to submit client reports and/or data as required in DCF PAM 155-2, Rule 65E-14, F.A.C. and by the due dates listed on Exhibit C, Required Reports. g. The ME's decision to reduce or withhold funds will be submitted to the network provider in writing. The written notice will specify the manner in which the provider has failed to comply with the terms of the contract. When, and if, compliance is achieved, the withheld funds will be disbursed to the network provider. h. If the Provider closes or suspends the provision of services funded by this contract, the provider agrees to notify the ME in writing thirty (30) calendar days prior to their intent to close, suspend or end service(s). If the provider fails to notify the ME, the provider hereby agrees not to request payment for services provided in prior months if the actual number of services in the month for which payment is being requested is less than twenty-five percent (25%) of the prorated amount of services by cost center as given on Exhibit G, State Funding by Program and Activity or twenty-five percent (25%) of the prorated share of the amount of funding as specified on Exhibit G, State Funding by Program and Activity. i. The ME in its sole discretion and subject to funding availability, may purchase from any provider prior to the end of the contract period any service units provided at any time during the term of the contract. 2. Additional Release of Funds At its sole discretion, the ME may approve the release of more than the monthly prorated amount when the network provider submits a written request justifying the release of additional funds, if funds are available and services have been provided. 3. Medicaid Billing a. The Department is always the payer of last resort. The ME and the network provider specifically agree that the Department, through the ME is never a liable third party for Medicaid eligible services provided to individuals that meet the eligibility criteria for Medicaid. Authorized network provider services shall be reimbursed in the following order of precedence: i. Any liable first, second, and/or third party payers, then ii. Medicaid, pursuant to s. 409.910, F.S., if the individual meets the eligibility criteria for Medicaid, and the service is Medicaid eligible, then iii. The Department through the ME (only if none of the above are available or eligible for payment). iv. The network provider shall identify and report Medicaid earnings separate Guidance/Care Center, Inc. Exhibit B Contract No. ME225-4-27 Page 2 of 5 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% 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; vii. In no event shall both Medicaid and the ME be billed for the same service; b. The network provider operating a residential treatment facility licensed as a crisis stabilization unit, detoxification facility, short-term residential treatment facility, residential treatment facility Levels 1 or 2, or therapeutic group home that is greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee For-Service programs for any services for individuals eligible for Medicaid while in these facilities; and c. The network provider operating a children's residential treatment center of greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee-For Service programs for any services for individuals meeting the eligibility criteria for Medicaid in these facilities except as permitted under the Medicaid State Inpatient Psychiatric Program Waiver. 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 assist individuals eligible for Medicaid covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 4. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, or Provider Services Networks. Unless waived in Section D (Special Provisions) of this contract, the provider agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will be considered to be "third party payer" contractual fees as defined in Rule 65E-14.001(2)(z), F.A.C. Services which are covered by the sub-capitated contracts and provided to persons covered by these contracts must not be billed to the department. 5. Temporary Assistance to Needy Families (TANF) Billing a. The provider's attention is directed to its obligations under applicable parts of Part A or Title IV of the Social Security Act and the provider agrees that TANF funds shall be expended for TANF participants as outlined in the Temporary Assistance to Needy Families (TANF) Guidelines. TANF Guidelines can be obtained from the contract manager, or can be found at the following web site: http://www.dcf.state.fl.us/programs/samh/contract/tanf.pdf b. The contract shall specify the unit cost rate for each cost center contracted for TANF funding, which shall be the same rate as for non-TANF funding, but the contract shall not specify the number of TANF units or the amount of TANF funding for individual cost centers. 6. Invoice Requirements a. The rates negotiated with any network provider may not exceed the model rate as specified in Rule 65E-14, F.A.C. An exception is granted to the network provider whose rates were grandfathered in upon the transition from contracting directly with Department of Children and Families to the ME, providing that the network provider continue to meet criteria. Guidance/Care Center, Inc. Exhibit B Contract No. ME225-4-27 Page 3 of 5 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% b. Network providers are 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 ME and the Department, other payment methods may be permitted. c. The network provider shall request payment monthly through submission of a properly completed invoice, Exhibit E-1, Substance Abuse and Mental Health Monthly Request for Non-TANF Payment/Advance and/or Exhibit E-2, Substance Abuse and Mental Health Monthly Request for TANF Payment/Advance, within ten (10) days following the end of the month for which payment is being requested for the delivery of service. Payment to the network provider by the ME is subject to the availability of funds and payments received from the Department. Exhibits E-1 and E-2 are incorporated herein by reference and available at the following website: t .11ww e.sf hn.o 5%20Contracting%2OPa e.hf d. If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the ME indicating this information within ten (10) days following the end of the month. The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this contract, within ten (10) calendar days following the end of the month for which payment is being requested. e. If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the ME indicating this information within ten (10) calendar days following the end of the month. Should the network provider fail to submit an invoice or written documentation if no services are due to be invoiced from the preceding month, within thirty(30) calendar days following the end of the month, then the ME at sole discretion can reallocate funds. If the Network Provider fails to submit an invoice or written documentation for two (2) consecutive months within a twelve (12) month period, the ME at sole discretion can terminate the contract. f. The network provider's final invoice must reconcile actual service units provided during the contract period with the amount paid by the ME. The provider shall submit their fiscal year final invoice to the ME within fifteen (15) days after the end of each state fiscal year in the contract period. g. Pursuant to 65E-14.021(10)(b)6.b., F.A.C. , the year-to-date number of units of service reported on a request for payment or any associated worksheet shall not exceed the total number of units reported and accepted in the ME's data system pursuant to Rule 65E- 14.022, F.A.C. h. Pursuant to 65E-14.021(10)(a)2., F.A.C., any costs or service 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 to Medicaid, and all units for SAMH client services paid from other sources, including Social Security, Medicare payments, and funds eligible for local matching which include patient fees from first, second, and third-party payers, from each monthly request for payment. 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 post-audit. Guidance/Care Center, Inc. Exhibit B Contract No. ME225-4-27 Page 4 of 5 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% 7. Supporting Documentation a. The network provider agrees to maintain and submit to the ME, if applicable, service documentation for each service billed to the ME pursuant to this contract. The network provider shall track all units billed to the ME by program and by Other Cost Accumulator (OCA). Proper service documentation for each SAMH cost center is outlined in Rule 65E- 14.021, F.A.C., and Exhibit AB, Cost Center Description-Substance Abuse Recovery Support Services (Individual and Group), Exhibit M, Cost Center Description- Clinical Supervision Cost Center, Exhibit Y, TANF SAMH Guidelines and TANF SAMH Incidental Expenditures for Housing Assistance, if applicable. b. The provider shall maintain documentation to support all units billed to the ME and units subtracted for SAMH client services on each monthly request for payment. c. The network provider shall ensure that all services provided are entered into the KIS, PBPS, or other data system designated by the ME. d. The ME, Department and the State's Chief Financial Officer reserve the right to request supporting documentation at any time after actual units have been delivered. 8. Funding Sweeps The network provider agrees that at the sole discretion of the ME and at such time and upon terms, conditions or criteria set by the ME, a review of the funding utilization rate or pattern of the provider may be conducted by the ME. Based upon such review, if it is determined that the rate of utilization may result in a lapse of funds, then in that event the ME may amend the network provider's total amount of funding by reducing same in order to prevent the potential lapse. Additionally, the network provider's funding may be reduced and reallocated within the system of care, as determined by the ME and its sole discretion, in order to meet the changing needs of the system of care. The ME will notify the network provider in writing of the reduction prior to amending the total amount of funding. The ME's Lapse Policy is incorporated herein by reference. Guidance/Care Center, Inc. Exhibit B Contract No. ME225-4-27 Page 5 of 5 °iouth Fllo riklaa 13c h ar iwu iraall III Ic allth Networh,Iru% Exhibit C Required Reports #of Required Reports Due Date Copies Send to: Response to Monitoring Reports and Corrective Action Within 10 calendar days from the day the report ME Contract Plans is received. 1 Manager Sliding Fee Scale[reflecting the uniform schedule of Within 30 calendar days after the execution 1 ME Contract discounts referenced in 65E-14.018(4)] of the contract or by August 1 of each fiscal year. Manager Final FY 2013-2014 (1)Network Providers Agency Service Capacity Report, (2)Projected Cost Center Operating and Capital Within 30 calendar days after Contract execution ME Contract Budget(If applicable), or by August 1 of each fiscal year or upon request 1 Manager (3)Cost Center Personnel Detail Report(If applicable), & of the Contract Manager (4)Program Description. Monthly Data Required by DCF PAM 155-2 Electronic ME IT Office Within 4 calendar days after end of month Submission Incident Report Within 24 hours of occurrence, in IRAS accordance 1 with CFOP 215-6. ME VP of Quarterly Financial Statements(Balance Sheet and October 31,2013(Period:07/01/13—09/30/13) 1 Finance Statement of Activity) January 31,2014(Period: 10/01/13-12/31/13) April 30,2014(Period:01/01/14-03/31/14) ME Contract July 31,2014(Period:04/01/14-06/30/14) Manager October 31,2013(Period:07/01/13—09/30/13) ME VP of January 31,2014(Period: 10/01/13-12/31/13) 1 Finance Form 941 and Bank Statement April 30,2014(Period:01/01/14-03/31/14) July 31,2014(Period:04/01/14-06/30/14) ME Contract Manager Year-End Financial Reports for Network Providers Not Requiring Audits Per Attachment II ME Schedule of State Earnings Due 45 calendar days after the end of the fiscal 1 Contract year. Manager ME Schedule of Related Party Transaction Adjustments Due 45 calendar days after the end of the fiscal 1 Contract year. Manager Projected Cost Center Operating and Capital Budget Due 45 calendar days after the end of the fiscal ME Actual Expenses&Revenues Schedule year. 1 Contract Manager Guidance/Care Center, Inc. Exhibit C Contract No. ME225-4-27 Page 1 of 6 °iouth F'llo riklaa 13c h ar iwu iraall III Ic allth Nctworh,Iru% Due 45 calendar days after the end of the fiscal ME Schedule of Bed-Day Availability Payments 1 Contract year. Manager ME Agency Prepared Financial Statements(Balance Sheet Due 45 calendar days after the end of the 1 Contract and Statement of Activity) fiscal year. Manager Year-End Financial Reports for Network Providers Requiring Audits Per Attachment II 180 calendar days after the end of the network Financial&Compliance Audit to include the necessary provider's fiscal year or 30 calendar days after its ME schedules per Attachment I I completion,whichever comes first. 1 Contract Manager (See Attachment II) Other Reports,as applicable ME Contract Monthly, by the 10th calendar day Manager Monthly Service Invoice after the month 1 & of service ME Sr. Accountant ME Contract Manager Invoice Review Supporting Documentation As requested by the contract manager 1 & ME Sr. Accountant 1 ME Contract DA Client Communication Assessment Auxiliary Aid By the 4 h business day following the Manager Service Record Monthly Summary Report, if applicable reporting month ME Contract By July 15 of each fiscal year and/or 15 days Manager Final Invoice after contract end date 1 & ME Sr. Accountant Within 30 days of contract execution. Submit Provider's Grievance Procedures updates as amended within 30 days of 1 ME Contract Manager execution of the amendment Provider Informed Consent Forms 1 ME Contract Within 30 days of contract execution Manager Provider's Emergency Preparedness Plan Within 30 days of contract execution 1 ME Contract Manager Provider's Civil Rights Compliance Questionnaire 1 ME Contract Within 30 days of contract execution Manager Provider's Security Agreements, per Standard Contract 1 ME Contract Within 30 days of contract execution Manager Guidance/Care Center, Inc. Exhibit C Contract No. ME225-4-27 Page 2 of 6 °iouth F'llo riklaa Beh aN Io raall III Ic allt➢a Nctworh,Iru% Affidavit Regarding Debarment Annually, prior to contract execution,or as 1 ME Contract requested by the contract manager. Manager Inventory Report, if applicable Within 30 days of contract execution 1 ME Contract Manager "No Wrong Door"Policy and Procedure August 1,2013 1 ME Contract Manager Quality Assurance/Quality Improvement Plan August 1,2013 1 ME Contract Manager 1 October 31,2013 Quarterly Report on Implementation of Quality January 31,2014 ME Contract Improvement Report April 30,2014 Manager July 31,2014 1 ME Contract Co-occurring Summary Report and Action Plan 06/30/2014 Manager 1 ME Contract Cultural and Linguistic Competence Action Plan October 31, 2013 Manager January 31,2014 1 ME Contract Report on Implementation of Cultural and Linguistic April 30,2014 Manager Competence Initiative(included in the Quarterly QI Plan) July 31, 2014 ME Contract Trauma Informed Care(TIC)-Agency Self-Assessment December 30th of each fiscal year of the 1 Manager contract 1 ME Contract January 15th of each fiscal year of the Manager Trauma Informed Care(TIC)-Commitment Plan contract Cooperative Agreements Within 30 days of execution of the 1 EContract agreementsManager 1 ME Contract Within 90 calendar days of the effective date of Manager Memorandum of Understanding(MOU)with a Federally the contract(for newly executed MOU's) Qualified Health Center(FQHC) OR within 30 days for renewed MOU's As per the contract and/or as requested by 1 ME TANF TANF SAMH Program Logs and Service Data,if applicable the contract manager Supervisor 1 ME Contract Client Trust Fund Letter, if applicable August 1,2013 Manager 1 Quality ElectronicAssurance/ Submission Quality Improvement Crisis Stabilization Unit Census, if applicable Monthly by the 1 oth for the preceding month's Specialist census ME Contract Manager Guidance/Care Center, Inc. Exhibit C Contract No. ME225-4-27 Page 3 of 6 °iouth F'llo riklaa Behar iwuiraall III Ic allth Nctworh,Iru% Family/Adult Intervention Specialist Treatment Summary Per Exhibit J, FIS/AIS Intervention Services 1 Per Exhibit J, Report, if applicable Provider Protocols FIS/AIS Intervention 1 ME Payer Class Data, if applicable October 1,2013 Contract Manager 1 External Quality Assurance Reviews, Monitoring As per the contract and/or as requested by ME Reports, Surveys&Corrective Action Plans, if applicable the contract manager Contract Manager Reports Required for Children's Mental Health Providers,if applicable Children's Mental Health Quarterly clinical reports on all Per the contract and Exhibit R. 1 Copy in chart dependent children, if applicable Children's Mental Health Quarterly clinical reports on all As per the contract and/or as requested by 1 Copy in chart community children, if applicable the contract manager ME Contract Manager Infant Mental Health—Demographic Report,if applicable By the 15th of every month following the month 1 & of service ME VP of Behavioral Health Services ME Contract Manager October 15,2013 & Infant Mental Health-Narrative Milestones Report On January 15,2014 1 Client Outcomes,if applicable April 15,2014 ME VP of July 15, 2014 Behavioral Health Services ME Contract Manager Infant Mental Health-Narrative Summary Report On July 15, 2014 1 & Client Outcomes&Effectiveness of Treatment, if applicable ME VP of Behavioral Health Services Reports Required for Adult Mental Health Providers,if applicable ME Contract Incidental Fund Invoice and Expenditure Log for Adult Mental Manager Health Services(Exhibit O), if applicable Monthly by the 1dh of each month following 1 & the month of service ME System of Care Staff PATH Annual Data Report to SAMHSA,if applicable Per PATH Per PATH Grant Application Instructions 1 Grant Application Instructions ME Contract PATH Annual Reports,if applicable Drafts to be submitted to ME for Southern Manager Region SAMH Program Office, DCF Central 1 & Office in Tallahassee in April or May of each ME System of fiscal year as requested Care Staff Guidance/Care Center, Inc. Exhibit C Contract No. ME225-4-27 Page 4 of 6 °iouth Fllo riklaa @tc h ar iwu iraall III Ic allth Networh,Iru% Reports Required for Forensic Services Providers,if applicable ME Forensic 1 Coordinator/ Monthly Report for Individuals on Conditional Release, if By 15th of each month Mental Health applicable Administrator Office 1 ME SAMH Statewide Forensic Bed Census Report, if Weekly(Every Thursday by 5:00 pm) Forensic applicable Coordinator Reports Required for Consumer-Driven Agencies October 31,2013 Membership Report January 31,2014 1 ME Contract April 30,2014 Manager July 31, 2014 Reports Required for Substance Abuse Services Providers,as applicable ME Contract Manager& Annual Report for HIV Early Intervention Services,SAPT Upon Request 1 Substance Block Grant Set Aside Funded Services Only Abuse Program Office ME Contract Annual Report for Evidenced-based Injection Drug User Manager& Outreach Services,SAPT Block Grant Mandate, Designated 1 Substance Providers Only Upon Request Abuse Program Office ME Contract Annual Report for Pregnant Women and Women With Manager& Dependent Children SAPT Block Grant Set Aside Funded Upon Request 1 Substance Services Only I I 1A buse Reports Required for Substance Abuse Prevention Services Providers ME Contract Performance Based Prevention System(PBPS) Data Manager Entry Training for Prevention Program Coordinator and Within 30 calendars days of hire and annually 1 & thereafter ME Director any data entry staff,if applicable of Prevention Services Guidance/Care Center, Inc. Exhibit C Contract No. ME225-4-27 Page 5 of 6 °iouth Lilo riklaa @tc h ar iwu iraall III Ic allth Networh,Iru% ME Contract Manager Prevention Planning Tool (PPT),if applicable Within 30 calendars days of contract execution and 1 & annually thereafter ME Director of Prevention Services ME Contract Prevention Services Invoices Back-Up Report printed from Manager Submitted with the monthly invoice 1 & PBPS, if applicable ME Sr. Accountant ME Contract October 31,2013 Manager January 31,2014 1 & Coalition Activities Report,if applicable April 30,2014 ME Director July 31, 2014 of Prevention Services ME Contract Within 90 calendar days of the effective date of Manager Memorandum of Understanding the contract(for newly executed MOU's) OR & g within 30 days for renewed MOU's ME Director of Prevention Waitlist Wait List (until automated system is operational) As detailed in the Utilization Management 1 ME Contract Manual Manager Guidance/Care Center, Inc. Exhibit C Contract No. ME225-4-27 Page 6 of 6 South IFl rlda Behavioral Health Network,Inc;. Exhibit D Substance Abuse & Mental Health Required Performance Outcomes &Outputs (Part 1) Provider Name: Guidance/Care Center,Inc. Contract#: ME225-4-27 Date: 07/01/2013 Revision#: I. Mental Health Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adult Mental Health a.Adults with Severe and Persistent Mental Illness(SPMI)(MOO 16)/(MH016) 2021 b.Adults with Serious and Acute Episodes of Mental Illness(M05301)/(MH5301) 75 c.Adults with Mental Health Problems(M05302)/(MH5302) 333 d.Adults with Forensic Involvement(M0018)/(MHO18) 17 2.Children's Mental Health a.Children with Serious Emotional Disturbances(SED)(M003 1)/(MH03 1) 204 b.Children with Emotional Disturbances(ED)(M0032)/(MH032) 406 c.Children at-risk of Emotional Disturbances(M0033)/(MH033) N/A B.Required Performance Outcome Standards for Each Target Population Minimum Contract (GAA/NOMS) 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 o housing environment will be at least(M0742)/MH742) 90/° 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)/(MH003) 40 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) 86% 3.Adult Mental Health-Adults with Serious Mental Illness(SPMI,MH Crisis, Forensic) a.Percent of adults with serious mental illness who are competitively employed will 24/o o be at least(M0703)/MH703) 4.Adult Mental Health-Forensic Involvement a.Percent of adults in forensic involvement who live in stable housing environment o will be at least(M0743)/MH743) 67/o 5. Adult Mental Health-(All Target Populations identified in Section 1.A. 1.A.-d. above)Percent of persons served by the Department of Children and Families' funds that TBD show a reduction in clinical and co-occurring symptoms from admission to discharge. (GAA 1) 6. Adult Mental Health-(All Target Populations identified in Section 1.A. 1.A.-d. above)Percent of persons served by the Department of Children and Families' funds that TBD improve their ability to care for themselves and manage their activities of daily living from admission to discharge(GAA 2) 7. Adult Mental Health-(All Target Populations identified in Section 1.A. 1.A.-d. TBD above)Percent of persons served by the Department of Children and Families' funds that show improvement in their interpersonal and family relationships, family environment or Guidance/Care Center, Inc. Exhibit D Contract No. ME225-4-27 Page 1 of 4 South IFl rlda Behavioral Health Network,Inc. behavior in their home setting, and their work or school environments from admission to discharge. (GAA 3) 8. Adult Mental Health-(All Target Populations identified in Section 1. A. 1.A.-d. TBD above)Percent of Persons served by Department of Children and Families' funds that are satisfied with the services they receive (GAA 6) 9. Adult Mental Health-(All Target Populations identified in Section 1.A. 1.A.-d. TBD above)Percent of Persons served by Department of Children and Families' funds will show a reduction in criminal/juvenile justice involvement,harmful behavior to self or others,and security management needs. (GAA 7) 6.Children Mental Health-Seriously Emotionally Disturbed a.Percent of children who live in stable housing environment will be at least (M0779)/(MH779) 93% b.Percent of children who improve their level of functioning will be at least o (M0378)/MH378) 65/o c.Percent of school days seriously emotionally disturbed children attended will be at o least(M0012)/(MH404) 86/o 7.Children Mental Health-Emotionally Disturbed a.Percent of children who live in stable housing environment will be at least o (M0778)/(MH778) 95/o b.Percent of children who improve their level of functioning will be at least (M0377)/(MH377) 64% 8.Children Mental Health-At-Risk of Emotional Disturbance a.Percent of children who live in stable housing environment will be at least o (M0780)/(MH780) 96/o 9.Children's Mental Health-(All Target Populations identified in Section 1. A.2. a.—c. above)Percent of persons served by the Department of Children and Families' TBD funds that show a reduction in clinical and co-occurring symptoms from admission to discharge. (GAA 1) 10. Children's Mental Health-(All Target Populations identified in Section I.A.2. a.—c. above)Percent of persons served by the Department of Children and Families' TBD funds that improve their ability to care for themselves and manage their activities of daily living from admission to discharge(GAA 2) 11. Children's Mental Health-(All Target Populations identified in Section I.A.2. TBD a.—c. above)Percent of persons served by the Department of Children and Families' funds that show improvement in their interpersonal and family relationships,family environment or behavior in their home setting,and their work or school environments from admission to discharge. (GAA 3) 12. Children's Mental Health-(All Target Populations identified in Section 1.A.2. TBD a.—c. above)Percent of Persons served by Department of Children and Families' funds that are satisfied with the services they receive(GAA 6) 13. Children's Mental Health-(All Target Populations identified in Section I.A.2. a.— TBD c. above)Percent of Persons served by Department of Children and Families' funds will show a reduction in criminal/juvenile justice involvement,harmful behavior to self or others,and security management needs. (GAA 7) 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 95% Abuse and Mental Health Information System will be at least(SAMHIS)(M0759) Guidance/Care Center, Inc. Exhibit D Contract No. ME225-4-27 Page 2 of 4 South IFl rlda Behavioral Health Network,Inc;. Exhibit D Substance Abuse & Mental Health Required Performance Outcomes &Outputs (Part II) 11. Substance Abuse Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adults with Substance Abuse Problems a.Number of Adults Served(M0063)/(SA063) 592 2. Children with Substance Abuse Problems a.Number of Children Served(M0052)/(SA052) 205 3.Adult At-Risk of Substance Abuse Problems-(NonGAA) a.Number of adults participating in Prevention Services(M0785)/(SA785) 25309 b.Number of adults participating in Level 1 Prevention Programs N/A (M0767)/(SA767) c.Number of adults participating in Level 2 Prevention Programs N/A (M0768)/(SA768) d.Number of adults participating in Level 1 Prevention Programs who complete N/A 85 percent of the program's schedule of activities(M0769)/(SA769) e.Number of adults participating in Level 2 Prevention Programs who complete 85 N/A 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) 5000 b.Number of children participating in Level 1 Prevention Programs 1123 (M0761)/(SA761) c.Number of children participating in Level 2 Prevention 50 Programs(M0695)/(SA695) d.Number of children participating in Level 1 Prevention Programs who complete 955 85 percent of the program's schedule of activities(M0763)/(SA763) e.Number of children participating in Level 2 Prevention Programs who complete 43 85 percent of the program's schedule of activities(M0764)(SA764) Minimum Contract B.Required Performance Outcome Standards for Each Target Population Standard 1.Adults with Substance Abuse Problems a.Percent of adults who successfully complete substance abuse treatment services 51% will be at least(M0755)/SA755) b.Percent change in clients who are employed from admission to discharge will be 10% at least(M0753)/SA405) c.Percent of adults who live in a stable housing environment at the time of 94% discharge will be at least(M0756)/SA756) d.Percent change in the number of adults arrested 30 days prior to admission 14.60% versus 30 days prior to discharge(M0754/SA754) e.Percent of persons served by the Department of Children and Families' funds that show a reduction in clinical and co-occurring symptoms from admission to discharge. TBD (GAA 1) f. Percent of persons served by the Department of Children and Families' funds that improve their ability to care for themselves and manage their activities of daily living TBD from admission to discharge(GAA 2) g. Percent of persons served by the Department of Children and Families' funds that TBD show improvement in their interpersonal and family relationships,family environment or behavior in their home setting,and their work or school environments from admission to discharge. (GAA 3) h. Percent of Persons served by Department of Children and Families' funds that are TBD Guidance/Care Center, Inc. Exhibit D Contract No. ME225-4-27 Page 3 of 4 South IFl rlda Behavioral Health Network,Inc. satisfied with the services they receive (GAA 6) i. Percent of Persons served by Department of Children and Families' funds will TBD show a reduction in criminal/juvenile justice involvement,harmful behavior to self or others,and security management needs. (GAA 7) 2.Adult At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of adults participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least(M077 1)/(SA77 1) b.Percent of adults participating in Level 2 Prevention Programs who complete 85 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 48% services will be at least(M0725)/(SA725) b.Percent of children who live in a stable housing environment will be at least 93% (M0752)/SA752) c.Percent change in the number of children arrested 30 days prior to admission 19.60% versus 30 days prior to discharge will be at least(M075 l/SA75 1) d.Percent of persons served by the Department of Children and Families' funds that show a reduction in clinical and co-occurring symptoms from admission to discharge. TBD (GAA 1) e. Percent of persons served by the Department of Children and Families' funds that improve their ability to care for themselves and manage their activities of daily living TBD from admission to discharge(GAA 2) f. Percent of persons served by the Department of Children and Families' funds that TBD show improvement in their interpersonal and family relationships, family environment or behavior in their home setting,and their work or school environments from admission to discharge. (GAA 3) g. Percent of Persons served by Department of Children and Families' funds that are TBD satisfied with the services they receive (GAA 6) h. Percent of persons served by Department of Children and Families' funds will TBD show a reduction in criminal/juvenile justice involvement,harmful behavior to self or others,and security management needs. (GAA 7) 4.Children At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of children participating in Level 1 Prevention Programs who complete 85% 85 percent of the program's schedule of activities will be at least(M0765)/(SA765) b.Percent of children participating in Level 2 Prevention Programs who complete 85% 85 percent of the program's schedule of activities will be at least(M0766)/(SA766) 5.Data Submission for Prevention Program Tool(baseline-Non GAA) a.Percent of approved Prevention Descriptions completed within 30 days of 50% 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)admission records in 95% the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) Guidance/Care Center, Inc. Exhibit D Contract No. ME225-4-27 Page 4 of 4 °iouth Fllvuu°idaa Bch aN6oraall Illfcsallt➢a Net°worh,1aam% Exhibit E Monthly Payment/Advance Request (Non-TANF and TANF Invoices) 1. Exhibit E-1, Monthly Payment/Advance Request(Non-TANF Invoice) 2. Exhibit E-2, Monthly Payment/Advance Request(TANF Invoice) These exhibits are incorporated by reference and available at following website: ://w sfbn.orq/ 5�l�20�ontractinq�l�20 age. tm Guidance/Care Center, Inc. Exhibit E Contract No. ME225-4-27 1 of 1 °iouthFllvuildaaBehariwuiraall III Icallth Networh,faam% Exhibit F Minimum Requirements The network 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: I. PROGRAMMATIC AUTHORITY(FEDERAL) A. Mental Health 42 U.S.C. 300x to 300x-9 (Block Grant for community Mental Health Services) h_t_tp://www4e law.comelleedu/uscode/42/ch6AschXVlI B.html B. Substance Abuse Prevention and Treatment Block Grant(SAPTBG) 42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes) http://www4.law.cornell.edu/uscode/html/uscode42/usc sec 42 00000290--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_a!lps sups 01 42 10 6 A 20 XVII 30 Q 40 ii.html 42 CFR, Part 54 (Charitable choice) http://www.access.gpo.go 03/42cfr54 03.html 45 CFR 96.120— 137 (SA Treatment&Prevention Block Grants) http://www.access.gpo.go 03/45cfr96 03.html Restrictions on expenditures of SAPTBG 45 CFR 96.135 hLtp-://www.access.aDo.aov/nara/cfr/waisidx 01/45cfr96 01.html C. Substance Abuse-Confidentiality 42 CFR, Part 2 hLtp-://www.access.aDo.aov/nara/cfr/waisidx 03/42cfr2 03.html D. Health Insurance Portability and Accountability Act(HIPAA) 45 CFR 164 http://www.access.gpo.go 03/45cfr164 03.html E. Social Security Income for the Aged, Blind and Disabled 20 CFR 416 hLtp-://www.access.aDo.aov/nara/cfr/waisidx 03/20cfr416 03.html F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 CFR 240 relating to SSA http://www.access.gpo.go 03/31 cfr240 03.html G. Temporary Assistance to Needy Families (TANF) Part A, Title IV of the Social Security Act 45 CFR, Part 260 hLtp-://www.access.aDo.ciov/nara/cfr/waisidx 03/45cfr260 03.html Section 414.1585, F.S. Exhibit F Guidance/Care Center, Inc. Page 1 of 5 Contract No. ME225-4-27 �iouth FlomlduBehaN Iorall III I calth Networh, I rm% H. Positive Alternatives bo Homelessness (PATH) Public Health Services Act, Title V. Part C. Section S21. osamended 42U.S.C. 200oo-21 ot. soq. ShewortB. McKinney Homeless Assistance Amendments Act of100O. Public Law 1O1-G4S 42CFR. Part S4 |. Americans with Disabilities Act mf1SSO 42U.S.C. 12101 otsoq. U. FLORIDA STATUTES All State ofFlorida Statutes can be found ot the following vvobsito: A. Child Welfare and Community Based Care Choptor30. F.S. Proceedings Relating to Children Choptor110. F.S. Public Records Chapter 4O2. F.S. Health and Human Services; Miscellaneous Provisions Chapter 43S. F.S. Employment Screening Chapter 40O. F.S. Psychological Services Chapter 401. F.S. Clinical, Counseling and Psychotherapy services Chapter 1OO2. F.S. Student and Parental Rights and Educational Choices Sootion4O2.3OS7. F.S. Persons not required to be rofingorprintodorrescreened Section 414.20S. F.S. Temporary Cash Assistance; Public Records Exemptions B. Substance Abuse and Mental Health Services Chapter 3D1. F.S. Public Health General Provisions Choptor3DG. F.S. Particular Conditions Affecting Public Health Chapter 30S. F.S. Hospital Licensing and Regulation Choptor304. F.S. Mental Health Chapter 307. F.S. Substance Abuse Services Choptor4OO. F.S. Nursing Home and Related Health Coro Facilities Chapter 43S. F.S. Employment Screening Chapter 4SD. F.S. Medical Practice Choptor4S0. F.S. Osteopathic Medicine Chapter 4G4. F.S. Nursing Chapter 4GS. F.S. Pharmacy Chapter 40O. F.S. Psychological Services Chapter 401. F.S. Clinical, Counseling and Psychotherapy Services Chapter 400. F.S. Drug, Cosmetic and Household Products ChoptorSS3. F.S. Building Construction Standards Chapter D03. F.S. Drug Abuse Prevention and Control Section 400.006(8). F.S. Optional Modiooid —ConnnnunityMonto| Health Services C. Developmental Disabilities Choptor303. F.S. Oovo|opnnonto| Disabilities Exhibit F Guidance/Care Center, Inc. Page 2»f5 Contract No. ME2254'27 °iouthFllvuildaaBehariwuiraall III Icallth Networh,faam% D. Adult Protective Services Chapter 415, F.S. Adult Protective Services E. Forensics 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; F. Florida Assertive Community Treatment(FACT) General Appropriations Act .http://www.flsen G. State Administrative Procedures and Services Chapter 120, F.S. Administrative Procedures Act Chapter 287, F.S. Procurement of Personal Property and Services Chapter 815, F.S. Computer- Related Crimes Section 112.061, F.S. Per diem and Travel Expenses* Section 112.3185, F.S. Additional Standards for State Agency Employees Section 215.422, F.S. Payments, Warrants & Invoices; Processing Times Section 216.181(16)(b), F.S. Advanced funds invested in interest bearing accounts *Travel Expenses are specified in the DFS Reference Guide for State Expenditures httpe//www.myfloridacfo.com/aadir/reference°/a5Fauide/reference guideehtm III. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care All references to F.A.C. may be found at the following website: htty�se//wwweflruleseorq/defaulteasp� 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 65E-4, 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 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 Exhibit F Guidance/Care Center, Inc. Page 3 of 5 Contract No. ME225-4-27 �iouth FlomlduBehaN Iorall III I calth Networh, I rm% [V. MISCELLANEOUS A. Department mf Children and Families Operating Procedures CFOP 155-10, Services for Children with Mental Health &Any Co-occurring Substance Abuse Treatment Needs |n Out of Home Care Placements CFOP21S-G. Incident Reporting and Client Risk Prevention B. Federal Cost Principles OMB Cirou|orA-21. Cost Principles for Educational Institutions OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments OMB Circular Al 02, Grants and Cooperative Agreements with State and Local Governments OMB Cirou|orA-122. Cost Principles for Non-profit Organizations C. Audits OMB Circular A-1 33, Audits of States, Local Governments and Non-Profit Organizations Section 215.07. F.S., Florida Single Audit Act Comptrollers Memorandum#O3 (1000-2000): Florida Single Audit Act |nnp|onnontotion D. Administrative Requirements 45 CFR, Port 74 - Uniform Administration Requirements for Awards and Subovvords to Institutions of Higher Education, Hospitals, other Non-Profit Organizations and Other Commercial Organizations 45 CFR. Port02 - Uniform Administration Requirements (State and Local Govornnnonta)\ OMB Circular A11O. Uniform Administrative Requirements for Grants and Other Agreements E. Data Collection and Reporting Requirements Ru|oGSE-14.O22. F.A.C. Section 307.321(3)(o), F.S.. Data collection &dissemination system Exhibit F �iouth FlomlduBehaN Iorall III I calth Networh, I rm% Soohon304.74(3)(o). F.S., Data Submission Section 304.77, F.S.. Uniform management information, 0000unting, and reporting systems for providers. CFP 155-2. Mental Health and Substance Abuse Data Moosunannont Handbook Exhibit F 07/01/2013 Exhibit G:STATE FUNDING BY PROGRAM&ACTIVITY Fiscal Year 2013-2014 Provider Name. Guidance/Care Center,Inc. Contract 4: 225-4-27 Revision 4: Adult Mental Health Children Mental Health Activity/Cost Center TANF$ Unit TANF$ Unit X=Yes Rate X=Yes Rate 1 2 3 4 5 6 7 Emergency Stabilization 502004 503001 03. Crisis Stabilization (No TANF)Unit:bed-day ,.. ..„ r. w. pppppppp yyyyqq pp 1,026,903 04. Crisis Support/Emergency Unit:staffhour 86,000 �� $ 40.44 $ 15,677 09. Inpatient (No TANF) Unit:24-hr day Non-TANF= $ 1,112,903 Non-TANF= $ 15,677 Total Emergency Stabilization= $ 1,112,903 Total Emergency Stabilization= $ 15,677 Uncompensated Units= $ 222,581 Uncompensated Units= $ 3,135 Recovery&Resiliency 54241$ 503013 01. Assessment Unit:contact hour 170,166 �� „$ 80.76 $ 36,922.00 02. Case Management Unit:direct staff hour $ 63.21 $ 68,140 $ 41,930.00 05. Day Care Unit:4-hr day 06. Day/Night pp yyyypp Unit:4-hr day 07. Drop-In/Self Help Centers(No-TANF) �� Unit:facility day �� $ 296 30 $ 65,000 08. In-Home and On Site Unit:direct staff hour _ $ 70.20 $ 280 325,445.00 10. Intensive Case Management Unit:direct staff hour 11. Intervention-Individual pp yyyypp Unit:direct staff hour $........62.98 $ 60,641 12. Medical Services (No TANF) Unit:contact hour �� $�390.47 $ 505,826 $ 63,974.00 14. Outpatient-Individual Unit:contact hour $ 91.09 $ 124,524 $ 1,606.00 15. Outreach Unit:non-direct staffhour „ $ 20,500 16. Prevention pp yyyypp Unit:non-direct staff hour 17. Prevention/Intervention-Day Unit:4-hr day 18. Residential Level I pp yyyypp Unit:24-hr day �...$wwww.,.265.11 $ 71,266 19. Residential Level II Unit:24-hr day 20. Residential Level III pp yyyypp Unit:24-hr day ,,.,.,.,.,wwww.,.,.,.,wwww.,.,., 21. Residential Level IV Unit:24-hr day 22. Respite Services pp yyyypp Unit:contact hour 23. Sheltered Employment (No TANF) Unit:4-hr day 25. Supported Employment pp yyyypp Unit:direct staff hour ,,.,.,.,.,wwww.,.,.,.,wwww.,.,., 26. Supportive Housing/Living Unit:direct staff hour „$ 51.99 $ 90,827 29. Aftercare-Individual Unit:direct staff hour $ 63.21 $ 7,000 84.00 30. Information and Referral (No TANF) Unit:staff hour �� .$..�....27.08 $ 6,050 35. Outpatient-Group pp yyyypp Unit:contact hour 4..$ ....22.77 $ 10,000 ��«��C��gBfl $ 2277 $ 23.00 36. Room and Board w/Supervision Level I Unit:24-hr day 37. Room and Board w/Supervision Level II pp yyyypp Unit:24-hr day ,,.,.,.,.,wwww.,.,.,.,wwww.,.,., 38. Room and Board w/Supervision Level III 4 $ 7137 $ 52,000 Unit:24-hr day 39. Short-tern Residential Treatment Unit:Bed-Day Exhibit G Guidance/Care Center,Inc. Page 1 of 4 Contract No.ME225-4-27 07/01/2013 Exhibit G:STATE FUNDING BY PROGRAM&ACTIVITY Fiscal Year 2013-2014 Provider Name. Guidance/Care Center,Inc. Contract 4: 225-4-27 Revision 4: Adult Mental Health Children's Mental Health Activity/Cost Center TANF$ Unit TANF$ Unit X=Yes Rate X=Yes Rate 1 2 4 6 7 9 11 542428 503423 40.Mental Health Clubhouse Services Unit:Clubhouse staff hour �.$..�....37.71� $ 3,000 42.Intervention-Group pp yyyypp Unit:contact hour �..$ 1575 $ 15,000 43.Aftercare-Group Unit:contact hour $�15.80 $ 1,000 16 48.Clinical Supervision for Evidence-Based Practices •� Unit:contact hour ....................................... �� _ Non-TANF= $ 1,271,220 Non-TANF= $ 470,000 TANF= $ _www TANF= Total Recovery&Resiliency = $ 1,271,220 Total Recovery&Resiliency= $ 470,000 Uncompensated Units= Uncompensated Units= $ 94,000 Recovery&Resiliency-FACT Team 54242$ 34. FACT Teams (No TANF) Unit:staff hour �� ....................................... 4 ,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,., FACT= $ Total FACT= $ Uncompensated Units= Recovery&Resiliency-Community Forensic 54242$ 503013 19. Residential Level II IIIIIIIIIIIIIIIIIIIIIIIIII pp yyyypp�� I Unit:24-hr day L...................... L..............................�, IIIIIlll4NRN0NNN�ftC��C��gBflK9 L .................d L................. 39. Short-term Residential Treatment pp yyyypp pp yyyypp pp yyyypp gg gg gg Unit:Bed-Day Non-TANF= $ Non-TANF= II$ y gyq gyp g TANF= ...$........................................� TANF= II C��gB��gBfl�M Total Forensic Services= $ Total Forensic Services= $ Uncompensated Units= Uncompensated Units= Recovery&Resiliency-Incidental Expenses 54242$ 503013 28. Incidental Expenses:General Unit:each 50 spent 28. Incidental Expenses:-F.A.C.E.S. Unit:each$50 spent 28. Incidental Expenses:Forensic Unit:each 50 spent 50.00 10000 00 Non-TANF= $ 23,900 Non-TANF= $ TANF= $ _www TANF= Total Incidental Expenses= $ 23,900 Total Incidental Expenses= $ Uncompensated Units= $ 4,780 Uncompensated Units= Total Non-TANF= $ 2,408,023 Total Non-TANF= $ 485,677.00 Total TANF= $ Total TANF= Total Mental Health Funds= $ 2,408,023 Total Mental Health Funds= $ 485,677.00 Exhibit G Guidance/Care Center,Inc. Page 2 of 4 Contract No.ME225-4-27 07/01/2013 Exhibit G:STATE FUNDING BY PROGRAM&ACTIVITY Fiscal Year 2013-2014 Provider Name. Guidance/Care Center,Inc. Contract 4: 225-4-27 Revision 4: Adult Substance Abuse Children's Substance Abuse Activity/Cost Center TANF$ Unit TANF$ Unit X=Yes Rate X=Yes Rate 1 2 3 4 5 6 7 Detoxification 60300 602601 24. Substance Abuse Detoxification (No TANF) Unit:bed-day �� ..$.�...204.94 $ 186,643.00 32. Outpatient Detoxification (No TANF) Unit:4-hr day Total Non-TANF= $ 186,643.00 Total Non-TANF= $ Total Detoxification= $ 186,643.00 Total Detoxification= $ Uncompensated Units= $ 37,328.60 Uncompensated Units= Prevention 60300 602902 16. Prevention Unit:non-direct staff hour 172,262 17. Prevention/Intervention-Day pp yyyypp p yyp Unit:4-hr day 30. Information and Referral (No TANF) Unit:staff hour Total Non-TANF= $ Total Non-TANF= $ 172,262 .wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww. .wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww. Total Prevention= $ Total Prevention= $ 172,262 Uncompensated Units= Uncompensated Units= $ 34,452 Treatment and Aftercare 643007 602603 01. Assessment Unit:contact hour $ 80.76 $ 42,665 $ 8076 $ 24,725 02. Case Management Unit:direct staff hour $ 63.21 $ 46,585 $ 63 21 $ 5,000 04. Crisis Support/Emergency Unit:staff hour $ 40.44 $ 6,000 $ 40 36 $ 30,000 05. Day Care Unit:4-hr day ................ 06. Day/Night Unit:4-hr day ...,.,.,wwww.,.,.,.,wwww....... ......... ......... .................. 08. In-Home&On Site Unit:direct staff hour $ 70.20 $ 755 $ 70 20 $ 1,400 10. Intensive Case Management Unit:direct staff hour ppppppppppppppppppppp pppppppppppppppppppppp ppppppppppppppppppppp ppppppppppppppppppppp I�IIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQII� I�IIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQII� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I�IIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQII� I�IIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQIIQII� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 11. Intervention-Individual Unit:direct staff hour $ 62.98 $ 79,585 $ 62 98 $ 153,725 12. Medical Services (No TANF) pppppppp yyyyqq pp,, pppppppp yyyyqq pp Unit:contact hour ��«��Cflgp��Cfl9��tl4 4,..,.$wwww..„389t.86..� $ 100 ��«��Cflgp��Cfl9��tl@ 4....$...........„3.89..86 $ 100 13. Methadone Maintenance (No TANF) Unit:dosage 14. Outpatient-Individual Unit:contact hour $ 91.09 $ 86,270 $ 9109 $ 182 15. Outreach Unit:non-direct staff hour $ 43.04 $ 17,299 $ 42 89 $ 13,957 18. Residential Level I Unit:24-hr day ...,.,.,wwww.,.,.,.,wwww....... ......... ......... .................. 19. Residential Level II Unit:24-hr day 20. Residential Level III Unit:24-hr day ...,.,.,wwww.,.,.,.,wwww....... ......... ......... .................. 21. Residential Level IV Unit:24-hr day 22. Respite Services Unit:contact hour 25. Supported Employment Unit:direct staff hour 26. Supportive Housing/Living I I Unit:direct staff hour L,.,.,.,. L......... ......... L .................. 27. TASC Unit:direct staff hour $ 62 OS $ 30,879 $ 62 OS $ 50,000 29. Aftercare Unit:direct staff hour $ 63.21 $ 14,223 $ 63 21 $ 50 Exhibit G Guidance/Care Center,Inc. Page 3 of 4 Contract No.ME225-4-27 07/01/2013 Exhibit G:STATE FUNDING BY PROGRAM&ACTIVITY Fiscal Year 2013-2014 Provider Name. Guidance/Care Center,Inc. Contract 4: 225-4-27 Revision 4: Adult Substance Abuse Children's Substance Abuse Activity/Cost Center TANF$ Unit TANF$ Unit X=Yes Rate X=Yes Rate 1 2 3 4 5 6 7 35. Outpatient-Group Unit:Contact Hour $ 22.77 $ 20,000 36. Room and Board w/Supervision Level I Unit:24-hr day ...,.,.,wwww.,.,.,.,wwww....... ......... ......... .................. 37. Room and Board w/Supervision Level II Unit:24-hr day 38. Room and Board w/Supervision Level III Unit:24-hr day ...,.,.,wwww.,.,.,.,wwww....... ......... ......... .................. 42.Intervention-Group Unit:Contact hour 43.Aftercare-Group Unit:contact hour 46.Recovery Support-Individual I I Unit:direct staff hour 47.Recovery Support-Group I I Unit:contact hour L,.,.,.,. L......... ......... L .................. 48.Clinical Supervision for Evidence-Based Practices Unit:contact hour $ 67.44 $ 1,618 Total Non-TANF= $ 345,979 Total Non-TANF= $ 279,139 wwwwwwwwwwwwwwwwwwwwwww www_ Total TANF= Total TANF= $ Total Treatment&Aftercare= $ 345,979 Total Treatment&Aftercare= $ 279,139 Uncompensated Units= $ 69,196 Uncompensated Units= $ 55,828 Incidental Expenses 643007 602603 28.Incidental Expenses Unit:each$50 spent $.................50.00 $,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,44 154 Total Non-TANF= $ 44,154 Total Non-TANF= $ wwwwwwwwwwwwwwwwwwwwwww www_ Total TANF= Total TANF= $ Total Incidental Expenses= $ 44,154 Total Incidental Expenses= $ Total Non-TANF= $ 576,776 Total Non-TANF= $ 451,401 wwwwwwwwwwwwwwwwwwwwwww www_ Total TANF= Total TANF= $ Total Substance Abuse Funds= $ 576,776 Total Substance Abuse Funds= $ 451,401 Exhibit G Guidance/Care Center,Inc. Page 4 of 4 Contract No.ME225-4-27 FY 2013-2014 EXHIBIT IT:FUNDING DETAIL 07 01 2013 ..................................................................................................................................................................................................................................... / / Provider Name:Guidance/Care Center,&c. Contract#:'............,IVIE225-4-27.,.,.,.., Revision#:........................................ ........................................................................................................................................................MENTAL..HEALTH....................... Budget Entity 60910506-Adult's Mental Health OCA AMOUNT Budget Entity 60910506-Children'S Metal Health OCA AMOUNT 502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION G/A-ADULT COMM.MENTAL HEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435) ADAMH Trost Frmd IT(027005)* % SS( $ ADAMH Trost Frmd IT(027005)* CISS( $ General Revenue(000326)* 1.ISS( $ General Revenue(000326)* CfSS( $ 15677 TSTF(122023)* % S S( $ FGTF-Title XXI(261015) 890w $ General Revenue(000326)* S%1111( $ G/A-BAKER ACT SERVICES (100611) G/A-CHILDREN'S BAKER ACT (104257) General Revenue(000326)* A}S S( $ 1 112 904 General Revenue(000326)* Cf 4 S( $ Social Services Block Grant(639022) Cf SS( $ Emergency Stabilization Total= $ 1112 903 Emergency Stabilization Total= $ 15,677 Uncompensated Units $ 222,581 Uncompensated Units $ 3,135 502018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY G/A-ADULT COMM.MENTAL HEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435) ADAMH Trost Frmd IT(027005) AhUPS1 $ ADAMH Trost Frmd IT(027005)* Ch"ps: $ 153�752 General Revenue(000326) AUhS $ 1038 i48 General Revenue(000326)* ChhSl $ 286248 GR/AGAPE Fan Ministry(000326)* AF 1.111D $ General Revenue-Children At Risk of ED(000326) GR/Conmr Forensic Beds-Adidt Svc(000326) CFf 9 1S $ 160 000 FGTF-MIAMI-DADE Wrap Arormd Pg.(261015) G%TD7S 1 $ ADAMHTrostFrmd-FACT Achnin(027005) f"1119 $ Federal Grant Trost Frmd(261015) Chh41 $ i0000 General Revenue-FACT Achnin(000326) f"1 119 $ FGTF-Title XXI(261015) 89Q 13 � � FGTF-FMGPMA-Medicaid Achnin(261015) f"1 119 $ General Revenue-FACT svcs(000326) f"I S 19 $ FGTF FGGGPT-Trans From Homelessness(261015) GX018 $ 90c827 General Revenue(000326) SMff 1? $ G/A-PURCHASED RESIDENTIAL WTTF TANF(401001) 39118 ,.,$.,.,., .... TREATMENT SERVICES (102780) General Revenue(000326) LPL M $ GR/MCAID&Non-MCAID MOE(000326)* FT N%T $ Tobacco Settlement Trost Ftmd(122023) %ppsl Federal Grant TmstFrmd(261015) Ahh51 ------------------------ $ G/A-INDIGENT PSYCH MEDS PROGRAM (101350) General Revenue(000326)* % T S( ---------------------- $ 5 945 TotalNon-TANF $ 1,295,120 Total Non-TANF $ 470,000 Recovery&Resiliency Total= $ 1,295,120 Recovery&Resiliency Total= $ 470 000 Uncompensated Units $ 259,024 Uncompensated Units $ 94,000 TOTAL ADULT'S MENTAL HEALTH= $ 2,408,023 TOTAL CHILDREN'S MENTAL HEALTH= $ 485,677 SUBSTANCE ABUSE Budget Entity 60910604-Adult's Substance Abuse OCA AMOUNT Budget Entity 60910604-Children's Substance Abuse OCA AMOUNT 603005-DETOXIFICATION 602001-DETOXIFICATION/ARF G/A-COMM SUBSTANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS (100420) ADAMH TmstFrmdIT(027005)*** DT k 1S $ 84 i59 ADAMH TmstFrmdIT(027005)*** DI k(S $ General Revenue(000326)** D'Ik14 $ 102284 GeneraLRevenue(000326)** DI (S $ --------------------- TSTF(122023)** DI k(S $ Detoxification Total= $ 156643 Detoxification Total= $ Uncompensated Units $ 37,329 Uncompensated Units $ - 603006-PREVENTION SERVICES 602002-PREVENTION SERVICES G/A-COMM SUBSTANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS(100420) General Revenue(000326)** PhV 1S $ ADAMH Trost Frmd TF(027005)*** P}V(S $ 172262 ADAMH Trost Frmd TF(027005)**** PhV 15 $ General Revenue(000326)** P}V(S $ Prevention Services Total= $ Prevention Services Total= $ 172,262 Uncompensated Units $ - Uncompensated Units $ 34,452 603007-TREATMENT&AFTERCARE 602003-TREATMENT&AFTERCARE G/A-COMM SUBSTANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS(100420) ADAMH Trost Frmd IT(027005)*** 'IRI^,.S $ i21c938 ADAMH Trost Frmd IT(027005)*** '1p'Ius $ General Revemie(000326)** 'IRI14 $ 64595 General Revenue(000326)** 'IRIus O&M TF(516015) 'IR I 1S $ TSTF(122023)** 'Ih 1(S $ 279 li9 ADAMH TrostAmd TF(027005)*** 2711I\ $ ic600 '. O&MTF(516015)** 'IR I('S $ ADAMH Trost Frmd IT(027005)*** 2775OM �$ ADAMH Trost Frmd IT(027005)*** 27('fiS' $ General Revenue(000326) 391('0 $ WTTF TANF(401001) 391('1 $ WTTF TANF(401001) 391('0 ,.,$.,.,., .... General Revenne(000326)** SPR'S ,�$��. ...... GR-Indigent Drag Pro MOE(000326)** DLG08 $ ADAMH Trost Frmd IT(027005)*** SPR'S $ General Revenue(000326)** SP71S $ SSBG TF(639002) 'IR Ius $ ADAMH Trost Frmd IT(027005)*** -------------------- SP71S .$ .... ....... TotalNon-TANF $ 390,133 Total Non-TANF $ 279,139 Treatment&Aftercare Total= $ 390133 Treatment&Aftercare Total= $ 279139 Uncompensated Units $ 78,027 Uncompensated Units $ 55,828 TOTAL ADULT'S SUBSTANCE ABUSE_ $ 576776 TOTAL CHILDREN'S SUBSTANCE ABUSE= $ 451,401 TOTAL ALL PROGRAMS= $ 3,921,877 TOTAL ALL UNCOMPENSATED UNITS= $ 784 375 FUNDS NOT REQUIRING MATCH: GRAND TOTAL OF PROGRAMS&UNCOMPENSATED UNITS= $ 4 006 252 'iDrug Abuse Services $,,,,,,,,,,,,,,518,882 ''. TOTAL FUNDS REQUIRING MATCH= $ 2,817,025 ''...Deinstitutionalization Project............................................................................$.,.,.,.,.,.,.21Q000 ''.... LOCAL MATCH REQUIRED= $ 939 008 CMHProgram $ i75970 ADDITIONAL LOCAL MATCH '.MH Block Grant $ TOTAL FUNDS NOT REQUIRING MATCH= $ 1 104 852 GRAND TOTAL LOCAL MATCH= $ 93 0008 ^`Cmadly Martel Health Block Orent ""`Fxpenditrve must be Substance Abrrse Prevartimr end Treahnart Block Orent eligible "`Substance Abuse Prevartion end Treahnart Block Orent-Rmdine Aereement-RESTRICTIONS APPLY Guidance/Care Center, Inc. Exhibit H Contract No. ME225-4-27 Page 1 of 1 07/01/2013 PART HI-NEZP LOCAL MATCH PLAN SUMMARY RY FY 2013-2014 AMH Total $ 543.849.00 Angeacy Name: Guidance/Care Centex,Inc. CMH Total $ - Contrac[Nmnber: NM225-4-27 ASA Total $ 290.008.42 Date:7/l/2013 CSA Total $ 105.151.00 Grand Total $ 939 008.42 ADULT MLNTAL DrAT,TII CH11,DRFN'S NITNTAL HEALTH ADULT SUBSTANCE ARUSF C'tH11,DIAF,N'S SUI3SI'ANCF,ARUSE 1.Assessment 1.Assessment 1.Assessment 1.Assessment A.T02A1 Match �, 64AIOg,10 A.T02A1 MA2CIl A.T02A1 Match �, 36.499,00 A.T02A1 Match $ b.Rate $, $0.Z6 b.Rate b.Rate $, $0,76 i b.Rate c.Units Ruchased 74Z94,c.Units Purchased n/a c.Units Purchased 451,94„c.Units Purchased 2.Case Management 2.Case Management 2.Case Management 2.Case Management .............. .............. ........................... ,.,..... .,,......,.. ........................... A.Total Match $ 20.000.00 A.Total Match A.Total MA2CIl �, 4$,148.OkY;A.Total MA2CIl b.Rate $ 63.21 b.Rate b.Rate $, 6121 b.Rate c.Units Purchased 316.41 c.Units Purchased n/a c.Units Purchased 761A$jc.Units Purchased n/a 3.Crisis Stabilization 3.Crisis Stabilization 3.Crisis Stabilization 3.Crisis Stabilization A.Total MA2C11 �, I�r.44Z,C}4.A.Total MA2Cb A.Total MatchA.T02Al Matchb.Rate $, 323.Z7 b.RAte b.RAte b.Rate c.Units Purchased 409.08 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased i>/a 4.Crisis Support/Emergency 4.Crisis Support/Emergency 4.Crisis Support/Emergency 4.Crisis Support/Emergency ........ ............ ........................... ....,......... ....,............ ..,........ .....,.........,........ a.Total Match $, 12,000b0 a.Total Match a.Total Match $ 2.000.00 a.Total Match $ 43.000.00 b.Rate $, 40,44 b.Rate b.Rate $ 40.44 b.Rate $ 40.44 c.Units Purchased 296,74!c.Units Purchased n/a c.Units Purchased 49.46 c.Units Purchased 1.063.30 5.Day Care 5.Day Care 5.Day Care 5.Day Care a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 6.Day=Night 6.Day=Night 6.Day=Night 6.Day=Night a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 7.Drop-In/Self-Hell)Centers 7.Drop-lu/Self--Help Centers 7.Drop-lu/Self--Help Centers 7.Drop-lu/Self--Help Centers A.T02A1 MA2CIl S, ,'7,791,00%A.T02A1 MA2CIl A.T02A1 MA2CIl A.T02A1 MA2CIl b.Rate $, 296.30 b.Rate b.Rate b.Rate c.Units Purchased 26,29 c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased i>/a S.In Homeand On-Site Senices S.In-Home and On-Site Senices S.In-Home and On-Site Senices S.In-Home and On-Site Senices a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 9.Inpatient 9.Inpatient 9.Inpatient 9.Inpatient a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 10.Intensive Case Management 10.Intensive Case Management 10.Intensive Case Management 10.Intensive Case Management a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 11.Intervention 11.Intervention 11.Intervention 11.Intervention .............. .............. ....,......... .....,........ .. .... .......... ..,........ .....,.,.,.,.,.,........ a.Total Match $ 20.000.00 a.Total Match a.Total Match $, - ''..a.Total Match $ 25.000.00 b.Rate $ 62.98 b.Rate b.Rate "b.Rate c.Units Purchased 317.56 c.Units Purchased n/a c.Units Purchased pia c.Units Purchased 396.95 12.Medical Sen4ces 12.Medical Sen4ces 12.Medical Sen4ces 12.Medical Sen4ces A.T02A1 Match A.T02A1 MA2CIl A.T02A1 Match A.T02A1 Match b.Rate $ 389,86 b.Rate b.Rate b.Rate c.Units Purchased 316,72%c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 13.Methadone Maintenance 13.Methadone Maintenance 13.Methadone Maintenance 13.Methadone Maintenance a.Total Match a.Total Match a.Total Match a.Total Matclu b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 14.Outpatient-Individual 14.Outpatient-Individual 14.Outpatient-Individual 14.Outpatient-Individual a.Total Match $ 13,978,00; ............. .............. v ..,........ .....,.........,........ i A.TOLAL Match A.Total Match � 'i0,000,(Yb i A.TOmL Match b.Rate $, 91,011 b.Rate b.Rate $, 9109'b.Rate c.Units Rrchased 153.45;c.Units Purchased n/a c.Units Purchased 219.55 c.Units Purchased n/a 15.Outreach 15.Outreach 15.Outreach 15.Outreach A.Total Match $, 4$,040,00 A.Total Match A.Total Match $, 4,10,0,0b:A.Total Match $, 21.573,04 b.Rate $, !4,3It 11 b.Rate b.Rate $, 43,04!b.Rate $, 43,04, c.Units Purchased 11,15,c.Units1huchased n/a c.Units Purchased 95,26 c.Units1huchased 16.Prevention 16.Prevention 16.Prevention 16.Prevention ,( A.Total Match ......... ........ A.T02AlMatch ......... ......... A.Total Match ......... .......... A.Total Match 15%66 b.Rate b.Rate b.Rate b.Rate $, 43,20 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased 360k0 17.Pr evention/Intervention-Day 17.Pi evention/Intervention-Day 17.Pi evention/Intervention-Day 17.Pi evention/Intervention-Day a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 18.Residential Level I 18.Residential Level I 18.Residential Level I 18.Residential Level I A.Total MA2C11 . $, ! 00 A.Total MA2C1 A.Total MA2C1 A.Total MA2C1 2Ib.Rate b.Rate b.RAteb.Rate c Units Purchased 340,071 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 19.Residential Level II 19.Residential Level II 19.Residential Level II 19.Residential Level II a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 20.Residential Level III 20.Residential Level III 20.Residential Level III 20.Residential Level III a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a Guidance/Care Center, Inc. Local Match Contract No. ME225-4-27 Page 1 of 2 07/01/2013 PART HI-NEEY LOCAL MATCH PLAN SUMMARY FY 2013-2014 AMH Total $ 543.849.00 Angeacy Name: Guidance/Care Centex,Inc. CMH Total $ - Contrac[Nmnber: NM225-4-27 ASA Total $ 290.008.42 Date:7/l/2013 CSA Total $ 105.151.00 Grand Total $ 939 008.42 ADULT MENTAL ktEAT,TH ; CH11,I)REN'S MiTNTAL HiEAL'TU AWIT SUBSTANCE ABUSE C111I.11iiEN'S SUBSTANCE ABUSE 21.Residential Level IV 21.Residential Level IV 21.Residential Level IV 21.Residential Level IV a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units thucbased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 22.Respite Sen4ces 22.Respite Sen4ces 22.Respite Sen4ces 22.Respite Sen4ces a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 23.Sheltered Employment 23.Sheltered Employment 23.Sheltered Employment 23.Sheltered Employment a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 24.Substance Abuse Detoxification 24.Substance Abuse Detoxification 24.Substance Abuse Detoxification 24.Substance Abuse Detoxification A.Total Match A.Total Match A.TOLAL Match $ i7I1,4g4.64`A.TOLAL Match b.Rate b.Rate b.Rate $ 2(Y494 b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased $29,51 c.Units Purchased n/a 25.Supported Employment 25.Supported Employment 25.Supported Employment 25.Supported Employment a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 26.Supported Housing/Living 26.Supported Housing/Living 26.Supported Housing/Living 26.Supported Housing/Living A.T02A1 MA2CIl � �,ti(r�,lT4 i A.T02A1 MA2CIl A.T02A1 Match A.T02A1 Match b.Rate $ 5i,99 b.Rate b.Rate b.Rate c.Units Rrchased TISAI c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 27.TASC 27.TASC 27.TASC 27.TASC a.Total Match a.Total Match a.Total Match '''-a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units thuchased i>/a c.Units Purchased n/a c.Units Purchased pfa c.Units Purchased n/a 28.Incidental Expenses 28.Incidental Expenses 28.Incidental Expenses 28.Incidental Expenses a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 29.Aftercare 29.Aftercare 29.Aftercare 29.Aftercare a.Total Match $ a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 30.Information and Referral 30.Information and Referral 30.Information and Referral 30.Information and Referral .............. .............. ........................ ........................ ..,........ .....,.........,........ a.Total Match $ 10.000.00 a.Total Match a.Total Match a.Total Match b.Rate $ 27.08 b.Rate b.Rate b.Rate c.Units P.chAsed 369.28 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 31.Reserved 31.Reserved 31.Reserved 31.Reserved 32.Outpatient Detoxification 32.Outpatient Detoxification 32.Outpatient Detoxification 32.Outpatient Detoxification a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 33.Reserved 33.Reserved 33.Reserved 33.Reserved 34.FACT Team 34.FACT Teanr 34.FACT Teanr 34.FACT Teanr a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 35.Outpatient-Group 35.Outpatient-Group 35.Outpatient-Group 35.Outpatient-Group .............. .............. ....,......... .....,........ ....,......... ...6i......... ..,........ .....,.........,........ A.Total Match A.TOLAL Match A.TOLAL Match $ 9.3OI.42 A.TOLAL Match b.Rate b.Rate b.Rate $ 22.77 b.Rate c.Units Rrchased n/a c.Units Purchased n/a c.Units Purchased 408.49 c.Units Purchased n/a 36.Room&Board with Supen4sion Level I 36.Room&Board with Supervision Level I 36.Room&Board with Supervision Level I 36.Room&Board with Supervision Level I a.Total Match a.Total Matclu 1 a.Total Match 1 a.Total Match b.State Rate b.Rate b.Rate b.Rate c.Hours or Units Purchased I n/a c.Hours or Units Purchased n/a c.Hours or Units Purchased I n/a c.Hours or Units Purchased n/a 37.Room&Board with Supervision Level II 37.Room&Board with Supervision Level II 37.Room&Board with Supervision Level II 37.Room&Board with Supervision Level II a.Total Matclu a.Total Matclu a.Total Match a.Total Match b.State Rate b.Rate i b.Rate b.Rate c.Hours or Units Purchased n/a c.Hours or Units Purchased n/a c.Hours or Units Purchased i>/a c.Hours or Units Purchased n/a 38.Room&Board with Supervision Level IH 38.Room&Board with Supervision Level IH 38.Room&Board with Supervision Level IH 38.Room&Board with Supervision Level IH a.Total Match1 a.Total Match 1 a.Total Match 1 a.Total Match b.State Rate b.Rate b.Rate b.Rate c.Hours or Units Purchased I n/a c.Hours or Units Purchased n/a c.Hours or Units Purchased I n/a c.Hours or Units Purchased n/a 39.Short-term Residential Treatment 39.Short-term Residential Treatment 39.Short-term Residential Treatment 39.Short-term Residential Treatment a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 40.Mental Health Clubhouse Services 40.Mental Health Clubhouse Services 40.Mental Health Clubhouse Services 40.Mental Health Clubhouse Services a.Total Match a.Total Match a.Total Match a.Total Match b.Rate b.Rate b.Rate b.Rate c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a AMH Total $ 543.149.00 CMH Total $ ASA Total $ 290.008.42 ICSA Total $ 105.151.00 Guidance/Care Center, Inc. Local Match Contract No. ME225-4-27 Page 2 of 2 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,1aam% Rev. 01/10/2013 Exhibit I Family Intervention Services (FIS)and Adult Intervention Services (AIS) Provider Protocols POLICY: It is the policy of South Florida Behavioral Health Network (SFBHN) to establish protocols for treatment providers that receive referrals and/or provide services to consumers that have been identified as FIS/AIS consumers. These protocols have been established to ensure that this high-risk, priority population receives expedited services. PROCEDURE: In accordance to the SFBHN Contract, the items delineated below are the contractually required protocols for any consumer that has been identified as an FIS or AIS and has been referred to an SFBHN treatment provider. SFBHN will be notified by the FIS/AIS program if a provider is not complying within these established protocols. FIS Screening: a) The FIS/AIS Case Manager conducts a screening at the request of the DCF Protective Investigator(PI) b) Should the initial screening determine that the consumer is in need of behavioral health services, the FIS/AIS Case Manager will make a referral to a treatment provider for a full assessment and linkage to services as specified below. Referrals: a) The FIS/AIS Case Manager will contact the treatment provider to request an appointment for an individual that has been identified by the DCF Protective Investigator (PI) as being in need of FIS/AIS services. I. The FIS/AIS Case Manager will submit the SFBHN Consent to Release Information and the FIS/AIS Referral form as part of the referral packet. b) The Provider must provide the FIS/AIS case manager an appointment for intake within seven 7 calendar days of the initial phone call. An appointment must be provided within this timeframe regardless of the indigent consumer's ability to pay. Consumers will be financially assessed utilizing the sliding fee scale as specified in SFBHN main contract with the network provider. For consumers with insurance, referrals will be made directly to a provider who accepts that insurance. I. Should the consumer be a no-show at the appointment, the provider will notify the FIS/AIS case manager within 24 hours of the no-show. ii. Should the consumer need services not available at the provider, the provider will ensure linkage to recommended services and notify the FIS/AIS case manager. Substance Abuse: a) Assessment: Prior to the referral to the treatment provider, the FIS/AIS Case Manager will complete an initial screening assessment and a copy will be provided to the treatment provider at the time of referral. The FIS/AIS consumer must have a GAIN I assessment completed within 20 days of admission into Outpatient SA Treatment. The completed assessment must be provided to the FIS/AIS Case Manager within this timeframe. If the consumer is placed in Residential SA Treatment, the GAIN I is due within 5 days of admission. Upon completion of the GAIN, the provider will provide a copy to the FIS/AIS case manager. Guidance/Care Center, Inc. Exhibit I Contract No. ME225-4-27 Page 1 of 2 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,1aam% Rev. 01/10/2013 b) Drug Testing: The initial drug test is conducted by the FIS/AIS worker prior to the referral to the treatment provider. Subsequent weekly random drug testing will be conducted by the treatment provider commencing the date of admission. At minimum, all FIS/AIS consumers must be drug tested once a week during the first 2 weeks of treatment. After the initial 2 weeks, random drug testing will occur by the provider based on the consumer's progress in treatment and the results of those drug screening will be provided to the FIS/AIS Case Manager until the case has been closed. Should the consumer be court involved, drug screenings will be conducted at the intervals required by the courts. When the consumer is discharged from the FIS/AIS program, subsequent random drug screenings will be conducted as specified in the consumer's individualized treatment plan. Mental Health: a) Assessment: The FIS/AIS consumer must have a complete Bio-psychosocial assessment completed within 20 days of admission into Outpatient MH Treatment. If the consumer is placed in Residential MH Treatment, the assessment is due within 5 days of admission. The completed assessment must be provided to the FIS/AIS Case Manager within these timeframes. Upon the implementation by the Managing Entity of a network mental health assessment, the provider will use the identified assessment for all FIS/AIS consumers. Documentation a) The Provider will submit weekly progress reports during the first two weeks of treatment to the FIS/AIS Case Manager. After the initial two weeks, monthly treatment summaries will be submitted until such time as the case is closed with the DCF Protective Investigations Unit (PI). b) The standardize FIS/AIS Treatment Summary Form will be utilized. I. The form must be submitted at the required intervals as specified above. ii. It must be completely filled out including: client demographic information, diagnostic information, progress in treatment, and urinalysis results (if applicable). iii. The form must be signed and dated by the treating clinician. c) The Provider will coordinate with the FIS/AIS Case Manager and/or the DCF PI to participate in staffings as required. Direct Referrals from Protective Investigators (Pis) a) Should a provider receive a direct referral from a PI, the provider will accept the consumer into treatment and notify the Managing Entity of the occurrence. Guidance/Care Center, Inc. Exhibit I Contract No. ME225-4-27 Page 2 of 2 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% Exhibit J Family/Adult Intervention Specialist(FIS/AIS) Treatment Summary Report Initial ❑ Weekly ❑ Monthly ❑ Agency: Date: Client Name: Social Security Number: DOB: Axis I: Axis II: Axis III: Axis IV: Axis V: Progress in Treatment: Urinalysis Results: Therapist Signature and Title: Print Name: Guidance/Care Center, Inc. Exhibit J Contract No. ME225-4-27 Page 1 of 1 § / ill j k 7 / \ % } � \ / % - / § $ � w / ■ _ _ = p k c ¥ x / LU § •— % � � 0 E ] D � CL U \ � @ \ ) � \ ) � 3 : \ : P6� °iouthLllvuu°ii.daBehariwuiraall III Icallth Networh,faam% Exhibit L Assisted Livinq Facilities with Limited Mental Health License Authority: s. 394.4574, F.S. Network providers that enter into a cooperative agreement with an Assisted Living Facility-Limited Mental Health (ALF-LMH) that are also responsible for providing case management services to mental health residents in the ALF-LMH shall: 1) Ensure that the ALF-LMH where the consumer is residing at, or referred to, maintains a current Agency for Health Care Administration (AHCA) license for ALF-LMH facilities. The network provider shall maintain a copy of the AHCA ALF-LMH facility license in each consumer file. Referrals to unlicensed ALF-LMH are unlawful and are subject to sanctions by AHCA. The ME shall monitor the network provider's compliance with the terms and conditions of this exhibit. 2) Ensure that all mental health residents as defined in s. 394.4574 (1) F.S. are assessed by a psychiatrist, clinical psychologist, clinical social worker or psychiatric nurse or 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. 3) Ensure that case managers are assigned to all ALF-LMH residents who meet criteria as a mental health resident. If the resident declines case management, case managers must attempt to engage the person for a period not less than 30 days and document efforts in the ALF records. If the mental health resident continues to decline services, they must be encouraged to do so in writing, unless that is also refused. Documentation of a resident's declination of case management services and stated reason for declination must be maintained in case records at the ALF-LMH. 4) Ensure that individuals living in ALF-LMH and meeting the definition of a mental health resident served by the network provider are offered mental health services needed, including but not limited to case management, psychiatric medication treatment, access to drop-in centers, clubhouses and other services where available. 5) Ensure that a cooperative agreement to provide mental health services, including case management as required in s. 429.075 F.S, is developed between the network provider and administrator of the ALF-LMH. 6) Ensure that the cooperative agreement identifies, at a minimum: mental health services available; contact information for both the ALF Administrator and mental health provider, including after-hours emergency access; transportation provision; and services and activities available at the ALF-LMH. The ALF-LMH administrators must also be given contact information for the Department's Circuit Substance Abuse Mental Health Program Office and the managing entity, as appropriate. The cooperative agreement must contain a provision requiring the provider to maintain a file for each ALF- LMH client with copies of all required documentation. All ALF-LMH client records must be available for production by the network provider for monitoring purposes. 7) Ensure that the Cooperative Agreement is annually updated between the provider and the ALF-LMH Administrator. 8) Ensure that an annual community living support plan, as defined in s. 429.02 F.S., is prepared by the assigned case manager and the resident served, in consultation with the ALF-LMH administrator of the facility in face-to-face meetings. At a minimum, meetings will be held for initial plan development and annual updates to the plan. More frequent meetings shall be held as necessary to resolve Exhibit L Guidance/Care Center, Inc. Page 1 of 2 Contract No. ME225-4-27 °iouthLllvuu°ii.daBehariwuiraall III Icallth Networh,faam% 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. 9) Report all concerns related to health and safety violations to appropriate officials at the Agency for Health Care Administration and the Department's Abuse Hotline at 1-800-962-2873. Exhibit L Guidance/Care Center, Inc. Page 2 of 2 Contract No. ME225-4-27 °iouth Fllvuu°idaa Behariuiraall III Ic allth Networh,faam% Rev. 07/01/2011 Exhibit M Clinical Supervision for Evidence-Based Practices 1. Description: Clinical Supervision for Evidence Based Practices takes place in either a one-on-one or group setting. The clinical supervision is an intervention that is provided to agency personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of evidence-based practices. In the case of specific evidence-based practices with defined clinical supervision protocols, the clinical supervisor is a person who is credentialed in those protocols. For the purposes of this document, an evidence-based practice is one that is based on accepted practices in the profession and is supported by research, field recognition, or published practice guidelines. Clinical supervision for evidence-based practices is intended to continuously improve the skills of individuals who provide services directly to clients. The supervision is an evaluative process, extending over time, and has the simultaneous purposes of enhancing the professional functioning of the clinician or group of clinicians, monitoring the quality of services provided to clients and providing feedback regarding those services to the trainee. The functional areas of clinical supervision for evidence-based practices include the following: • Monitor clinicians via observance of direct service provision or review of clinical documentation to ensure fidelity and consistency in adherence to accepted evidence-based treatment principles and practices • Supplement formal training knowledge with "real world knowledge" so clinicians can learn the practical application of evidence-based treatment practices • Determine the accuracy of clinicians' assessment and referral skills • Evaluate staff performance linked to utilization of evidence-based practices • Determine the appropriateness of the treatment or service intervention selected relative to the specific needs of the client served • Support the clinician in adopting new clinical practices through the provision of focused supervision, guidance and feedback • Provide clinician(s) a structured process to ensure efficient use of time and resources and allow time in supervision for reflection/practice on the quality of services offered to the clients • Reinforce positive attitudes among clinicians to adopt and implement the evidence-based practices Clinical Supervision services may be provided to groups (no more than 4 direct service staff per group) or to individuals in face-to-face and/or web-based learning setting. Both individual and group services are billable on the basis of a contact hour in increments of 1 hour per week, at a minimum. Reimbursement for clinical supervision service hours shall not exceed the contracted staff hour rate with a total annual reimbursement rate not to exceed $1,754.00 annually per clinician supervised. Total annual reimbursement for the provider agency shall not exceed $50,000.00. The billable hours of supervision will be documented by time log maintenance including date, start time, end time, names of supervisor and supervised clinician(s), and the functional area of supervision. The time log will be signed by both the supervisor and the clinician(s) receiving the supervision. An implementation plan must be approved by the department prior to the commencement of any activities reimbursable under this cost center. The clinical supervision plan will include the following: • Detailed description of the proposed evidence-based practice implementation • Description of how the practice will be integrated into the provider's clinical practices with an emphasis on minimizing negative impact on direct service provision • Listing of positions within the agency designated to provide the supervision and the required qualifications (degree, licensure, or specialized training in the implementation of evidence- based practices) position incumbents must have • Listing of positions within the agency identified to receive the supervision and the proposed number of billable hours of supervision per individual trainee • Presentation of the method to be used to measure the effectiveness of the chosen evidence- based practice, including expected outcomes and objectives (quantify via pre/post training tests) Guidance/Care Center, Inc. Exhibit M Contract No. ME225-4-27 Page 1 of 2 °iouth Fllvuu°idaa Behariuiraall III Ic allth Networh,faam% Rev. 07/01/2011 2. Programs: Adult Substance Abuse, Children's Substance Abuse 3. Unit of Measure: Contact Hour—direct supervision 4. Data Elements: a. Service Documentation —Duty Roster; (1) Recipient of Clinical Supervision name and identification number; (11) Clinical Supervisor name and identification number; (111) Date of Supervision; (IV) Duration, beginning and end time ; (V) Cost Center; and (VI) Program b. Audit Documentation —Time Log; (1) Recipient of Clinical Supervision name and identification number; (11) Clinical Supervisor name and identification number; (111) Date of Supervision; (IV) Duration, beginning and end time; (V) Cost Center; and (VI) Program 5. Unit cost rate: $ 67.44 per hour Guidance/Care Center, Inc. Exhibit M Contract No. ME225-4-27 Page 2 of 2 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% Exhibit N Special Provisions For the Indigent Drug Program 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: (a) Have an annual income that is at or below 150% of the Federal Poverty Income Guidelines, as published annually in the Federal Register. (b) 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. (c) If the individual has third party insurance for psychotropic medications but has temporarily been denied benefits for these medications, they may receive IDP medications until such time as eligibility has been reestablished. (d) 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. (e) The network provider shall participate in any regional training events made available by the Department. The network provider shall also participate in any training events made available by the Louis de la Parte Florida Mental Health Institute of the University of South Florida's Medicaid Drug Therapy Management System Program for Behavioral Health which is posted on the following website: http:Hflmedicaidbh.fmhi.usf.edu/. (f) The network provider shall for purposes of auditing and/or monitoring, retain and make available upon request a copy of the license and the permit issued in accordance with the requirements specified in s. 499.012(1)(d), F.S. Guidance/Care Center, Inc. Exhibit N Contract No. ME225-4-27 Page 1 of 1 a ' § m / \ oa j 2 * ■ _ ƒ 7 % / / U j q $ \ \ O x 0 / \ { a / .. 0 § \ \ I J « c 7 \ \ 2 \ f 4 w 7 E .0 kC k m 2 $ ƒ 2 ) k E 2 ° = n � � 2 0 \ S § R \ \ k a cr 2 / > I m cn 2 0 2 E k _ — / % 0 2 E a ■ 2 / \ k Co $ o b ? � £ § / \ k m / ƒ $ \ \ \ \ k k o � k � § « / 5 x ) a a @ CL 3 D- x o G # \ \ 2 m w — /CY 0 2 g u ° ° 2 � f \_ c 2 5 f 5 0 LL cr § m © g E ■ ■ \ Co a o \ C \ \ LU / k f / \ E ; 0 f_ U X \ k / § LU m o Co § u o � u 2 § § ± / 2 e e — � 0 r ° % Co = e \ co / \ � ' 0 3 \ G G G o dU- _ > 2 2 2 £ 0 / \ / / / % § / / lu \ a \ E E E ± m \ a e ® 3 3 3 % & } k ƒ \ o D o a) / § ? 0 c c _ a k k k / \ \ \ \ 0 0 \ \ \ % a o 0 0 o O R o R R R c _ — \ 0 § / / / : ^ / \ /f \ b 5 5 5 f \ ■ 2 « ■ 2 \ \ \ / °iouth Fllvuu°idaa Behariuiraall III Ic allth Networh,faam% Rev. 07/01/2011 Exhibit Q Missing Children The network provider agrees when services are for children who are adjudicated dependent where the care of the child is assigned to the department or network provider, to follow the procedures outlined in Rule 65C-30.019, F.A.C. and Rule 65C-29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175-85, entitled "Prevention, Reporting, and Services to Missing Children". The network provider will perform the departmental functions as described in Rule 65C-30.019, F.A.C. and CFOP 175-85 which correspond to the functional role of this contract. The network provider also agrees when services for children are community based and the child involved is not adjudicated dependent, to comply with all licensing and contracting requirements. 1. Definitions a. Designee - a person, contractual network provider or other agency or entity named by the department. b. Exigent Circumstances - situations that require immediate actions, such as the child is under the age of thirteen, believed to be out of the zone of safety for their age and development, mentally incapacitated, in a life threatening situation, in the company of others who could endanger their welfare or is absent under circumstance inconsistent with established behaviors. c. FDLE-MCIC - Florida Department of Law Enforcement-Missing Children's Information Center. d. Family Services Counselor - a professional position responsible for case management for children placements. The term includes Department of Children and Families staff and staff working for an agency named as a designee. e. Missing Child - a person who is under the age of 18 years; whose location has not been determined; is currently placed in an out-of-home care setting; court order in-home placement; or is the subject of an active abuse investigation in which the child has been sheltered, would have been sheltered if their location had become known, or who was in the physical custody of the department or a network provider when they went missing; and who has been or will be reported as missing to a law enforcement agency. 2. Reporting Missing Children a. The network provider agrees to immediately notify the family services counselor(s), their supervisor, and/or the CBC Lead agency, and the legal guardian to ensure that they are fully aware of the circumstances involving a missing child. b. The network provider shall ensure and document that the family services counselor(s), their supervisor, and/or the CBC Lead agency have assumed responsibility for taking all required steps to recover the missing child and are fully engaged. c. The network provider agrees to instruct caregivers, including relative and non-relative caregivers, and all other staff that might be required to report a child as missing to local law enforcement to immediately undertake the following activities, as applicable, and document all 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: Guidance/Care Center, Inc. Exhibit Q Contract No. ME225-4-27 Page 1 of 3 °iouth Fllvuu°idaa Behariuiraall III Ic allth Networh,faam% Rev. 07/01/2011 (1) Take a report of the missing child. (2) Assign a case number to the missing child report and provide the case number back to the caregiver or person who is reporting the child missing. (3) Provide local law enforcement with a recent high quality photo of the child, or provide local law enforcement with a recent high quality photo when one becomes available. (4) Request that a copy of the police report be provided to the family services counselor once a police report becomes available. (5) If the responding law enforcement officer refuses to take a missing child report, for any reason, the individual attempting to report the child as missing will document the officer's name and specific local law enforcement agency name and request to speak to the law enforcement agency Watch/Shift Commander. If the law enforcement agency Watch Commander refuses to take a missing child report and it is a caregiver that is attempting to report the child as missing, the caregiver will immediately contact the family services counselor or on-call staff and provide them with all information related to local law enforcement not issuing a missing child report. Once the family services counselor or on-call staff have learned that a local law enforcement agency will not issue a missing child report they will immediately seek assistance from the local area Community Based Care (CBC) Child Location Specialist or the Department of Children and Families Regional Criminal Justice Services Coordinator on resolving any issue related to reporting the child as missing to local law enforcement. (6) If it is a caregiver who has reported the child as missing to local law enforcement or attempted to report a child as missing to local law enforcement, they shall immediately notify the child's family services counselor or emergency on-call staff and provide them with the following information: (a) The law enforcement agency name that the child was reported as missing to or attempted to be reported as missing to; (b) The law enforcement missing child case number if one was issued by local law enforcement; (c) A copy of the law enforcement report when one is made available; (d) Detailed information on the child's overall state of mind and behavior prior to the child going missing; (e) Detailed description of what the child was last seen wearing; (f) Detailed information on possible locations that the child might be going to; and (g) Detailed information on any individuals that the child might be traveling with. e. If exigent circumstances do not exist, the caregiver , family services counselor, or other network provider staff will within the first four (4) hours of learning that a child might be missing check to see what, if any, of the child's personal belongings are missing or if the child left a note; and, the caregiver , family services counselor, or other staff (if the family services counselor is not yet engaged), will: (1) Contact the following persons as appropriate to ascertain if the child has been seen, or has given any indications that may explain the child's missing status: (a)School/child's teachers and school resource officer; (b)The child's relatives/parents, both local and non-local, if appropriate, and the caregiver has the means for such contact; (c)Any friends or places that the child generally frequents, the local runaway shelter, if there is one in the community; and, Guidance/Care Center, Inc. Exhibit Q Contract No. ME225-4-27 Page 2 of 3 °iouth Fllvuu°idaa Behariuiraall III Ic allth Networh,faam% Rev. 07/01/2011 (d)The child's employer, if applicable. (2) Write down any information gathered that might help locate the child. (3) Provide telephone/beeper numbers and ask for the individuals above to call back and share information if they have further information or see the child. f. If at any time during the initial four (4) hour search for the child, if the caregiver, family services counselor, or any other network provider employee (if the family services counselor is not yet engaged), becomes concerned about the immediate safety and well-being of the child, or the child's location remains unknown after four (4) hours from the time that the caregiver, family services counselor, or network provider employee learned that the location of the child was unknown, they shall immediately call local law enforcement and they shall follow the steps outlined in Section 2.a., above. g. If at any time, the child is located or returns to the caregivers home after law enforcement has been notified of the missing child case, all law enforcement agencies and other agencies that were notified of the missing child episode must be contacted immediately by the caregiver, family services counselor, or other network provider employee who made the report. If at any time new information is obtained on a possible location of the missing child, the caregiver, family services counselor, or any other employee of the network provider shall immediately contact all law enforcement agencies and other agencies that were notified of the missing child episode as to the possible location of the child. If the Family Services Counselor has been engaged, the network provider shall also inform them and the legal guardian of the new information once law enforcement has been notified. h. All of the department's documentation related to the missing child episode shall be completed and entered into the department's approved missing child reporting system within one working day of the family services counselor, on-call staff, or Community Based Care (CBC) Child Location Specialist learning of a missing child episode regardless of whether local law enforcement has issued a missing child report number. This includes the uploading of a recent high quality photograph of the child into the department's approved missing child reporting system. If local law enforcement has refused to issue a missing child report a dummy local law enforcement case number of 00000 and the name of the local law agency that refused to issue the missing child report shall be used to complete and enter the missing child episode into the department's approved missing child reporting system. Guidance/Care Center, Inc. Exhibit Q Contract No. ME225-4-27 Page 3 of 3 °iotith Fllvuu°idaa Behariuiraall III Ic allth NebVorl,,fn ca Exhibit R Child Welfare Quarterly Clinical Report 71 Abe YWNV4'AmYMdl:Itl4AVAMMi�WLV4,NY'Ys, I. The network provider shall complete typed quarterly progress report, as shown in Section II. below, and shall file it in the medical record. The network provider is required to provide to the Department of Children and Families or Community Based Care workers, immediately upon request, with the most recent quarterly written report detailing the progress, current status and therapeutic needs of the named child. II. CHILD WELFARE QUARTERLY CLINICAL REPORT Mental Health Agency Name: 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 Problem(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 III: Axis IV: CGAS: Psychotropic Medications: Y/N If yes:Name of Psychiatrist: Was Medication treatment Plan completed? Y/N If yes,date of court approval: Current medication and dosage: Previous medication,if applicable: Rational for current medication: Date that child started taking the medication.. Child's Treatment Summary/Therapeutic Recommendations: Therapist Signature Supervisor Signature Guidance/Care Center, Inc. Exhibit R Contract No. ME225-4-27 Page 1 of 1 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% Exhibit V Special Provisions for the Forensic Services Program The network provider will be responsible for ensuring the provision of mental health, substance abuse and ancillary services to individuals charged with felony offenses and 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(SRT) by the ME's Forensic Coordinator and/or Forensic Specialists shall be granted an on-site face-to-face interview with 72 hours of referral. Written findings and recommendations must be completed and submitted to the referral source and the regional forensic coordinator. (b) All individuals referred for admission to a residential treatment facility by the ME's Forensic Coordinator and/or Forensic Specialists will be granted an on-site face-to-face interview within a minimum of 72 hours of referral, 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 Forensic Coordinator. The network provider must submit written findings and recommendations to the referral source and the ME's Forensic Coordinator within 48 hours of client interview. (c) The network providers' case manager will coordinate services and provide the court with routine progress reports as required by the conditional release order Rule 65E-15.051(14), F.A.C. (d) The network providers' case manager will immediately consult the Forensic Specialist regarding any apparent conditional release violation. Network Provider staff will be responsible for notifying the court and the Forensic Specialist of any conditional release violations via affidavit or sworn statement per s. 916.17(2), F.S. (e) The network provider will not return individuals on conditional release to court prior to consultation with the ME's Forensic Coordinator and/or assigned Forensic Specialist, except in cases of physical aggression by the individual in question. (f) Programs must provide services in English, Spanish and Creole. (g) Diversion- The network provider will be responsible for the provision of services and the monitoring of individuals charged with felonies in the Miami-Dade and Monroe County Jails who are at risk of commitment to the Department of Children and Families, but who may be diverted to the community by the Forensic Team. i. The network provider will facilitate and coordinate the provision of mental health treatment, competency restoration training, residential care or housing with supervision, medical and auxiliary services if appropriate, case management and monitoring of individuals who are being diverted from commitment to the Department of Children and Families, pursuant to chapter 916, F. S. Guidance/Care Center, Inc. Exhibit V Contract No. ME225-4-27 Page 1 of 3 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% ii. The network provider will facilitate and support the activities of the Forensic Team by providing accommodations for the provision of competency restoration training at the provider's facility(ies). iii. The network provider 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. (h) Discharge Planning — The network provider will be responsible for ensuring the active collaboration with the forensic specialists in discharge planning activities for forensic clients at state treatment facilities i. The network provider will, per the request of the forensic specialists, participate in treatment team, and discharge planning meetings for forensic clients in state treatment facilities. ii. The network provider will assist the Forensic Team in the development and submission of conditional release plans, discharge plans to state treatment facilities and to the committing court. iii. If requested, the network provider will attend court hearings in the cases of individuals being discharged from state treatment facilities and ensure effective linkage to their service continuum. (i) Conditional Release Monitoring —The network provider will ensure that individuals on conditional release order in Dade and Monroe Counties, including individuals transferred into the counties from other circuits are monitored. i. 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 Forensic Coordinator is copied on written correspondence to the court. iii. The network provider will ensure the review of required monthly monitoring reports in order to intervene in problematic situations, to provide alternative treatment modalities when necessary, and to identify trends and issues that illustrate opportunities for improvement in service delivery. The network provider will bring the aforementioned situations, trends and issues to the immediate attention of the ME Forensic Coordinator. iv. The network provider will maintain current copies of conditional release orders. (j) Utilization Management - The network provider shall facilitate the Forensic Specialists' requirement to manage the residential treatment beds funded by community forensic dollars and the statewide community forensic beds in the Southern Region. This includes a short -term residential treatment facility and residential level 2 beds. (k) Statewide Community Forensic Residential Services i. Citrus Health Network, Inc.: The network provider agrees to make available eight (8) residential beds in the STAR Program, for eligible consumers from other circuits in need Guidance/Care Center, Inc. Exhibit V Contract No. ME225-4-27 Page 2 of 3 °iouthFllvuu°idaaBehariwuiraall III Icallth Networh,faam% of forensic mental health services placed by the ME. It is agreed that during the term of this agreement, these beds shall not be used for any other purpose. The network provider agrees that the ME's decision for placement is final and binding on all parties. The network provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports and to the individuals identified. ii. Psychosocial Rehabilitation Center, Inc. d/b/a Fellowship House: The network provider agrees to make available four (4) residential beds for eligible consumers from other circuits in need of forensic mental health services placed by the ME. It is agreed that during the term of this agreement, these beds shall not be used for any other purpose. The network provider agrees that the ME's decision for placement is final and binding on all parties. The network provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports and to the individuals identified. iii. Passageway Residence of Dade County, Inc.: The network provider agrees make available fourteen (14) residential level 2 beds for eligible consumers from other circuits in need of forensic mental health services placed by the ME. It is agreed that during the term of this agreement these beds shall not be used for any other purpose. The network provider agrees that the ME's decision for placement is final and binding on all parties. The network provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports and to the individuals identified. Guidance/Care Center, Inc. Exhibit V Contract No. ME225-4-27 Page 3 of 3 °iouthFllvuu°idaaBehaNIoraall III Icallth Networh,faam% Exhibit X Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services I. The network provider shall: (a) Submit an annual PATH application to the Mental Health Program Office as requested; (b) Provide support services for individuals who have a serious mental illness and/or substance abuse and are homeless or at imminent risk of becoming homeless; (c) Implement services and provide deliverables as set forth and described in each approved and signed Local Intended Use Application which is a requirement of the PATH grant application; (d)Submit Annual Data Report to SAMHSA; (e)Submit the Annual reapplication for the PATH Grant. II. 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 Guidance/Care Center, Inc. Exhibit X Contract No. ME225-4-27 Page 1 of 1 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,Iru% Exhibit AA Substance Abuse Family Intervention Specialist Services A. The network provider agrees to comply with the provisions of this exhibit and agrees to collaborate with the ME and the Department in executing the action steps identified in the Southern Region SAMH Integration with Child Welfare plan, herein incorporated by reference. 1. PURPOSE 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. 2. AUTHORITY 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.). 3. PROGRAM SPECIFIC TERMS 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. 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. 4. GEOGRAPHIC AREA& LOCATION a. Services will be provided to the residents of Monroe county and will be performed at the location 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 Guidance/Care Center, Inc. Exhibit AA Contract No. ME225-4-27 Page 1 of 5 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,Iru% 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. 6. PROFESSIONAL QUALIFICATIONS 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 parent(s)/caregiver(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-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. 8. REFERRALS TO FIS a. A referral shall be made when the child protective investigator suspects that parent(s)'/caregiver(s)' behavioral health disorders 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. 9. CASELOAD 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. 10. SCREENING 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 Guidance/Care Center, Inc. Exhibit AA Contract No. ME225-4-27 Page 2 of 5 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,Iru% 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. 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 of Miami-Dade/Monroe, Inc.within the community. 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 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; II. Linking clients to services as dictated by their needs; and III. Facilitating client's participation in treatment by removing barriers. 14. PROGRESS REPORT& STAFFING 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 Guidance/Care Center, Inc. Exhibit AA Contract No. ME225-4-27 Page 3 of 5 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,Iru% 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; II. The court issues a subpoena to the FIS; III. 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 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; II. The case is closed by the child welfare agency; III. 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. 17. CASE RECORDS 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 MEs contract manager. 18. DATA REPORTING REQUIREMENTS 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, Required Reports. Guidance/Care Center, Inc. Exhibit AA Contract No. ME225-4-27 Page 4 of 5 °iouth Fllvuu°idaa Behariuiraall III Ic allth Neovoil,Iru% 19. TRAINING 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. 20. INCIDENTALS FUNDS a. These funds may be used to remove barriers to treatment that are identified as problems in the client's intervention plan and to provide resources that are necessary to keep the family member in treatment. This funding may be used when no other resources are available. b. Uses of these funds include, but are not limited to, transportation, childcare, housing assistance, clothing, and educational/vocational assistance. Incidental funds may also be used for toxicology screens when they are identified as necessary in the client's screening or case management monitoring process, and in those instances when it is necessary to verify use or abstinence for a client in treatment. c. Although use of these funds for toxicology screens is allowable, this should only occur in situations where other resources are unavailable. Incidental Expense funds should primarily be used to fund clients' needs to remove barriers to treatment. d. Criteria for use of the incidental funds, procedures for accessing them, and the accounting for expenditures will be developed cooperatively between the provider, the FIS, and the ME's System of Care staff. The ME's System of Care staff will have final approval of the criteria, procedures, and accounting for these funds. e. Each month, the network provider shall submit a report to the ME's Sr. Accountant, which details year-to-date expenditures and the balance of the 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 Expense funds. 21. INCIDENTAL FUND REQUEST FORM a. The incidental fund request must contain, at a minimum, the information below: I. Name of the FIS accessing funds; II. Funds spent on behalf of(client name); III. Referral type (protective investigation/supervision); IV. Date of request; V. Description of Goods/Services requested; VI. How the purchase is related directly to the FIS intervention plan; VII. Goal/Reason for purchase amount requested; and VIII. FIS and approving authority signature with date. Guidance/Care Center, Inc. Exhibit AA Contract No. ME225-4-27 Page 5 of 5 dwawlllfllhi Florida B0uavioral tfw^wdfllhi w°fwow°IIk, line. Exhibit AC Special Provisions for Substance Abuse Prevention Services I. Special Provisions (1) The substance abuse prevention services network provider shall provide prevention services as outlined in 65D-30.013, F.A.C., and in accordance with this contract, the program description and Attachment V, Scope of Work. (2) Evidence Based Prevention: The network provider is required to use an evidence-based prevention program. If the network provider is involved in the validation process for prevention programs, the network provider must notify the ME's Director of Prevention Services annually on the progress of the validation process. (3) The prevention services network provider shall ensure that a PPT is contained in the Performance Based Prevention System. The "final" PPT shall be printed from PBPS and sent to the ME's contract manager for approval within thirty(30)days of contract execution. The ME shall review and approve the Prevention Program Tool (PPT). (4) 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 PBPS and complete online or face-to-face training within thirty (30) days of hire, and annually thereafter. The network providers shall submit an attestation certifying the completion of the data entry to the contract manager within thirty (30) days of completion. This applies to network providers, including subcontractors who have their own data system and upload data to PBPS. (5) 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. II. Performance Specifications a. Performance Measures i. The network provider agrees that the Performance Based Prevention System (PBPS) 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 specified by the ME. The network provider shall submit all service related data for clients funded, in whole or in part, by SAMH and/or local match funds. ii. 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 PBPS and complete the online or face-to-face training within thirty (30) calendar days of hire, and annually thereafter. The network providers shall maintain the certificate of Guidance/Care Center, Inc. Exhibit AC Contract No. ME225-4-27 Page 1 of 5 dwawlllfllhi Florida B0uavioral tfw^wdfllhi w°fwow°IIk, h1c. attendance for all participants for all trainings. This does not apply to network providers who have their own data system and upload data to PBPS. iii. In addition to the performance standards and required outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, in Section D. 6. Special Provisions, Performance Measures for Continuous Quality Improvement Programs, the provider shall also meet the requirements set forth in Attachment V, Scope of Work. b. Performance Evaluation Methodology The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs, the standard and outcomes in Section D. 6. Performance Measures for Continuous Quality Improvement Programs, and in Attachment V, Scope of Work, during the contract period, to determine if the network provider is achieving the levels that are specified. III. Network Provider Responsibilities a. Network Provider Unique Activities i. The network provider shall adhere to the deliverables as set forth in Attachment V, Scope of Work. ii. Renewals For prevention services awarded through the SFBHN Solicitation #003, Prevention Invitation to Negotiate, Prevention of Substance Abuse and Related Consequences, 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 of funds. Renewals for two (2) years and three (3) shall be made by mutual agreement and shall be contingent upon satisfactory performance, monitoring and evaluations as determined by SFBHN, subject to the availability of funds. Any renewal shall be in writing. iii. Pursuant to s. 394.74(3)(e), F.S., the network provider shall maintain data on the performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, for the types of services provided under this contract and maintain data specified in Attachment V, Scope of Work , for the types of prevention strategies under this contract. iv. To help develop and support capacity to address community substance abuse needs prevention services providers and substance abuse coalitions funded by the ME are required to enter into and/or maintain a memorandum of understanding. The network provider is required to submit a copy (ies) of the fully executed MOU to the ME Contract Manager by the date specified in the Exhibit C, Required Reports. IV. Co-Occurring Initiative (1) The substance abuse prevention services funded network provider shall perform the following tasks related to the co-occurring disorder service capability initiative: (a) Evaluate network provider co-occurring disorder service capability as directed by the Guidance/Care Center, Inc. Exhibit AC Contract No. ME225-4-27 Page 2 of 5 dwawlllfllhi Florida B0uavioral tfw^wdfllhi w°fwow°IIk, line. ME using the COMPASS-Prevention Tool with: i. A focus group of administrators and prevention services staff, ii. A minimum of one program or a sample of programs on or before June 30th of each year. iii. Follow-up evaluations done at least annually for each program or sample of programs; and iv. Programs or a sample of programs in accordance with timeframes outlined in the action plan for each contract year. (b) Develop and submit to the ME for approval an action plan for referring clients with co- occurring disorders by June 30th of each year of the contract term that details: (i) Networking capacities with local network providers in the community for persons with co-occurring disorders; (ii) Strategies and activities to develop or improve co-occurring disorder educational and referral capability; (iii) Timeframes for reviewing co-occurring disorder educational and referral capability within the prevention program. (c) Develop and submit to the ME a summary report by June 30th of each year that details: i. The types of network provider involvement in state and local co-occurring planning processes; ii. The number of times the COMPASS was used and the composition of the 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; iv. Overall progress toward co-occurring disorder educational and referral capability development in accordance with timeframes specified in the action plan. V. Continuous Quality Improvement Programs for Substance Abuse Prevention Services Network Providers (1) The network provider must maintain a continuous quality improvement program to objectively and systematically monitor and evaluate the appropriateness and quality of care, to ensure that services are rendered consistent with prevailing professional standards, and to identify and resolve problems. Additionally, the program must support activities to ensure that fraud, waste and abuse do not occur. Guidance/Care Center, Inc. Exhibit AC Contract No. ME225-4-27 Page 3 of 5 dwawlllfllhi ID^IDo 6da B0uavioi,al tfw^wdfllhi w°fwow°Ilk, line. (2) The network provider must have a quality assurance and improvement plan and processes through which quality is continually monitored to achieve the program's planned outcomes. A copy of this plan must be submitted to the ME upon request. Best practices for quality performance measures should be incorporated: experienced, well-trained staff, adequate participant-staff ratio, theory-driven programs, retention of research-based core elements, variety of teaching methods and interactive approaches, sufficient exposure to the services/intensity, Long-term prevention programs/duration and complementary components, positive relationships, cultural sensitivity and relevance, meaningful performance measures that are valid and reliable, and data for decision-making. Additionally, a minimum guideline for the network provider's continuous quality improvement program, including, but not limited to: (a) Ongoing efforts to improve products, services or processes to include ME initiatives; (b) Records maintenance, tracking and compliance as applicable; (c) Staff competencies, training, and development standards; (d) Evidence-based practices (EBPs) utilized by the agency and how these EBPs are monitored to ensure fidelity to the model; (e) Service-environment safety and infection control standards; (f) Incident reporting policies and procedures that include verification of corrective action and a provision that specifies that a person who files an incident report, in good faith, may not be subjected to any civil action by virtue of that incident report; and (g) Fraud, waste, abuse and other potential wrongdoing auditing, monitoring, and remediation procedures. (3) The continuous quality improvement program is the responsibility of the director and is subject to review and approval by the governing board of the service provider 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) Provide a framework for evaluating outcomes including: i. Output measures, such as capacities, technologies, and infrastructure that make up the system of care; ii. Process measures, such as administrative and supervision components; iii. Outcome measures pertaining to the outcomes of services; (b) Provide for a system of analyzing those factors which have an effect on performance; (c) Provide for a system of reporting the results of continuous quality improvement reviews; and, (d) Incorporate best practice models for use in improving performance in those areas which are deficient. (6) The ME may access all service network provider records and policies necessary to determine compliance with this section. Records relating solely to actions taken in carrying out this section and records obtained by the ME to determine a network provider's compliance with this section are confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution. Such Guidance/Care Center, Inc. Exhibit AC Contract No. ME225-4-27 Page 4 of 5 dwawlllfllhi ID^IDo 6da rlluaviw i'al tfw^wdfllhi w°fwow°Ilk, line. records are not admissible in any civil or administrative action except in disciplinary proceedings by the Department of Health or the appropriate regulatory board, and are not part of the record of investigation and prosecution in disciplinary proceedings made available to the public by the Department of Health or the appropriate regulatory board. Meetings or portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011. Guidance/Care Center, Inc. Exhibit AC Contract No. ME225-4-27 Page 5 of 5 South IFlorld,a Behavioral Health Network,Inc. Rev. 07/01/2012 ATTACHMENT II The administration of resources awarded by the Managing Entity to the network provider may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 215.97, F.S., as revised, the Managing Entity 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 Managing Entity 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 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 to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the department's inspector general, the state's Chief Financial Officer or the Auditor General. AUDITS PART I: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non-profit organization as defined in OMB Circular A-133, 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, 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 Managing Entity. 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 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 of Recovery 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 2 CFR 215.21 "Uniform Administrative Requirements for Grants and Agreements" and OMB Circular A-102 Common Rules provisions, recipients agree to maintain records that identify adequately the source and application of Recovery Act funds. OMB Circular A-102 is available at http://www.whitehouse.gov/omb/circulars/al02/a102.html. (b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," recipients agree to separately identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of Federal Awards (SEFA) and the Data Collection Form (SF—SAC) required by OMB Circular A-133. OMB Circular A-133 is available at http://www.whitehouse.gov/omb/circulars/al33/al33.html. This shall be accomplished by identifying expenditures for Federal awards made under the Recovery Act separately 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 as the first characters in Item 9d of Part III 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 Attachment II Guidance/Care Center, Inc. Page I of 3 Contract No. ME225-4-27 South IFlorld,a Behavioral Health Network,Inc. Rev. 07/01/2012 a recipient awards Recovery Act funds for an existing program, the information furnished to subrecipients shall distinguish the subawards of incremental Recovery Act funds from regular subawards under the existing program. (d) Recipients agree to require their subrecipients to include on their SEFA information 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 II:STATE REQUIREMENTS This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes. In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the recipient must have a State single or project-specific audit conducted in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities)or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. 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 Managing Entity, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with the 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. PART III: REPORT SUBMISSION Any reports, management letters, or other information required to be submitted to the Managing Entity pursuant to this agreement shall be submitted within 180 days after the end of the network provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes: A. Managing Entity Contract Manager for this contract(1 electronic copy and management letter, if issued ) B. 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://harvester.census.gov/fac/collect/ddeindex.html 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 by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450 Email address: flaudgen_localgovt@aud.state.fl.us Attachment II Guidance/Care Center, Inc. Page 2 of 3 Contract No. ME225-4-27 South IFlorld,a Behavioral Health Network,Inc. Rev. 07/01/2012 Network providers, when submitting audit report packages to the Managing Entity 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 network provider must be indicated in correspondence submitted to the Managing Entity 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 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 is issued, unless extended in writing by the managing entity. Attachment II Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-4-27 South Florida r0"o , Qeha�mra| *��0� Health Network,Inc. ATTACHMENT III CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief,that: (1) No federal appropriated funds have been paid urwill bo paid, byoron behalf of the undersigned, ioany person for influencing or attempting to |nUu*noo an officer or an employee of any agency, e member of coogoauu, an officer or employee of cnn8mss, or an *mp|*y°* ofa member nfcongress in connection with the awarding of any federal oontnoct, the making of any federal grant, the making uf any federal loan, the en1cr�ng into of any cooperative agaeeman,, and the extnnnion, xnnhnue1ion, enemm|, mmendment, 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 he paid to any person for influencing or attempting to influence an officer oremployee of any ogonoy, o member ofcongress, an officer or employee of congress, or an, employee of e member of congress in connection with this federal contract, grant, |oam, or cooperative pRnnoment. the undersigned shall complete and submit Standard Fom+ LLL. ^Disx|ouur* FurmtoReportLohbying.^inncro,denoaw|thita)nstructiona. (3) The undersigned shall nequJre that the language of this certification be included in the award documents for all sub-awards at all hors (including uubcon1noctn, sub'gnamte, and contracts under grants, loans and cooperative agreements)and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352. Title 31. U.G. 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 suchhai|una. ��A rllflo Signature Ae Name of AL11horized In6vidual Application or Contract Number NomaofOrganization Address of Organization CF 1123, PDF 03/80 6uidunoexCa/eCenier. |nu Attachment III Contract No. ME225-4-27 Page l of SOLIth i'lorida �15�0 " Behavioral lqetwork'Inc. ATTACHMENT IV Working Agreement for SSI/SSDI Outreach,Access,and Recovery (SOAR) Initiative Community Provider Agency 77ae ConmiimityProvidei-Agencysbafibave designated SOAR&alnedstsff w1io agree to do the Mowing.- 1.. Participate In the SOAR Initiative to il)CILICIC the submission of SOAR web-based data outlined in this Working Agreement. 2. Contact the identified Social Security Administration (SSA) liaison according to the COMI-nUnity Provider Agency's zip code,and create an individualized application submission procedure that will be utilized for all initial SOAR, applications. 'ne prw..,c,(1tu-e should include the agreed upon preferred method of coninninication with the SSA liaison-m.�, )w the protective,filing date will be established for each claim. 3. SLibnfit claims for SOAR applicants as soon as possible but within MO WCCkS of the notification,at the latest. 4. Complete and submit a SSA 1696 Appointment of Representative Form that will list the name of tile individual and the agency that will serve as the SOAR claimant's representative. This form will be submitted with the application. 5. I"OIIOV%l UP On any additional needed non-medical information for SSA within two working clays of notilication 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. 6. Receive notification from the SSA claims representative once the claim has cleared the non-medical process and has been sent to the Division of Disability Determinations (DDD). This notification will take place within 24 hours of sending the claim to the DDD. 7, Obtain all existing medical information and submit it to the DDD, once the application for SSI/SSDI is Completed. 8. Contact the DDD office within one week of notification of the claim having gone to the DDD to determine who the disability adjudicator is and make contact by phone with that adjudicator, notifying hinl/lier of working with a SOAR claimant, confirming the authorized representative Status, and informing the examiner of the records being collected. 9. Maintain contact with the DDD adjudicator as appropriate, to check oil the status of the claim and to Continue to submit information. 10, Submit all existing medical information and additional evaluation information to the DDD within 30 calendar days Of the submission of the application to the DDD by SSA, 11. Submit:the medical summary report to the DDD within 30 calendar days as well. 12. Collect data regarding SOAR applications and submit it on an ongoing basis, via the Policy Research Associait web-based data entry program. Lxecutive DiWctx)r(Pfint Name) Community Provider Agency Signature Date Guidance/Care Center, inc. Attachment IV Contract No. ME225-4-27 Page I of 1 South Florida ;'i"90do Behavioral Health(Network,Inc. ATTACHMENT V Scope of Work DESCRIPTION OF SERVICES(Include overall intention of program, outline of program activities,target population to be served, implementation of EBP,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, three middle schools and two elementary schools.The TGFDV Program will be available to all 101"graders attending any one of the three Monroe County High Schools, as well as youth living at Florida Keys Children's Shelter in Tavernier.The TGFD Program will be available to 51"and 61"graders attending Big Pine Academy, 7th and 81"graders attending Key Largo Middle School, and Plantation Key Middle School, and K-51"graders attending Stanley Switlik School, and 61"graders at Marathon Middle School. Site Name Street Address City Zip Code #Children/ # # Youth Parents Other Key West High School 2100 Flagler Ave Key West 33040 292 0 0 Coral Shores High School 89901 Old Highway Tavernier 33070 182 0 0 Key Largo Middle School 104801 Overseas Highway Key Largo 33037 196 0 0 Plantation Key Middle School 100 Lake Rd. Tavernier 33050 120 0 0 Stanley Switlik School 3400 Overseas Highway Marathon 33050 75 0 0 Marathon Middle High School 350 Sombrero Rd. Marathon 33050 190 0 0 Fla Keys Children's Shelter 73 High Point Rd. Tavernier 33070 40 0 0 Big Pine Academy 30220 Overseas Highway Big Pine 33043 28 0 0 Guidance/Care Center, Inc. Contract No. ME225-4-27 Attachment V Page 1 of 8 South Florida Behavioral Health(Network,Inc. PERFORMANCE MEASURES Quantity Activities/Service Name& Description (Include # # # #Required %To Meet Activity frequency, intensity, &duration of sessions, as well as Children/ Parents Others Sessions Required Level (1 or 2) the number of cycles expected to be offered and Youth tentative 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 each 2014 cohort Teen Intervene 50 0 0 85% 2 50 served from July 1, 2013 through June, 30, 2014 1 assessment 3 sessions for 1.5 hours each Environmental Strategy—Parents Who Host, Lose 51000 20,109 5,000 100% NA The Most 822 Environmental Public education, Social Marketing, Media Advocacy activities Strategy 400 Public Service Announcements on radio and monthly newspaper ads 5 press releases 250 Monthly Newsletters "Monroe Parents Know" distributed to community agencies/doctor offices/hospitals/schools 1 media campaign 10 presentations in the community 20 campaign posters in windows of local businesses 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 https://www.drugfreeactionalliance.org/parents-who- host/prevention Quantity Performance Measures Activity/Service Name and #of participants to receive Required#of sessions for %of participants Description 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 Guidance/Care Center, Inc. Contract No. ME225-4-27 Attachment V Page 2 of 8 South I l rida ;'i"90do Behavioral Health(Network,Inc. Too Good For Drugs Too Good For 1,123 10 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 activities 85%=51,527 Parents Who Host, Lose the Most participants Quality Description of the required program Quality measures. Quality Measure Measurement and Reporting Tool Timing Average number of sessions attended Participant sign-in sheets collected at each . At the end of each cohort of (Participant Retention) session—Pre and Post tests from each group sessions 85%of 1,123 participants or 955 will participant and each cohort • NOTE: Letters of Agreement complete Too Good for Drugs,Too Good for with all participating schools Drugs and Violence post test and a minimum will be submitted prior to of 8 sessions Participant satisfaction surveys implementation of each TGFD/TGFDV program 85%of 50 or 43 participants complete the Participant sign-in sheets collected at each Teen Intervene sessions—a minimum of 3 session Propose one (1) by July 31,2013,two (2) by August 30,2013,four(4) by sessions September 30,2013,six(6) by October Pre and Post tests from each participant 31,2013,five(5) by November 30, 2013,three(3) by December 31,2013, Participant satisfaction surveys five(5) by January 31,2014, six(6) by February 28,2014,six(6) by March 31, 2014,one(1) by April 30,2014,eight (8) by May 31,2014,and three(3) by June 30,2014 for a total of 50 youth. NOTE: Monroe County FCAT's tentatively scheduled for April,2014 Measure: (Survey and Logs) Guidance/Care Center, Inc. Contract No. ME225-4-27 Attachment V Page 3 of 8 South Florida ;'i"90do Behavioral Health(Network,Inc. #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 30, 2014 for youth in Teen Intervene Observation of service delivery/ Fidelity Curriculum fidelity checklist One time for each cohort (school) checklist in October 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 monitoring training/certification Participant Outcomes Outcome Data source/Measurement F Timing Associated Activity 1,123 youth will receive the 1. Data entered into the At admission into program NOTE: Continued staff TGFDV/TGFD curricula annually PBPS system &The GCC training per Mendez database At end of sessions Foundation 2. Client enrollment forms recommendations 3. Pre/post surveys Propose (every two (2)years). Each cohort to begin TGFD/TGFDV TGFCV/TGFD as follows: Key West High, sessions facilitated; September 2013, and February, Data collected and 2014 entered in database; Stanley Switlik School, August, Data analyzed; 2013 and ongoing for four(4) Program improvement quarters each 9 weeks activities Big Pine Academy, September, 2013 Outputs: 8 Of 10 Marathon Middle School, sessions September, 2013 Marathon High School, February, 2014 NOTE: Monroe County Coral Shores High School, August, FCAT's are tentatively 2013 scheduled for April, Florida Keys Children's Shelter, 2014 July 1, 2013 Plantation Key School, October, 2013 Plantation Key School, October, 2013 50 youth will receive Teen 1. Data entered into the At admission into the program Prior to delivery of I" Intervene annually PBPS system &GCC session database At end of sessions youth will 2. Client enrollment forms complete a post survey Sessions delivered Guidance/Care Center, Inc. Contract No. ME225-4-27 Attachment V Page 4of8 South l rida Behavioral Health(Network,Inc. Survey administered 85%of the youth will complete 1.Attendance records 1.Youth sign attendance records Youth sign the at least the required 10 2. Service deliver data for each session attendance record at sessions of TGFDV/TGFD entered into GCC database 2. Staff enter service delivery data the beginning of each curricula daily session 3. Post surveys administered at Post surveys the end of the sessions administered and data collected and analyzed 85%of the high school 1.Attendance records 1.Youth sign attendance records Youth sign the students will complete at least 2. Data entered into GCC at each session attendance record at the 3 required sessions of Teen database 2. Staff enter service delivery data the beginning of each Intervene daily/based on services rendered session 3. Post surveys administered at the end of the sessions Post surveys administered and data collected and analyzed 85%of the youth will improve TGFDV/TGFD pre/post tests Collected immediately prior to the During the first/last their attitudes and beliefs I"session and immediately sessions of the related to risk of harm of following the last session curriculum; for youth underage drinking 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 prior to the Youth will complete alcohol use in past 30-day by I"session and immediately the surveys; for youth curriculum completion following the last session only completing the 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 PBPS and/or SFBHN data Monthly Research and requested into the PBPS 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 Campaign materials targeting Promotion Parents Who July. 1, 2013-June 30,2014 MOU's with SAO, GCC, parents and adults in the Host Campaign "Monroe Parents Know" monthly Monroe Co. Coalition community to include monthly newsletters distributed and HSA. newsletters (Monroe Parents throughout Monroe County the Know), monthly newspaper first week of each month, PSA's on State Attorney's Office, ad P hr three (3) radio stations covering e r Attachment V Page 5 of 8 South I l rida ;'i"90do Behavioral Health Network,Inc. different radio stations Monroe County, each and Human Services throughout Monroe County, broadcasting the PSA's a minimum Associates to be ads on Monroe County Sheriff's of fifteen (15)times monthly at represented at the website, handouts at monthly targeted times of the day and Monroe County Student Advisory Council night, ads on Monroe County Coalition monthly meetings, Parents Who Host Sheriff's website corresponding to meetings the 3rd Stickers on front page of local major teen events in the County Tuesday of each newspapers such as Homecoming in October, month in Key West, FI Quarterly meetings with 2014, Spring Break in Feb, March, and to collaborate to Increased collaboration with Monroe County Sheriff's April, achieve outcomes of Law Enforcement in Monroe Office/Key West Police 2014,Pro min May,2014,Graduation EBP's; outcomes County to increase Department in June, 2014; monthly ads on the measured by monthly enforcement of Florida's Social Monroe Co.Schools website reports of each agency Hosting law of parents and reminding parents of the Florida at monthly Coalition adults providing alcohol to Host Law, Parents Who Host meetings; information minors handouts at monthly Student compiled by Coalition Advisory Council meetings I" Tuesday of each month at all three NOTE: Due to the (3) high schools beginning 9/2/13 elimination of —6/3/2014; Parents Who Host attorney's position at stickers placed on Keynoter and SAO, the money paid Increase arrests by both Key Free Press newspapers 1x in to hire him ($30,000), West Police and Monroe October, 2013, 1x in December, will be incorporated County Sheriff as a result of the 2013, 1x in April, 2014, 1x in May, back into Parents Who collaborations with both 2014. Host Campaign— departments proposed uses include video PSA's at three (3) Increased awareness of the movie theaters—one community as to the Florida Increased calls to Key West Call both police departments by in Key West, one in Host Law Police Department and to 151"of each month to get reports Marathon, and one in Monroe County Sheriff's of calls Tavernier, Florida; Department to report underage cinema PSA's to run drinking parties throughout 2013-2014 depending on cost;. Mailings, more staff time to distribute brochures, newsletters, and window clings, and placing of additional stickers on home- delivered newspapers; more radio PSA"s and more community presentations EVIDENCE BASED PROGRAMS(EBP) Guidance/Care Center, Inc. Contract No. ME225-4-27 Attachment V Page 6 of 8 South l rida ;";:11904 Behavioral Health(Network,Inc. 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), SAMSHA approved, NREPP Option 1 Too Good for Drugs (TGFD) Teen Intervene SAMSHA approved, NREPP Option 1 Parents Who Host, Lose the Most Promising Practice with research to support it Option 2 https://www.drugfreeactionaIIiance.org/parents- who-host/prevention TASK LIST Activities Year 1 Activities/Service Name& Description #&Type of EBP %to Meet Participants Recommended this Sessions or Hours Outcome Activity Title: Too Good For Violence/Too Good For Drugs 1,123 youth 1 hour for 10 85% Activity Description: Participants will be recruited from designated sessions schools and will receive a pretest assessment of their risk and protective factors.The curriculum will be administered once per week for 10 sessions and the post-test will be administered at the end of the sessions Frequency:One time upon program entry. Intensity: 8-10 sessions Duration: 1 hour per session. Activity Title:Teen Intervene Curriculum 50 youth 3 sessions @ 1.5 85% Activity Description: Participants will be required to attend 90 minute hour per session sessions Frequency:One time per week Intensity: Three sessions Duration:One 90 minute session Activity Title: Parents Who Host, Lose the Most 5000 822 100% Activity Description:. Participants will be reached by ads, radio PSA's, children/youth, mailings, community meetings, posters placed at local businesses, 20,109 parents, newsletters placed at local agencies 5000 others Frequency: PSA's 44 weeks Intensity:3x/day for 3 days per week Duration:30 seconds each Activity Title: Parents Who Host, Lose the Most 15-20 parents, 12 sessions 85% Activity Description: Community Meetings teachers,city Frequency: 1x monthly Aug 2013-July 2014 &,county Intensity: 12 meetings personnel, Duration:60 minute meetings business Attachment V Page 7 of 8 South I i rida ;";:11904 Behavioral Health(Network,Inc. leaders, community members Activity Title: Parents Who Host, Lose the Most 50 mailings Mailings =36 100% Description:. Mailings & Poster placement each Cycle to hrs/Cycle- Frepuency& Intensity: 4x Mailings, Poster placement 1x cycle 1, 1x key contacts in Posters=40 cycle2, Newsletters distributed 1x monthly, 2 cycles, Stickers placed on community for hrs. Free Press Newspapers/Keynoter Newspapers lxcycle 1 and lxcycle 2 outreach Newsletters Duration: 6 months support, 20 =40hrs, Poster/Sticker Newspapers=20hrs Placements at local businesses. Guidance/Care Center, Inc. Contract No. ME225-4-27 Attachment V Page 8 of 8 07/01/2012 South Florida Behavioral Inc.Health Network, STANDARD CONTRACT THIS CONTRACT is entered into between the South Florida Behavioral Health Network, Inc., (SFBHN) hereinafter referred to as the "Managing Entity" (ME) and Guidance/Care Center, Inc., hereinafter referred to as the "Network Provider." 1. Contract Document The Network provider shall provide services in accordance with the terms and conditions specified in this contract including all attachments, exhibits, the application filed with the Department of Children and Families by the Network Provider dated 06/12/2012, incorporated herein by reference, and any other documents incorporated by reference which constitute the contract document. 2. Requirements of Section 287.058, Florida Statutes (F.S.) The Network Provider shall provide units of deliverables, including reports, findings, and drafts, as specified in this contract. These deliverables must be received and accepted by the contract manager and/or designee, in writing prior to payment. The Network Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre-audit and post-audit; where itemized payment for travel expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061, F.S., or at such lower rates as may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the Network Provider in conjunction with this contract except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the Network Provider's failure to comply with this provision shall constitute an immediate breach of contract for which the ME may unilaterally terminate the contract. 3. Provisions of the Prime Contract All provisions, terms and conditions, or amendments, addendum, changes or revisions applicable to the Network Provider made subsequent to the initial execution of the Prime Contract, i.e., the Contract entered into between the DCF and SFBHN (ME), not in conflict with this Contract, shall be binding upon the Network Provider and the Network Provider agrees to comply with same. The Prime Contract is incorporated by reference in this Contract. In case of conflict with the provisions, terms and conditions of The Prime Contract and this Contract, the provisions, terms and conditions of this Contract will prevail. 4. Effective and Ending Dates This contract shall begin on November 1, 2012. It shall end at midnight, local time in Miami-Dade County, Florida on June 30, 2015, subject to the satisfactory performance by the network provider and subject to the availability of funds. 5. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate state court in Miami-Dade County, Guidance/Care Center, Inc. Page 1 of 121 Contract#PPG-1-06 07/01/2012 Florida. 6. Federal Law a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations. b. If this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (40 CFR, Part 30). The Network Provider shall report any violations of the above to the ME. c. No federal funds received in connection with this contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of$100,000, the Network Provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment III. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to payment under this contract. d. Unauthorized aliens shall not be employed. The ME shall consider the employment of unauthorized aliens a violation of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be cause for unilateral cancellation of this contract by the ME. Pursuant to Executive Order11-2 signed on January 4, 2011, the Network Provider, and if applicable all subcontractors for work contemplated under this contract, shall use the E-Verify system established by the U.S. Department of Homeland Security to verify the employment eligibility of its employees and the subcontractors' employees performing under this contract. e. If this contract contains $10,000 or more of federal funds, the Network Provider shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 and 45 CFR, Part 92, if applicable. f. If this contract contains federal funds and provides services to children up to age 18, the Network Provider shall comply with the Pro- Children Act of 1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both. 7. Audits, Inspections, Investigations, Records and Retention a. The Network Provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income and expenditures of funds 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 (6) years after completion of the contract or longer when required by law. In the event an audit is required by this contract, records shall be retained for a minimum period of 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 ME. Guidance/Care Center, Inc. Page 2 of 121 Contract#PPG-1-06 07/01/2012 c. Upon demand, at no additional cost to the ME, the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME, State, and Federal auditors, pursuant to 45 CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment IV. g. The Network Provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by The Office of the Inspector General (section 20.055, F.S.). h. The Network Provider shall include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and assignments. 8. Monitoring by the ME The Network Provider shall permit all persons who are duly authorized by the ME to inspect and copy any records, papers, documents, facilities, goods and services of the Network Provider which are relevant to this contract, and to interview any clients, employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the terms and conditions of this contract. Following such review, the ME will deliver to the Network Provider a written report of its findings, and may direct the development, by the Network Provider, of a corrective action plan where appropriate. The Network Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. This provision will not limit the ME's termination rights under Section 40. Failure to implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall be grounds for contract termination. 9. Indemnification a. The Network Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and hold harmless the ME, State and the Florida Department of Children and Families (DCF), and its officers, agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys' fees, arising from or relating to any alleged act or omission by the Network Provider, its agents, employees, partners, or subcontractors, provided, however, that the Network Provider shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or omission of the ME. b. The Network Provider shall fully indemnify, defend and hold harmless the ME, the State and the DCF, from any suits, actions, damages, and costs of every name and description , including attorneys' fees, arising from or relating to violation of infringement of a trademark, copyright, patent, trade secret or intellectual property right, provided, however, that the foregoing obligation shall not apply to the ME's misuse or modification of Network Provider's products or a ME's operation or use of Network Provider's products in a manner not contemplated by the contract or the purchase order. If any product is the subject of an infringement suit or in the Network Provider's opinion is likely to become the subject of such a suit, the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non-infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use, the ME shall not be liable for any royalties. The Network Provider's indemnification for violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this Guidance/Care Center, Inc. Page 3 of 121 Contract#PPG-1-06 07/01/2012 contract or delivered to the ME for the use of the ME, its employees, agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all claims and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or trade secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 34. d. The Network Provider shall not be liable for any cost, expense, 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 to evacuate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the ME negligent shall excuse the Network Provider of performance under this provision, in which case the ME shall have no obligation to reimburse the Network Provider for costs of its defense. If the Network Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the ME shall be to the extent permitted by section 768.28, F.S. or other applicable law, and without waiving the limits of sovereign immunity. 10. Insurance 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, unless it is a state agency or subdivision as defined by subsection 768.28(2), F.S., the Network Provider accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the Network Provider and the clients to be served under this contract. The limits of coverage under each policy maintained by the Network Provider do not limit the Network Provider's liability and obligations under this contract. Upon the execution of this contract, the Network Provider shall furnish the ME written verification supporting both the determination and existence of such insurance coverage. Such coverage may be provided by a self-insurance program established and operating under the laws of the State of Florida. The ME reserves the right to require additional insurance as specified in this contract. 11. Confidentiality of Client Information The Network Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 12. Assignments and Subcontracts a. The Network Provider shall not assign the responsibility for this contract to another party without prior written approval of the ME, upon the ME's sole determination that such assignment will not adversely affect the public interest; however, in no event may the Network Provider assign or enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned on full and faithful performance of Network Provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval of the ME shall be null and void. The Network Provider shall not subcontract for any of the work contemplated under this contract without prior written approval of the ME, which shall not be unreasonably withheld. b. The Network Provider shall ensure that all subcontract agreements for work contemplated under this contract, adhere to all of the requirements of the ME's Prime Contract with the department, and all the requirements of this contract. A copy of the contract can be found at the ME's website, www.sfbhn.org. c. To the extent permitted by Florida Law, and in compliance with Section 9. of this Standard Guidance/Care Center, Inc. Page 4 of 121 Contract#PPG-1-06 07/01/2012 Contract, the Network Provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the Network Provider or its subcontractors. Any subcontracts shall be evidenced by a written document. The Network Provider further agrees that the ME shall not be liable to the subcontractor in any way or for any reason. The Network Provider, at its expense, will defend the ME against such claims. d. The Network Provider shall make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the ME in accordance with section 287.0585, F.S., unless otherwise stated in the contract between the Network Provider and subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the Network Provider and paid by the Network Provider to the subcontractor in the amount of one-half of one percent (.005) of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15%) percent of the outstanding balance due. e. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under its contract with the ME to another governmental agency in the State of Florida, upon giving prior written notice to the ME. In the event the State of Florida approves transfer of the ME's obligations, the Network Provider remains responsible for all work performed and all expenses incurred in connection with the contract. This contract shall remain binding upon the successors in interest of either the Network Provider or the ME. f. The Network Provider agrees that it will award sub-grants to PPG Partners as described in its application and that it will do all things which it asserted that it will do in that application including, but not limited to, supervising and coordinating expenditures made by sub-providers. The Network Provider further agrees to assure that funds are expended for the purposes intended and that a full accounting for these grants funds is made. g. The Network Provider shall include, or cause to be included, in all subcontracts (at any tier) the substance of all clauses contained in this Standard Contract that mention or describe subcontract compliance. 13. Return of Funds a. The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network Provider by the ME and any interest attributable to such funds pursuant to the terms 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 made, the contract manager or designee, on behalf of the ME, will notify the Network Provider by letter of such findings. Should repayment not be made forthwith, the Network Provider will be charged interest on the outstanding balance after the ME notification or Network Provider discovery. Payments made for such services subsequently determined by the ME to be in full compliance with the contract requirements shall be deemed overpayments. b. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utilization and Performance measures monitored by ME. 14. Client Risk Prevention and Incident Reporting If services to clients are to be provided under this contract, the Network Provider and any subcontractors shall, in accordance with the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner prescribed in CFOP 215-6 or circuit or region operating procedures. The Network Provider shall immediately report any knowledge or reasonable suspicion of Guidance/Care Center, Inc. Page 5 of 121 Contract#PPG-1-06 07/01/2012 abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Network Provider and its employees. 15. Civil Rights Requirements In accordance with Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, or the Florida Civil Rights Act of 1992, as applicable the Network Provider shall not discriminate against any employee (or applicant for employment) in the performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the Network Provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80, 83, 84, 90, and 91, Title VI of the Civil Rights Act of 1964, or the Florida Civil Rights Act of 1992, as applicable and CFOP 60-16. These requirements shall apply to all contractors, subcontractors, 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 Checklist, 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 of the Contractor a. In performing its obligations under this contract, the Network Provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the ME or the State of Florida, except where the Network Provider is a state agency. Neither the Network Provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME unless specifically authorized in writing to do so. This contract does not create any right to state retirement, leave benefits or any other benefits of state employees as a result of performing the duties or obligations of this contract. b. The Network Provider shall take such actions as may be necessary to ensure that each subcontractor of the Network Provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the ME or the State of Florida. The ME will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial or clerical support) to the Network Provider, or its subcontractor or assignee, unless specifically agreed to by the ME in this contract. c. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the Network Provider. 17. Sponsorship As required by section 286.25, F.S., if the Network Provider is a non-governmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program state: "Sponsored by (Network Provider's Name), Inc., South Florida Behavioral Health Network, and the State of Florida, Department of Children and Families". If the sponsorship reference is in written material, the words "South Florida Behavioral Health Network " and "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. 18. Publicity Without limitation, the Network Provider and its employees, agents, and representatives will not, without the ME's prior written consent in each instance, use in advertising, publicity or any other Guidance/Care Center, Inc. Page 6 of 121 Contract#PPG-1-06 07/01/2012 promotional endeavor any ME or State mark, the name of the ME's or State mark, the name of the ME, the State, or any ME or State affiliate or any officer or employee of the ME or the State, or represent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed by the ME, or refer to the existence of this contract in press releases, advertising or materials distributed to the Network Provider's prospective customers. 19. Final Invoice The final invoice for payment shall be submitted to the ME no more than fifteen (15) days after the contract ends or is terminated. If the Network Provider fails to do so, all rights to payment are forfeited and the ME will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Network Provider and necessary adjustments thereto, have been approved by the ME. 20. Use of Funds for Lobbying Prohibited The Network Provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a state agency. 21. Public Entity Crime Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the discriminatory vendor list. When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, or an entity or affiliate has been placed on the discriminatory vendor list, such person, entity or affiliate may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S., for CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. This provision applies to the Network Provider and all their subcontractors. 22. Gratuities The Network Provider agrees that it will not offer to give or give any gift to any ME employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the ME, any violation of this provision will result in referral of the Network Provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the Network Provider's name on the suspended vendors list for an appropriate period. The Network Provider will ensure that its subcontractors, if any, comply with these provisions. 23. Intellectual Property a. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals, presentations, films, or other copyrightable materials, arising in relation to Network Provider's performance under this contract, and the performance of all of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the ME, fully compensated for by the contract amount, and that neither the Network Provider nor any of its officers, agents nor subcontractors may claim any interest in any intellectual property rights accruing under or in connection with the performance of this contract. It is specifically agreed that the ME shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under this Guidance/Care Center, Inc. Page 7 of 121 Contract#PPG-1-06 07/01/2012 contract, or in any way connected herewith. Notwithstanding the foregoing provision, if the Network Provider is a university and a member of the State University System of Florida, then section 1004.23, F.S., shall apply. b. If the Network Provider uses or delivers to the ME for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by this contract. c. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida, then section 1004.23, F.S., shall apply, but the ME shall retain a perpetual, fully-paid, non-exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any state funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the state a security interest in the property at least to the amount of the state funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. As a condition of receipt of state funding for this purpose, the Network Provider agrees that, if it disposes of the property before the ME's interest is vacated, the Network Provider will refund the proportionate share of the state's initial investment, as adjusted by depreciation. 25. Information Security Obligations a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Network Provider employees that request or have access to any ME or DCF data system or information. b. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network Provider employees immediately upon termination of employment. c. The Network Provider shall provide the latest DCF security awareness training to its staff and subcontractors who have access to ME or DCF information. d. All Network Provider employees who have access to ME or DCF information shall comply with, and be provided a copy of CFOP 50-2, and shall sign the DCF Security Agreement form CF 0114 annually to the Managing Entity's contract manager and the Managing Entity's Director of Information Technology. A copy of CF 0114 may be obtained from the contract manager. e. The Network Provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data and storage devices are encrypted as prescribed in CFOP 50-2. If encryption of these devices is not possible, then the Network Provider shall assure that unencrypted personal and confidential ME or DCF data will not be stored on unencrypted storage devices. The Network Provider shall require the same of all subcontractors. f. The Network Provider agrees to notify the contract manager as soon as possible, but no later than five (5) business days following the determination of any breach or potential breach of personal and Guidance/Care Center, Inc. Page 8 of 121 Contract#PPG-1-06 07/01/2012 confidential ME or DCF data. The Network Provider shall require the same notification requirements of all subcontractors. g. The Network Provider shall provide notice to affected parties no later than 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. Accordingly, the ME has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the ME's Network Providers will either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a reasonable period of time. 27. Network Provider Employment Opportunities a. Agency for Workforce Innovation and Workforce Florida: The Network Provider understands that the DCF, the Agency for Workforce Innovation, and Workforce Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Agency for Workforce Innovation and Workforce Florida. b. Transitioning Young Adults: The Network Provider understands DCF's Operation Full Employment initiative to assist young adults aging out of the dependency system. The ME encourages Network Provider participation with the local Community-Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. 1320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164). 29. Emergency Preparedness a. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Network Provider shall, within thirty (30) days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the ME, or its contracted agents to ensure the safety, permanency and well-being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a non-licensed relative/non-relative home, or be placed in a licensed foster care setting. b. The ME agrees to respond in writing within thirty (30) days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the ME may exercise oversight authority over such Network Provider in order to assure implementation of agreed emergency relief provisions. Guidance/Care Center, Inc. Page 9 of 121 Contract#PPG-1-06 07/01/2012 c. An updated emergency preparedness plan shall be submitted by the Network Provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The ME agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME. The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal filing, whichever comes first. 31. Whistleblower's Act Requirements In accordance with subsection 112.3187(2), F.S., the Network Provider and its subcontractors shall not retaliate against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee. The Network Provider and any subcontractor shall inform its employees that they and other persons may file a complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle-blower's Hotline number at 1- 800-543-5353. 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or disclosure. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the Network Provider fails to promptly submit a redacted copy, the ME is authorized to produce the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard-of-Hearing Guidance/Care Center, Inc. Page 10 of 121 Contract#PPG-1-06 07/01/2012 a. The Network Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.F.R. Part 84 (hereinafter referred to as Section 504), the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP) 60-10, Chapter 4, entitled "Auxiliary Aids and Services for the Deaf or Hard-of-Hearing." b. If the Network Provider or any of its subcontractors employs fifteen (15) or more employees, the Network Provider shall designate a Single-Point-of- Contact (one per firm) to ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504, the ADA, and CFOP 60-10, Chapter 4. The name and contact information for the Network Provider's Single-Point-of-Contact shall be furnished to the ME's Grant or Contract Manager within fourteen (14) calendar days of the effective date of this requirement. c. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60-10, Chapter 4. A Single-Point-of-Contact shall be required for each subcontractor that employs fifteen (15) or more employees. This Single-Point-of-Contact will ensure effective communication with deaf or hard-of- hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the Network Provider's Single-Point-of-Contact. d. The Single-Point-of-Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60-10, Chapter 4. Further, employees of Network Providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60-10, Chapter 4. This attestation shall be maintained in the employee's personnel file. 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 services at no-cost to the deaf or hard-of-hearing customers or companions are posted near where people enter or are admitted within the agent locations. Such Notices must be posted immediately by Network Providers and subcontractors. The approved Notice can be downloaded through the Internet at: htti)://www.dcf.state.fl.us/admin/civiIrights/ f. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids/services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored. The Network Provider shall submit compliance reports monthly, by the 4th business day following the reporting month, to the ME's Grant or Contract Manager. The Network Provider shall distribute Customer Feedback forms to customers or companions, and provide assistance in completing the forms as 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 service employees shall 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 to their Attestation of Understanding, and maintain them in their personnel file. 34. Contract Amount The ME shall pay for contracted services according to the terms and conditions of this Contract in an amount not to exceed $433,341.00, subject to the availability of funds and satisfactory performance of all terms by the Network Provider. The remaining amount of $0.00 represents "Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of Guidance/Care Center, Inc. Page 11 of 121 Contract#PPG-1-06 07/01/2012 funds, may pay to the Network Provider, in whole or in part, or not at all, for Exemplary Performance by the Network Provider. Exemplary Performance will be determined by the Network Provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. 35. Contract Payment The ME has ten (10) working days, subject to the availability of funds, to inspect, approve, and issue payment to the network provider for good and services, unless the bid specifications, purchase order, or this contract specify otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if payment is not available within forty (40) days, measured from the latter of the date a properly completed invoice is received by the ME or the goods or services are received, inspected, and approved, a separate interest penalty set by the Chief Financial Officer pursuant to section 55.03, F.S., will be due and payable in addition to the invoice amount. Payments to health care providers for hospital, medical, or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment is determined. Financial penalties will be calculated at the daily interest rate of .03333%. Invoices returned to a Network Provider due to preparation errors will result in a non-interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment shall be made only upon written acceptance by the ME and shall remain subject to the subsequent audit or review to confirm contract compliance. 36. Financial Consequences for Network Provider's Failure to Perform If the Network Provider fails to meet the minimum level of service or performance identified in this 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 payment, withholding payments until deficiency is cured, tendering only partial payments, imposition of penalties per Section 39., and termination of contract and requisition of services form an alternate source. Any payment made in reliance on the Network Provider's evidence of performance which evidence is subsequently determined to be erroneous, will be immediately due as an overpayment in accordance with Section 13. above, entitled "Return of Funds" to the extent of such error. 37. Vendor Ombudsman A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this office are found in section 215.422, F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at (850) 413-5516. 38. Notice Any notice that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery. Said notice shall be sent to the representative of the Network Provider responsible for administration of the program, to the designated address contained in this contract. 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action a. In accordance with the provisions of section 402.73(1), F.S., and Rule 65-29.001, F.A.C., corrective action plans may be required for noncompliance, 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. b. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances exist, shall be based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, if imposed, shall not exceed ten percent (10%) of the total contract payments during the period in which Guidance/Care Center, Inc. Page 12 of 121 Contract#PPG-1-06 07/01/2012 the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of a ten percent (10%) penalty of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. c. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five percent (5%) penalty. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent (2%) penalty. 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 be terminated by either party without cause upon no less than thirty (30) calendar days' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the contract manager or the representative of the Network Provider responsible for administration of the program. This provision shall not limit the ME's ability to terminate this contract for cause according to other provisions herein. b. In the event funds for payment pursuant to this contract become unavailable, the ME may terminate this contract upon no less than twenty-four (24) hour notice in writing to the Network Provider. Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery. The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the Network Provider will be compensated for any work satisfactorily completed. c. In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than twenty-four (24) hours (excluding Saturday, Sunday, and Holidays) notice in writing to the Network Provider after Network Provider's failure to fully cure such noncompliance within the time specified in a written notice of noncompliance issued by the ME specifying the nature of the noncompliance and the actions required to terminate the contract. The ME's failure to demand performance of any provision of this contract shall not be deemed a waiver of performance. The ME's waiver of any one breach of any provision of this contract shall not be deemed to be a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions of this contract. The provisions herein do not limit the ME's right to remedies at law or in equity. d. Failure to have performed any contractual obligations with the ME in a manner satisfactory to the ME will be a sufficient cause for termination. To be terminated as a Network Provider under this provision, the Network Provider must have: (1) previously failed to satisfactorily perform in a contract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the ME; or (2) had a contract terminated by the ME for cause. Termination shall be upon no less than twenty-four (24) hour notice in writing. e. Should the termination of the contract be inevitable, the network provider shall work in collaboration with the ME to develop a transition plan and timeline to ensure the uninterrupted continuum of services to individuals served under this contract, to include but not limited to the transfer of client records. 41. Renegotiations or Modifications Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted Guidance/Care Center, Inc. Page 13 of 121 Contract#PPG-1-06 07/01/2012 retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently included in the ME's prime contract with the DCF. 42. Dispute Resolution 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 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 its representative for dispute resolution purposes, 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 of the respective parties. Upon referral to this second step, the Executive Directors of the parties shall confer in an attempt to amicably resolve the issue. If the Executive Directors of the parties cannot resolve the issue, then in that 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 of termination under Section 40. 43. Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (For Contracts Valued at $1,000,000.00 (total contract value), or more, awarded, extended, or renewed on or after July 1, 2011). The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described in s.219.473, F.S. Pursuant to section s.287.135(5), F.S., the ME may immediately terminate this contract for cause if the Network Provider is found to have submitted a false certification or if the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List during the term of the contract. Guidance/Care Center, Inc. Page 14 of 121 Contract#PPG-1-06 07/01/2012 44. Official Payee and Representatives(Names,Addresses,Telephone Numbers and E-Mail Addresses a.The Provider name, as shown on page 1 of this Contract, and c.The name,address,and telephone of the Contract Manager for mailing address of the official payee to whom the payment shall the ME for this contract is: be made is: Guidance/Care Center, Inc. Evelyn Kelly 3000 41s`Street Ocean South Florida Behavioral Health Network, Inc. Marathon, Florida 33050 7205 Corporate Center Drive, Suite#200 Miami, Florida 33126 Tel: (786)507-7461 E-Mail: elkellyCMF?ful b. The name of the contact person and street address where the d.The name,address,and telephone number of the representative Provider's financial and administrative records representative of the Provider responsible for the administration are maintained is: of the orociram under this contract is: Marianne Benvenuti, Regional Controller Frank Rabbito, Sr.Vice President 3000 41 st Street Ocean 3050 Biscayne Boulevard, Suite 900 Marathon, Florida 33050 Miami, Florida 33137 Tel: (305)434-7660 Ext.31:1131 Tel: (305)571-8600 E-mail:I fmr_a..b..bi1o..(? , �mo_,:gram E-mail: 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, 1,11,111,and IV and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME Prime Contract (which can be found at http://www.sfbhn.org), contain all the terms and: conditions agreed upon by the parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications, representations, or agreements, either verbal: or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents, the documents shall be interpreted in the following order of precedence: a. Attachment 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 bytheir undersigned officials as duly authorized. PROVIDER: Guidan re Center, Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED SIGNED BY: BY� NAME: Frank Rabbito NAM : ohn W. Dow TITLE: Sr.Vice President. (TIT LE: PresidentICEO DATE: DATE: Federal Tax ID#(or SSN#): 59-1458324 Provider Fiscal Year Ending Date: 06130 Guidance/Care Center, Inc. Page 15 of 121 Contract#PPG-1-06 07/01/2012 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" means an educational process or procedure intended to stimulate learning. (3) "Adaptation" is a modest to significant modification of an intervention to meet the needs of different people, situations, or settings. (4) "Adolescent" means a client who is receiving substance abuse treatment prevention services who is between the ages of 12 and 17. (5) "Adult" is an individual 18 years of age or older. (6) "Approaches" mean the methods used in dealing with or accomplishing a task or goal. (7) "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. (8) "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. (9) "Available Appropriations" means State and other governmental funds allocated for mental health and substance abuse services including Guidance/Care Center, Inc. Page 16 of 121 Contract#PPG-1-06 07/01/2012 prevention and the associated local matching funds. (10) "Baseline" is the initial time point in service interventions just before the intervention or treatment begins. The information gathered at baseline is used to measure change in targeted outcomes over the course of the services. (11) "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 (12) "Casual 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. (13) "Children/Youth" is an individual 0-17 years of age. (14) Client" (synonymous with recipients of services/individual(s) served) means any individual who is receiving services in any substance abuse or mental health program whose cost of care is paid, in part or in whole, by the Department, Medicaid, Medicaid capitated managed care entities, or local match. Individuals who take part in substance abuse prevention programs or services are referred to as participants. (15) "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. (16) "Coalition" is a formal 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. (17) "Community" means a specific geographic or demographic population. Geographic includes counties and municipalities. Demographic includes race, ethnicity, age, gender or any combination thereof. In terms of the Prevention Partnership program "Community" is a collaborative partnership between local community substance abuse coalitions with the primary goal of addressing underage alcohol issues in the surrounding communities. Guidance/Care Center, Inc. Page 17 of 121 Contract#PPG-1-06 07/01/2012 (18) "Community Conditions" is circumstances that underlie underage drinking or other 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. (19) "Community Events" mean generally, one-time activities that are conducted in response to a 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 fairs), 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 is a duplicated count (Indirect Prevention only). (20) "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. (21) "Community 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 assess problems related to substance use or abuse in their community, develop and facilitate a coordinated response to those problems, track and report on progress toward community goals and objectives, and build community capacity to implement evidence-based practices in planning and implementation. (22) "Community Prevention" 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 to change one or more community conditions. (23) "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. (24) "Comprehensive Community Action Plan" means a plan developed by a local, department recognized, community substance abuse coalition which Guidance/Care Center, Inc. Page 18 of 121 Contract#PPG-1-06 07/01/2012 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 to change conditions and factors that underlie alcohol and other drug problems and related consequences. The plan includes two goals: 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. (25) "Consequences" is 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. (26) "Consolidated Program Description" means the combination of all of the managing entity network providers' program descriptions and the managing entity program description. (27) "Consumer Price Index" is a measure of the average change in prices over time of goods and services purchased. (28) "Continuous Quality Improvement" means 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. (29) "Contract Manager" means 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. (30) "Contributing Factors" are more specific dimensions or aspects of constructs which collectively can be used to measure the theory to which they are linked. (31) "Co-occurring Disorder" means any combination of mental health and substance abuse in any individual, whether or not they have been already Guidance/Care Center, Inc. Page 19 of 121 Contract#PPG-1-06 07/01/2012 diagnosed. (32) "Co-occurring disordered family" means 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. (33) "Co-occurring Disorder Service Capability" means 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. (34) "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). (35) "Cost Analysis" means the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (36) "Cost Center" means 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. (37) "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 the service. (38) "Data Management" means activities that use data elements to track cost, utilization, quality of care and access to services within the network of providers. (39) "DCF PAM 155-2" means 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.fl.us/programs/samh/pubs_reports.shtm1, and is incorporated herein by reference. (40) "Department" means the State of Florida Department of Children and Guidance/Care Center, Inc. Page 20 of 121 Contract#PPG-1-06 07/01/2012 Families. (41) "Direct Contact" means activities conducted by a 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). (42) "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. (43) "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. (44) "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. (45) "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. Guidance/Care Center, Inc. Page 21 of 121 Contract#PPG-1-06 07/01/2012 (46) "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. (47) "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. (48) "Evidence-Based" means those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. (49) "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. (50) "Fidelity" is the degree to which the evidence-based practice implemented adheres to the practice's implementation design. (51) "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. (52) "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. (53) "Governing Board" means the Commission, Board of Directors, Board Guidance/Care Center, Inc. Page 22 of 121 Contract#PPG-1-06 07/01/2012 of Trustees, Governing Body, etc. (54) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act. (55) "Implementation" is the use of a prevention or service interventions in a specific community-based or other setting with a particular target audience. (56) "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. (57) "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 (58) "Indirect 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. 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." (59) "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). (60) "KIT Solutions" means the entity that maintains the database called Performance Based Prevention System (PBPS). (61) "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. (62) "Logic Model" is a tool that allows key stakeholders to develop a Guidance/Care Center, Inc. Page 23 of 121 Contract#PPG-1-06 07/01/2012 strategic plan to address an identified community problem. (63) "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. (64) "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. (65) "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. (66) "Needs Assessment Logic Model (NALM)" is a written rationale developed from epidemiology data that illustrates the connection between local substance use/abuse consumption patterns, consequences and intervening variables. This information determines the long-term outcome and is used in the development of the Comprehensive Community Action Plan to inform the identification of strategies and approaches to achieve that outcome. (67) "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. (68) "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. (69) "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. (70) "Overpayment" is for the purposes of this contract, the amount of Guidance/Care Center, Inc. Page 24 of 121 Contract#PPG-1-06 07/01/2012 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. (71) "Participant" is means any individual who takes part in targeted substance abuse prevention programs, activities or services which are paid, in part or in whole, by the Department through the ME. (72) "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/. (73) "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. (74) "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. (75) "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. (76) "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. (77) "Program Planning Tool (PPT)" is the data collection module contained in the PBPS 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. (78) "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). (79) "Prevention Service" is a structured schedule of activities designed so Guidance/Care Center, Inc. Page 25 of 121 Contract#PPG-1-06 07/01/2012 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). (80) "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. (81) "Promising Practices" is the use of practices that incorporate the best objective information available regarding effectiveness and acceptability. (82) "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. (83) "Protected Health Information" (PHI) is any information whether oral or recorded in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. (84) "Provider Network" (subcontractor or network provider) is 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. (85) "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. (86) "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 Guidance/Care Center, Inc. Page 26 of 121 Contract#PPG-1-06 07/01/2012 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. (87) "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. (88) "SAMH" means the Substance Abuse and Mental Health Programs within the Department. (89) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVE/VIS Program can and may provide assistance in verifying eligibility in cases where a client does not possess sufficient documentation. (90) "Schedule of Activities" is the written instructional content, materials, resources, and processes necessary to attain educational objectives (91) "Selective prevention" refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. (92) "Selective prevention" refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. (93) "Service Units" are those units of measure specified in Rule 65E- 14.021, F.A.C. and in the Substance Abuse Recovery Support Services, Adult Comprehensive Community Service Teams, Children's Comprehensive Community Service Teams and Clinical Supervision for Evidence Based Practices exhibits. (94) "Stakeholder" means individuals/groups with an interest in the provision of behavioral health services. (95) "State Designated Prevention Evaluation Contractor" is a comprehensive drug research center Contracted by the Department to Guidance/Care Center, Inc. Page 27 of 121 Contract#PPG-1-06 07/01/2012 evaluate prevention outcomes. (96) "Strategic Prevention Framework (SPF)" is the SPF is a community- based data driven approach to community mobilization that employs ongoing assessment and evaluation to move communities toward their goals of reducing 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) select 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. (97) "Strategies" is a plan of action or policy designed to achieve a major goal. (98) "Substance abuse" means a pattern of chronic or harmful use of alcohol, illicit or prescribed drugs that result in adverse physical, psychological, or social consequences. (99) "Substance Abuse and Mental Health Information System (SAMHIS)" means the Department's online data system which network providers are required to use to collect and report data and performance outcomes on individuals 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 DCF PAM 155-2. (100) "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. (Contract managers may delete if there is no prevention in this contract.) (101) "Sustainability" is the long-term survival and continued effectiveness of an intervention. (102) "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. (103) "Targeted Prevention" means education and other evidenced- based practices conducted with groups of individuals to reduce personal risk factors or substance abuse or strengthen protective factors. Guidance/Care Center, Inc. Page 28 of 121 Contract#PPG-1-06 07/01/2012 (104) "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. (105) "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. (106) "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. (107) "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 Prevention Partnership Grant (PPG) agreement are to fund rigorous, effective, evidence-based, substance abuse prevention programs and strategies intended to prevent or reduce Florida substance use and abuse rates at the community level. PPG activities must relate to the local community department-approved local Needs Assessment Logic Model (NALM) to show target population and subpopulation problems to be addressed. The goals and objectives of the Comprehensive Community Action Plan (CCAP) calls for evidence-based prevention program activities or strategies for which there is a demonstrated need. The target population, according to the state priorities, to be addressed through this agreement: x Past 30 day youth alcohol use Past 30 day youth marijuana use Prescription drug misuse (youth to age 20) 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 and/or children with behavioral health issues as authorized in section 394.9082, F.S., section 397.99, F.S. and in the Prime Contract, which is incorporated herein by reference. The Network Provider shall also collaborate with the Managing Entity to Guidance/Care Center, Inc. Page 29 of 121 Contract#PPG-1-06 07/01/2012 better meet the needs of individuals receiving services through this contract. The partnership process will be open, transparent, dynamic, fluid, and visible. The process shall also serve as an opportunity for collaboration to continuously improve the quality of services provided to the lives of the people of Florida. During the course of the 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 shall assist, upon request of the managing entity, in fulfilling its contractual obligations pursuant to the Prime Contract with the Department of Children and Families including but not limited to the following functions- (1) System of Care Development and Management; (2) Utilization Management; (3) Quality Improvement; (4) Data Collection, Reporting, and Analysis; (5) Financial Management; (6) Disaster Planning and Responsiveness b. Authority Section 394.9082, F.S., and the Prime Contract provides the Managing Entity with the authority to contract for these services. c. Scope of Service The following scope of service applies to the contract period and any renewal or extension- (1) The network provider is responsible for the administration and provision of services to the target population(s) indicated in Exhibit A, Participants to be Served, and in accordance with the tasks outlined in Section B.1.a., of this contract. Services shall also be delivered at the locations specified in, and in accordance with the Program Description, as required by Rule 65E-14.021 , F.A.C. which is herein incorporated by reference, and maintained in the ME's contract manager's file. (2) Services are to be delivered in the following county(ies). Miami-Dade County X Monroe County d. Major Program Goals Guidance/Care Center, Inc. Page 30 of 121 Contract#PPG-1-06 07/01/2012 (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 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 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/ and/or from the contract manager. e. Minimum Programmatic Requirements The network provider shall maintain the following minimum programmatic requirements- (1) System of Care The consumer-centered and family-focused system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self-determination and choice; (c) Be ethically, socially, and culturally responsible; and (d) Be dedicated to excellence and quality results. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; Guidance/Care Center, Inc. Page 31 of 121 Contract#PPG-1-06 07/01/2012 (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. 3. Clients to be Served See Exhibit A, Participants to be Served B. MANNER OF SERVICE PROVISION 1. Service Tasks The following tasks must be completed for each fiscal year covered in the contract period. a. Task List (1) The network provider shall adhere to the services as outlined in the approved Prevention Program Description and in as set forth in Attachment II, Scope of Work. (2) The network provider shall submit an activity work plan by 12/07/2012, and by July 31 of each fiscal year thereafter, to ensure that the program will be successful and on schedule and which shall be detailed as follows. • For indicated (Level 2) programs, all steps necessary to select the individual participants to participate in the program; for universal and selective programs (Level 1), all steps necessary to obtain authorization to conduct activities to the proposed groups. • A detailed 3 year plan for all intended activities to be performed during the grant period. Changes to the initial plan must be approved, in writing, by the Contract Manager prior to implementation. Guidance/Care Center, Inc. Page 32 of 121 Contract#PPG-1-06 07/01/2012 • All steps necessary for tracking outcomes of programs and strategies in the 3 year plan. Changes to the initial plan must be approved, in writing, by the Contract Manager prior to implementation. • Resource estimates and assignments in each step must include all resources needed including staff, hardware, software, physical locations and materials. • Gantt charts showing planned start and end dates of all steps, milestones, and decision points. • A schedule, which provides adequate department SFBHN review time, revision time, if needed, and additional subsequent review time, with specific due dates of all outputs and deliverables. (3) The network provider shall submit a monthly status report, along with the monthly invoice, by the due dates specified in Exhibit C, Required Reports, until full implementation of the work plan is reached. The objective of the monthly status report is to demonstrate the accomplishments towards achieving the goals detailed in the 3 year plan. The activities incorporated into the monthly status report shall include at a minimum the following: • Verify needed accommodations to complete program such as school board authorization, media, accessibility (if applicable), dates, and space requirements. • Prepare staff and purchase supplies and other required materials. • Prepare information technology (IT) capabilities. • The network provider shall complete the Prevention Program Tool (PPT) contained in the Performance Based Prevention System (PBPS) during the initial contract negotiations or when negotiating an amendment to the agreement, and submit to the Contract Manager for review. Once the contract has been signed, the "final" approved PPT shall be printed from PBPS and sent to the Contract Manager within thirty (30) days of execution of this contract. • The network provider's Prevention Program Coordinator and any other personnel responsible for entering data into the Prevention data system, including providers who upload data from their own system, shall register and complete training on use of the PPT at least annually. Guidance/Care Center, Inc. Page 33 of 121 Contract#PPG-1-06 07/01/2012 The provider shall submit, to the Contract Manager, an attestation affirming the completion of the PPT training within thirty (30) of execution of this contract. • The provider shall execute a memorandum of understanding with the local community substance abuse coalitions within sixty (60) days of execution of this agreement to help develop prevention capacity to implement relevant and appropriate evidence-based practices in support of a department-approved Comprehensive Community Action Plan. • Based on the most recent local department approved Comprehensive Community Action Plan, the provider agrees to administer and deliver appropriate evidence-based programs or strategies as specified in the Program Description required by Rule 65E-14.021, F.A.C., and is on file in the SFBHN Contract Manager's file and incorporated herein by reference. (4) The network provider shall submit a monthly invoice support report, by the due dates specified in Exhibit C, Required Reports. The invoice support report shall document the following: • Provide prevention programming as specified in proposal and administer pre-and post-tests within the timeframes as specified in Attachment II, Scope of Work. • Provide report evidencing that the strategies for prevention services and activities measures were met. • Identify staff time spent performing prevention program services and activities. (5) The network provider shall complete a Fidelity Checklist after each cohort and submit it to the contract manager by the dates specified in Exhibit C, Required Reports. (6) The network provider shall ensure supervision for fidelity and program implementation is documented on a monthly basis. Documentation shall be maintained at the provider's location and submitted to SFBHN upon request. (7) The network provider shall complete an annual Evidence-based Fidelity Self- Assessment Survey by May 1st of each fiscal year. The Department will provide the link for the yearly Fidelity Self-Assessment survey in S u rveyM onkey©. If warranted, the network provider shall complete a Fidelity Improvement Plan Guidance/Care Center, Inc. Page 34 of 121 Contract#PPG-1-06 07/01/2012 by June 15t" of each fiscal year. The objectives of the evidence-based fidelity self-assessment survey and fidelity improvement plan are to ensure fidelity to the chosen program or prevention strategy and ensure quality of the data being submitted. The activities in this process include but are not limited to: • Verify automated pre-and post-test and demographic data with a sample of actual data collection forms. • Institute quality fidelity improvement measures that monitor the faithfulness of the evidence-based program or strategy. • Complete the fidelity checklist as part of the Fidelity Self-Assessment S u rvey. (8) The network provider shall provide prevention services as outlined in 65D- 30.013, F.A.C., and in accordance with this contract and the approved Prevention Program Description. (9) The network provider shall ensure that a PPT is completed in the Performance Based Prevention System. (10) The network provider shall execute a memorandum of understanding with the local community substance abuse coalitions to help develop and support capacity to address community substance abuse needs. (11) Based on the most recent local department approved comprehensive community action plan, the network provider agrees to ensure to administer and deliver appropriate evidence-based programs or strategies. (12) Based on client needs, the network provider agrees to provide appropriate services from the list of approved programs/activities described in Exhibit G, State Funding by Program and Activity and the description of such services specified in the Program Description as required by Rule 65E-14.021, F.A.C. (13) The network provider shall serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes/Outputs within the activities specified in Exhibit G, State Funding by Program and Activity, the approved Prevention Program Description and in Attachment II, Scope of Work. (14) 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, of the Standard Contract. Guidance/Care Center, Inc. Page 35 of 121 Contract#PPG-1-06 07/01/2012 (15)For licensable services, the network provider shall have and maintain correct and current Department of Children and Families licenses and only bill for services under those licenses. In the event any 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 license(s) are reinstated by the Department of Children and Families. (16)By 12/01/2012, the network provider shall submit to the ME's contract 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 served, which is herein incorporated by reference. The network provider shall submit updates as amended of the Quality Assurance Plan within 30 days of adoption. (17)By 12/01/2012 establish a Quality Improvement Plan, which is herein incorporated by reference, of quality improvement activities for fiscal year 2012-2013 and every fiscal year thereafter, to improve performance. The network provider shall submit amendments to the Quality Improvement Plan, and quarterly reports on the implementation of plan to the managing entity's contract manager. (18) By 12/01/2012, the network provider shall submit to the ME's contract manager a plan describing how fidelity to the evidence-based practice(s) purchased under this contract will be guaranteed. The fidelity plan shall be in a format developed by the network provider and acceptable to SFBHN. (19)The network provider shall submit quarterly status reports to the original Fidelity Plan, evidencing the fidelity to the evidence-based practice(s). The report shall be submitted to the ME's contract manager by the dates specified in Exhibit C, Required Reports, in a format developed by the network provider and acceptable to SFBHN. (20)By 12/01/2012, the network provider shall submit to the ME's contract 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. (21)By 12/01/2012, the network provider shall submit to the ME's contract manager a disaster plan consistent with Section 29., Emergency Preparedness, of the Standard Contract. (22)On an annual basis, within thirty (30) days of the beginning of hurricane Guidance/Care Center, Inc. Page 36 of 121 Contract#PPG-1-06 07/01/2012 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. (23) By 12/01/2012, the network provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. (24) The network provider shall submit to the managing entity an annual follow- up report, by June 30 of each fiscal year of the contract, on their implementation of the co-occurring action plans. (25) The network provider shall perform the following tasks related to the co- occurring disorder service capability initiative: (a) Evaluate network provider co-occurring disorder service capability as directed by the ME using the COMPASS-Prevention Tool with: i. A focus group of administrators and prevention services staff, ii. A minimum of one program or a sample of programs on or before June 30t" of each year. iii. Follow-up evaluations done at least annually for each program or sample of programs; and iv. Programs or a sample of programs in accordance with timeframes outlined in the action plan for each contract year. (b) Develop and submit to the managing entity for approval an action plan for referring clients with co-occurring disorders by June 30th of each year of the contract term that details: i. Networking capacities with local network providers in the community for persons with co- occurring disorders; ii. Strategies and activities to develop or improve co-occurring disorder educational and referral capability; iii. Timeframes for reviewing co-occurring disorder educational and referral capability within the prevention program. (c) Develop and submit to the managing entity a summary report by June 30th of each year that details: i. The types of network provider involvement in state and local co- Guidance/Care Center, Inc. Page 37 of 121 Contract#PPG-1-06 07/01/2012 occurring planning processes; ii. The number of times the COMPASS was used and the composition of the 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; iv. Overall progress toward co-occurring disorder educational and referral capability development in accordance with timeframes specified in the action plan. (26)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. (27) The network provider shall maintain a mechanism for monitoring, updating, and disseminating policies and procedures regarding compliance with current government laws, rules, practices, regulations, and the ME's policies and procedures. (28) The network provider shall attend the Regional Prevention Meetings and any called meetings when notified by the ME. (29)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 regulations. (30) The network provider shall comply with all requests for information and/or documentation to enable the managing entity to complete the billing validation process. (31)The network provider shall develop and assure the delivery of services based on Evidence - Based Practices Guidelines in accordance with the approved Prevention Program Description. (32) The network provider shall ensure access to services that meet linguistic and cultural needs of recipients. (33) The network provider agrees to provide sign language, translation, and Guidance/Care Center, Inc. Page 38 of 121 Contract#PPG-1-06 07/01/2012 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. (34) The network provider assures to engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. (35)The network provider shall take appropriate steps to obtain 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 ME with their full accreditation and licensing reports upon request. Providers whose contract or annual service reimbursement amount exceeds $35,000 but is less than $350,000 and serve more than three unrelated persons, must comply with the CARF Standards for Unaccredited Providers. (36) Develop and Disseminate Consumer Manual The network providers shall assist the ME in developing and maintaining a manual for service recipients which includes information about access procedures, recipient rights and responsibilities (including grievance and appeal procedures). This information will be available for use by the consumers within each subcontractor location. (37) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery Participate in Planning: At the ME's request, 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. (38) Develop, Maintain and Improve Reporting The network provider shall submit reports included in Exhibit C, Required Reports and Attachment II, Scope of Work. 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 managing entity's contract manager. The managing entity reserves the right to reject reports as incomplete, inadequate or unacceptable. (39)The network 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 Guidance/Care Center, Inc. Page 39 of 121 Contract#PPG-1-06 07/01/2012 at: http://www.dcf.state.fl.us/news/human research policy.shtm1. 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 vender, even if the aforementioned has their own Institutional Review Board which has granted approval. b. Task Limits The network provider shall perform services in accordance with applicable, rules, statutes, licensing standards the approved Prevention Program Description and with the deliverables as set forth in Attachment II, Scope of Work. The network provider is not authorized by the ME to perform any tasks related to the project other than those described and referenced in in this contract, without the express written consent of the ME. 2. Staffing Requirements a. Staffing Levels (1) The network provider shall maintain staffing levels in compliance with applicable rules, statutes, and licensing standards. See Exhibit F, Minimum Service Requirements. (2) The network provider shall 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 with regard to professional qualifications. See Exhibit F, Minimum Service Requirements. (2) The network provider shall provide employment screening for all mental health personnel and all owners, directors, and chief financial officers of service network providers using the standards for Level II screening set forth in Chapter 435, and s. 408.809 F.S., except as otherwise specified in s. 394.4572(1)(b)-(c), F.S. For the purposes of this contract, "Mental health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct contact with individuals held for examination or admitted for mental health treatment. Additionally, the network provider shall provide employment screening for substance abuse personnel using the standards set forth in Chapter 397, F.S. This includes all owners, directors, and chief financial officers of service network providers and all service network provider personnel who have direct contact with children receiving services or with adults who are developmentally disabled receiving services. Guidance/Care Center, Inc. Page 40 of 121 Contract#PPG-1-06 07/01/2012 c. Staffing Changes The network provider shall notify the ME's contract manager, in writing within (10) calendar days of staffing changes regarding the positions of Chief Executive Officer, Chief Financial Officer, Medical Director, and Clinical Director. Additionally, the network provider will notify the ME's contract manager in writing, of changes in the Executive Director or any senior management position. d. Subcontractors (1) This contract allows the network provider to subcontract for the provision of all services, subject to the 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 contract will be routed through the ME's contract manager for approval. The ME is obligated nor will it pay for any services delivered prior to its written approval of the act of subcontracting. The act of subcontracting shall not in any way relieve the provider of any responsibility for the contractual obligations of this contract. (2) The network provider shall implement and maintain procedures for subcontract procurement, development, performance, and management that comply with state and federal requirements, as well as includes managing entity pre approval. (3) The network provider shall maintain individual subcontractor files for each subcontractor and provide a copy of all subcontracts and any amendments to the 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 barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; (b) is under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services, or which adversely reflects their ability to properly handle public funds; (c) is currently involved, or has been involved within the last 5 years, with any litigation, regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the department, the state or its subdivisions, or a federal entity providing funds to the department; (d) had a contract terminated by the department or ME for failure to satisfactorily perform or for cause; or, Guidance/Care Center, Inc. Page 41 of 121 Contract#PPG-1-06 07/01/2012 (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. (5) All subcontract agreements shall adopt the applicable terms and conditions of the network provider's contract with the ME, which is incorporated herein by reference. Subcontract agreements shall include a detailed scope of work; clear and specific deliverables; and performance standards. The subcontractors will be required to follow the network provider's and the ME's Policies and Procedures, and Contract, which is incorporated herein by reference and may be found on the ME's website www.sfbhn.org. (6) Unless the Department agrees to an alternative payment method as authorized in section 394.9082, F.S., and prior to entering into any subcontract, or an amendment which modifies the previously negotiated unit cost rate or adds additional cost centers, the network provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14.021,F.A.C. A cost analysis is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. Subcontractors will be required to comply with Rule 65E-14.021, F.A.C., 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. (7) The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services funds "To provide financial assistance to any entity other than a public or non-profit private entity". Ordinarily, the term "financial assistance" is used to describe a grant relationship as distinguished from a procurement relationship, typically funded by contract. While the above-referenced statute and regulations preclude States from providing grants to for-profit entities, procurement contracts may be entered into with for-profit entities. This is the latest interpretation from the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (4/5/2009). [PHS Act, ss. 1931(a)(1)(E), and 1916 (a)(5), and 45 CFR, Part 96.135(a)(5)] Additional guidance for contracting SAPTBG funds can be obtained in the SAMH Funding Restrictions Guide at the following website: (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 Guidance/Care Center, Inc. Page 42 of 121 Contract#PPG-1-06 07/01/2012 performance that could impair continued service delivery. 3. Service Location and Equipment a. Service Delivery Location The location of services will be as specified in the approved Prevention Program Description required by Rule 65E-14.021(8)(d)1.d.(III), F.A.C. and/or as specified in Attachment II, Scope of Work. b. Service Times (1) A continuum of services shall be provided on the days and times as specified in the approved Program Description and/or Attachment II, Scope of Work. (2) The network provider shall notify the ME's contract manager, in writing, at least ten (10) calendar days prior to any changes in days and times where services are being provided pursuant to Rule 65E-14.021(8)(d)5., F.A.C. c. Changes in Location The network provider shall notify the M E's contract manager, in writing, at least ten (10) calendar days prior to any changes in location where services are being provided pursuant to Rule 65E-14.021(8)(d)d(III), F.A.C. d. Equipment The network provider shall furnish all appropriate equipment necessary for the effective delivery of the services purchased. 4. Deliverables a. Services The network provider shall deliver the services specified in and described in the approved Prevention Program Description submitted by the network provider, as set forth in Exhibit G, State Funding by Program and Activity and in Attachment II, Scope of Work. b. Records and Documentation The network provider shall protect confidential records from disclosure and protect client confidentiality in accordance with ss. 397.501(7), 394.455(3), 394.4615, and 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. c. Reports Guidance/Care Center, Inc. Page 43 of 121 Contract#PPG-1-06 07/01/2012 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 a separate act in writing. The managing entity reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the 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 requirements, declare this agreement to be in default. (1) The network provider shall submit to the ME financial and programmatic reports specified in Exhibit C, Required Reports and as outlined in Attachment II, Scope of Work 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. (3) The network provider shall submit prevention data to PBPS. The network provider shall submit the data electronically by the 4th of each month. The network provider shall also: (a) Ensure that the data submitted clearly documents all program participants, programs and strategies which occurred under this contract; (b) Ensure that one hundred percent (100%) of all data submitted to PBPS is consistent with the data maintained in the network provider's clients' files; (c) Review the network provider's File Upload History screen in PBPS to determine the number of records accepted, updated and rejected. Based on this review, the network provider shall download any associated error files to determine which network provider records were rejected and to make sure that the rejected records are corrected and resubmitted in the PBPS. (d) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the network provider's total monthly submission per data set, which results in a rejection rate of ten percent (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 s. 402.73(1), F. S., and Rule 65-29.001 F.A.C., corrective action plans may be required for non-compliance, Guidance/Care Center, Inc. Page 44 of 121 Contract#PPG-1-06 07/01/2012 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. (4) Upon request, the network provider shall submit to the ME and the Department information regarding the amount and number of services paid for by the Substance Abuse Prevention and Treatment Block Grant. 5. Performance Specifications a. Performance Measures (1) The network provider shall meet the performance standards and required outcomes as specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs and as outlined in Attachment II, Scope of Work. (2) The network provider agrees that the Performance Based Prevention System (PBPS) 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 and Attachment II, Scope of Work. The network provider shall submit all service related data for clients funded, in whole or in part, by SAMH funds. (3) 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 PBPS and complete online or face-to-face training within thirty (30) days of hire, and annually thereafter. The network providers shall maintain the certificate of attendance for all participants for all trainings and submit an attestation affirming the completion of the PPT training within thirty (30) days of execution of this contract. This applies to network providers, including subcontractors who have their own data system and upload data to PBPS. b. Performance Measurement Terms DCF PAM 155-2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the managing entity to objectively measure a network provider's performance, and contains policies and procedures for submitting the required data. KIT Solutions maintains the procedures for submitting the required prevention data into PBPS. c. Performance Evaluation Methodology (1) The network provider shall collect information and submit performance data and individual client outcomes, to the managing entity data system in compliance with Guidance/Care Center, Inc. Page 45 of 121 Contract#PPG-1-06 07/01/2012 DCF PAM 155-2 requirements. The specific methodologies for each performance measure may be found at the following website: http://dash boa rd.dcf.state.f1.us (2) The network provider is expected to have the capability to engage in organized performance improvement activities, and to be able to participate in partnership with the department and ME in performance improvement projects that are related to system wide transformation and improvement of services for individuals and families. (3) By execution of this contract the network provider hereby acknowledges and agrees that its performance under the contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the network provider fails to meet these standards, the ME, at its exclusive option, may allow a reasonable period, not to exceed six (6) months, for the network provider to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the ME within the prescribed time, and if no extenuating circumstances can be documented by the network provider to the ME's satisfaction, the ME must terminate the contract. The ME has the sole authority to determine whether there are extenuating or mitigating circumstances. (4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs, and in Attachment II, Scope of Work, during the contract period, to determine if the network provider is achieving the levels that are specified (5) Performance data information may be found on the department's web-based performance Dashboard at: http://dcfdashboard.dcf.state.fl.us/. Additional prevention data information may be found on the Exhibit D Substance Abuse and Mental Health Required Performance Outcomes/Outputs Report which is transmitted to the ME Director of Prevention Services monthly. 6. Network Provider Responsibilities a. Network Provider Unique Activities (1) The network provider is responsible for the satisfactory performance of the tasks referenced in of this contract. By executing this contract, the network provider recognizes its responsibility for the tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to be fully accountable for the performance thereof whether performed by the network provider or its subcontractors. (2) The network provider agrees that services other than those set out in this Guidance/Care Center, Inc. Page 46 of 121 Contract#PPG-1-06 07/01/2012 contract will be provided only upon receipt of a written authorization from the managing entity's contract manager or an authorized managing entity 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. (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. (4) The network provider shall comply with all other applicable federal laws, state statutes and associated administrative rules as may be promulgated or amended. See Exhibit F, Minimum Service Requirements. (5) Pursuant to s. 394.74(3)(e), F.S., the network provider shall maintain data on the performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, for the types of services provided under this contract and maintain data specified in, Attachment II, Scope of Work, for the types of prevention strategies under this contract. The network provider shall submit such data to the ME upon request. (6) A network provider that receives federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants agrees to comply with Subparts I and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x-21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (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) If required by 45 CFR Parts 160, 162, or 164; the following provisions shall apply [45 CFR 164.504(e)(2)(ii)]: (a) The network provider hereby agrees not to use or disclose protected health information (PHI) except as permitted or required by this contract, state or federal law. (b) The network provider agrees to use appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this contract or applicable law. (c) The network provider agrees to report to the department any use or Guidance/Care Center, Inc. Page 47 of 121 Contract#PPG-1-06 07/01/2012 disclosure of the information not provided for by this contract or applicable law. (d) The network provider hereby assures the department that if any PHI received from the department, or received by the network provider on the department'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 to the network provider with respect to such information. (e) The network provider agrees to make PHI available in accordance with 45 C.F.R. 164.524. (f) The network provider agrees to make PHI available for amendment and to incorporate any amendments to PHI in accordance with 45 C.F.R. 164.526. (g) The network provider agrees to make available the information required to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528. (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 created or received by the network provider on behalf of the department 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 retention, it will return or destroy all PHI received from the department or received by the network provider on behalf of the department that the network provider still maintains regardless of form. If not feasible, the protections of this contract are hereby extended to that 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 contract. (10) The network provider shall provide performance information or reports other than those required by this agreement at the request of the ME, the Southern Region's SAMH Regional Director, or their designee. For requests that are complex and difficult to address, all parties will develop and implement a mutually viable work plan. (11) The network provider shall cooperate with the ME and the Department when investigations are conducted regarding a regulatory complaint of the network provider. Guidance/Care Center, Inc. Page 48 of 121 Contract#PPG-1-06 07/01/2012 (12) The network provider shall make available and communicate all plans, policies, procedures, and manuals to the ME staff, network provider staff, and to clients/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 by client, , and have the ability to provide an audit trail. Maximize all potential sources of revenue to increase services, and institute efficiencies that will consolidate infrastructure and management functions in order to maximize funding, (14) The network provider will have a data system in place that adequately supports the collection, tracking, and analysis of data necessary to perform utilization management activities, reviews of clinical/administrative performance related to levels of care, clinical outcomes, and adherence to clinical/administrative standards. (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 (10) days of receipt by network provider. (16) The network provider shall maintain human resource policies and procedures that provide safeguards to ensure compliance with laws, rules and regulations. Integrate current and/or new state/federal requirements and policy initiatives into its operations upon provision by the Department and ME of the same. (17) The network provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (18) The network provider shall make available source documentation of units billed by network provider upon request from the ME staff. 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 developing, implementing and/or maintaining a system of care in support of the agreements with the substance abuse prevention coalition providers funded by the ME. (b) The network provider agrees to fulfill their designated role in Guidance/Care Center, Inc. Page 49 of 121 Contract#PPG-1-06 07/01/2012 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 engaged by the managing entity for the development of cooperative agreements with other external stakeholders. (d) The failure of other providers or entities does not relieve the network provider of any accountability for tasks or services that the network provider is obligated to perform pursuant to this contract. (e) The network provider shall execute a Memorandum of Understanding (MOU) with a local community coalition. The MOU shall be submitted to the ME's contract manager on or before November 30, 2012, and on July 31St of each fiscal year thereafter. 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 to ensure that network providers comply with all participant-related services and other requirements of this contract. (2) The network provider agrees that the managing entity is solely responsible for the oversight of the network provider and enforcement of all terms and conditions of this contract. Any and all enquiries and/or issues arising under this contract are to be brought solely and directly to the 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 services in Miami-Dade and Monroe counties as stipulated in the Prime Contract, and in this contract. Prevention services are designed to preclude the development Guidance/Care Center, Inc. Page 50 of 121 Contract#PPG-1-06 07/01/2012 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. (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. 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 or Department 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. c. Training and Technical Assistance (1) The ME's contact manager will provide technical assistance concerning the terms and conditions of this contract. The ME will provide technical assistance and support to the network provider to ensure the continued integration of services and support for clients. 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 Attachment II, Scope of Work. In addition, the ME may convene cross-organizational training and assistance to help non-accredited network providers become accredited. (2) The managing entity implements a training program for its staff and the network provider staff. The trainings assure that staff receives externally Guidance/Care Center, Inc. Page 51 of 121 Contract#PPG-1-06 07/01/2012 mandated and internal training. The managing entity may coordinate training or directly provide training to network provider staff. d. Managing Entity Determinations Through the Department, the ME has exclusive authority to make the following determination(s) and to set the procedures that the network provider shall follow in obtaining the required determination(s): Whether the network provider is meeting the terms and conditions of this contract, to include the Standard Contract, Attachment I, II, III, and IV and any documents incorporated into any attachment by reference, Program Description, and any documents incorporated by herein by reference. C. Method of Payment Exhibit B, Method of Payment Exhibit E-1 Substance Abuse and Mental Health Services Monthly Request for Non- TANF Payment /Advance Exhibit G, State Funding by Program and Activity Exhibit H, Funding Detail and Local Match D. Special Provisions 1. The network provider is expected to reduce its administration cost to 13% for Fiscal Year 2012-2013, 10.28% for fiscal year 2013-2014 and 9.9% for fiscal year 2014-2015, for SAMH services purchased under this contract. The cost savings shall be reallocated to support the increase of direct 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 should be engaged in performance improvement activities to improve its ability to recognize accurate prevalence of co-occurring disorders in its data system. 3. Evidence Based Prevention All network providers rendering substance abuse prevention services are required to use an evidence-based prevention program. Network provider agencies involved in the validation process for prevention programs must notify the Managing Entity's Director of Prevention Services of progress annually. 4. Continuous Quality Improvement Programs for Substance Abuse Prevention Services Network Providers Guidance/Care Center, Inc. Page 52 of 121 Contract#PPG-1-06 07/01/2012 (1) The network provider must maintain a continuous quality improvement program to objectively and systematically monitor and evaluate the appropriateness and quality of care, to ensure that services are rendered consistent with prevailing professional standards, and to identify and resolve problems. Additionally, the program must support activities to ensure that fraud, waste and abuse do not occur. (2) Each service provider must have a quality assurance and improvement plan and processes through which quality is continually monitored to achieve the program's planned outcomes. A copy of this plan must be submitted to the managing entity upon request. Best practices for quality performance measures should be incorporated: experienced, well-trained staff, adequate participant- staff ratio, theory-driven programs, retention of research-based core elements, variety of teaching methods and interactive approaches, sufficient exposure to the services/intensity, Long-term prevention programs/duration and complementary components, positive relationships, cultural sensitivity and relevance, meaningful performance measures that are valid and reliable, and data for decision-making. Additionally, a minimum guideline for the network provider's continuous quality improvement program, including, but not limited to: (a) Ongoing efforts to improve products, services or processes to include managing entity initiatives. (b) Records maintenance, tracking and compliance as applicable. (c) Staff competencies, training, and development standards. (d) service-environment safety and infection control standards. (e) Incident reporting policies and procedures that include verification of corrective action and a provision that specifies that a person who files an incident report, in good faith, may not be subjected to any civil action by virtue of that incident report. (f) Fraud, waste, abuse and other potential wrongdoing auditing, monitoring, and remediation procedures. (3) The continuous quality improvement program is the responsibility of the director and is subject to review and approval by the governing board of the service provider 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. Guidance/Care Center, Inc. Page 53 of 121 Contract#PPG-1-06 07/01/2012 (5) The quality improvement program must also: (a) Provide a framework for evaluating outcomes including" (i) Output measures, such as capacities, technologies, and infrastructure that make up the system of care. (ii) Process measures, such as administrative and supervision components (iii) Outcome measures pertaining to the outcomes of services; (b) Provide for a system of analyzing those factors which have an effect on performance; (c) Provide for a system of reporting the results of continuous quality improvement reviews; and, (d) Incorporate best practice models for use in improving performance in those areas which are deficient. The ME and the Department may access all service network provider records and policies necessary to determine compliance with this section. Records relating solely to actions 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 s. 119.07(1) and s. 24(a), Art. I of the State Constitution. Such records are not admissible in any civil or administrative action except in disciplinary proceedings by the Department of Health or the appropriate regulatory board, and are not part of the record of investigation and prosecution in disciplinary proceedings made available to the public by the Department of Health or the appropriate regulatory board. Meetings or portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011. 5. Incident Reports The network provider shall submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215-6, within 24 hours of receiving notification of a reportable incident. In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee-related incidents of criminal activity, the network provider must notify the ME Risk and Compliance Coordinator as soon as possible, but not to exceed 24 hours. 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 Guidance/Care Center, Inc. Page 54 of 121 Contract#PPG-1-06 07/01/2012 is requested, each network provider will submit the information requested by the ME within 24 hours unless 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 to the Office of the Inspector General and those not reportable in IRAS, with the following information: Consumer's initials, incident report tracking number from IRAS (if applicable), incident report category, date and time of incident, and follow-up action taken. All network providers (inpatient and outpatient) will report seclusion and restraint events in accordance with Rule 65E-5.180(7)(g), F.A.C. into SAMHIS. 6. Mandatory Reporting Requirements The network provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the network provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: 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 Other reportable incidents shall be reported to the ME and Department's Office of Inspector General by completing a Notification/Investigation Request (form CF 1934) and emailing the request to the Office of Inspector General at ig_complaints@dcf.state.fl.us. The network provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399-0700; or via fax at (850) 488-1428. A reportable incident is defined in Children and Families Operating Procedures CFOP 180-4 (CFOP 180-4) Mandatory Reporting Requirements to The Office of The Inspector General, which can be obtained from the contract manager. 7. Option for Increased Services The network provider acknowledges and agrees that the contract may be amended to include additional, negotiated, services as deemed necessary by the managing entity. Additional services can only be increased if the network provider demonstrates competence in the provision of contractual services and meets whatever criteria are established by the 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 to be given to network providers for additional services. 8. Sliding Fee Scale The ME requires the network provider to comply with the provisions of Rule 65E- 14.0187 F.A.C. A copy of the network provider's sliding fee scale that reflects the Guidance/Care Center, Inc. Page 55 of 121 Contract#PPG-1-06 07/01/2012 uniform schedule of discounts referenced in Rule 65E-14.018(4), F.A.C. shall be furnished to the managing entity within thirty (30) days of contract execution. 9. National Provider Identifier (NPI) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. An application for an NPI may be submitted online at https://nppes.cros.hhs.gov/ PP S/Static o ard.do?fo ard=static.npistart. Additional information can be obtained from one of the following websites. The Florida Medicaid HIPAA located at- http-//www.fdhc.state.fl.us/hipaa/index.shtmi The National Plan and Provider Enumeration System (NPPES) located at. https-//nppes.cms.hhs.gov/NPPES/Welcome.do The CMS NPI located at: http-//www.cms.hhs.gov/NationalProvidentStand/ 10.Ethical Conduct The network provider understands that performance under this contract involves the expenditure of public funds from both the state and federal governments, and that the acceptance of such funds obligates the network provider to perform its services in accordance with the very highest standards of ethical conduct. No employee, director, officer, agent of the network provider shall engage in any business, financial or legal relationships that undermine the public trust, whether the conduct is unethical, or lends itself to the appearance of ethical impropriety. Network providers' directors, officers or employees shall not participate in any matter that would inure to their special gain, and shall recuse themselves accordingly. Public funds may not be used for purposes of lobbying, or for political contributions, or for any expense related to such activities, pursuant to Section 20. of the Standard Contract of this contract. The network provider understands that the managing entity contracts with the department, and as a subcontractor, recognizes that the department is a public agency which is mandated to conduct business in the sunshine, pursuant to section 286.011, F.S., and chapter 119, Florida Law, and that all issues relating to the business of the department, the managing entity and the 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 42., of the Standard Contract and section 286.011, F.S. The network provider's conduct is subject to all state and federal laws governing the conduct of entities engaged in the business of providing services to government. Guidance/Care Center, Inc. Page 56 of 121 Contract#PPG-1-06 07/01/2012 11.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. 12.Information Technology Resources If applicable, the network providers must receive written approval from the managing entity prior to purchasing any Information Technology Resource (ITR) contract funds. The Contract Manager is responsible for serving as the liaison between the network provider and the managing entity during the completion of the process as instructed by the Contract Manager. The network provider will not be reimbursed for any ITR purchases made prior to obtaining the managing entity's written approval. 13.Programmatic, Fiscal & Contractual Contract File References All of the documentation submitted by the network provider which may include, but not be limited to the network provider's original proposal, Program Description, Program/Cost Center Actual Expenses and Revenues Schedule, Projected Cost Center Operating and Capital Budget, Agency Capacity Report and Personnel Detail Record, are herein incorporated by reference for programmatic, contractual and fiscal assurances of service provision These referenced contractual documents will be part of the contract manager's file. Documents incorporated by reference in this contract are available in the managing entity contract manager's file. 14.Employee Loans Funds provided by the ME to the network provider under this contract shall not be used by the network provider to make loans to their employees, officers, directors and/or subcontractors. Violation of this provision shall be considered a breach of contract and the termination of this contract shall be in accordance with the Section 42., of the Standard Contract. A loan is defined as any advancement of money for which the repayment period extends beyond the next scheduled pay period. 15.Travel The network provider's internal procedures will assure that: travel voucher Form DFS-AA-15, State of Florida Voucher for Reimbursement of Traveling Expenses, incorporated herein by reference, be utilized completed and maintained on file by the network provider. Original receipts for expenses incurred during officially authorized travel, items such as car rental and air transportation, parking and lodging, tolls and fares, must be maintained on file by the Network provider. Section 287.058 (1) (b) F.S., requires that bills for any travel expense shall be maintained in accordance with Guidance/Care Center, Inc. Page 57 of 121 Contract#PPG-1-06 07/01/2012 Section 112.061, F.S. governing payments for traveling expenses. CFOP 40-1 (Official Travel of State Employees and Non-Employees) provides further explanation, clarification, and instruction regarding the reimbursement of traveling expenses necessarily incurred during the performance of business. The network provider must retain on file documentation of all travel expenses to include the following data elements: name of the traveler, dates of travel, travel destination, purpose of travel, hours of departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of payee and payee's supervisor. For prevention services that are paid on the basis of direct staff hour, as specified in Chapter 65E-14, F.A.C., this unit of measure represents the actual time spent on activities directly associated with a single client, including case staffing. Time may include travel if the travel is integral to a service event otherwise billable to the Managing Entity. Direct staff hour shall be paid on the basis of utilization. For prevention services that are paid on the basis of non-direct staff hour, as specified in Chapter 65E-14, F.A.C., this unit of measure represents the actual time spent on activities that cannot be directly associated with a single client, but are integral to the program and described in the approved Prevention Program Description. Time may include travel if the travel is integral to a service event otherwise billable to the Managing Entity. Non-direct staff hour shall be paid on the basis of utilization. The network provider agrees to maximize the use of state residents, state products, and other Florida-based businesses in fulfilling their contractual duties under this contract. 16.Verification of Employment Status (E-Verify) 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 network provider/grantee to perform work pursuant to this contract within the United States and its territories, and all persons (including subcontractors) assigned by the network provider to perform work pursuant to the contract with the ME. "Subcontract" means any contract entered into by a subcontractor 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 Guidance/Care Center, Inc. Page 58 of 121 Contract#PPG-1-06 07/01/2012 or services to or for a prime provider or another subcontractor. (b) Enrollment and verification requirements. (1) The network provider shall - (i) Enroll. Enroll as a network provider in the E-Verify program within thirty (30) calendar days of contract award; (ii) Verify all new employees. Within ninety (90) calendar days of enrollment in the E- Verify program, begin to use E-Verify to initiate verification of employment eligibility. All new employees assigned by the network provider/subcontractor to perform work pursuant to the contract with the ME shall be verified as employment eligible within three (3) business days after the date of hire; and (2) The network provider shall comply, for the period of performance of this contract, with the requirement of the E-Verify program enrollment. (i) The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate the network provider's enrollment and deny access to the E- Verify system in accordance with the terms of the enrollment. In such case, the network provider will be referred to a DHS or SSA suspension or debarment official. (ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the network provider 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 network provider 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 of Homeland Security Web site: http://www.dhs.ciov/ -Verify . (d) Individuals previously verified. The network provider is not required by this clause to perform additional employment verification using E-Verify for any employee whose employment eligibility was previously verified by the provider/grantee through the E- Verify program. (e) Individuals performing work prior to the E-verify requirement. The network provider is not required by this clause to perform additional employment verification using E-Verify for any employee whose employment eligibility was previously verified by the network provider through the E-Verify program. (f) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file. Guidance/Care Center, Inc. Page 59 of 121 Contract#PPG-1-06 07/01/2012 (g) Subcontracts. The network provider shall include the requirements of this clause, including this paragraph (g) (appropriately modified for identification of the parties), in each subcontract. (h) The subcontractor at any tier level must comply with the E-Verify clause as subject to the same requirements as the network provider. E. List of Exhibits The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. Exhibit A, Participants to be Served Exhibit B, Method of Payment Exhibit C, Required Reports Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs Exhibit E-1, Substance Abuse and Mental Health Monthly Request for Non- TANF Payment/Advance Exhibit F, Minimum Service Requirements Exhibit G, State Funding by Program and Activity Exhibit H, Funding Detail & Local Match Plans Guidance/Care Center, Inc. Page 60 of 121 Contract#PPG-1-06 07/01/2012 EXHIBITA PARTICIPANTSTO BE SERVED A. General Description The network provider shall furnish services funded by this contract to the target population(s) checked below- Non-Prevention Prevention ❑ Adult Mental Health-Forensic Involvement ❑ Adult Substance Abuse ❑ Adult Mental Health-Severe&Persistent Mental Illness ® Children's Substance Abuse ❑ Adult Mental Health-Serious&Acute Episodes of Mental Illness ❑ Community Prevention-Adult Substance Abuse ❑ Adult Mental Health-Mental Health Problems ❑ Community Prevention-Children Substance Abuse ❑ Children's Mental Health-Emotional Disturbances ❑ Children's Mental Health-At Risk of Emotional Disturbances ❑ Children's Mental Health-Serious Emotional Disturbances ❑ Adult Substance Abuse ❑ Children's Substance Abuse B. Client/Participant Eligibility 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. C. Participant Determination a. Determination of client eligibility is exclusively the responsibility of the network provider. b. 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 a. 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 specified in Exhibit G, State Funding by Program and Activity. b. 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. c. 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. Page 61 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT B METHOD OF PAYMENT 1. Payment Clauses a. This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, State Funding by Program and Activity. The ME shall pay the network provider for the delivery of service units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed $ 433,341.00 , subject to the availability of funds and satisfactory performance of all terms by the network provider. Of the total Contract amount, the ME will be required to pay $ 433,341.00 subject to the delivery and billing for services. The remaining amount of$ 0.00 represents "Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the network provider, in whole or in part, or not at all, for Exemplary Performance by the network provider. Exemplary Performance will be determined by the network provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. b. Aftercare, Intervention, Outpatient, and Recovery Support Services (Substance Abuse) are eligible for special group rates. Group services shall be billed on the basis of a contact hour, at 25% of the contract's established rate for the individual services for the same cost center. Excluding Outpatient, total hourly reimbursement for group services shall not exceed the charges for ten individuals per group. Group size limitations outlined in the current Medicaid Handbook apply to Outpatient group services funded under this contract. c. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds in the amount of$108,336.00 as indicated in Exhibit H, Funding Detail and Local Match. Should the network provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match as it appears on Exhibit H, Funding Detail, will automatically change, utilizing the following formula: The additional match required on the uncompensated units = Uncompensated Substance Abuse Services X 16.67% + Uncompensated Mental Health Services that is not exempt from local match requirements X 33.33% *The following MH services are exempt from local match requirement L Deinstitutionalization Projects Guidance/Care Center, Inc. Page 62 of 121 Contract#PPG-1-06 07/01/2012 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 by a public receiving facility) FACT Teams ii. Children's Mental Health Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. d. In accordance with the provisions of s. 402.73(1), F.S., and Rule 65-29.001, Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. e. The managing entity shall reduce or withhold funds pursuant to Rule 65-29.001, F.A.C., if the network provider fails to comply with the terms of the contract and/or fails to submit client reports and/or data as required in DCF PAM 155-2, Rule 65E-14, F.A.C. and by the due dates listed on Exhibit C, Required Reports. f. The 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 be disbursed to the provider. g. If the Provider closes or suspends the provision of services funded by this contract, the provider agrees to notify the managing entity in writing thirty (30) calendar days prior to their intent to close, suspend or end service(s). If the provider fails to notify the managing entity, the provider hereby agrees not to request payment for services provided in prior months if the actual number of services in the month for which payment is being requested is less than twenty- five percent (25%) of the prorated amount of services by cost center as given on Exhibit G, State Funding by Program and Activity or twenty-five percent (25%) of the prorated share of the amount of funding as specified on Exhibit G, 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 to the end of the contract period any service units provided at any time during the term of the contract. 2. MyFloridaMarketP lace Transaction Fee Guidance/Care Center, Inc. Page 63 of 121 Contract#PPG-1-06 07/01/2012 This contract is exempt from the MyFloridaMarketPlace Transaction Fee in accordance with Rule 60A-1.032(l)(d), F.A.C. 3. Additional Release of Funds At its sole discretion, the ME may approve the release of more than the monthly prorated amount when the network provider submits a written request justifying the release of additional funds, if funds are available and services have been provided. 4. Medicaid Billing (if applicable) a. The Department is always the payor of 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 services provided to individuals that meet the eligibility criteria for Medicaid. Authorized network provider services shall be reimbursed in the following order of precedence: L Any liable first, second, and/or third party payors, then ii. Medicaid, pursuant to s. 409.910, F.S., if the individual meets the eligibility criteria for Medicaid, and the service is Medicaid eligible, then iii. The Department through the ME (only if none of the above are available or eligible for payment). iv. The network provider shall identify and report Medicaid earnings separate from all other fees; v. Medicaid earnings cannot be used as local match; A. The network provider shall ensure that Medicaid payments are accounted for in compliance with federal regulations; vii. In no event shall both Medicaid and the ME be billed for the same service; b. The network provider operating a residential treatment facility licensed as a crisis stabilization unit, detoxification facility, short-term residential treatment facility, residential treatment facility Levels 1 or 2, or therapeutic group home that is greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee For-Service programs for any services for individuals eligible for Medicaid while in these facilities; and c. The network provider operating a children's residential treatment center of greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee- For Service programs for any services for individuals meeting the eligibility criteria for Medicaid in these facilities except as permitted under the Medicaid State Inpatient Psychiatric Program Waiver. 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 Guidance/Care Center, Inc. Page 64 of 121 Contract#PPG-1-06 07/01/2012 e. The network provider agrees to assist individuals eligible for Medicaid covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 5. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, or Provider Services Networks. Unless waived in Section D (Special Provisions) of this contract, the provider agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will be considered to be "third party payer" contractual fees as defined in Rule 65E-14.001(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 ME. 6. Invoice Requirements a. The rates negotiated with any network provider may not exceed the model rate 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 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 ME and the Department, other payment methods may be permitted. c. The network provider shall request payment monthly through submission of a properly completed invoice, Exhibit E-1, Substance Abuse and Mental Health Monthly Request for Non-TANF Payment/Advance within seven (7) days following the end of the month for which payment is being requested for the delivery of service. d. If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the ME indicating this information within seven (7) days following the end of the month. e. The network provider's final invoice must reconcile actual service units provided during the contract period with the amount paid by the ME. The provider shall submit their fiscal year final invoice to the ME within fifteen (15) days after the end of each state fiscal year in the contract period. f. Pursuant to 65E-1 4.021(1 0)(b)6.b., F.A.C. , the year-to-date number of units of service reported on a request for payment or any associated worksheet shall not Guidance/Care Center, Inc. Page 65 of 121 Contract#PPG-1-06 07/01/2012 exceed the total number of units reported and accepted in the ME's data system pursuant to Rule 65E-14.022, F.A.C. g. Pursuant to 65E-14.021(10)(a)2., F.A.C., any costs or service 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 to Medicaid, and all units for SAMH client services paid from other sources, including Social Security, Medicare payments, and funds eligible for local matching which include patient fees from first, second, and third-party payers, from each monthly request for payment. 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. h. Invoices shall be submitted in detail sufficient for a proper pre-audit and post-audit. 7. Supporting Documentation The network provider agrees to maintain and submit to the ME, if applicable, service documentation for each service billed to the ME pursuant to this contract. Proper service documentation for each SAMH cost center is outlined in Rule 65E-14.021(7), F.A.C. The provider shall maintain and/or submit as defined in Attachment I, Section B.1.a. by the dates specified in Exhibit C, Required Reports, documentation to support all units billed to the ME and units subtracted for SAMH client services on each monthly request for payment. The network provider shall ensure that all services provided are entered into the PBPS. The ME, Department, and the State's Chief Financial Officer reserve the right to request supporting documentation at any time after actual units have been delivered. 8. Funding Sweeps The network provider agrees that at the sole discretion of the ME and at such time and upon terms, conditions or criteria set by the managing entity, a review of the funding utilization rate or pattern of the provider may be conducted by the ME. Based upon such review, if it is determined that the rate of utilization may result in a lapse of funds, then in that event the ME may amend the network provider's total amount of funding by reducing same in order to prevent the potential lapse. The ME will notify the network provider in writing of the reduction prior to amending the total amount of funding. The ME's Lapse Policy is incorporated herein by reference. Guidance/Care Center, Inc. Page 66 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT C REQUIRED REPORTS Required Reports Due Date #of Send to: Copies Response to Monitoring Reports and Corrective Action Within 10 days from the day the report is SFBHN Contract Plans received. 1 Manager Sliding Fee Scale[reflecting the uniform schedule of Within 30 days after the beginning of each SFBHN Contract discounts referenced in 65E-14.018(4)] fiscal year. 1 Manager Final FY 2012-2013 (1)Network Providers Agency Service Capacity Report,(2) Within 30 days after Contract execution or Projected Cost Center Operating and Capital upon request of the Contract Manager 1 SFBHN Contract Budget(If applicable), Manager (3)Cost Center Personnel Detail Report(If applicable),& (4)Program Description. Electronic Monthly Data Required by DCF PAM 155-2 Within 4 days after end of month following the SFBHN MIS Office month of service Submission Incident Report Within 24 hours of occurrence 1 IRAS Audit Schedules for Network Providers, as applicable Due 180 days after the end of the fiscal year SFBHN Contract Schedule of State Earnings or 30 days upon completion of audit, 1 Manager whichever comes first. Due 180 days after the end of the fiscal year SFBHN Contract Schedule of Related Party Transaction Adjustments or 30 days upon completion of audit, 1 Manager whichever comes first. Program/Cost Center Actual Expenses&Revenues Due 180 days after the end of the fiscal year SFBHN Contract Schedule or 30 days upon completion of audit, 1 Manager whichever comes first. Due 180 days after the end of the fiscal year SFBHN Contract Schedule of Bed-Day Availability Payments or 30 days upon completion of audit, 1 Manager whichever comes first. 180 days after the end of the managing Financial&Compliance Audit per Attachment IV entity's fiscal year or 30 days after its 1 SFBHN Contract completion,whichever comes first. Manager (See Attachment IV) Other Reports Monthly Service Invoice Monthly, by the 7`h after the 1 SFBHN Contract month of service Manager Activity Work Plan December 7,2012 and by July 31` of each fiscal 1 SFBHN Contract Lear Manager Memorandum of Understanding(MOU)with a Coalition November 30`h,2012 and by July 31'`of 1 SFBHN Contract each fiscal year Manager Monthly, by the 7`h after the month of service SFBHN Contract Monthly Status Report(Tracking Implementation of Activity until full implementation is reached for each 1 Work Plan) p Manager fiscal year Guidance/Care Center, Inc. Page 67 of 121 Contract#PPG-1-06 07/01/2012 Invoice Support Report Monthly, by the 7`h after the 1 SFBHN Contract month of service Manager Fidelity Plan for Evidence-Based Practice December 1,2012 1 SFBHN Contract Manager Quarterly Fidelity Plan for Evidence Based Practice Status January 15,2013 1 SFBHN Contract Report Manager April 15,2013 July 15,2013 Two(2)weeks following the completion of SFBHN Contract Fidelity Checklist(After the completion of each cohort) each cohort 1 Manager Supervision for Fidelity and Program Implementation Monthly 1 Network Provider Site submitted to SFBHN upon request. Evidence-based Fidelity Self-Assessment Survey May Vt of each fiscal year 1 SFBHN Contract Manager Fidelity Improvement Plan, if needed June 15`h of each fiscal year 1 SFBHN Contract Manager Prevention Program Tool Training Attestation Within 30 days of contract execution 1 SFBHN Contract Manager Final Invoice By July 15 of each fiscal year and/or 15 days 1 SFBHN Contract after contract end date Manager Within 30 days of contract execution. Submit SFBHN Contract Provider's Grievance Procedures updates as amended within 30 days of 1 Manager execution of the amendment Provider Informed Consent Forms SFBHN Contract Within 30 days of contract execution 1 Manager SFBHN Contract Provider's Emergency Preparedness Plan Within 30 days of contract execution 1 Manager SFBHN Contract Provider's Civil Rights Compliance Questionnaire Within 30 days of contract execution 1 Manager SFBHN Contract Provider's Security Agreements, per Standard Contract Within 30 days of contract execution 1 Manager Annually, prior to contract SFBHN Contract Affidavit Regarding Debarment execution,or as requested by the contract 1 manager. Manager SFBHN Contract Inventory Report Within 30 days of contract execution 1 Manager "No Wrong Door"Policy and Procedure December 1, 2012 1 SFBHN Contract Manager Quality Improvement Plan December,2012 1 SFBHN Contract Manager Quarterly Report on Implementation of Quality January 15,2013 1 SFBHN Contract Improvement Plan April 15,2013 Manager July 15, 2013 Quality Assurance Plan December 1,2012 1 SFBHN Contract Manager Guidance/Care Center, Inc. Page 68 of 121 Contract#PPG-1-06 07/01/2012 Quarterly Report on the Implementation of Quality January 15,2013 1 SFBHN Contract Assurance Plan April 15,2013 Manager July 15, 2013 Co-occurring Action Plans 06/30/2013 1 SFBHN Contract Manager COMPASS Follow-up Self-Assessment 06/30/2013 1 SFBHN Contract Manager Cooperative Agreements Within 30 days of execution of the 1 SFBHN Contract agreements Manager 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 1 SFBHN Contract Reports,Surveys&Corrective Action Plans the contract manager Manager Guidance/Care Center, Inc. Page 69 of 121 Contract#PPG-1-06 07/01/2012 Exhibit D SUBSTANCE ABUSE & MENTAL HEALTH REQUIRED PERFOMANCE OUTCOMES/OUTPUTS For Fiscal Year 2012-2013 Provider Name: Guidance/Care Center,Inc. Contract#: PPG-1-06 Date: 11/01/2012 Revision#: NA 1. Mental Health Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adult Mental Health a.Adults with Severe and Persistent Mental Illness(SPMI)(M0016)/(MH016) NA b.Adults with Serious and Acute Episodes of Mental Illness(M05301)/(MH5301) NA c.Adults with Mental Health Problems(M05302)/(MH5302) NA d.Adults with Forensic Involvement(MOO 18)/(MH018) NA 2.Children's Mental Health a.Children with Serious Emotional Disturbances(SED)(M0031)/(MH031) NA b.Children with Emotional Disturbances(ED)(M0032)/(MHO32) NA c.Children at-risk of Emotional Disturbances(M0033)/(MHO33) NA B.Required Performance Outcome Standards for Each Target Population Minimum Contract 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 for adults with severe and persistent mental illness will be at least 30 (M0003)/(MH003) 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)/NM744) 90% 3.Adult Mental Health-Adults with Serious Mental Illness(SPMI,MH Crisis, Forensic) a.Percent of adults with serious mental illness who are competitively employed will be at least(M0703)/NM703) 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. Page 70 of 121 Contract#PPG-1-06 07/01/2012 b.Percent of children who improve their level of functioning will be at least (M0378)/MH378) 65% c.Percent of school days seriously emotionally disturbed children attended will be at least(M0012)/(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)/(MH377) 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) II.Substance Abuse Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adults with Substance Abuse Problems a.Number of Adults Served(M0063)/(SA063) NA 2.Children with Substance Abuse Problems a.Number of Children Served(M0052)/(SA052) NA 3.Adult At-Risk of Substance Abuse Problems-(NonGAA) a.Number of adults to include parents of children/youth at risk of substance abuse 170 participating in Prevention Services(M0785)/(SA785) b.Number of adults to include parents of children/youth at risk of substance abuse 23 participating in Level 1 Prevention Programs(M0767)/(SA767) c.Number of adults to include parents of children/youth at risk of substance abuse NA participating in Level 2 Prevention Programs(M0768)/(SA768) d.Number of adults to include parents of children/youth at risk of substance abuse 20 participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities(M0769)/(SA769) e.Number of adults to include parents of children/youth at risk of substance NA abuse participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities(M0770)/(SA770) 4.Children/Youth At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Number of children/youth participating in Prevention Services 2,370 (M0762)/(SA762) b.Number of children/youth participating in Level 1 Prevention Programs( 330 M0761)/(SA761) c.Number of children/youth participating in Level 2 Prevention 206 Progralus(M0695)/(SA695) d.Number of children/youth participating in Level 1 Prevention Programs who 281 complete 85 percent of the program's schedule of activities(M0763)/(SA763) Guidance/Care Center, Inc. Page 71 of 121 Contract#PPG-1-06 07/01/2012 e.Number of children/youth participating in Level 2 Prevention Programs who 175 complete 85 percent of the program's schedule of activities(M0764)(SA764) Minimum Contract B.Required Performance Outcome Standards for Each Target Population Standard 1.Adults with Substance Abuse Problems a.Percent of adults who successfully complete substance abuse treatment services 50% will be at least(M0755)/SA755) b.Percent change in clients who are employed from admission to discharge will be 20% at least(M0753)/SA405) c.Percent of adults who live in a stable housing environment at the time of 80% discharge will be at least(M0756)/SA756) d.Percent change in the number of adults arrested 30 days prior to admission 35% versus 30 days prior to discharge(M0754/SA754) 2.Adult At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least(M077 1)/(SA77 1) b.Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 2 Prevention Programs who complete 85 percent of the 85% 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 55% services will be at least(SA725)/(SA755) b.Percent of children who live in a stable housing environment will be at least 85% (M0752)/SA752) c.Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge will be at least(M075 l/SA75 1) 4.Children At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of children/youth participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0765)/(SA765) b.Percent of children/youth participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0766)/(SA766) 5.Data Submission for Prevention Program Tool(baseline-Non GAA) a.Percent of approved Prevention Descriptions completed within 30 days of 50% 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)admission records 95% in the Substance Abuse and Mental Health Information System will be at least(SAMHIS)(M0758) Guidance/Care Center, Inc. Page 72 of 121 Contract#PPG-1-06 07/01/2012 D. In addition to the above performance measures above,the network Minimum Contract provider will use at least three (3) additional performance measures based Standard upon their evidence-based program or strategy. 1. Percentage of decrease in the overall quantity and frequency of high-risk 5% drinking. 2. Percentage of change in the number of alcohol and other drug(AOD)- NA related problems. 3. Improvements in number of underlying community conditions(as NA percentage). 4. Percent changes in alcohol sales and service techniques and policies in NA social or commercial hosting situations that cater to students. 5. Improvements in evidence-based implementation fidelity(as percentage). g% 6. Improvements in use of culturally competent prevention content(as percentage). NA 7. Increase in the percentage of individuals involved in AOD abuse prevention 5% efforts. 8. Decrease in the percentage of media advertisements promoting high-risk NA drinking. E.Process Measure 1. Total number of persons,youth and 18-20 year olds served monthly and Monthly: 175 yearly. Yearly:2,100 2. Total number of capacity enhancement activities. NA 3. Total number of relationship building activities with other community partners. NA 4. Total number and frequency of alcohol-free social activities. NA Guidance/Care Center, Inc. Page 73 of 121 Contract#PPG-1-06 07/01/2012 Exhibit D SUBSTANCE ABUSE & MENTAL HEALTH REQUIRED PERFOMANCE OUTCOMES/OUTPUTS For Fiscal Year 2013-2014 Provider Name: Guidance/Care Center,Inc. Contract#: PPG-1-06 Date: 07/01/2013 Revision#: NA 1. Mental Health Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adult Mental Health a.Adults with Severe and Persistent Mental Illness(SPMI)(M0016)/(MH016) NA b.Adults with Serious and Acute Episodes of Mental Illness(M05301)/(MH5301) NA c.Adults with Mental Health Problems(M05302)/(MH5302) NA d.Adults with Forensic Involvement(MOO 18)/(MH018) NA 2.Children's Mental Health a.Children with Serious Emotional Disturbances(SED)(M0031)/(MH031) NA b.Children with Emotional Disturbances(ED)(M0032)/(MHO32) NA c.Children at-risk of Emotional Disturbances(M0033)/(MHO33) NA B.Required Performance Outcome Standards for Each Target Population Minimum Contract 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 for adults with severe and persistent mental illness will be at least 30 (M0003)/(MH003) 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)/NM744) 90% 3.Adult Mental Health-Adults with Serious Mental Illness(SPMI,MH Crisis, Forensic) a.Percent of adults with serious mental illness who are competitively employed will be at least(M0703)/NM703) 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. Page 74 of 121 Contract#PPG-1-06 07/01/2012 b.Percent of children who improve their level of functioning will be at least (M0378)/MH378) 65% c.Percent of school days seriously emotionally disturbed children attended will be at least(M0012)/(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)/(MH377) 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) II.Substance Abuse Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adults with Substance Abuse Problems a.Number of Adults Served(M0063)/(SA063) NA 2.Children with Substance Abuse Problems a.Number of Children Served(M0052)/(SA052) NA 3.Adult At-Risk of Substance Abuse Problems-(NonGAA) a.Number of adults to include parents of children/youth at risk of substance abuse 170 participating in Prevention Services(M0785)/(SA785) b.Number of adults to include parents of children/youth at risk of substance abuse 42 participating in Level 1 Prevention Programs(M0767)/(SA767) c.Number of adults to include parents of children/youth at risk of substance abuse NA participating in Level 2 Prevention Programs(M0768)/(SA768) d.Number of adults to include parents of children/youth at risk of substance abuse 38 participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities(M0769)/(SA769) e.Number of adults to include parents of children/youth at risk of substance NA abuse participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities(M0770)/(SA770) 4.Children/Youth At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Number of children/youth participating in Prevention Services 2,370 (M0762)/(SA762) b.Number of children/youth participating in Level 1 Prevention Programs( 410 M0761)/(SA761) c.Number of children/youth participating in Level 2 Prevention 206 Progralus(M0695)/(SA695) d.Number of children/youth participating in Level 1 Prevention Programs who 349 complete 85 percent of the program's schedule of activities(M0763)/(SA763) Guidance/Care Center, Inc. Page 75 of 121 Contract#PPG-1-06 07/01/2012 e.Number of children/youth participating in Level 2 Prevention Programs who 175 complete 85 percent of the program's schedule of activities(M0764)(SA764) Minimum Contract B.Required Performance Outcome Standards for Each Target Population Standard 1.Adults with Substance Abuse Problems a.Percent of adults who successfully complete substance abuse treatment services 50% will be at least(M0755)/SA755) b.Percent change in clients who are employed from admission to discharge will be 20% at least(M0753)/SA405) c.Percent of adults who live in a stable housing environment at the time of 80% discharge will be at least(M0756)/SA756) d.Percent change in the number of adults arrested 30 days prior to admission 35% versus 30 days prior to discharge(M0754/SA754) 2.Adult At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least(M077 1)/(SA77 1) b.Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 2 Prevention Programs who complete 85 percent of the 85% 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 55% services will be at least(SA725)/(SA755) b.Percent of children who live in a stable housing environment will be at least 85% (M0752)/SA752) c.Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge will be at least(M075 l/SA75 1) 4.Children At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of children/youth participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0765)/(SA765) b.Percent of children/youth participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0766)/(SA766) 5.Data Submission for Prevention Program Tool(baseline-Non GAA) a.Percent of approved Prevention Descriptions completed within 30 days of 50% 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)admission records 95% in the Substance Abuse and Mental Health Information System will be at least(SAMHIS)(M0758) Guidance/Care Center, Inc. Page 76 of 121 Contract#PPG-1-06 07/01/2012 D. In addition to the above performance measures above,the network provider will use at least three (3) additional performance measures based Minimum Contract upon their evidence-based program or strategy. Standard 1. Percentage of decrease in the overall quantity and frequency of high-risk drinking. 5% 2. Percentage of change in the number of alcohol and other drug(AOD)- NA related problems. 3. Improvements in number of underlying community conditions(as NA percentage). 4. Percent changes in alcohol sales and service techniques and policies in NA social or commercial hosting situations that cater to students. 5. Improvements in evidence-based implementation fidelity(as percentage). g% 6. Improvements in use of culturally competent prevention content(as percentage). NA 7. Increase in the percentage of individuals involved in AOD abuse prevention 5% efforts. 8. Decrease in the percentage of media advertisements promoting high-risk NA drinking. E.Process Measure 1. Total number of persons,youth and 18-20 year olds served monthly and Monthly: 175 yearly. Yearly:2,100 2. Total number of capacity enhancement activities. NA 3. Total number of relationship building activities with other community partners. NA 4. Total number and frequency of alcohol-free social activities. NA Guidance/Care Center, Inc. Page 77 of 121 Contract#PPG-1-06 07/01/2012 Exhibit D SUBSTANCE ABUSE & MENTAL HEALTH REQUIRED PERFOMANCE OUTCOMES/OUTPUTS For Fiscal Year 2014-2015 Provider Name: Guidance/Care Center,Inc. Contract#: PPG-1-06 Date: 07/01/2014 Revision#: NA 1. Mental Health Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adult Mental Health a.Adults with Severe and Persistent Mental Illness(SPMI)(M0016)/(MH016) NA b.Adults with Serious and Acute Episodes of Mental Illness(M05301)/(MH5301) NA c.Adults with Mental Health Problems(M05302)/(MH5302) NA d.Adults with Forensic Involvement(MOO 18)/(MH018) NA 2.Children's Mental Health a.Children with Serious Emotional Disturbances(SED)(M0031)/(MH031) NA b.Children with Emotional Disturbances(ED)(M0032)/(MHO32) NA c.Children at-risk of Emotional Disturbances(M0033)/(MHO33) NA B.Required Performance Outcome Standards for Each Target Population Minimum Contract 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 for adults with severe and persistent mental illness will be at least 30 (M0003)/(MH003) 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)/NM744) 90% 3.Adult Mental Health-Adults with Serious Mental Illness(SPMI,MH Crisis, Forensic) a.Percent of adults with serious mental illness who are competitively employed will be at least(M0703)/NM703) 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. Page 78 of 121 Contract#PPG-1-06 07/01/2012 b.Percent of children who improve their level of functioning will be at least (M0378)/MH378) 65% c.Percent of school days seriously emotionally disturbed children attended will be at least(M0012)/(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)/(MH377) 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) II.Substance Abuse Contracted Services A.Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH,and Local Match) Numbers to Be Served 1.Adults with Substance Abuse Problems a.Number of Adults Served(M0063)/(SA063) NA 2.Children with Substance Abuse Problems a.Number of Children Served(M0052)/(SA052) NA 3.Adult At-Risk of Substance Abuse Problems-(NonGAA) a.Number of adults to include parents of children/youth at risk of substance abuse 170 participating in Prevention Services(M0785)/(SA785) b.Number of adults to include parents of children/youth at risk of substance abuse 42 participating in Level 1 Prevention Programs(M0767)/(SA767) c.Number of adults to include parents of children/youth at risk of substance abuse NA participating in Level 2 Prevention Programs(M0768)/(SA768) d.Number of adults to include parents of children/youth at risk of substance abuse 36 participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities(M0769)/(SA769) e.Number of adults to include parents of children/youth at risk of substance NA abuse participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities(M0770)/(SA770) 4.Children/Youth At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Number of children/youth participating in Prevention Services 2,370 (M0762)/(SA762) b.Number of children/youth participating in Level 1 Prevention Programs( 410 M0761)/(SA761) c.Number of children/youth participating in Level 2 Prevention 206 Progralus(M0695)/(SA695) d.Number of children/youth participating in Level 1 Prevention Programs who 349 complete 85 percent of the program's schedule of activities(M0763)/(SA763) Guidance/Care Center, Inc. Page 79 of 121 Contract#PPG-1-06 07/01/2012 e.Number of children/youth participating in Level 2 Prevention Programs who 175 complete 85 percent of the program's schedule of activities(M0764)(SA764) Minimum Contract B.Required Performance Outcome Standards for Each Target Population Standard 1.Adults with Substance Abuse Problems a.Percent of adults who successfully complete substance abuse treatment services 50% will be at least(M0755)/SA755) b.Percent change in clients who are employed from admission to discharge will be 20% at least(M0753)/SA405) c.Percent of adults who live in a stable housing environment at the time of 80% discharge will be at least(M0756)/SA756) d.Percent change in the number of adults arrested 30 days prior to admission 35% versus 30 days prior to discharge(M0754/SA754) 2.Adult At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least(M077 1)/(SA77 1) b.Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 2 Prevention Programs who complete 85 percent of the 85% 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 55% services will be at least(SA725)/(SA755) b.Percent of children who live in a stable housing environment will be at least 85% (M0752)/SA752) c.Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge will be at least(M075 l/SA75 1) 4.Children At-Risk of Substance Abuse Problems-(Baseline-Non GAA) a.Percent of children/youth participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0765)/(SA765) b.Percent of children/youth participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0766)/(SA766) 5.Data Submission for Prevention Program Tool(baseline-Non GAA) a.Percent of approved Prevention Descriptions completed within 30 days of 50% 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)admission records 95% in the Substance Abuse and Mental Health Information System will be at least(SAMHIS)(M0758) Guidance/Care Center, Inc. Page 80 of 121 Contract#PPG-1-06 07/01/2012 D. In addition to the above performance measures above,the network Minimum Contract provider will use at least three (3) additional performance measures based Standard upon their evidence-based program or strategy. 1. Percentage of decrease in the overall quantity and frequency of high-risk 5% drinking. 2. Percentage of change in the number of alcohol and other drug(AOD)- NA related problems. 3. Improvements in number of underlying community conditions(as NA percentage). 4. Percent changes in alcohol sales and service techniques and policies in NA social or commercial hosting situations that cater to students. 5. Improvements in evidence-based implementation fidelity(as percentage). g% 6. Improvements in use of culturally competent prevention content(as percentage). NA 7. Increase in the percentage of individuals involved in AOD abuse prevention 5% efforts. 8. Decrease in the percentage of media advertisements promoting high-risk NA drinking. E.Process Measure 1. Total number of persons,youth and 18-20 year olds served monthly and Monthly:175 yearly. Yearly:2,100 2. Total number of capacity enhancement activities. NA 3. Total number of relationship building activities with other community partners. NA 4. Total number and frequency of alcohol-free social activities. NA Guidance/Care Center, Inc. Page 81 of 121 Contract#PPG-1-06 07/01/2012 Exhibit E-1 AGENCYNAME EXHIBIT E-1 b-CONTRACT No CHILDREN SUBSTANCE ABUSE O Non-TANF ning": MONTHLY PAYMENT/ADVANCE REQUEST FEDERAL ID# O(Idlfferent 1M1an F ID). PART t-EARNINGS (YTD UnPaitl Proratetl Sbare (Ovaetl)ue Unn Rate r xtn.lTANF$Ea d Earn g Earn gs) -is Momb iw Ony ',. — only miry eoe10soz (od.c of ''.. e roare-sozooO XXXXXXX go 00 $o 00 $o 0o XXXXXXX $o 00 .00000. nagem ent XXXXXXX $000 $000 $000 XXXXXXX $000 000000 SupporVEmerge—y XXXXXXX $000 $000 $000 XXXXXXX $000 .00000 Oay Care XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 0 00000 OayiNlgM1t XXXXXXX $000 $000 $000 XXXXXXX $000 .00000 - XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 0 00000 nagement XXXXXXX $000 $000 $000 XXXXXXX $000 .00000 - XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 0 00000 oup`la XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 o 00000 XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 0 00000 XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 o 00000 Outpatlent M XXXXXXX $000 $000 $000 XXXXXXX $000 000000 Outpatient-Grdoupua XXXXXXX $000 $000 $000 XXXXXXX $000 .00000 XXXXXXX $O 00 $O 00 $O 00 XXXXXXX $O 00 0 00000 XXXXXXX $O oo So— $O oo XXXXXXX $O o0 000000 - nh—ld Rates XXXXXXX $0 No So— $0 No XXXXXXX $0 No 000000 XXXXXXX $O oo So— $O oo XXXXXXX $O oo 000000 XXXXXXX $O 00 So— $O 00 XXXXXXX $O 00 000000 XXXXXXX $O oo $0 00 $O oo XXXXXXX $O o0 000000 esp_Sery cesl lV XXXXXXX $0 No So— $0 No XXXXXXX $0 No 000000 Supported Em ploym ent XXXXXXX $O oo So— $O oo XXXXXXX $O oo 000000 Supportive Housing/Living XXXXXXX $0 No So— $0 No XXXXXXX $0 No 000000 TASCXXXXXXX $O oo So— $O oo XXXXXXX $O oo 000000 - d XXXXXXX $O 00 So— $O 00 XXXXXXX $O 00 000000 o ulp XXXXXXX $O oo So— $O oo XXXXXXX $O o0 000000 Supery s"On Lev I XXXXXXX $O 00 So— $O 00 XXXXXXX $O 00 000000 Su pe-s"on L XXXXXXX $O oo So— $O oo XXXXXXX $O o0 000000 Roo, Supervision Lev III XXXXXXX $0 No So— $0 No XXXXXXX $0 No 000000 very Suppo t-Individual XXXXXXX $O oo So— $O oo XXXXXXX $O oo 000000 very Support-Group XXXXXXX $O 00 So— So— XXXXXXX $O 00 000000 XXXXXXX So— So— XXXXXXX So— 000000 re Total= $O.00 $O.00 $O.00 $O.00 $O.00 ' XXXXXXX $000 $000 XXXXXXX $000 000000 Oubp axle nt O e tox' Yon XXXXXXX $000 $000 XXXXXXX $000 000000 - $O.00 $O.00 $O.00 $O.00 $O.00 D (YTD Un itl Proratetl Sbare (Ovaetl)ue Unn Rate - PART t-EARNINGS Cornmuetl. TANF$Ea d Earn g Earn gs) tb�s Momb vity only Iloo.247/ ®.rityri� miry soslOsoz (od.H of - 002 XXXXXXX $O oo $O oo XXXXXXX So— o000000 -Oay XXXXXXX $o OO $o OO XXXXXXX So— o00000 Info--on XXXXXXX So— So— XXXXXXX So— 000000 $o.00 $o.00 $o.00 $o.00 $o.00 In lntic den ExP 77s �1 XXXXXXX So— So— XXXXXXX So— 000000 I tl I $O.00 $o.00 $O.00 $O.00 $o.00 TOTAL. $O.00 $O.00 $O.00 $O.00 $O.00 $O.00 IIIty Is allowed I!lu nded via SAPTBG Unless the contractor requests and 1M1e ME approves payment In excess of the prorated share. h.Less Rec oupmu of of Interest= $0.00 i.Less Recoupme Ativance $0.00 j.TOTAL AMOUNT OF ME PAYMENT/AD=Nnl E= $O.00 $0.00 $0.00 $0.00 $0.00 Oue$o00 d $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $o 00 $0 00 $O 00 $O 00 So— $O 00 k. TOTALAMOUNTOFMEADVANCE= $O.00 I. TOTAL AMOUNTOF ME PAYMENT= $O.00 PART 3-CERTIFICATION&APPROVAL certfy the above to be accurate and in agreement with this agen,ys records and with the ternvs of this agenc)/s contract with the M. m Add t—Iy,I certify[hat all client demographic and service event data has been submitted 1-the ME in accordance with the contract Sign Title Oafe n. For ME use only: ME USE ONLY Date Invoice Rece i—d: Date Gootls/Services ReceI— Date Insp—d and Appro — A —d B /D.— Guidance/Care Center, Inc. Page 82 of 121 Contract#PPG-1-06 O7/O1/2O12 07/01/2012 EXHIBIT F Minimum Service Requirements The network 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: I. PROGRAMMATIC AUTHORITY (FEDERAL) A. Mental Health 42 U.S.C. 300x to 300x-9 (Block Grant for community Mental Health Services) http://www4.law.cornel1.edu/uscode/42/ch6AschXVIIpB.h ml B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes) http://www4.law.cornel1.edu/uscode/htm1/uscode42/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.cornel1.edu/uscode/htm1/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) hqE://www.access.qr)o.qov/nara/cfr/waisidx 03/45cfr96 03.html Restrictions on expenditures of SAPTBG 45 CFR 96.135 http://www.access.gpo.gov/nara/cfr/waisidx 01/45cfr96 01.html C. Substance Abuse-Confidentiality 42 CFR, Part 2 hqE://www.access.qr)o.qov/nara/cfr/waisidx 03/42cfr2 03.html Guidance/Care Center, Inc. Page 84 of 121 Contract#PPG-1-06 07/01/2012 D. Health Insurance Portability and Accountability Act (HIPAA) 45 CFR 164 hqE://www.access.qr)o.qov/nara/cfr/waisidx 03/45cfr164 03.html E. Social Security Income for the Aged, Blind and Disabled 20 CFR 416 http://www.access.goo.gov/nary/cfr/w isidx 03/20cfr416 03.html F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 CFR 240 relating to SSA http://www. ccess.gr)o.gov/nary/cfr/wisidx 03/31cfr240 03.html G. Temporary Assistance to Needy Families (TANF) Part A, Title IV of the Social Security Act 45 CFR, Part 260 http://www. ccess.gr)o.gov/nary/cfr/wisidx 03/45cfr260 03.html Section 414.1585, F.S. hqE://www.leq.state.fl.us/statutes/index.cfm?Ar)r) mode® ispl y Statute&Search String= U L=0400-0499/0414/Sections/0414.1585.html 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. http://www.law.cornel1.edu/uscode/htm1/uscode42/usc cur) 01 42 10 6A 20 III -A 30 C.html Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101-645 http://www4.l w.cornell.edu/usc-cqi/qet external.cqi?tyr)e=r)ubL t rget=101-645 Guidance/Care Center, Inc. Page 85 of 121 Contract#PPG-1-06 07/01/2012 42 CFR, Part 54 http://www.access.gpo.gov/nara/cfr/waisidx 03/42cfr54 03.html I. Americans with Disabilities Act of 1990 42 U.S.C. 12101 et seq. http://www.law.cornel1.edu/uscode/html/uscode42/usc sec 42 00012101-®®®000® .htmI II. FLORIDA STATUTES All State of Florida Statutes can be found at the following website- L22L//www.leg.state.fl.us/statutes/index.cfm?Mode=VlewStatutes Subme nu®1 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. Public Health General Provisions Chapter 386, F.S. Particular Conditions Affecting Public Health Chapter 395, F.S. Hospital Licensing and Regulation Chapter 394, F.S. Mental Health Chapter 397, F.S. Substance Abuse Services Guidance/Care Center, Inc. Page 86 of 121 Contract#PPG-1-06 07/01/2012 Chapter 400, F.S. Nursing Home and Related Health Care Facilities Chapter 435, F.S. Employment Screening Chapter 458, F.S. Medical Practice Chapter 459, F.S. Osteopathic Medicine Chapter 464, F.S. Nursing Chapter 465, F.S. Pharmacy Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy Services Chapter 499, F.S. Drug, Cosmetic and Household Products Chapter 553, F.S. Building Construction Standards Chapter 893, F.S. Drug Abuse Prevention and Control Section 409.906(8), F.S. Optional Medicaid — Community Mental Health Services C. Developmental Disabilities Chapter 393, F.S. Developmental Disabilities D. Adult Protective Services Chapter 415, F.S. Adult Protective Services E. Forensics 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; F. Florida Assertive Community Treatment (FACT) General Appropriations Act http://www.fisenate.govNVelcome/index.cfm?CFID=105701865&CFTOKE =34016817 Guidance/Care Center, Inc. Page 87 of 121 Contract#PPG-1-06 07/01/2012 G. State Administrative Procedures and Services Chapter 120, F.S. Administrative Procedures Act Chapter 287, F.S. Procurement of Personal Property and Services Chapter 815, F.S. Computer - Related Crimes Section 112.061, F.S. Per diem and Travel Expenses* Section 112.3185, F.S. Additional Standards for State Agency Employees Section 215.422, F.S. Payments, Warrants & Invoices; Processing Times Section 216.181(16)(b), F.S. Advanced funds invested in interest bearing accounts *Travel Expenses are specified in the DFS Reference Guide for State Expenditures h tp://www.myfloridacfo.com/aadir/reference°/®S guide/reference guide.htm III. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care All references to F.A.C. may be found at the following website: hops://www.flrules.or�/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 65E-4, F.A.C. Community Mental Health Regulation Rule 65E-5, F.A.C. Mental Health Act Regulation Guidance/Care Center, Inc. Page 88 of 121 Contract#PPG-1-06 07/01/2012 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 C. Financial Penalties Rule 65-29, F.A.C. Penalties on Service Providers D. 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 p://www.dcf.state.fl.us/admin/publications/policies/155-10.pdf CFOP 215-6, Incident Reporting and Client Risk Prevention hula://www.dcf.state.fl.us/publications/policies/215-6.pdf B. Federal Cost Principles OMB Circular A-21, Cost Principles for Educational Institutions hqE://www.whitehouse.qov/omb/circulars a021 2004 OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments hqE://www.whitehouse.ciov/omb/circulars a087 2004 OMB Circular A102, Grants and Cooperative Agreements with State and Local Governments Guidance/Care Center, Inc. Page 89 of 121 Contract#PPG-1-06 07/01/2012 irculars a102 OMB Circular A-1 22, Cost Principles for Non-profit Organizations hqE://www.whitehouse.qov/omb/circulars a122 2004 C. Audits OMB Circular A-1 33, Audits of States, Local Governments and Non-Profit Organizations L22://www.whitehouse.gov/sites/ efault/files/omb/assets/al33/al33 revised 200 ZS. df Section 215.97, F.S., Florida Single Audit Act hqE://www.leci.state.fl.us/statutes/index.cfm?Ar)r) mode=Display Statute&Search Strinq=&URL=0200-0299/0215/Sections/0215.97.htmI Comptrollers Memorandum #03 (1999-2000)- Florida Single Audit Act Implementation hq ://www.myfloridacfo.com/aadir/cm0/cm990003.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 http://www.access.gpo.gov/nara/cfr/waisidx 06/45cfr74 06.htmi 45 CFR, Part 92 - Uniform Administration Requirements (State and Local Governments)\ h2p,//www.access.goo.gov/nara/cfr/waisidx 06/45cfr92 06.htmi OMB Circular Al 10, Uniform Administrative Requirements for Grants and Other Agreements hq ://www.whitehouse.gov/omb/circulars/al10/a110.html E. Data Collection and Reporting Requirements Rule 65E-14.022, F.A.C. https://www.flrules.org/gateway/ruleNo.asp?ID=65E-14.022 Section 397.321(3)(c), F.S., Data collection & dissemination system Guidance/Care Center, Inc. Page 90 of 121 Contract#PPG-1-06 07/01/2012 hqE://www.leci.state.fl.us/Statutes/index.cfm?Ar)r) mode=Disr)lav Statute&Searc h Strinq=&URL=0300-0399/0397/Sections/0397.321.htmI Section 394.74(3)(e), F.S., Data Submission hgE://www.leq.state.fl.us/Statutes/index.cfm?Ar)r) mode=Disr)lav Statute&Searc h Strinq=&URL=0300-0399/0394/Sections/0394.74.htmI Section 394.77, F.S., Uniform management information, accounting, and reporting systems for providers. hgE://www.leq.state.fl.us/Statutes/index.cfm?Ar)r) mode=Disr)lav Statute&Searc h Strinq=&URL=0300-0399/0394/Sections/0394.77.htmI CFP 155-2, Mental Health and Substance Abuse Data Measurement Handbook hgE://www.dcf.state.fl.us/proqrams/SaMh�/ UbS� reports.shtml Guidance/Care Center, Inc. Page 91 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2012-2013 F.IJ hlt t..SIM'f FUNDING 13Y F'fxCr(#IFAM&0.C•A�IVI'l I ftvratl Vew'2012--201,1 FTovidts N [t Iaiahw'laCt aav t eaiG:�Pi Iwe fR ui.�. ._�� .................ry 'Qtl'gdlr..`J ... [".tCli�SclF ld°i4a,Itlk� ..._� lltcvds'i lql tt } .Adult Mertta.l I1A.Am r Llailadrear Meatl.aal lleallb Activl)y!a„"ofil(,cillea TAW�,$ U11�K °PANE*$ &TOT K voe RAI" N=Ves I2wte 1 2 :3 J. 5 6 T P.AIlel'a,oicy stabOlaavon 11,' IsH ati t risk Slabilizali6M1.(No L",c V) ttutit�'dled-day 2>i?22� VV2,��k2R21An ttl Crisis SuIW)rwu'nd°a'uaaa•,ecu�° . it„a::swdr'duraw' 2�222��2 :..1 22(2d2��2 IKf Inpadicwfl(No IAANp) UEA 2a1,�rday N.,l:ANd;.,:. NormI'�ANp:.- I ofal lAM4,rrSeatry 14ah1iaafloil 5J 'total N,rrYe,pllry'Statalldwalim $li n I Jrncnruprneswtvd ttr,ifv Ilnrmeaeps°auwault;a'G tl,1M�'4.�s Recovery&Reuilknrucy 101...sl:Hnesswnmit. 4lruit.:caanpacr.dacnur 02. 2i�2222 Case pil Nlmuipaucru 22MINI 1 .,1 d tuiN:;"9aven.i rtalTlrcnu' �..... t 05. IDay 3.4v t fait:S-1w day aav''v'u It 9 U01h 1-'I'w'tday h.., d 07 lD,utn=➢oi[°'rrefifJJr>Ip C'eua�aaa tilq,"T,r'h�["'dT� Uflia lwavdady day (K 1FAILwrke au d t:Arl Sits. Unik:dims N1wt7"lucw.ir ................ �,�.,................... ��f9 7,�i �1Pi1U971��i i �.®.......�.®..�...)r W.Iranengrve Can N'hwuappi'ta'rr. t nW dire,ua'wtf-hntw' tI. l.wtv^swrareOa,a-hulmdtard Ulli:t:diml Aaff"how' .. .1 �1101111ME 1 .. 1! med'ua';allserwes(Nod,'INS') VAIi:Q ulw hoult i222'222J� �. � 222Y22220 "' W. Oaw'pru,iuq-lirwl.O dual .. , 1I„it:r:a,a�t tint dua�,r ll5, t:,rtuftc•4,cda IJati'd:,uattudw'sttl��sgatlglln&dtu' .......... ...�� L.....................,,1 MOM �..................... 1>.revea:atim 111'alr_nnn rtuecl.aill'limr d i )1�~z ecntuwudradeeuc�itlant-14�ay ..., lraatt:rl�,r day >w2�I��W171�V�i i"G �1��ViE �VI ( PR1`i�IVANI S, 1111 P�11mll hteAdati hM lxvel t llrril:2h-fr4a'y �,-1. —1 ) m...... �22�2222 ,..,,,,..... a� W, XiMdmdal Level A tlawt:24-hr(lay 1,. ®..k .,®®� 2211VI12WIt22 R 20.. I{cmdeuar.pal Iza el.llI Wril.:26-h ch'�ty �,.. .. .. .�. i 21. Itesideutinl L l fWi tf,li:h:"N k-Ire adara SI iNitHlON 22. Jl.3.ti;pdtc;eenrgccs 4 IIpId�1�ay�, �dylI(Y�N�mp�Ilgp�gylp�pM11�!1�prtpyq^I yr Unit"'Wad ad how ..,m ,..m,v l 1 ®.�.� I�YOIII�MIIYIIWI»I�)YUlk1�lUYA 23 SiuefidaivAll:tuployrovot (NoTAN'1'�') t[I it I-v day 22I�dSV� �r �,,,.,� 1�21222 122222'ii2 ��1Y119 IdUClllll!ABdVWUtIMNY $��y�� 2,5. Stuppmed OuladoWuvrctw. U114:(Ow Fdaffhp1.w �, R�l1 it M(E 1 ..... ter, 'Sujjpolivi IdrtuialuusanvirtS ttrwt.dim'd AWhowr L i 11111 � ...� 21, Aftuh:cmv-hadiwvidaatul (lrti:t:dirW hdHMMIur .....� 'ldl IrM;Nma4m andMRef(Twil(,NoTANF) ttl'tir ma1rhouat' 11110 2 V ........... �.....1 1I1'2OMMI f. .. ........1_J oturpwd'israu•6rmu pr 11,61::au,u ad tlac lur liil l2l22 f �. .1 Ada 12ait.Yllta'vuh(l tl$m,d wts'Ip@J"t umeo d.ev d.I Olit:2bt-Iw day 37 I0wil gj,adl l nd wl'h.wµelyrossdorul.e;+rcd Id p 1161:244.day �..,... � �.. .I MEMBER I. ...,... A Room,and Board v isupper'vuxiotu d.ml M t7auif;24-h,clay 1.�.. ..n ..� �� ..........,� �V�� ............. 39.. Sdacwt:-tom]ltevidcr,d.dwl'fr esaruruc,ll. MEMBERS 11111111�lll IN2IYNfM2iii�22 itru �9t,Ya'I wryp'i ad 4 Guidance/Care Center, Inc. Page 92 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2012-2013 Exhibit G:S I A 11 FUND IN i.;ITY I IROGRAM&A(l BA III FUM Your 2012 U'll PqAid. ................ ................. .... Cmd"'md��4........... Adoill Mental flethith Ilealilm AM NI ly Qol CaTta IANIW,% Ulkil 1ANFI; UaR vo� RAlo V(, Role 6 9 it 111111!(109)Ivywe AIM homw t aovjtstim houl ................................ .............................. ,13,AkicUm-(Amp mAuthar ......................... r......................... ........................................... Now TAN F Nw�IAN F- T.)IN J?- 'TAN F I'Mal ktsmml&Rt"MM'ney V I Ohl Retovery&144jenoy Mi U04,- t 5—mp'l—OM 1 loh.- Remwy&Reslikency FACT Tpam 34, PM11'femm (NO'LANfl IT101,"J"ll-ho'n ....................... ................................... ....................... FACI - 'I Wal FA(l &Ro011oory ............................ ............................... ........... ........... Nomi-I'ANF Nom-I'ANV� TANT, 'I-)VNF 1,06d CCWT Servirvs so, ratw COVI'sawk,"'A(VNI��faYYn��lM1f SO UncampaisOM Units Rm,vviwy&iv,ilI"ic) CCST F.A.CM& Fah P."4:'S'1`-lroai'Mvurluwl Unil"51wfr0lm, ...... ... Noo,IIANT":,.:: 'I AN F-50111111111111 R 61 a]11.A.C.LS SM'Vices V1 'mvwjwmai.l Uop� Rpruvery&ReNillmey Onsillmill",Forl"nor iq, -- --------- — .. .... Umt 24-1p&U . I 39, Shml-lum Itch dmik8l frummilli Owl;hed-Dw Nw UANY FANF Tqgwl Rmtkit l*rvkv,%- SO TOW ilormlac Servk"N P Unit's- Unit's RpRovpvy&ResfltmlCy Incide0all L"pav;Lx(immal .......... ....................................... .... ................... Unit"CINV50 ew J I. ...................... 2& Incidultai ENImll'ses.fuffvsic ............ ........................Odr Nil,I ANTF- No-IANF- IANlf t AN11'r I�fl iJJJM Expmws TlIcklemal ENmlw UlRVMp(MsRlVd U11113 Ullrompellsatod I afts I OtAl Nwi 1ANV I Mol No"'IAN V 'VotW rANF Tol.1 MmW tl—lth rmd. SO TWA WWA I kA-Alfll Fmuh- If,1, Guidance/Care Center, Inc. Page 93 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2012-2013 F-IdWift G:S I A IF FUNDING 13Y PROGRAM&AC IN14Y ftwal UYL,vi,k,Nm- ....................................... ............................. ................................................................................................I O I —,—].. ...... R-isilN Adult Wntaxice Almw Childreai SubOmtce,kbuse AMO ly Cmia TAN175 VIM 'TANFS VA L %-WN RAlo Y7 Yt, Ruta 1 3 6 Ovaifirliflopt Z4, $u�Aaj ice Abw Delmd&vakvi(No tANT) Ililit!bcfl-d"'y ....................................... iz Olitt"Ifi-t DefOxificaliull(No[AMI) Lift I Air(imy ...................... EMIRS L—� IoffAlNmAANF� I MM Non 1AN1e',, Towl pul"fle'lifloll- $o TOW IM6411CA11011^ SO Uncompeiisated UnK5 x. Uncoupeosatett Ulifts Prevenfiliot 16 prevmlim Multi r¢arra-drmeel stafffiour 1911ME1111 L........................................ t 'I t 7. Prmenl i mi/tymnuiti LNL-Day 0 d t:4-111 day ......... ..... . NORMAN �.............................. Vn I AN P)Jnfmwtim aryd Relcual (Nor Unit slaffhoill, IRWIN= L..................J foNiNm I'ANY TOO N owl ANP.................. 1 MW Wevtv 0.1- 104 UllcolvilmixatNI Units Vneffimpensalml Unit's- W 1',—immi canal Aflef carte 01. Amwinew .............. Unil ............................... .................................. .......................I jiliv diml STOW i5mr, suppoWl"Jilugmiq ................. lm. ................. ................... 05 JA5(',Iwe Univ 4-1v day 0')% DRY)Nighl ........................................... I.............................................. lJoil�4-1o.day 6 .I W. I'l-I kvw.&'(Al"Or UEIA,dilevi ............ ................ ........................... I........................ A fntci�svvc Case Utit dir-ecl StAffholm. an= Simm MIN IM= so= IMEMEMI IntOventmi-Individual .............. l2. NILA-�Svivi..(NT. ANF)t(A Lit CM Nct hour NT&had,nneMijjaenmwQ V�iii:dtwoge 'alivit-jitflimbial I Inuit:,colliav hour J t J 115 Oltumich Ul ii t:IRML-dil Mt S.LAT 114AIN ReALIMItim]JA^vel I Ufliv 244m,day I J I Sad Rcid-jial Lkwr]0 thdt:24-1m,day I L I I 20. R�,mwtial Ui,ol M Ujlj�:24-hi day 21. R-ickmtiml L"ej 1v Ullil:244NT day 22, Rupite Smuci .......... Ullit:coilltact Will, . 25, Supp(LIINI bliploymalt Uttirdirml .........................................t f........................................... Zk ................................ ............................. ................................ 27 TAS'U ..............................i It'lit direcl AAMMIN], 'I............—" Zlji Aflelcaic Unit-di—I.Malfh w F7 Guidance/Care Center, Inc. Page 94 of 121 Contract#PPG-1-06 07/01/2012 Exhibit G 2012-2013 P"Ailpit i..STAIT,FUND IN 4.;BY PROGRAM&Ml Ml V FUM Yem,IM Vill file n J"WROH) C-Ind P,� i, ............ ---- -- -- I MmIl Substavive Abuse cWhIrem's SmiWance)hoe, AM NI�y 4A,,q Cmto I ANIV 5 V110 TAW$ Viol X vo Ralt, V(, Rate 3 4 ..................... ........... Room and 1�imrd W.Si pejwwti Ln,el I ............................. Uffl 1!24-14,flay ............................ J 17, 3& ROOIALMD(f N),Ald WiSLJIM-OSRAN UNd M trildl:w4-111 day J 12.bllwVL,OOj"a- UFO.Clmlmcl llow ,13.Mhocm v-Y.@ mp ............. UW wola0hour "I............................ ....................................... ""I............ ................ J ,kj' Rmwety Suppoil-Individual ......... ................. Unir doev slaffhmr L L................ ,17.R--ry Supp.1- Upo:ewoo N�Om .............. ........................ . ........................... ............................. 49,(1jAcm,supov mon for Ewdwee-baAed 1),uli cc, cfl cm ilr .......... ...................—`- 'I mW Nw,TANF T m al N ool AN F- I'C"Al I,%NF ILGfaj tANF Towl Trvaumill&Afttwure TOW freatumit&I Aftm,,,mre Vp UllmllpellmdVA Units UmmiAlwnsalvd Units rmIfirtal Aft", (TS1 14, (VSTAvclRvAoaj Univ S,tlffHojw, Nm,TAN F Non-IANV IANV I-ANIP I Maj(TST"'Aff's M) ToW Gfl4'Servlops- $10 Ullebult)(Immed UJIM5 Units ImIdental ExImuk'n 7 29 Imid.,11.1 RxIml—, I lilit Click S50 gpdlt L TOW Nmi'TANF 'Tc4qI.NqmTAlNF TWO-IANF lWal TANF' I OIAI Wridefitm Kveltsel M) I MAI ItIcAmItAl Mvmspq $0 1 Giml Nwi 1ANY- I otal Non IANF S]�l 1 Ad TOM VANV 'I c&A'I AN F- W .............................................. V.1.1 SubM.—Ab,.-Fwid�- I W.1 Al--Fund - Guidance/Care Center, Inc. Page 95 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2013-2014 F-IJOAt G:S I A 14:FUNDING 13Y PROGRAM&ACTIVI'l I PKcal Vm 2013 2014 FTovid.N.-[6ti7f�m 11".-v................................ cmilmd ------ [zevi,4umj#: .. . ......................................................................................................................................................D Adidt Mental I leallb Clakir"I Menlal Wallb AcfjvjlyN,`�,fil(,cillej IANF S UnK TANF 3l. VTOt 1 2 4 5 6 7 FAIlwaoicy stabOlzavon 03. CriskSlabilizalmij(No L"V) U0,kd-day 04, Crisis Uno stWhow MINES Im 00. Inpalitit(No JANV) UEA-21111 day N.,FANF- NosIANF, I CA'Al FAM4,FgKicy 14ah1fil.afloil total EATiel'onry Stabilily.alim $10 Recovery&Resifimq 101. Agsessnmit Unil c"vao fimr 02. Case Maruipa'aw Upil dwftl"dall'bo" BIMINI 1 1 05. 1')my(:'tape Oul:44w day .. ........................... pp� ................. U01h 1-Im"(lay j 07. UfliL ftwiWy day (K 1FAILArke and d:Al1 Silt, Unil dims RimMmir W.1ru9gove Can Nhwapmumil UnW direv,hinfl-how 1. NlmoOn ,a-hulmd1W Ullit diml Aaff hour .. ........ 1 1101111 ME I lit medicall serwes(No lANP) VA I i 1:Qwlw houl Oalpmdir q-WhOduml ljadl_cout."d ho", ............................................. .........................................OWN I.............I..............I L,.......................1..... MOM eveltim Unil,nnn-dw eel.aill'Jimr tyllit'I 41fr day 112101 MOVE= MRSIVANIMS, 11119111mll . ............. : ReAdwhM txvel I � ............................... .... U71il 24-fr4ay: L-11—111- L_� .............. W, RiMdmdal Level 0 Uml:24-hr(lay 20. Rcmdenrual I a~el fl I Wril';24-fm chly J i 21, Residultim]L"Cl W ry ..................................... Vilit 114-111&N, SIMON Unit G OCxCN.i'1[.10m 23, S�w�WivAl E.mployrovot (NoTANT) [I it'I-v day 2-5. Suppmed OulAoymaji U114:(Ow�.'Oaffjww ..®............I ............................] ROME= E I.......................... 26, 'Sujjpolivi TJN1,qn1OJvj1)g UTIA:divi'd AW how L i 11111 29, Aftu cm v-Individwil UlLit dirW NAHMMIM .............. ......................7, EMIR 'lu OMmmalmandRef(Twil (,NoTANF) Ullir ma1rhow, 11110 ........... 11MOMMI E11 _J .15'. O4ulp.1 imP-6:rm�p 11,61:au,uMad Y, Rooui hind Bm,d wts'aptimmeo Levd I OlitZbWO day 37, Jt(,�Qnj gj,adl Ll�md Jxvel 11 161:244.day ........ MEMBER I....................................... A Room,and Board wisupLivision Lml M ............. Ulk 24-hl day 39. shm-tom] nd-Dwy EMISSION 11111111fflll RXIMMISNOM d 4 Guidance/Care Center, Inc. Page 96 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2013-2014 Exhibit 1.3:S I A IF FUNDING BY 11110c;RAM&A(l BA III f1wcal Y"r 2013 U14 Prmid. ........................----------------------------------- ........... ........................................................................... MOM Mental flethith Udldren'5 Menial flealilm AM 0 ly Qol CaTta 'JANIW,% Uldl IANF$ UMI X-vo, RAlo %,, V(, Role 1 u 4 6 9 it 111111!(109)Ivywe AIM homw 10 OW)FIR t�lld L wvjtsv�how 43,Akicaw-(Amp mAuthar ......................... r......................... ........................................... N.n,TA,NF Nwu'IAN F- I.)vN I? 'TAN V I'Mal lltsmml&Rt"MM'ney V 1061 Retovery&144jenoy -------- Mi Uu.-A"uptuott.1 U.,19,- 1 loh.- Remwy&Reslikency FACT Tpam 34, PM11'femm (NOl-.ANfl Ullil-d"ll ho'n FACI 'I Mal FA(l So &R�-Wloory MP 4t,".,V`];dwdAx7alunM ............................ ............................... ........... ........... Nomi-I'ANF Nou-I'ANV� TANT, 'I-)VNF 1,06d CCWT Servirvs so, ratw COVI'sawk," SO UncampaisOM Units Rm,vviwy&iv,ilI"ic) CCST F.A.CM& Unil"51wfrolm, ...... ... Noo,I I ANF, 'I AN F-50111111111111 I W a]11.A.C.LS�SM'Vices V1 1'mvwjw4nai.l Uops Rpruvery&ReNillmey Onsillmill",Forl"nor ——--- ---------------— ............................ Um I t 24-1p&U .................... 39, Shml-lum Reiidmik8l Owl;hed-Dw Nw UANY FAN V Tqgwl Rmtkit l*rvkv,%- SO TOW ilormlac Servk"N P Units- I illvmllpeus*M Unit's RpRovpvy&ResfltmlCy 7777;1 Incide0all Imm;Lx(immal .......... ....................................... .... ................... Unit"CINV50 ew J ...................... 2& Incidultai ENImll'ses.fuffvsic ............ ........................mch Aye.kpmlt �j Naar,I ANTV- No-IANF- IAN*f I ANI"r I�flY iJJJM Expmws $M,a If tNfal TlIcklemal ENmlw� $0 UHMNIP(Wate,t)U11113 Ullrompellsatod I afts I OtAl Nwi IANV t Mol No"'IAN V 'VotW rANV Tol.1 MmW tl—Ith rmd. SO TWA WWA I kA-Alfll Fmuh- vo If, Guidance/Care Center, Inc. Page 97 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2013-2014 t6d,11r11 0:S'l A rV.FUNDING OV PRO(;RAM$L 4e('1 M 0" ftwal Year 2013,2014 Fro6,k, R-n9i M,11: Adalk FibA—ry Alww C7A156-1-Snl,5,4—Ab.—, Acti sity f Cusl Cwtu I ANT' Ujiff 1ANF$ Unit X -Yes Rate x-Ves Nate 1 2 3 4 �R 6 7 I.Moxificatim 24, (Nol'ANI) Ojai:1 ukhy 32, (No-IANF) Unil:44w day -total Nmi'I ANF „1W id Non I ANF I ON 1TeNo lnaatYull $0 Total DOOM 11(aflon P Upworai'mmiled Chills- TYomqwwW,-d UaW,- 111"evelm19o1s I W, pre"'Nim 11"42 wn4limO Ald'el"I'mor SC3,210 F7, Day t 4il:4-11F r2my .................... 1101111111 1 J ,A Mj'(,j�jmth,,,apdRej'wAt(Nol'ANF) Upil m0hom I MW Nm J",kNF- Iola]NoWTANF` S114,447 .................... ......... Total R I Ow Uncompensaled OWS Unconapewsated Uidti $0 l'up.1merul and Afliwkgrs! Unit C'mhuJOhmm, Cmi." 111 I Mall kjdA Lr D DOY C'm t .......... W 44ur floy Univ 4-1w(w ............I I.........." ............. OR hOhN,W,&011 Silk 1 j ,11 iC dir"I slafffmir ......® - ............................. ............................................ J 1.11sive Case Mailag(mmit th'il:direct'hfflw',. low= Womm" Mom= MOM IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIPI l 1, hklmAmn-Individual Umt:direct stalfhow l2. Njcdical Smite,(No'FANF) On`u MISMA M211 L, l i. (NO I ANF) I MEMO= I:----- 114, jj paammli oldml ....... ...... cqmiaa how ............. ...Unit!non-dvva Wwr ... .................................... Unit:24-IN day 9, Resickviml Level 0 thiii:31-Im day ................... .............. I,IA '24-I'd,ay 21. Rk'V1.6M L-1 ly Udt 24d.'WY L J 22. Ke pif.N,-k- Unit;VOMMV�howf L- L 25, Sojj�,,410 rmpkymeul Unit;fW'el Aaffjomr X "Suipp(likv IINIA61g)Uvillg Unit!direct staffhom, 7, 'FASC UlIiL direct 44affhow ................ N Aflue te Ullit dirml malyhow 7 .............. .......................... ..................... ............. r",ONNP?Nl mrFvr 3 A 4 Guidance/Care Center, Inc. Page 98 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2013-2014 Exhibit G,:S I A I'll,FUND IN 4.;BY PROGRAM&ACI I VI V FUM Yem,2(013 014 Nw— P ..........................................................................................................................................................................I - ............ Admft Substavive Abuse ChIldrem's SmiWance)h1tw AMNRy,(4A,,q Cmto 'I ANF,5 01" TAW$ 041 N vo Ralt, V(, Rate 3 4 ............................ ........... Unit (7cmtact HfAll" W,. Room ind 1kimrd W.Si,upejwwtB Ln,el I Ulfl 1!24-14,flay Umt,24-hild,my ........ 3& ROOIALMD(f N),A]d WiSLJIM-OSWIN UNd M tridl:w4-111 day J 12.b11wVL,OOj"a- UFO.C'mimcl 11ow ,13.Mhocm v-t.@ mp ............. UW wMa0hour "I............................ ....................................... I............ ................ J ,kj' Rmwety Suppoil-Individual ......... ................. Unir doev stalThmir L L................ ,17.R--ry Supp.1- Upo:Lwoo�Om 49,(AjAcml supov4 mon for Ewdwee-baAed 1),uli cc, cfl cm i1r .........."."") ...................—`- 'I mW NwJANF T m W No o-'V AN F- I'C"Al]',%NF ILGfaj tANF Towl Trvaumill&Afttwure TOW freatumit&I Aftm,,,mre Vp U11(milpennav'd Units UmmiAlwnsalvd Units Aft", (TS1 44, 4VSTAvc1RVAwjj If l R51 0, Nm,TAN F Non-IANV IANV I-ANIP I Maj C(WT"'Aff's Total CX14'Servlops- $10 U11 cowl)(Immed UniN Units ImIdental ExImuk'n 7 29 Iwidml.l RxIml—, I writ:elich 1S50 gpdlt L TOW Nmi'TANF 'Tc4qI.NqmTA1NF TWO-IANF lWal TANF' I MAI Wridefitm Kveltsel M) I MAI ItIcAmItAl Mvmspq $0 1 Giml Nwi 1ANY- I otal Noji IANF SI1 1 Ad TWA VANV 'I AN F- V.1.1 SubM--Ab,.-Fwids- SO I W.1 Al--Fund - $144,447 Guidance/Care Center, Inc. Page 99 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2014-2015 Exhibit G:STATE FUNDING BYPROGRAM&ACTPaTY Fiscal Year 2014-2015 Provider Name Gl idance Cale Centel,hrc Contract# PPG-1 06 Revision# � Adult Mental Health Children Mental Health ActiNity/Cost Center TAXES unit TAXES unit X=Yes Rate X=Yes Rate 1 2 3 4 5 6 7 Emergency StaUlization 1 507004 03.Crisis Stabilization(No TANF) Una:bed-day 04.Crisis Support/Emergency 1 Unit:staffhour 09.Inpatient(No TANF) I Unit 24-Inday I Non-TAKE= I Non-TANF= 11 Total Emergency Stabilization= $0 I Total Emergency Stabilization= $0 1 UncompensatedUnits= I UncompensatedUnits= I Recovery&Resiliency 507JO18 I 50 013 I Ol.Assessment I Unit:contact hour �...... .........� .............._� I �� _.. ........_� 02.Case Management pppppppppp Unit:direct staffhour 05.Day Care Unit:4-hr day j ---. .....------.� 06.Day/Night pppppppppp Una:4-In day 07.Drop-In/SelfHelp Centers(No-TANT) Una:facility day ---��.1 08.In-Home and On Site I pppppppppp qq Una:direct staffhour 10.Intensive Case Management I Unit:direct staffhour 11.Intervention-Individual I pppppppppp qqp Unit:direct staffhour 12.Medical Services(No TANF) Unit:contacthour 14.Outpatient-Individual pppppppppp qqp Unit:contacthour 15.Outreach L..... ......... ............ I Unit non-direct staffhour 16.Prevention I pppppppppp Unit non-direct staffhour 17.Prevention/hitervention-Day I Unit:4-hrday 18.Residential Level I I pppppppppp Unit:24-In day �....... ............� ..................� I ��«��ftBflgC�� ... .........� 19.Residential Level II 1 I Unit 24-hrday 20.Residential Level III I pppppppppp qq Unit:24-In day 21.Residential Level PJ rr IIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIII r Unit 24-hr day 22.Respite Services pppppppppp qqp Unit:contacthour 23. Sheltered Employment(No TANF) Unit 4-hr day ..............� : 25. Supported Employment I pppppppppp qqp Unit:direct staffhour 26. Supportive Housing/Living L.... ......... ............ Una:direct staffhour 29.Aftercare-Individual I pppppppppp Unit:direct staffhour 30.Information and Referral(No TANF) 1 I Unit:staffhour 35.Outpatient-Gloup IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIpppppppppp U .............. Unit contacthour: .,I 36.Room and Board w/Supervision Level I I Unit:24-hrday I 37.Room and Board w/Supervision Level II pppppppppp qq Unit:24-In day 38.Room and Board w/Supervision Level III Unit:24-hrday 11---. .....-------� 39. Short-tennResidential Treatment Unit:Bed-Day ------ --------�� I Guidance/Care Center, Inc. Page 100 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2014-2015 Adult Mental Health Chihtren's Mental Health Activity/Cost Center TANF$ Unit TANF$ Unit X=Yes Rate X=Yes Rate 1 2 4 6 7 9 11 I 15021118. 1 503913 40.Mental Health Clubhouse Services . . I I I IIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIII Unit Clubhouse staffhour . 42.Inten ention-Group ppppp Unit:contact hour �.....�.. ...........� ................� 1 ��ftBflgC�� .................� 43.Aftercare-Group Unit:contact hour Non-TANF .,.,.,., .,.,.,.,.. I Non-TANF= TANF I TANF=�� Total Recovery&Resiliency= $0 I Total Recovery&Resiliency= $0 Uncon4vnsated Units= I Uncon4vnsated Units= I Recosery&Resiliency-FACT Team !502918 1 34.FACT Teams (No TAINT) I I Unit:staffhour L.......... ..........._I ....,.,.,.,.,. .I L.....,., .......,.,... FACT= 1 Total FACT= $0 I Uncon4vnsated Units= 1 I Recosery&Resffiency-CCST !50291$- 1 s 5430L3 44.CCST-Individual ryry I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIpppppppppp Unit: Staff Hour L....... ........... ........... .. L........ ............_1 I I44lll�ll4NRNttgCftBflgCftBflqC��N ............... L...... ................ I Non-TANF= I Non-TANF= pppppppppp yyyypp ggpp ggqq TANF �........ .............� I TANF=��ftBflgC��ftBfl��tl�fl��tll4 Total CCST Services= $0 I Total CCS T S ervices= $0 Uncompensated Units= I Uncompensated Units= I Recosery&resiliency-CCST-F.A.C.E.S. I s 503013 44.CCST-Individual I Unit: StaffHour I Non-TANF=IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIpppuuNNpryryryry�p�IIV1U1yJyJy�V T ANT=��VVVUNNNNpISMYIYIkIMIC/f///f////f//////////////AI Total F.A.C.E.S.Services= $0 Uncon4vnsated Units= I Recosery&Resffiency-Community Forensic 1 502018, 771 1 s 5430L3 19.Residential Level11 ry 1 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIpppppppppp Unit 24-hrday ........ ........... ........... .. L........ ..............1 1 I44lll�ll4NRNttgCftBflgCftBflqC��N ............... L...... ................. 39.Short-tenn Res identialTreatment ppppp q ppppp qq Unit Bed-Day Non-TANF= ryry IIIIIIIIIIIIIIIIII TANF ... ...,,1 VIhIhV dI VI....� ..... ..L....L....L....L. Total Forensic Services= $0 1 Total Forensic Services= $0 Uncompensated Units= I Uncompensated Units= Recosery&Resiliency-Incidental Exlvnses !502918 1 s 503013 29.Incidental Expenses:General Unit:each$50 spent �- ---------------------------] I ��I Iijujaimmumm --------. ...� �--------------------------- -�� 29.Incidental Expenses:CCST-F.A.CL S. Unit:each$50 spent ....�� ...��. ..� �------- ----------] I Iijujaeummou --------. ---I ----- ------------- 29.Incidental Expenses:Forensic ,,, 1 Unit:each$50 spent ��. �------- ]---------- I ��I Iijujaimmumm I Non-TANF= I Non-TANF= TANF I TANF Total Incidental A4xnses= $0 I Total Incidental A4xnses= $0 Uncon4vnsated Units= 1 Uncon4vnsated Units= I I Total Non-TANF= 1 Total Non-TANF= Total TAINT 1 Total TAINT Total Mental Health Funds= $0 I Total Mental Health Funds= $0 Guidance/Care Center, Inc. Page 101 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2014-2015 Adult Substance Abuse Chibtren's Substance Abuse Activity/Cost Center TANF$ Unit TANF$ Unit X=Yes Rate X=Yes Rate 1 2 3 4 5 6 7 I Detoxification ! 603065 1 602t101, 24.Substance Abuse Detoxification(No TANF) Unit:bed-day �� I �� ........- ....-- 32.Outpatient Detoxification(No TANF) I Unit:4-hrday --------------�� I 1 Total Non-TANF= I Total Non-TANF= Total Detoxification= $0 I Total Detoxification= $0 Uncomlxnsated Units= I Uncomlxnsated Units= I Prevention 6030t16 I 602t102'.. 16.Prevention Unit non-direct staffhour 1 $43..,20......,I 17.Prevention/Intervention-Day pppppppppp qq�,ry ppppp qq Unit:4-hr day 30.Iit staffhour and Referral(No TANF)Unit Unrt:staffhour I Total Non-TANF= I Total Non-TANF= $144,447 Total Prevention= $0 Total Prevention= $144,447 Uncomlxnsated Units= I Uncomlxnsated Units= $0 Treatment and Aftercare 603007 I 602903 I 01.Assessment I Unit:contact hour .... .. 1 L.. ., 02.Case Management ry I I ry Unit:direct staffhour ..... ........_I .......,.,......_I I .. ........_I .......,.,........_I 04.Crisis SupporUEmergency Unit:staffhour L...... ............ ..................... I L.. ........... ............ ....... 05.Day Care ry I I Unit:4-hrday I I 06.Day/Night Unit 4-hrday .............................. .................... I L.,. I ., .......... .................. 08.In-Home&On Site I Unit:direct staffhour I 10.Intensn e Case Management pppppppppppppppppppppppppppppppppp pppppppppppppppppppppppppppppppppp I pppppppppppppppppppppppppppppppppp pppppppppppppppppppppppppppppppppp Unit:direct staffhour 11.Intervention-Individual ry I Unit:direct staffhour ...... ........._I ......,.,.,.....,._I I L,.. ......,.,._I ..........,.....,....., 12.Medical Services (No TANF) Unit:contact hour .....................� I CflftttqttgC� ....... .......� 13.Methadone Maintenance(No TANF) I Unit:dosage I 14.Outpatient-Individual Unit:contact hour ...� ..................� I �... ......,� ...................� 15.Outreach ...... ... ... I ... ... .... Unit non-direct staffhour I 18.Residential Lev el I I Unit 24-hrday .................. 1 ...........,� ...................� 19.Residential Level 11 1 Unit 24-hr day .------------------ ------,--------� 1 �.,.. ......,.,.,.� � ............ .......� 20.Residential Lev el III I Unit:24-hrday �...... ..........� ...................... 1 �...� ...........,� ...................� 21.Residential Level IV .... 1 .. Unit 24-hr day ...... ...........� ......,.,.,.....,.,.� �.,.. ----.-------I ......,.,.,. ...,._1 22.Respite Services Unit:contact hour 25.Supported Employment Unit:direct staffhour 26. Supportn e Housing/Living Unit:direct staffhour 27.TASC ...... ... ... I ... ... Unit:direct staffhour I 29.Aftercare I I I Unit:direct staffhour ...... ........_ .......__....__I 1 L._ .......__I ....,.,.,.,.,. ____, Guidance/Care Center, Inc. Page 102 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT G 2014-2015 Adult Substance Abuse Children's Substance Abuse Aefivity/Cost Center TANS$ Unit TANS$ Unit X=Yes Rate X=Yes Rate 1 2 3 4 5 6 7 35.Outpatient-Croup �� .�...�„...�... I .....,�.............�...........,� �.�.��..�.��...,� Unit Contact Hour I 36.Room and Board w/Supery is ion Uv el I Unit:24-hr day 37.Room and Board w/Supery is ion Lev el 11 Unit:24-hr day I �.�.,......... I �.�.,......... �.�.� 38.Room and Board w/Supervis ion UvelIII Unit:24-hr day I .............................. ................................� I .......... ......................� 42.Intervention-Croup i I �� ....„...'.......... I Unit Contact hour I 43.Aftercare-Croup I Unit:contact hour 46.Recovery Support-Individual I Unit:direct staff hour 47.Recovery Support-Croup I Unit:contact hour 48.Clinical Supervision for Evidence-Based Practices Unit:contact hour Total Non-TANF= I Total Non-TANF= Total TANF _ I Total TANF -----------I I Total Treatment&Aftercare= $0 I Total Treatment&Aftercare= $0 UncompensatedUnits= I UncompensatedUnits= Treatment&After-CCST 603007 I 602003 44.CCST-Individual L i ........... i I ................................... L ii ................................ L ... ............................................ Unit: Staff Hour ii..................................1, L................................... L................................................1, I L..................................1, ................................... ................................................1, I Non-TANF= i I Non-TANF= i TANF=L................................................1, I TANF=L.................................................1, TotaICCST SerVIces= $0 I Total CCST SeiMces= $0 UncompensatedUnits= I UncompensatedUnits= Incidental Expenses 603007 602003 28.Incidental Expenses I I Unit:each$50 spent L.......... ..........._ L...,.,.,.,. I L.,.,.,.,. I I Total Non-TANF= I Total Non-TANF= Total TANF= I Total TANF= Total Incidental Expenses= $0 I Total Incidental Expenses= $0 I I I Total Non-TANF— I Total Non-TANF= $144,447 Total TANF I I Total TANF $0 Total Substance Abuse Funds= $0 I Total Substance Abuse Funds= $144,447 I Guidance/Care Center, Inc. Page 103 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H FUNDING DETAIL 2012-2013 Jd",.Ikl 11 TX11HRIT11 Twwf+I)TNi Tw'7W k .,. .. .... ..�... �. e,,,,,ee „�,a d .. ...... i vfr� Y�,uW.,w.^rw,lilt e.A. Y,.rc�, Ui,ti✓M�.ni f i;:-. ( f �. OndMwEmily 609105M AdIwili,'s M'gmwfl IT-14ai (W,� APMjourir Qwwnl xit Tiaiiq 609101-d':➢iiAdi w Ridmipm9 a6-M, irGA AWM4MfE"e'd'T ^.&hY]00 i E M6Zwdi:7i"i'WG Y!i"4'A;AiV IY A'T TI(INi [LWwtitiy�'MIERO G E NVY�WARI L Mk Tti.y7'A V, AID r1'LTCOMIN1:JI!a"NTAL ITTfha M 0.0i7dr"TY1k _ t'/A,CTJTE15REV,'h AW uVYAL ITALTH 010641sj _ h"/ YMki A'I ^� r f yr R (01N O, A J e,rr�w Cm 4e fiolf a ar Cri.,i fl ' rA,A HAVI,A AVI"'E AlvI I T", 416FAIII _ Is(A,VI011A;AprN,S EIAYLM OAF„�f' siHutl'1',�17y i ,.i.��i�+vua, 1„ ,. 44 11r..��.,ifi sn.,i il. IN" S4N2m Wa:Ai'V&� v No 1*11NIIIII.Yd•AUYT4 wou,µJSC,iI"acw a&k.SANAa GL d'u V V.iA APUL'I'COMM."WN"T'AT U TAP.'T it i16wwYaip _ A,1, 'i+99'Cr IA4 ItIlAP.jCE kflR.aki /UF PAH by 41 /C.7 Imo. 1 d 1d# f rl d Sli....car"ii" 1, .� 001477 t h f at/I L r I r f tli IA 1 +J F r I l i Ah h,b aEDVAjV ! P l R W4 P i n ( fl Il CL dl. l IJ i.� fb., M. I 61 f u4 i i ! ,} 1 I I fA,F i J ➢J!Yi F I iw f 1 r If i i t s 1 f m mm1 b.!e tv w1 ➢�,.;�Ir ✓..` Y 1 F 111 A'i l i k L b Ji iO f i Ir,t; i fl J n YV kP 1 � f • 7 < li li u Y i 1 a f iW Cll idl aFAbFa7Il1'8aA)II h79 RAT V, m YIL.Ina NIL YCVCp I M tlldl'T TkAw9 b„ ill / 1 1 i(G N Id R 41 AN I ➢ F'" R111T I IAdM 1,Vd(I'll I (.i 1•�miv f. ;�.F i{�i"I It�.r bn A'f f Ss'rFr dfv&wliwN rz'a:1"+K 11 EwM,D&I'k—ia6Ai"A4 Y1GYA3.Fi11 ,.., 4 r, . ,..,. " 1 1 .. ...i I r;i ,MIT, r tldiwwn� q Jh ki 6 uy➢ I 7w ytin;a y d418 alma ry Y IwA 1a �+t r'.rikr rf Iwi; F i i�4l�e anlii tr ulF "IIO"4d+wa h➢tliw:7""R AAT Ci'P Aw..T9A'Aa A"dg-� '& a"i7"P'Aa('14 MII51k,1"WS MGKNTA%.OF AL YM $ TBudwin NiiiiiagMYFiitlii ,A,11114`i&liilxwrm Bi.Nie.nro 0CA ATIOD 11TN'T M.dii'o NinnLY Oi 9VW94.Y::'Ih lld b'm iN 0bVA A@iapial'NI maim w a,4fc"II'0,vji[[•➢C•f4'1.'Ad7h' 601 131:'."fl'c'nXIVICA.'0.'VIudINrN,VY WA V Y.4YANQNIrwii A"IS7+Po'.74 AH 1i5.T AW N 4AY�gIMb B>4k 411A,4111f,A 01 4G NBfN6"IANP,Al UNK A'W S' $gt4Na2kYt d.P.1 kA71 C bi' tAY A 1 h;1°"• � � L :S Gf f F kF7 fI:741°;t•+'� I .� 4ni"Yenwpdu 9 rteT+ S 1V wuniarrNrvt iT;glld'=' 'k I xnwnini.nm Pal iii4¢ aS U .alma&rni d U.."', $� dak,l[16 PNtl 602001 M41,fa N1A0N.yPPV't41 6; GIA a Iwp41"id'xl'td A2"A11 T A111INT i CIN L>CMwG Y1, d A L YYd1 aN,At lil S4dRKITAN,5 kjgr gip',i,Wf g'QASWN120 P _ 1 T R%1' P @ 1 1CY 1°"" f 1 it i AT, NI F.AU,UMiT,r drliu�lw��I.frr y>w•i«. ,,,,,,,,I i Ir i_, i � r,vmin a P f i r. I f- tivi 4 S 7 4 ti I Ihi I r:TP'n .fi r e t' al 6Ap',0(j7•"TRV):A If NI,4bry eV A Fjf I!C'A R F Mr 11SA'Cp A.YYBLV':Jw g f4+l1'E1t'U'.fi!IW T I Mtf•..iA,6kA';. VtAV1'Y„yd"I'H kad Vi"w41T"1C,'4..A&AalYF 54G:"M1: gaoaY6aaYr _ 6FN I.d1aA.PJA'LI]/Y1&L!dU'Ti'4,Pd4,F AN31&S�&:':W4"ti tIfNW9Gp1 iI } I I 'i } f L 6�S1 Y 1 5l IO:I Tt n 4 T , r, r A'a 11{Tr 1 'iif rl v,iT tip9lr1 • ri Alf lyi lii>1 .^ L wf rh tLl liri,a I a Mir,rrlA II .� NdFlU1 111111010 i 1 111 _ y I T t4 i;,t k 1 1=malt""* AI i L 6 a I1.(1 ',rq,l ',� Liri ii ie rr.l al"`e I YI i iqi re i:ir 5,r 4:ia,Sd Leo 121,10I,T "Orr, ri r.[plan i 4iw,gl ea'nl ,'I Li i'i7 a �r 4r P5i IDlr,vv T'na f t f i'.ilaf""•• G I�, .. •t•i'i�N'illl N Jli A1A & I- V 'Ar i k ATI—w pli ➢`tYa'AI,AVVII'I'Lr NUIIBTThPA'4:'Yt iARIII'SM'+ S t0i` tl,.C1IMuandS.N%'W IiLNI'.iANOI AIWINt;- s Lx4j_4'T' 'I("ILA' �A LL IAdta:wuRAM%� 8 16JI.l�UT TOTAL Al E aF"C60."ASAP k T7.'R'A"I':ll 1111`61. 1 '�tid i.IX ii'Vr Ja 11G7,..1e;'I's"d;i3Y';t (MANI:aDTOTAL*FPROQRAAWJ. IPMi3Pi9PENS^A,YED a PRIW S E44,441 1 'fi At NW-7�hyIII N _ d T_ A it6 ,'Ai MA" ti I".Cdc7 LIJflAt'i'Yl„R .. v„ .. .,, �'i k,,tJL A'R'dr'a2iNaiA;7a '6 ,e�r�err r�.AT �Aa uA,,r.ii��_& r6,r�o^,_, x r, A �a awra� n I Weil 7x il"K.��e'prr Guidance/Care Center, Inc. Page 104 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H FUNDING DETAIL 2013-2014 FY 2013-2014 EXHIBIT IT FUNDING DETAIL Pre ider Neme Guide. e Cere Cent r Inc C n rect#I PPG 1 06 I R von# I MENTAL HEALTH Budget E.-60910_506-Adult's 54e.ta1 Health OCA AMOUNT Budget E.tity 60910506-Chtldre.'S 54e.tal Health OCA AMOENT 502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION G/A-ADULT COMM.MENTAL HEALTH 000610) G/A-CHILDREN'S MENTAL HEALTH 000a 5) ADAM'Trust Fund TF(021005)* �t 1 _ ADAMH Trust Fund TF(021005)* 1 111 1 Gen erel R11-11(000326)* �t 1 --al—,-(000326)* (IS51 !(III TSTF('22023). 1t 1 FGTF Title XXI(261015) fi Qol Gen erel Revenue(000326)* sntkl�l , Gen erel Revenue(000326)* .\tkI(l G/A-BAKERACTSERVICFS 000611) G/A-CHILDREN'S BAKER ACT (104257) --al—,-(000326)- AI 1 General Revenue(000326)* (111, TSTF(122023)* 111 ... ....... ...... ..... Emerge.cy'Stabilizatio.Total= $ Emerge.cy'Stabil izatio.Total= $ Uncompensated Units $ - Uncompensated Units $ - 502018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY G/A-ADULT COMM.MENTAL HEALTH 000610) G/A-CHILDREN'S MENTAL HEALTH 000a 5) ADAMH Trust Fund TF(027005) Ak HS1 { ADAMH Trust Fund TF(021005)* C f HS1 O&MTF(027005) AHHS1 1 General Revenue(000326)* (f HS1 Gen eral Re —e (000326) Akk S1 Gen eral Revenue Children At Riskof ED(000326) C�F.E]) GR/AGAPE Fam Mmi:try(000326)* �S\I\I]) FGTF-MIAMLDADEW rap Around Pro YR-1(261015) fdlQDshl .... ......... ---------......... GR/Comm Forensic Beds-Adult Svc(000326) C114�s. F ederal Grant Trust Fund(261015) CF.F.S1 ADAMH Trust Fund-FACT Admin(027005) F'1'.1", General Revenue(000326) SP iM� Gen erel Revenue-FACT Admin(000326) F1119 GR-JVRestor lncomp T.Pro(000326)* 32N0? FGTF-FMGPMA-M—di—id Admin (261015) F11119 FGTF-Title XXl(261015) fl9Ql Gen eral-FACT s vcs(000326) F'1119 FGTF-FGGGJD-JeilDrvers von Pro(261015) f..l])I1 _ G/A-PURCHASED RESIDENTIAL FGTF—FGGGPT Trans From Homel---s(261015) 1,O TREATMENT SERVICES 002780) O&MTF(027005) 1 11 lfl GR/MCAID&Non MCAID MOE(000326)* 9Y." , Gen ecal Revenue(000326) sntkl� v GR/Punch Res Treatment Medicaid Sv (000326) 91H'I'1 _ !Y W TTF TA NF(401001) 19,1b Gen anal Revenue(000326) LI t\tt Tobacco S ettlement Trust Fund(122023) AHHS1 F ederal Gran t Trus t Fund(261015) AHHS1 y_ G/A-INDIGENT PSYCRMEDS PROGRAM (101350) --al—,-(000326)- Total Non-TAN F $ - Total Non-TAN F $ - Recotrerv_&Res tlie.cv Total= $ R—.—,v&Res tlie.cv Total= $ Uncompensated Units $ - Uncompensated Units $ - TOTAL ADULT'S MENTAL HEALTH= $ TOTAL CHILDREN'S MENTAL HEALTH— $ SUBSTANCEABUSE Budget E.-60910604-Adult'.,S.bsta.ce Abuse OCA AMOUNT Budget E.tity 60910604-Childre—S.bsta.ce Abuse OCA AMOUNT 603005-DETOXIFICATION 602001-DETOXIFICATION/ARF G/A-COMMSUBSTANCE ABUSESVCS 000618) G/A-CHILD/ADOL SUBSTANCEABUSE SVCS 000420) ADAM H Trust Fund TF(027005)... ADAMH Trustun Fd TF(02J005)*** 1),x('.1v vv� —al—,-(000326)** Dlx�s. _ f --al--(000326)** ])Ix( TSTF(122023)** ])111 C 11 Detoxificatio.Total= $ Detoxificatioo Total= $ Uncompensated Units $ - Uncompensated Units $ - 603006-PREVENTION SERVICES 602002-PREVENTION SERVICES G/A-COMM SUBSTANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCEABUSE SVCS(100420) --al—,-(000326)-- Pk 1. _ ADAMH Trust F—d TF(027005)... YH l'C $ 89169_ ADAMH Trust Fund TF(027005).... Pkl11 _ --al—,-(000326)** YH VC. $ 54,678 General Revenue(000326)** SPS(S Pr e,reo tioo Sersices Total= $ Pr e,reo tioo Sersice.s Total= $ 144447 Uncompensated Units $ - Uncompensated Units $ - 603007-TREATMENT&AFTERCARE 602003-TREATMENT&AFTERCARE G/A-COMMSUBSTANCE ABUSESVCS (100618) G/A-CHILD/ADOL SUBSTANCEABUSE SVCS(100420) ADAMH Trust Fund TF(027005)*** ADAMH Trust Fund TF(02J005)*** IF:I'C Gen analF75,6 e(000326)** TE Ids. Gen anal Revenue(000326)** O&M TF(516015) 'I'R I`I TSTF(122023)** I F:I'C1 ADAM H Trust Fund TF(021005)*** :t>I1] O&MTF(516015)** IF:I'C1 ADAMH Trust Fun d TF(02J005)*** :t»'M INI ADAMH Trust Fund TF(027005)*** 2>G-It' General Revenue(000326) 39'1'(0 W TTF TA (401001) 391(1 W TTF TA' (401001) 191(0 Gen an al Revenue(000326)** s:PS(s _Ltd igent Drug Pro MOE(000326)** DF — { ADAM H Trust Fund TF(027005)... Spl(I FGTF-FL Acess to Rev(261015) ('11 E v SSBG TF(639002) I R I(S Me FGTF- dZid Adm(261015) \Q 1C 01 1r FGTF-Screen Inter Treat Pro(261015) 1.—1 General Revenue(000326)** 5F 11 ------------------- ADAMH Trust Fund TF(027005)... Sp—S Total Non-TANF $ - Total Non-TANF $ - Treatmeot&Aft--Total= $ Tr eatmeoI&Aftercm'e Total= $ Uncompensated Units $ - Uncompensated Units $ - TOTAL ADULT'S SUBSTANCEABUSE= $ TOTAL CHILDREN'S SUBSTANCEABUSE= $ 144,447 TOTAL ALL PROGRAMS= $ 144,447 TOTAL ALL UNCOMPENSATED UNITS= $ FUNDS NOT REQUIRINGMATCH: GRAND TOTAL OF PROGRAMS&UNCOMPENSATED UNITS= $ I44 447 D Ab S es $ TOTAL FUNDS REQUIRING MATCH $ 144,447 —i alLa n Project $ LOCAL MATCH REQUI n RED 112$ 36 CLHHP gemnt $ ADDITIONAL LOCAL MATCH _Block Gra $_ TOTALFUNDSNOT REQUIRINGMATCH= $ - GRAND TOTAL LOCAL MATCH— $ 36112 e tal Health Black G< enditur must be Srbst ance AbusenPrevention and Treatm ant Block Gran eligible BSrbst ance Abase Prevention and Treatment Black Grant-Fwding A�eem ant-AEST EU CT IONS APP Guidance/Care Center, Inc. Page 105 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H FUNDING DETAIL 2014-2015 FY 2014-2015 E EF M-FIINDING DEIAR, Provider Name Gt dance Ca C ter lnc. Contract tF PPG106 „�R ntF. „1 NIF FAL HEALTH 13 dkei n fity 60910506-A.hdt'.s NZ He th OCA ANDUNI 13 dket n fity 60910506-CI.H.L-W S NF..W He th OCA AtNDUNT 502004-� STABILPLATION 503001-� STABILPLATION C A- SILT CONINL NIF FAL HEALTH (100610) CJA-QIB.,DR S NIF FAL HEALTH (100435) ADAMH T—t Fund TF(027005)" `,l ,I ADAMH Tn Fund TF(027005)" <F 1 Gen eras Revenue(000326)" ',l>Sl G ralRevenue(000326)" <E 1 TSTF 022023) `,l ,I FGTF Title XXI(261015) )l Ol General Revenue(000326)" 1M11A1 .............. G eral Revenue(000326)" 4HIl1 --------------------- CA BAUFrz AC SERVICE$ (100611) C -CIIII.,D S�AC (10425) General Revenue(000326)" `,l S51 G neral Revenue(000326)" <F SS1 TSTF(122023) ll•S51 EoxrgencySMhiliz:.fion Toth= $ EoxrgencySMhiliz:.fion Toth= $ Uncompensated Units $ - Uncompensated Units $ - 502018-RECT)N F VY RE41LIFi\�CY 503013-RECT)N F VY RE41LIFi\�CY C A- SILT CONN1 NIE FAL HEALTH (100610) ...................... C A-CHR.DREN'S NIE FAL HEALTH (100435) .., .,.,.,.--- ADAMH Tn Fund TF(027005) ARR51 ADAMH Tn Fund TF(02'/005)"` CRRS1 O&MTF(02'J005) `,RR51 Gen eraLRevenue(000326)" <RR 11 General Revenue(000326) `,RR51 G .eraLRevenue CL ildren At Risk o f ED(000326) < `,PED ------- GR/AGAPEFam Ministry(000326)" lE MMD FGTF-MIAMI-DADS W� pAround Pro YR-1(261015) <4t DA,1 GR/Co mm Forens is Beds-Adult Svc(000326) (EBAS Federal Grant Tn Fund(261015) <RRSl ADAMH Tn Fund-FACT Admrzv(027005) EI'A19 G .eralRevenue(000326) SP�MA Gen eraLRevenue-FACT Admin(000326) EI'A 19 GR-.il�Restor lncomp To Pro(000326)" iNO3 FGTF-FMGPMA-Medicaid Adnvn(261015) EI'A 19 FGTF-Title XXI(261015) Gen eraL Revenue-FACT sues(000326) E I'S19 FGTF-FGGGJD-Jail Diversion Pro (26101- ([JD'I'1 CJA-PURCHASID RE4IDIN'I-LAI, FGTF FGGGPTTrans From Homeles mess(26101-1) (N013 TRFATNIEiV'I'9ERN'ICE4 (102780) O&MTF(027005) 4113 13 GR/MCAID&Non MCAID MOE(000326)" )E ft"s 41 Gen eraL Revenue(000326) >4113�, GR/Purch Res Treatment Medicaid Svcs(000326) ')PEf I S 4N'TTF TANF(401001) 39A 13 General Revenue(000326) f Pl'4tE Tobacco Settlement Tn Fund(122023) ARR51 Federal Grant Tn Fund(261015) `,RR51 CA-INDI�P9 N'QINIEDS PROQIANI (101350) General Revenue(000326)" ',RR51 To tal Non-TANF $ - Total Non-TANF $ - Recme..y Rc Re..silie.ry T.W- $ Recme..y Rc Re..silie.ry ToM1= $ Uncompensated Units $ - Uncompensated Units $ - TOTALADULT'S NIEiV'I'AL HEALTH= $ TOTALCHB.DRIN'S1N'I FALHEALTH= $ SUBSTA `CIE BLSE B.Ngetn.fity609l O6O4-A&dt'.,S..hs—w A .se OCA AtNDUNT B.Nget ll.fify60930604-Q.B.L en'.s S..hsfw.ce Alx.se OCA AtNDUNT 603005-DEIOXRICATION 602001-DEIOHICATION/ARF CA- NINISUBSTANCEA ESESVC3 (100618) CA-QIB.,IIVADOL SUBSTANCEA EISESVCS (100420) ADAMH Tnvst Fund TF(02'/005) *"�` ) XA, _ I ADAMH Tnvst Fund TF(02'/005)""` ) S v v„ Gen eraL Revenue(000326)"" ])IN15 Gen eraL Revenue(000326)"" ])IS<> fl TSTF(122023) ])I S<> Defoiific:.fion T.W- $ Defoiific:.fion T.W- $ U..{.e--dUA. - 603006-PREN'FN'I-IONSERVICE4 602002-PREN'FN'I-IONSERVICE4 CA- NINISUBSTANCEA ESESVC3 (100618) CA-QIII.,IIVADOLSUBSTANCEA EISESVCS(100420) General Revenue(000326)"" PR l`,5 ADAMH Tnvst Fund TF(02'/005)""" L Ef l<> $ 89'/69 ADAMH Tnvst Fund TF(027005)"``"`"�` PEf'A G .eral Revenue(000326) ^' 1 Ef l<S $ I. 6'JS General Revenue(000326)"` ,PTI Pr .fion Se..rvice..s Toth= $ Pr .fion Secvice..s Toth= $ 144.447 Uncompensated Units $ - Uncompensated Units $ - 603007-TRFATNIFNI 8e AFIFRCARE 602003-TRFATNIFNI 8e AFIFRCe1RE CA- NINISUBSTANCEA ESESVC3 (100618) CA-QIII.,IIVADOLSUBSTANCEA EISESVCS(100420) ADAMH Tn Fund TF(027005)"`*` I Ef I'A5 ADAMH Tn Fund TF(02'/005)""" I P I( Gen eraL Revenue(000326)"" I P I'A, General Revenue(000326)"" I P I l.5 08cM TF(5 160 15) I P I A 5 TSTF(122023)"" I Ef I<S ADAMH T—t Fund TF(02'/001Y*`*` »HIti O&MTF(516015)"" I P I(S ADAMH Tnv st Fund TF(02'/005)*"�"�` _74\'61M ADAMH Tnvst Fund TF(027005)""" _7<HV General Revenue(000326) i9TC0 4N'TTF TANF(401001) i'JIl 1 4N'TTF TANF(401001) i9T CO G .eral Reven ue(000326)"" "PT(S GR-Indigent DrugPro MOE(000326)"" DPG03 ADAMH Tnvst Fund TF(027005)" ""PT(S FGTF-FL Ace.s.s to Rev(261015) E 3IP" SSBG TF(639002) I P I l S FGTF-Medicaid Adm(2610I5) MA((11 FGTF-Screen Interim Treat Pro(261015) SB004 General Revenue(000326)"" SPTAS ADAMH Tn Fund TF(027005)"`` SPJAS Total Non-TANF $ - Total Non-TANF $ - Tre:.hmnt Rc AIlereve Toth= $ Tre:.hmnt Rc AIlereve Toth= $ Uncompensated Units $ - Uncompensated Units $ - TOTALADULT'S SUBSTAN EISE= $ TOTALCHR.DR S SUHSTANCEA ESE- $ 144,447 TOTAL ALL PR0Q 1S- $ 144,447 TOTAL ATED UNHS= $ FUNDS NOT REQUIRING MATCH TOTAL OF PROQ1AtN1S 8 UNCOMPENSATED UNITS- $ 144,447 �D-g Abuse Services $ TOTAL FUNDS REQUIRINGMATCH= $ 144,447 D .stvtutvon l atvon Project $ _ LOCAL MATCH REQUIRED= $ 36,112 CMH P $ ADDITIONAL LOCAL MATCH MIT Block Grant .......,.,. .......,.,., .......... $ ------.,----.. ............. TOTAL FUNDS NOT REQUIRINGMATCH= $ GRAND TOTAL LOCAL MATCH= $ 36,112 tal Health Black Gr enditur must be Sl.bstance AbusenPrevention and Treatment Black Grant eligible Sl.bst ance Abuse Prevention and Treatment Black Grant-Funding Agreement-RESTRICT IONSAPP Guidance/Care Center, Inc. Page 106 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2012-2013 IE V9M Ill NBt'UM LOCAIAIYrAV(At OxV„w.N AndPV'�rrat F !'•W llv r n,.r 4mraa Irv:.01 ikd,aJ ';bdh f',Ard, flA ulmfu,rp P9vv.nirar PFU I D,SA F,,6. 8 I.U.w Iurxrxxi'blxu1 4Yr i 1.^t, 'a,VVv;ip ¢ ,'W: I Jrt.xam, wia I.rM1 www,wnw _ A. unm', , 'A"f vl G.�inkniu )I,. 7r11d Ifl.rc=m 14 - r�"(rtAV IN'rie(fi 0 V,7lgep i4, F'1'Yri" f, IA.Mw. '6', Y; R. d V�^aa.:br,r°aearvl dsl^:,11 nn I.rmnY i rLal. t i,t rreb v�:n rr 4rn fv.urinvl:xat G xx htr Nw wm %d',: b4 pan tl l l Mn vapmmrmx a 9rdw wFSs,sxttL ......... ahied;AxvL p r To udl I;)l A a ua m"'IvPi E . I,id vrc ¢ 4 p $... 'I W li rU d Pa'.z;,i,sr^;�,a cur..l'ul.-x'n,d lr..a r ,ar y'er.'mi rNu e+Rui'.1'nneee I ,n,. b ICapm I „Y,.ml Gl kxie I e t di MA !IrE Iw:ai�d, I nlyd u9xRala Ik t-4-0 .a r.If rrin NO,-4 tlta. rhn,4 r 1, d so, t r s fhrr J,rm`w.,i rd:[. w CetlwaRlgm],wiu�.mrry^�rry H r_Iw Aµprunx,Famrppmny �'w.rr Nrpnan�¢ xpxeaF _ .eqs sngw(,wvvu,'mH,^�+w"n _ w t'u�rl A9 1q"o,,$ F IraYt a r,a R .,pit I,x.{p I�e,a:rf. rLrr U .Ih,d,,t,d n .,I.1HIr h.¢id Mvu I' !1„pd RI.,II .... ,,,.,, n uISrE f9nSxr#i ,..F,,,.,,, 0 9 A I d1d„iu b.....,,,,.,,. ,x 1 Is lNHI.^a �k U ,k�pn ,n Fw'.s �, 14rAe + Itaxn d Uaun: n IxrnrAd uWa w'.Y,F nr,i v v nx�Y (m. h 3vr I,n3:r,( !`u.�I-M n(a dYxry'-[Adwlx 6 D,Iy NCI9ip I, '$Y Dq Nijox re,".xlr t 4 N1p�n' _ .Y f rl'Ai px,Nrlr F rr 9'. 1 - _. .... J f Y,A tmpt! - m Yl W A,x9i 1 b N kr Nnd aln t o.axxr.] ILl4.1 I I,,,lux ia,at.1. C h 1 8 Irin a,L V.u�,llw;rat »Im J 1."9 AUNi'11'llr A:r'AU_ n 4 DI IIIY�WV MID CnrAara y e li.r d IflHIBde IIdII p-... m Im P";r9i�],491 Up l:"a'm , _ fi k'�ax =%H In Mt,gnr 1, YF^xra In Ha ta,'.rt9 r ifs ir.i,,nva 11 I-J v�'.a O ,15,da'.,rd -arJ 1.,,fv xrl'roart ,Js. 1,9xu lTew,wwndl9:Are Ai[:5,n rdnxw Y:pm Ell- 11rn Su„8rxnlu. Id MI..mwl: Wlur Am Mrrtx 1„pp nr a.xaxl lku\luu'Fea'Wxx.n 'n'Purnl dd:w�dl. d - a'I rr.Yl dlxYs'd, I -r Irz'q Pfi'nP��9t b n tld vs"'+Ia;" 4 i SI pe: &... d�p°u'e r 7 'I. Pxnc W lirµtr• ri .tv.rs an,aa.uad rr v vr'hx,xti,1 riin nr Gzn9raanrt rU4 n fxumR,xvwd Moyrw&rmx ....:t V S xlH.mx .. ......... b'C',I mod, {••••••••• I'�fi'!'rdU"+I:h �.,.... 5 l.,d Q�Il nl✓k, x an ril tlu<fl^.P� b f IYw's, A ihl Cl,b'a fl tr fl.tix 4 '� lrxne Y r ^,ry'4 R4 L avd e,(u a.wnv.Iwr rh a.m.¢4 r IUrn errutn11 as 7.'„HvxSvMa,Yk f slim Itl Marvrib r mm1 lwWra,niµbwam' I?i].-dw I,ext,h'Ixmrvyywrort f l] nwiexad ar ui AA mwnprmiw,ax •l.nxw 59wx l: Mlxrro' rxer.A _ nl Hl,tair lo<1 dl a*A, u P. its F d? $.... 1, adpa .4. ix.2'¢ry b te.rtlr lvx r,gard e.'a lu.Idr a nu9,r. f I nee; tyrr in,r.i.w+.d W, .rr hmrdrxn:d II hA. Wlpa I:]I d 191nx _11 d 1 ulu v, _ 91 b l rH n¢:rl 1 a,x h Po 'a'I an!M a.`.rdY +. I r A pn u'nl, p q :rwd 11l3xIl" 6 cl i Z, t F 1.14 f N 6 dl man:wI,d .w.A rdry Ir.Ivrr Ihu.ha-eM1 i Idq Itrce Y+,a 1u.,,xd. rur Jrul.Ixrr'^hawk § I.M1DIx@ 1bw.vlkv,n ...... Art db'¢I W. nmxx'. ... M901 Ari 'Iwve I Mwl S-1- m,ll �x T,A m1d, M1......., , t 12 rant lr '6 r-,A P& .. Nodu k I'Ib w,mLc S.._. )r ita ;A. a.Ns9is 4 � .Iimvy Yxrisvwi uay.:9,rvr inv rl,a.ul x`A n.lhv J-,.'x�,4 3.e WaufM1n]uvxmt rl-d I'4 h0g7wd nm A4nUnru'.xwnen, .... .._IVY riiu,Abvr,enam P@mLwHA'rw,ve. .._ I',ndxaI Paivui,unuru,v,. ..._ 11d4Ai'xalf vr.ANntlWrvmman w Tvn'ni P,4,1"-ah `'B rn't rl eni p0, { , Ir xl a1al�l b rr".d Ann t9, IC hm. p u Hd ,I Bp k it ll u,1 vkF-6 xn'r. . a J A as V t I�w: rile prep m-yrrpMrh b 'IH ap µyl Lux9wxvnl h R¢ •9xYnwll nv I Iµr A'dvr,pwu w raurl �[Ysr 19aS,rkRr A ', Tn,Yd 17vn "S „ 7rtzE I,M, d - -- I v n MuGa 11 fGi;r. ;'& Ir Itnnry'are t i„r la FNrr[A,v v) 'k r.1o�;Fria vsanPd na irc. ,),r WreM rm!II } ,RAH r rrt*1 rl xmll � Ia d;WAYtw61ri _ Is(XII"IwNr. _ I (N11,,uwEh y aa�YM v�r�!n I !S 7< r all'dxl'kr l g 'm'I A:ArcrnSn 9 it dlA.,r@ I r fl k BsuwI aria lr lu f ar l mrn�! :I II Gd ...I'fir rmwxiw,l. I'F,.. mi- It 6*aarevAw6rx, .......... ....... ,,.... ,r„dY.,tr, a'P'A 14."1" H A Pm' 1 m",1, '¢ x Tr 14 d9-Tn'� � r F...... 4Yr. r:LrvA inu l'x.axJ f InIM r low,f y'uM-I rufr Irc I.¢rreP"n=ert I. '. I1 XWaribwNw,Slvw,ry-ywmd- EM! _ I.WN ery xwrrlanY6p xexMv gan 91mh _.._ _'.I SM,+rtyrrJntl✓Eu,"n xwxwlp t'vl _ I 6'v r+mwrA6+pr/I,uvrnxluYatu:I.ry ,Trrvai Vd:,,al: Ira i.nl pll,✓mli , f v 9 Vri u,Jr. d m a m!p Ball Y I M,crxrHi v,>z,w:d 9 e„fix�rr Iart rH.,.x Y ,.rr,; lrr,l'ra F.a.vd. �1L x,,l lr, 4v.,r Nmrrt 1 ryl:,q.. Id fiGrv+Yp lixl dnW'FII fR NrvfIL nbvtl]m,d! " 1S Jx to l,at9,d p,xald6 i M dd.C9xR LamMi x Lr+l's714 sx,id A '�a'lx.,l MMltr 8.... , r du ad Pk'e CV, f %a:e tnrrvyuen'r u'A.In'. V.eu Hr L.�IE n`.1i a true)i,ai Iva e1�Fr rGrana'd uu '.Il,rawAmrxwanl d,nuM Ik I,+w*salfxxlaaaA J-4III 1+ldxwdFln¢MI d,+.alx Il r Vp,'rw."W W-1 II ,b iinul trl i?tidx d u.V-1 kn o I, 16 ..,a ,r d Wh,I, k %t'A 11m4 d I fi:,xn' d �_•ttw,.': II k,p,. ]raY'�e ix r.P:gtM1 ; rtu is l,.JI nvG txrd tn'.m x lnrl I'+sY.Y,r Yd i,r J.x.i'ere1-d MR ':;IPI[d,xn91Cxw,ly L A lip ide49dxa,aWlpi I-,j 911 ( R,4dp,"p,.wrk Ell `0 iPSrad.".ul I—I I'.i'1 r efiod 9dn""d, 1 - �,"I'-11.1,d, .. A A Mnlr0l A d 9a'd;nl b d vdm A rn Rd^ It 'I 1{1r, 15rrnul -1 ✓, r.rJx[Irv„k-d a'n. u..l,1-10 w v1 1,redr"A xnamx. III„Oa'S1 R"I,Iv,V? Guidance/Care Center, Inc. Page 107 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2012-2013 VAIIH 515 K WW'LOCAL L AW W".1f PLAN .loll,T1n,d t ... Ap,�vyland lr"R+*urvu&W ,.,AI 7'wk NA 'r rWNar R9 h Y Ia SA,I'11Y4 f I Q7 "k'1:latrA :49IURI nnaA N:wniN. 9 rr.I:.N I'aW� F NNmi W.rMgl f�wr81"✓ __ I s ntltl Mn'N.rrytll tlW W r8 tl,a�=x'd U1r _ 1 1[W I w Crud 1%, In AY'Wji 1N a a;1 J 0.9 Tale ^� ...., 6r p PbaWui $ {Yravxi r rmn%4 r i �e II rr.I,Ivrrs:.R Jn Ills Ifirr,l>aer4 r.x, hzl,l n:ln:uaed da .A f OW Io, m C wviwsoo arE ,l{l v�IN S'vvtlxvr I IE',AIA'6w'Nkus' r rn�mi I N 1� g 7�.r h9 Y h Y' n a,ng IV.Au;n & fa nxAe� p 'u.teriec &.... 'ii F6apr :g tnln ,9 ruinNx Nu..rem it n tl tlx Wnrhn,.arr n,rk. rru lSurN.nrx.l xk fhur1—A r , ,a sm' AEIIurryvWvm. I.i'.:'sNl APr¢I.aYrmrrn 91 lww�ol khr Nhvynurun _... ....._ Sh l.W lrmldlrManreur .. e t.nil M,%d. 6 'd l Yr.4, —... ._5 F. Y dt uh p M , Wl Vr.pilh f)re=5 4h rr M1,q ux�C c l rur hurP.a.m➢ r An 1v,_hrv:'rrvd ha 4 n^w,r.hnxn°a,w: Ah-F ra n�t rn.��nmmr _ �'iM RJ Ah—ilx.dn.lira. I3F d1 mAMu rinuhcf.lfivx_ _ 9LAa rVWrra N9wlmm.i- _ r I"i,,A IN,d cT.AM�nL ,Y...... .....r iv h ,. Id IAe$ 7 h P'rtlru :'% L Nw, = Ir k,An S, Flemc i S x,aaa Gtrv.lv:l eln u'........NiYF✓M=a.t Ya/w vietl1.10 N..1. nfr hSe lY eeQir;.ttrt 9Ud t"'�',uau Ud ku plmx,awm ...... ......... hnycl kmt mn— A.lwIJ.1ti. 1S lur .. r:.E•a ryl.er/'.rnrrat ..R,.1e 1 r..u.a 1 ry Irren,,ry .re^ r..ra p,f.re;�,l ,"lm hvf.N a ha,.-rt ,u,, 1 nr�,a»mwrd �rlro .n 81vp mW 11q O'aJJAyg --- I:If S*Wp YII fi gI4'ia% ...._ hWp dF%m ,Uftg M Slpp 'g ul.WagW—g, ., rrinF rvn NC I. '¢ ,•rs,n l yL-le li Ih N�wn, c :ausr i.u,:nw„ x n yin!,rte Pau;mumo.r,1 uhm. ur.1 ur lran',J n u u I'n;Lnrru,G nlm 7T'rAltV i�7'TARC m'TAAF' ",I'A�NR' I _ ._ r 1 rg NNmWY, 9 IarnY Pry pv�, 8 G q;yv ,b' ',q'pNM r 16 1r Y�r �'L 4r i+.rrcrw I W Yrvn't.r Nhr ina a'i 'u lr.1, rlr ha.a.a nfs allrr lrlxei! -i.rfre lk piarclvuc,B aJm ]i.irY lE'pavruW. Ida 1 I 1.L'-- .., tl {1 LN FP.,." _... IN .IE'.rcpinmum ......... n "realm k- I li Iw-rl11'1.h 6 -r Irm d PA ap.Y A I rM Ivlak(n F f�N'daPe M i&�Wldu'd r Y Nr f:hq^ r a I"fruo- & �m.rr IUnwv.:us.9 rl Y wnrh wgfi ritvr yr N wlwudd ivo r krL'x.riluyvmN. nn Aft--' I rUg?A0h �......... i i.g PA[,`.h ..g......., .........7�WIII§Pth " a xaa�r,e:a� r .. ¢p�.wn 6 �&A,Nry i rW:n b. ry 0.iWe g Pau+:ix rrVr�-A rAer W Ipr,t,R,P'f.,1 rrfie e 1 yrr 7 ruh7 m:4 ^,n , l..FYuz91tt'.nri '1N uhfnrnwAllm alrg R nneq vA .J T.1m1 awl. 1'.'d RrJ'nn nWF _ B atn W.u.d R[TII 11 l _ fF 'Y=.nf 1.nWrxdr rvnluna anxM h'NCtmrn➢ _ r"lirtvfs N Im ,I M r[,, II _ 1 dhtlar,:L ... ,A fen,vr Vvsv.amek Nr ie urre to mP.awt r rtd r tra,t.rw,»awri re, r yr„rr"RiwmrmP Wr :11 Frvumar d :f1 lkw."riY 11 Rnwn miuM1 �i.1'lnrmtrvrnl r Ir+tW IaNn.N � u'rn,]U,N rvla p. n R d h3 tr,5r f1' r r e>B P4nci� $ !W an �en'ax ivy...w,rn_ - ,I I,rls'ncd N P..x.rt r.U.{WuvNry>n.r4 Sl.Uh UAswneY :t:,t Rlmn—d o 5 Rrrwv-d a1 Jma A ,a M F T ,n "rs FACT r I O ACT Tm rr VV P T— 'a TiXf;J Kg,1, Po ... ...., ........ �h q'a,.0"vrrtAa n Prx.0 plar,ri r IR 4e6.++A. M ......u lan¢u frs,Y�ann,N as c.U ll :a:a.N +.. r✓' U }rrl,ncd �ruu ,,s N,rrLr aeN , x+.a "r.t p ,r (,'—p ik,nrynAi- KI qlr „ r-1 PN„7i'h d �n'I' rl nn 6 ttTe,; A 'ft PdrNr, le Ytxvry p 4r It- S +mnrt ro-r..,renrak r ce i,r:hmr o lrrru a.d �y wu a 1nq 1:^.reA _.n� r e x f.fir,�,ae rrsu. R'urrr Ck kS a.ell,gfupr&y iIG fd,.l UI,C IC+namarO vUi NaNq f",Lrm.9.f............ IaJ Uel. varJuil fik! 1AI.ra C,wwM'.1 fa A19 rrX�M AuHrUrrtrwid L Ad ..............m.. u igW]NIF fz N ! W' 9 7rdW'.rrdm l8 h wor.Yoxrx p 0 sz nw mtatire ry' 1 „ra;env "4 ,lurk ura!w: p r.r¢renr' , Is;r 4tu'^I.wtx'9 .rn rG floa , hn ^:a:pu,rvl rfre ! a=w mmM1..amri,5rdirlry tl6rr+,z r,._rrr1 ura:lawxl eds I't Raunwrep NLwtrdlw VtNr&up ra wWier f.uvA 11 i)k.wamlk Y9nux rN vaiN Argrvm VkNrean Earv2111tl 1"!12lnmru dp NFvar rl wluM gxgrnNAr.n l.,rm,gitl ti.Nluwm W&19 N.hh.Wwprrr.^v,uxr.l rewllF a i,iu„I ndwdrin 'e'iD,il'wdxerlt 6 7 ld Maeh & r w M �.rx # _. !lua.>3�.ur.- N p,lexrrre nwr. S , .ru..IuYrv. 4' ,wurrrr n rlv�,rz or lr r_t-w,h7nroN , rv�.k w^,r rn e�..vrv.l,-rrnwl. t rwrv, v#„�rt:rru*I',uwa w++,l >z emuar<r'..,rvo-vrdr,.,wl rd-a Rbu �Nwerl rulNYr%op - u'i/NI+tVnr.:r a Haul 0_mvwq lNl dW aA:4kwarA wiklxh prrcrN.Nrvnn Lanw11N1 .._ R k4hwr,tl Ynlhhr pw ,imm 1,raml llY._aNwr I.nvW Ill "F N !E Nla WrvUINIn A.grxm vN ,IA Irynac r $ l a m KIWI,k a,h 1 r. IryY11YY Yr, P"ll'x"A r.e.'r' INu w,q br1�i',u'-h zme4 rpd �Inru,n h',N I""d . I rpa a'h"IYatlX tlrv).Tn.dMrpn_gwnimq ryrvuaminrv. mna rerr Yk'r ilrW n6.UYnmrnmrp,.(: m—o-errrwv kxmCN:rpanm]', f%Pomtavq,vu fnwx/,n®rgnU IIn.rxmwet'.rg mlarmmh ,gIWO, 5 b HtuG'r +r:rc.x9 p k,��.0 a ln:h:.Feu R rf;a l Ilw rA. I M t nnm.6Wr �� F,rx r r Fn elrm�xYN aua rtl h�pa"1T Mtl.0 M,xa M '*"..,,,,... �M 11 1$ Saev9e=" _ A9 nnl Ull01,4'yffilp we A' Ir..., ,..... ]A%1 1 WOO W.Nr drlpmnu8gmxtrn ,rt't=W roArh l w rvr: h' ua NA nrN, g N, n�Iry N 'rvrns Ihnr u.nunp as irltn rV xrr x;:v{ iPa. hn,ri rl rrr rl ,rin h .fllruirrva rrvi ,rv. �r a'.61' _ +t+ ry np rui_.nrn wr g+ mrrrl.rw�eWy�_,.t 4 pw9 rnAv ur 7rrnr lrg x;ry +fr�Wmr Wt,r r<y� q yynyrwwmu�d:wn.IwNypx-rl yl ra(M,+:�tli r P id MrurFe 9 �i rr'P�r 1A9ma:P a Yrtd NdlWt.b 6 a 7rr.d PrF:nnW� 4I G Aidw ha NI.Mn^. 1a Y;.Wn: a.14¢1¢ J'r�au GS N;w:vY du�..,:1lrrz iMr�I nvk r .Am hnl,,t,vla.el ri! v,„I'+.aJiwrak xJm. kM1u1d'prumW �� r.MA a Im.ul y .h.sn 6 rr 41 Y ,'fi.!n uanrrl..... ¢ Fill FI II „r QI I Guidance/Care Center, Inc. Page 108 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2013-2014 PART III-NLW L€CAL MATCH PLAN StiMMARY FY 2013-2014 AMHTotal S - ATeneyNeme:�Cxsidenoe Cere Center,Ine. CMHTo tal NA Co ntraet Nmnber:PPG-1-06 A Total S - Dafi:7 1/2013 CSA Total S 36,112.00 Grand TMal $ 36.112.00 AD4ILT MENTAL HFALTH GI MDRGN"S WNTAFAHFAPTH A€FIILT;SMSTANCYAHTISF f.',HfLDR£N"SiSS11kS'CAN4;&;A}3USF. - 1 Assessment 1 As.se.ssment 1 Assessment 1 As.se.ssment e.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 2.Case bLnagement 2.case NLnagem..t 2.case NLnagem..t 2.case bLnagement a.Total Match I$ a.Total Match w$ a.Total Match °$ a.Total Match w$ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite a ha-d 3.Crisis Stabilisation 3.Crisis Stabilisation 3.Crisis Stabilisation 3.Crisis Stabilisation a.Total Match "$ a.Total Match "$ a.Total Match °$ a.Total Match °$ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite..haeed 4.Crisis S nppor t/Fmergenry 4.Crisis S nppor t/Fmergenry 4.Crisis S nppor t/Fmergenry 4.Crisis S nppor t/Fmergenry e.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 5.Day Care 5.Day Care 5.Day Care 5.Day Care .............. ......... ...,......... ....,.................. ....,........ e.Total Meteh $ - e.Total Meteh w$ - a.Total Meteh $ - e.Total Meteh w$ - b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 6.Day-Night 6.My Night 6.Day-Night 6.My Night e.Total Match �$ a.Total Match "$ a.Total Match °$ a.Total Match °$ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite a ha-d e.Unite PI-ha-d e.Unite..haeed 7.DI"tS elf-Help Centers 7.Drao-hr/S elf-Help Centers 7.DrW-L/S elf-Help Centers 7.DrW-L/S elf-Help Centers a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d S.In-H--dOn-Site S-ices S.In-Have and On-S its S-ices S.In-Have and On-S its S-ices S.In-Have and On-S its S-ices e.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite..haeed 9.Inpatient 9.Inpatient 9.Inpatient 9.Inpatient a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 10.Inten.s i-C.,a ALnagement 10.Inten.s i-C.,a ALnagement 10.Inten.s i-C.,a ALnag....t 10.Inten.s i-C.,a Nh..,ment a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite Rucha-d e.Unite PI-ha-d e.Unite PI-ha-d 11.Inter�xntion 11.Int'-lion 11.Int'-lion 11.Int'-lion a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ 3,49106 b.Rate $ b.Rate $ b.Rate $ b.Rate e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 56.35 12.Medical S-i- 12.Medical S-i- 12.Medical S-i- 12.Medical S-i- .......................... ..........., .....,........ ....,...........,........ ............, .....,........ a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 13.Methadone NW-.... 13.Methadone NLi-.... 13.Methadone NLi-.... 13.Methadone NW-.... Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 14.Outpatient-Indi,idnal 14.Outpatient-Indi,idnal 14.Outpatient-Indi,idnal 14.Outpatient-Indi,idnal a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 15.Outreach 15.Outreach 15.Outreach 15.Outreach a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ 10,00000 b.Rate $ b.Rate $ b.Rate $ b.Rate e.Unite PI-ha-d e.Unite PI-ha-d e.Unite..haeed e.Unite PI-ha-d 23148 16.Pre fi.. 16.Pre fi.. 16.Pre fi.. 16.Pre fi.. .......................... ..........., .....,........ ....,...........,........ 's.........., .....,........ e.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ 22,621.00 b.Rate $ b.Rate $ b.Rate $ b.Rate e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite..haeed 523.63 17.P-tion/Interventim-Day 17 -Day 17 -Day 17 -Day a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 15.Residential L-1 l 15.Residential L-1I 15.Residential L-1I 15.Residential L-1I a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d e.Unite PI-ha-d 19.Residential L-I H 19.Residential L-1 H 19.Residential L-1 H 19.Residential L-1 H e.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite..haeed e.Unite PI-ha-d e.Unite PI-ha-d 20.Residential Level HI 20.Residential Level HI 20.Residential Level HI 20.Residential Level HI .............. ......... ....,........ ....,.................. ............, ....,........ e.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ b.Rate $ b.Rate $ b.Rate $ b.Rate $ e.Unite PI-ha-d e.Unite Rucha-d e.Unite..haeed e.Unite--ha-d Guidance/Care Center, Inc. Page 109 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2013-2014 11 Residential Level A' 21 Residential Level A' 21 Residential Level A' 21 Residential Level A' TotalMh -Match a Total a -Match b Rate b Rat b -lvl- Rat, b Rat, e.U"it,R—ha-d e.Unite R—ha-d e.Unit,R—ha-d e.U"it,R—ha-d 12 Respite Sires 22 Respite —i— 22 Respite —i— 22 Respite —i— ......... ....... .......... .......... —..... a Total Match a Total Match a Total Match a Total Match bRa, b Rat: bRat, b Rat. e.U"it,R—ha-d Unite R—ha-d e.Unit,R—ha-d e.U"it,R—ha-d 13 Shdt,-dF,,A--t 23 Shdt,-dF,.0--t 23 Shdt—dF,.Oo—t 23 Shdt—dF,.Oo—t a To Match a Total a -Match a Total b RaalMatchb -lvl- Rat, b Rat' b -lvl- Rat, e.Unit,R—ha-d Unit,R—ha-d Unit, —ha-d Unit,R—ha-d 11 1,Wl... 24 24 24 a Totallvl-h a -Match a Total a -Match b Rate b Rat, b -lvl- Rat, b Rat, e.U"it,R—ha-d e.U"it,R—ha-d e.Unit,R—ha-d e.U"it,R—ha-d 15 Snppm WFmA--t 25 S—dF,.N--t 25 SWF,.N�—t 25 SWF,.N�—t a To Matcha T-llvl-h a Totallvl-h a Totallvl-h e. � b Rate b $ b Rat, Rat, b Rat. U,,it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d 16 SnW—dH—i.g/Lhi.g 26 S.,—dH—i.g/Li,i.g 26 Sn,—dH—i.g/Lhi.g 26 S.,—dH—i.g/Li,i.g a Totallvl-h a -Match a Total a -Match b Rate b Rat. b -lvl- Rat, b Rat, e.U,,it,R—ha-d e.U,,it,R—ha-d e.U"it,R—ha-d e.U,,it,R—ha-d TASC 27 TASC 27 TASC 27 TASC a Totallvl-h a Total Match a -Match a Total b Rate b -Rat, $ b Rat. b -lvl-Rat, e.U,,it,R—ha-d e.Unit,R—ha-d e.U,,it,R—ha-d e.U"it,R—ha-d IS hdd—la,—, 28 hdd-.laW—, 28 hdd—law—, 28 hdd-.laW"a .......... Totallvl-h a Total Match a Total Match a Total Match b Rate b Rat. b Rat. b Rat. e.U,,it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d 29.Aft—.- 29 Aft—.- 29 Aft—.- 29 Aft—.- a Totallvl-h a Total Match a -Match a Total b Rate b -Rat, b Rat. b -lvl-Rat, e.U,,it,R—ha-d e.Unit,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d 31�—ti— 1,dR,l... 30 and Referral 30 and Referral 30 and Referral a Totallvl-h a -Match a Total a -Match b Rate b Rat, b -lvl- Rat, b Rat. e.U"it,R—ha-d e.U"it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d 31 Reserved 31 Reserved 31 Reserved 31 Reserved 32 0.q,.ti—D—ifi-ti.. 32 0.q,ati—D—ifi-ti.. 32 0.q,.ti—D—ifi-ti.. 32 0.q,ati—D—ifi-ti.. a Totallvl-h a T-llvl-h a -Match a Match b Rate b Rat, b Rat, b Rat'e.Unit,R—ha-d Unit,R—ha,d e.U,,it,R—ha-d e.U,,it,R—ha-d 33 Reserved 33 Reserved 33 Reserved 33 Reserved 31 FACTTeam34 FACT Team34 FACT Team34 FACT Team a.Totallvl-h a -Match a Total a -Match b Rate b Rat, $ b -lvl- Rat, $ - b Rat, e.U"it,R—ha-d e.Unit,Rvehas ed e.U,,it,R—ha-d e.Unit,R—ha-d 35 0,ap.ti—t G—p 35 O.tp.ti"t-G'-p 31 Owp.ti— G—p 35 ti O.tp."t-G'-p a Total a Total Match a Total 1-i a Total Match b lvl- Ra�. b Rat, b -lvl- Rat, b Rat, e.Unite R—ha-d Unite R—ha,d Unite R—ha-d Unite R—ha,d 36 36 36 R—BB—d-ithS,,W,,i,i—�-11 36 R—BB-td-ithS,W,,i,i—�-ll a Total Match a Total Match a Total Match a Total Match b State Rate b State t, b State "P,— - b StateRat. e.H—,-Uit,R—ha-d —H ,R:Units, _ha-d ,H—�t%, had Hone Units-U, P,—ha-d 37 37 37 37 a Total Match a Total Match a Total Match a Total Match b State Rate $ b State Raft b State Rate $ b StateRat. e.Howe-Uit,R—ha-d us-Units H ,—ha-dHowe-Units P,— -had e.Hone Units-U, P,—ha-d 31 31 R—�B—d,ithS,,i,i—L-IM 31 R—�B-td-ithS,i,i—L-IM 31 R—�B-td-ithS,i,i—L-IM .. ........... Total Match b State State Raft $ b stat.Rat, H—,-Unite ....... a Total Match a Total Match a Total Match a e.H—,R:t,Uit,R—ha-d b e.Hus-Unite State Rate R—ha-d b e.H—,-Uit,R—ha-d R—ha-d 31 S-It,,-R,,id,,ti,lT...—t 31 Res idential ...—t 39 — —Sh—term -HAT —t 39 — —Sh—term -HAT —t a Match a -lvl- ! Total a Total a -Match b Rate b Rat. 1$ b -lvl- Rat, b Rat, e.U,,it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d e.U,,it,R—ha-d 40 Health Cl,�—S—i... ...............40 Health Cl,�—S—i... ......40 Health Cl,�—Sires 40 Nk..I�Ath Cl.�—S—i- a Match a T- a Total a Total b Rate b Rat"Match b -lvl- Rat, b -lvl- Rat'e.U"it,R—ha-d e.U,,it,R—ha-d e.Unit,R—ha-d e.U,,it,R—ha-d T`CC, .............41 C—,h...h,C,--,,il S—i-T—(CCST). 41 Ch—i- —C. .ih S—i-T—(CCS 41 Gaup C.—.ih S—i-T—(CCST). a Total a -Match a Total a -Match b Rate b Rat, b -lvl- Rat, b Rat, e.U"it,R—ha-d e.Unit,Rvehae ed e.U,,it,R—ha-d e.Unit,R—ha-d ,ANffl I—) $ CAM 1-1 $ ASA I—] CSA I—] $ 36.11200 Guidance/Care Center, Inc. Page 110 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2014-2015 PART III-NI AV LOCAL MATCH PLAN 84firiM1TARY EY 2019-2015 AMHTotal S - AgevcyName_�C idance Care Center,Inc CMHTotal NA Contract Number_-1-06 -A Total S - L-7/l/2014 QSA Total S 36 112.00 Cd'and To[sl $ 3E11200 ADULT WNT'AL MA€€'I% C MLI1I1'PAS MENIAL MALIN ADULT S,NXDT4 VS gIMSTANCZABDzL i i Assessment i Assessment i Assessment i Assessment a_Total Match $ a_Total Match $ a_Total Match ��$ a_Total Match w$ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 2 Case TTanagement 2Case TTanagemen[ 2 Case TTanagement 2 Case TTanagement a_Total Match $ a_Total Match $ a_Total Match �w$ a_Total Match w$ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 3_I t I'll Stabilizadon 3_Ct I-Stabili-.. 3_Ct'Isis Stabilizadon 3_Ct Isis Stabilizadon a_Total Match $ a_Total Match w$ a_Total Match �w$ a_Total Match w$ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 4_Ct I-S"I"1Fmm'gency 4_Ct I-S""'IFmm'1,-, 4_Ct I-S"I"1Fmm'gency 4_Ct I-S""'IFmm'gencp a_Total Match $ a_Total Match w$ a_Total Match �w$ a_Total Match w$ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 5.Dap Cm'e 5.Dap Cm'e 5.Dap Cm'e 5.Dap Cm'e a_Total Match �$ a_Total Match w$ a_Total Match �w$ a_Total Match w$ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 6.Dap-Night 6.Dap-tiight 6.Dap-tiight 6.Dap-tiight a_Total Match �$ a_Total Match w$ a_Total Match �w$ a_Total Match w$ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a ]_Dt'pp-Sel€Help Centm's 7_Dt -Ip/Sel€Help Centm's 7_Dt'pp-Sel€Help Centm's 7_Dt -Ip/Sel€Help Centm's a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 3.In-Home and On-Site Setaices 3.In-Home and On-Site Setaices 3.In-Hpmeand On-Site Betakes 3.In-Home and On-Site Setaices a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 9.Inp.i-t 9.Inpati-t 9.Inpati-t 9.Inpati-t a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 10 10 10 10_In[ensi�e Case TTanagemen[ a_Total Match $ a_Total Match $ a_Total Match $ a_Total Match $ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a i i.Intet'-l- ii.lntet'-iao ii.lntet'-iao ii.lntet'-iao .......................... ...,......... ....,......... .............,..........., ............, ....,......... a.Total Match $ a.Total Match $ a.Total Match $ a.Total Match $ 349100 b_-e $ b_-e $ b_-e $ b_-e $ 6195 c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased 5635 12 TTed-Set'sices 12 TTed-Set'sices 12 TTed-Set'sices 12 TTed-Set'sices a_Total Match $ a_Total Match $ a_Total Match $ a_Total Match $ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 13.TIeMM-Tlaintenance 13.TIeM 1-Tlaintenance 13.TIeM 1-Tlaintenance 13.TIeM 1-Tlaintenance a_Total Match $ a_Total Match $ a_Total Match $ a_Total Match $ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 14.Outpatient-Indisidnal 14.Outpatient-Indisidnal 14.Outpatient-Indisidnal 14.Outpatient-Indisidnal a_Total Match $ a_Total Match $ a_Total Match $ a_Total Match $ b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 15.Oph'each 15.Oph'each 15.Oph'each 15.Oph'each ..... .... ....... ........ ........ a_Total Match ......... ....a T$ _ otal Match a T$ _ otal Match T$ a_ otal Match $ 1666000 b_-e $ b_-e $ b_-e $ b_-e $ 4320 c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased 23148 16.Pt'esentim 16.Pt'esentim 16.Pt'esentim 16.Pt'esentim a.Total Match $ a.Total Match Total Match $ a.Total Match $ 2262100 b_-e $ b_Rffie $ b_-e $ b_-e $ 4320 c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased 523 63 1�_Pt'esentlpp/Intma"entlon-Dap 17_Pt'esentlpp/In[eta-entlon-Dap 17_Pt'esentlpp/In[eta-entlon-Dap 17_Pt'esentlpp/In[eta-entlon-Dap a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 13.Residentisl Lepel I 13.Residentisl Lepel I 13.Residentisl Lepel I 13.Residentisl Lepel I a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 19.Residential Lepel D 19.Residential Lepel D 19.Residential Lepel D 19.Residential Lepel D a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a 20_Residential Lepel ID 20_Residential Lepel ID 20_Residential Lepel ID 20_Residential Lepel ID a.Total Match $ a.Total Match $ - a.Total Match $ a.Total Match $ - b_Rate $ b_Rate $ b_Rate $ b_Rate $ c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a c Units Purchased x✓a Guidance/Care Center, Inc. Page 111 of 121 Contract#PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2014-2015 21.Re.s ideatial Lece11V 2L R-ideatiA Lece11V 2L R-ideatiA Lece11V 2L R-ideatiA Lece11V .................. ............., ....,........ ...................... .............,...,......... a.TotalMatch $ a.TotalMatch $ a.TotalMatch $ a.TotalMatch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 22.Respite S-i- 22.Respite S-i- 22.Respite S-i- 22.Respite S-i- To talMatch °$ a.TotalMatch $ a.TotalMatch w$ a.TotalMatch t$ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 23.Shelter edF`[A of 23.S helter edF,A of 23.Shelter edF,A of 23.ShelteredF,Ap of a.Tot Zt'a h °$ a.TotalMatch $ a.TotalMatch w$ a.TotalMatch t$ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Porch aced n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 24.Snhs ranee Abuse D-t ficannu 24.sobs ranee Abuse Detoaficafioo 24.sobs ranee Abuse Detoaficafioo 24.sobs ranee Abuse Detoaficafioo a.TotalMatch °$ a.TotalMatch $ a.TotalMatch w$ a.TotalMatch t$ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 25.Supported Fniplm'meat 25.Supported Fniplm'meat 25.Supported Fniplm'meat 25.Supported Fniplm'meat a.TotalMatch �$ a.TotalMatch $ a.TotalMatch �$ a.TotalMatch µ$ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased .7 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 26.Supprcted Bousiag/Liaag 26.Supprcted Bousiag/Liaag 26.Supported Bousiag/Liaag 26.Supported Bousiag/Liaag a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 21.TASC 2'/.TASC 2'/.TASC 2'/TASC a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Perch ae ed n/a c.Units Purchased n/a c.Units Porch aced n/a 28.Iocideotal Lxpeos es 28.Iocideotal Fx ,es 28.Iocideotal Fx ,es 28.Iocideotal Lxpeos es a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Porch aced n/a c.Units Porch ae ed n/a c.Units Porch aced n/a 29.Aftercare 29.Aftercare 29.Aftercare 29.Aftercare a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Perch aced n/a c.Units Perch ae ed n/a c.Units Purchased n/a 30.Iofrc-fl-and Referral 30.Iofrcnnfioo and Referral 30.Iofrc nnfioo and Referral 30.Iofrc nnfioo and Referral a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Porch aced n/a c.Units Porch ae ed n/a c.Units Porch aced n/a 3 L Re.--d 3 L Re.--d 3 L Re.--d 3 L Re.--d 32.OntpafieatD-ificafioo 32.OotpafieatD-ificafioo 32.Ootpafieat Detoxifi cafioo 32.OotpafieatD-ificafioo a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ a.TotalM arch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Perch aced n/a c.Units Perch ae ed n/a c.Units Purchased n/a 33.R---d 33.R---d 33.R---d 33.R---d 34.FACT Team 34.FACT Team 34.FACT Team 34.FACT Team a.Tot alMatch 5 ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.To alMatch 5 ........ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased .7 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 35.Ontpafi eot-Group 35.Ootpafi eot-Group 35.Ootpafi eot-Group 35.Ontpafi eot-Group a.T-Match 5 ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.T-1 arch 5 ........ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 36.Room C Boardw th Superasioo Lecel I 36.Room C Boardw th Superasioo Lecel I 36.Room C Boardw th Superasioo Lecel I 36.Room C Boardw th Superasioo Lecel I a.TotalMatch 5 ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.TotalMatch 5 ........ b.State Rate 5 b.State Rate 5 b.State Rate 5 b.State Rate 5 c.11-or Units Purchased n/a c.11-or Units Purchased n/a c.11-or Units Purchased n/a c.11-or Units Purchased n/a 31.Room C Boardw th Superasioo Lecel B 31.Room C Boardw th Superasioo Lecel B 31.Room C Boardw th Superasiou Lecel B 3'/.Room C Boardw th Super�i.s iou Lecel B a.TotalMatch $ ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.TotalMatch 5 ........ b.State Rate 5 b.State Rate 5 b.State Rate 5 b.State Rate 5 c.11-or Units Purchased n/a c.11-or Units Purchased n/a c.11-or Units Purchased n/a c.11-or Units Purchased n/a 3&Room C Boardw th Lecel M 3&Room C Boardw th Super�i.s iou Lecel M 3&Room C Boardw th Super�i.s iou Lecel M 3&Room C Boardw th Super�i.s iou Lecel M a.TotalMatch 5 ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.TotalMatch 5 ........ b.State Rate 5 b.State Rate 5 b.State Rate 5 b.State Rate 5 c.11-or Units Purchased n/a c.11-or Units Purchased n/a c.11-or Units Purchased n/a c.11-or Units Purchased n/a 39.Shrct-term Res ideafi al Treatment 39.Shrct-term R-ideafial Treatment 39.Sh-lterm R-ideafial Treatment 39.Sh-lterm R-ideafial Treatment a.To alMatch 5 ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.To alMatch 5 ........ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased .7 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 40.N4eatal B Alh Clubhouse Services 40.N4eatal B Alh Cl,bhou.se Services 40.N4eatal Bealth Clubhouse Sera ce.s 40.NU-111 lleAth clubhouse Seraces a.To alMatch 5 ....... ..-.........a.TotalMatch 5 ....... ........a.TotalMatch 5 ....... ........a.TotalMatch 5 ........ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a 44.CCST 41.C-T-h...i-Conmm hS-i e,Team(C(ST) 4L Conyrehea.si-ConmmaihS ace Team(CCST) 4L Conyrehea.si-Conmmaih'S ace TeamQ(7CST) a.TotalMatch $ a.TotalMatch $ a.TotalMatch $ a.TotalMatch $ b.Rate 5 b.Rate 5 b.Rate 5 b.Rate 5 c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a c.Units Purchased n/a h\II3 T'otnl $ clml'otnl $ A.SA.T'otnl $ I C:SA.T'otnl $ 36.112.00 Guidance/Care Center, Inc. Page 112 of 121 Contract#PPG-1-06 07/01/2012 ATTACHMENT II SCOPE OF WORK OPSC fIMICI 9 OF-S lCb (Inolttde overfill intenton,of progrprn,outilhe',of Program activities,target population to be-,servect,implementation of E8P,and partners of applicable): The Guidance/Care center's(G/CC)will provide the Project Success program using the Substance Abuse and Mental Health and Services Administraboen(SANMHSA)Center for Substance Abuse Prevention(CSAP)Project SUCCESS program recognized in the;National Registry of Evidence-based Programs and Practices(NREPP). The program will be available and accessible to high risk youth ages 1.2-18 who have experimented with alcohol showing early danger signs and multiple risk factors for substance abuse and attend Monroe County High Schools. Goal 1,Reduce DOI crashes countywide amongst 18-20 year olds by 10%in 2015 by meeting the following oblectivesa reducing alcohol use,increasing the perception of harm and risk in youth and enhancing positive,pro- social protective factors. Goal 2.Increase capacity by providing level 2 prevention programming forthose at high risk;thereby eliminating service gaps for these students by providing;the funding and resources necessary to ensure successful program implementation,continuity of care and partnership capacity countywide,. TARGET POPULA ON OR PARTICIPANTS(Include numbers in tables and a narrative description of participant characteristics below) teveI I A Level Nuffiberof Partleclpaots Youth living in Monroe County(Level 1&2) Year 1 Level 1 =330 Year 2 and 3 Level 1=410 Year 1,Level 2=206 Year 2 and 3==206 Parent Education Group(Level 1) Year 1=23 Year 2 and 3,--42 Youth participating in:school wide activities(Level 1) Years 1,2 and 3=25410 (2370=youth&1.70=adults) 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 12-17 years who reside in Monroe County.Services will be provided at all three high schools and Marathon Middle School.The Project SUCCESS Program will be available to 9-12 grade students attending any one:of the three Monroe County High Schools 6.12,graders at Marathon High/Middle:.The comparison of percentage of Monroe County youth and Florida Statewide youth who reported having used a list of 14 various drugs in their fifet:imes reveals that percentages for Monroe County youth exceed those for the state in every category(EYSAS 2010). A significantly greater percentage of Monroe County High School students,(40.9%) tlh,an statewide students(33.6%)witnessed gang members selling drugs. The ethnicity of these children breaks down as follows: 52.9%White,33.8%Hispanic,10.' G'In Black,1 4S°A Asian and 2.88%tither. # # # fit,Name Stt'eet Address: CRY lip Cade hOthrea/ parent's ter Youth Key West High School 21001Flagler Ave ICeyWest 3.3040 1200 20 80 Coral Shores Hugh School 89901 Cold Highway Tavernier 33070 740 12 50 Marathon Middle High School 350 Sombrero R& Marathon 3:3050 600 101 40 J sr r.'al N t, �;, 1 .,E.i� •a., ,,j; Guidance/Care Center, Inc. Page 113 of 121 Contract#PPG-1-06 07/01/2012 ATTACHMENT II SCOPE OF WORK PERFORMANCE MEASURES Quantity Activlties/Seruvice Name&Description(Include children/ # #Required! $o Meet Activity frequency,intensity,&duration ofsessions,as well as the Youth Parents Others Sessions-„ Required Level(1 nurmher of cycles expected to be offered and tentative or 2) schedule) Project SUCCESS: Total=410 served annually in Level 1 330 Year 1 0 0 . 9 sessions 85% 1 and 2 206 served annually un Level 2 1410 Years 2 for year 1: 330 served Level 1 and 2.06 in Level 2 9L 3 participants to achieve results 23 Year1 8'5% 1 Parent.Education Group and 42 2. Years 2 &3 1 School-wide prevention activities: 2540 4 School- wide opportuniti es Quantity Performance Measures Activity/Service Name,and *Of portkipants-to required#of sessions for %of participa ints Description !receive sieWjcer parliruparats to achieve result to meet required # Goal 1:Reduce the Monroe County prevalence irate of past 30-day alcohol use among youth Goal 2.Increase youths'attitudes and beliefs about the risk of harm of underage drinking Project SLUCESS 5 sessions 85% Year 1 Level 1 =330 281Participants Year 2 and 3 Level 1=410 349 Participants Year 1 Level 2 206 175 Participants Year 2 and 3-206 175 participants Parent Education Group 2 sessions for 1.5 hours 85% Year 1=23 19 participants Year 2 and 3=42 35 participants School-wide prevention 2540 4 opportunities awareness activities Qualityr Description of the required program Quality measures. '4 udf 'rzf ", �,:.ra{'( rR i'-.. Guidance/Care Center, Inc. Page 114 of 121 Contract#PPG-1-06 07/01/2012 ATTACHMENT 11 SCOPE OF WORK Q4,411ty Measure WasuroMeftt and ReportingTool Timing, Avevage number at sessions attended 85 end of 330 participants or 281,will 11 At the d of each cohort of (Participant Retention) [complete Project SUCCESS pre/post group sessions test,attendance records and a minimum of 9 sessions((dote;410 will be servedin yrs,2&3) 0 Collected immediately prior 85%of 23 or 20 participants complete to the Ist session and the Parent Education Group—a im rvediately following the last minimum of 2 sessions sessiom Measure:(Student Survey of Risk and Protective Factors and Logs) NoW 42 parents,will be served in yrs,2 &3 * 70%of youth will increase their a Monitodrig,the Future instrument; & Collected immediately prior, attitudes and beliefs related to risk of pre/post tests to the I"session and harem of underage drinking immediately following the last * 701A of the youth will have no or a a Monitoring the Future instrument; session decrease in past 30-day alcohol use pre/post tests 0 Wlected immediately prior by curriculum completion to the I"session and A 700A of youth will decrease favorable * Monitoring the Future instrument; immediately following the last attitudes toward alcohol and drug use pre/post tests session 0 701A of parents will der: * Collected irmnediatel,pirio, favorable attitudes tow �0 Student Survey of Risk and to the 1"session and and drug use. Protective Factors immediately following the last session * Collected immediately prior to the V'session and irn miediately following the last session, #and%of youth satisfied with services 900% At the end of each Program provided Satisfaction survey cohort for youth in Project SUCCES'S • At the end of each Parent Education session Observation of service delivery/Fidelity Curriculum fidelity checklist At the end of each cohort for checklist I youth Documentation of structured supervision Supervisory ToollXhecklist and Notes During regular supervisory sessions for each staff and not ess than one time per month ft and%of staff with necessary 100% At the time of contract training/certification Imonitoring participant Outcomes Assoc fatedAtt 616 youtb willl receive the I.,Data entered into the At admission into Staff trained;Program Pao ect 5UCCE55 curriculum PBPS sLitem 9,The 15CC ero ram tirnetines developed, Guidance/Care Center, Inc. Page 115 of 121 Contract#PPG-1-06 07/01/2012 ATTACHMENT 11 SCOPE OF WORK EVIDENCE BASED PROGRAMS(E8P) 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 per formed with Fidelity,they should deliver analogously high quality services. Listed are the evidence based programs that will be used during activities/service delivery. EWdence Based Pr9grift De*natlng envy A $treto of Evidence g ProjectSUCCESS SAMSHA approved,IN REPP Option I !Parent Education Group Part of Project SUCCESS-SAMSHA approved, Option I NREPP School-wide awareness activities Part of Project SUCCESS-SAMSHA approved, Option 1 NREPP TASK LIST Activities Year 1 Activities/Service Name&Descirlption #&Type of EBP %to Participants Recommended meet Sessions or this Hours Outcome Activity Title; Recruitment/Orientation and Assessment 410 youth 40-60 minutes 85% ALtivitt Description Participants wilill be recruited frorn designated schools 330 in yr,I for I session and will receive a pretest assessment of their risk and protective factors. FreguenrLr One time upon program entry, Intensill,.1 sessions Duratiom 40-60 minutes leer session. ActiiviLY Title: Project SUCCESS(Prevention Education Series) Curriculum 206 9 sessions 85% Activity DesEs2tion:Participants will!be required to attend 9, minute 1.5 hour,per sessions Level 7 session LMg2ency--One time per week lnten5itw; 6-12 sessions Duration:One 90 minute session AE �vjTitle�, Parents,Education Group 23 in yt.I I session per 85% Activity OesceZl2tion.-, Participants will receive ATOD educabon information 42 in yrs,2& cohort for 60 LEgyenc _-Once 3 minutes Intensitil.ly,1for each cohort _!lunation:60 Activity Title;Project SUCCESS post testing 300 youth 60 min. 85% ActivityDescription: Participants will receive a post test assessment of their sessions risk and protectilve factors, Frequency,-Ix upon program completion jajensr : I session Duration:60 minutes Additional Requirements: Obtain MOU with county level coalition by November 30,2011 Other reports as required by funder �,,,," ", �,"" " d Guidance/Care Center, Inc. Page 116 of 121 Contract#PPG-1-06 07/01/2012 ATTACHMENT 11 SCOPE OF WORK EVIDENCE BASED PROGRAMS(EBP) N11 strategies funded by South Florida Behavioral Health Network should deliver high quality,eviderwe-ba5ed practices that are strength-based,child/youtfVfarnily centered,accessible,respectful of diversity and mindful of community cointext ancdl connections,or constitute best practices that have been approved by Sol 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 Balsed Prograro 00,signatiricAcericy, We'll of Evidence ]Project SUCCESS SAMSHA approved,NREPP Option I IParent Education Group Part of Project: UCCESS-SAMSIIA approved, Option I NREPP School-wide awareness activities Part of Project SUCCESS-SAMSIIA approved, Caption NREPP TASK LIST Activities Year lActivitles/Service Name&Description #&Type of EBP %to Participarits Recommended Meet Sessions or this Hours Outcome Activity ride: Recruitment/Orienta I ion and Assessment 410 youth 40-60 minutes 8 5% Activity Description:Participants with be recruited from designated schools 330 in yr.I fort session and wilt receive a pretest assessment of their risk and protective factors, Freguenry:One time upon program entry, hrtensity:1 sessions Ourotion: 40-60minutes per session, Activit i Si sessions 85% y'ritle., project SUCCESS(Prevention Education Series) Currcul "I 206 u Activity Descir'2rion:Participants will be required to attend 9, minute 1.5 hour per sessions Level 2 session FiM,idency:One time per week Intensitk: 6-12 sessions Duration:One 90 minute session ActivitiTitle: Parents Education Group 42 1 session per 8 5% Participants will receive ATOD education information 23 in ym,2& cohort for 60 FregoencV.-Once 3 minutes Intensity.,1x1foreoch cohort D uro tion:60 80vittiftle:Prooct SUCCESS post testing 300 youth 60-rain, 85% Ac1iyi1yQescr6yl Participants will receive a posttest assessment of their sessions risk and''protective factors I-')eArsgiir A Ix upon program completion )ntCnSi%' J session DuQ266n,-60 minutes Additional Requirenrl Obtain MOU with county level coalition by November 30,2012. Other reports,as required by funder Guidance/Care Center, Inc. Page 117 of 121 Contract#PPG-1-06 07/01f2012 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 Farm-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, US. Code. Any person who fails to file the required ertification shall be subject to a civil penalty of not less than $10,000 and not more than $100„0 for�ac ch failure. Signature Date Name of harized Indiv ua Contract Number Al Name of Organization 1�% .<00 J)-k () (list Address of Organization Guidance/Care Center, Inc. Page 118 of 121 Contract#PPG-1-06 07/01/2012 ATTACHMENT IV The administration of resources awarded by the Managing Entity to the network provider may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 215.97, F.S., as revised, the Managing Entity 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 Managing Entity 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 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 to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the department's inspector general, the state's Chief Financial Officer or the Auditor General. AUDITS PART I: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non-profit organization as defined in OMB Circular A-133, 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, 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 Managing Entity. 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 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 of Recovery 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 2 CFR 215.21 "Uniform Administrative Requirements for Grants and Agreements" and OMB Circular A-102 Common Rules provisions, recipients agree to maintain records that identify adequately the source and application of Recovery Act funds. OMB Circular A-102 is available at http://www.whitehouse.gov/omb/circulars/a102/a102.html. (b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-133, ''Audits of States, Local Governments, and Non-Profit Organizations," recipients agree to separately identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of Federal Awards (SEFA) and the Data Collection Form (SF—SAC) required by OMB Circular A-133. OMB Circular Guidance/Care Center, Inc. Page 119 of 121 Contract#PPG-1-06 07/01/2012 A-133 is available at http://www.whitehouse.gov/omb/circulars/a133/al33.html. This shall be accomplished by identifying expenditures for Federal awards made under the Recovery Act separately 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 as the first characters in Item 9d of Part III 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 a recipient awards Recovery Act funds for an existing program, the information furnished to subrecipients shall distinguish the subawards of incremental Recovery Act funds from regular subawards under the existing program. (d) Recipients agree to require their subrecipients to include on their SEFA information 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 II: STATE REQUIREMENTS This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes. In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the recipient must have a State single or project-specific audit conducted in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities)or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. 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 Managing Entity, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with the 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. PART III: REPORT SUBMISSION Any reports, management letters, or other information required to be submitted to the Managing Entity pursuant to this agreement shall be submitted within 180 days after the end of the network provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes: A. Managing Entity Contract Manager for this contract (1 electronic copy and management letter, if issued ) B. 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 Guidance/Care Center, Inc. Page 120 of 121 Contract#PPG-1-06 07/01/2012 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://harvester.census.gov/fac/collect/ddeindexehtml 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 by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450 Email address: flaudgen_localgovt@aud.state.fl.us Network providers, when submitting audit report packages to the Managing Entity 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 network provider must be indicated in correspondence submitted to the Managing Entity 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 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 is issued, unless extended in writing by the managing entity. Guidance/Care Center, Inc. Page 121 of 121 Contract#PPG-1-06 September 20, 2013 Contract No. KH225 Amendment# 0012 THIS AMENDMENT, entered into between the State of Florida, Department of Children and Families, hereinafter referred to as the "Department," and South Florida Behavioral Health Network, Inc., hereinafter referred to as the "Provider," amends Contract No. KH225. PREAMBLE: This is the twelfth (12`h) amendment to contract KH225. The purpose of this Amendment #0012 is to add a special provision incorporating into Contract No. KH225 those provisions required by 45 CFR s.164.504(e) and adds Attachment IV to the contract. Additionally, Section C. Method of Payment language is amended. There is no budgetary impact as a result of these changes. Therefore, the Standard Contract and Attachment I are amended, and Attachment IV is added to this contract. 1. Page 1, Standard Contract, Section 4, Contract Document, as previously amended on Pagel of Amendment #0009, is hereby amended to add Attachment IV to the first sentence in the paragraph as follows: 4. Contract Document. The Provider shall provide services in accordance with the terms and conditions specified in this contract including its attachments 1,11, III, and IV, and any exhibits reference in said attachments, together with any documents incorporated by reference, which contain all the terms and conditions agreed upon by the parties. The definitions found in the Standard Contract Definitions, located at http://www.dcf.state.f1.us/adminlcontracts/docslGIossaryofContractTerms.pdf are incorporated into and made a part of this contract. The PUR 1000 Form (10106 version) is hereby incorporated into and made a part of this contract. Sections 1 A., 2-4, 6, 8-13, 20, 23, 27, and 31 of the PUR 1000 Form are not applicable to this contract. In the event of any conflict between the PUR 1000 Form and any other terms or conditions of this contract, such other terms or conditions shall take precedence over the PUR 1000 Form. 2. Page 8, Standard Contract, above the signature block, as previously amended on Page 1 of Amendment #0008, amends the total number of pages in the contract due to the addition of Attachment IV as follows: "IN WITNESS THEREOF, the parties hereto have caused this one hundred and thirteen (113) page contract to be executed by their undersigned official as duly authorized." 3. Page 60, Attachment I, dated 07101/2012, Section C. Method of Payment, Paragraph 1., as previously amended on Page 1 of Amendment #0011, is hereby amended to read: 1. Payment Clauses a. This is a fixed price, fixed payment contract, subject to reconciliation of allowable expenditures on a periodic basis. Beginning July 1, 2013 and each state fiscal year thereafter, the Schedule of Funds identifies the type and amount of funding provided. The Schedule of Funds will be incorporated into this Contract replacing Exhibit B, Funding Detail, and the total contract amount will be adjusted accordingly. The Department will pay the Managing Entity, upon the satisfactory completion of all the services and terms and conditions specified in the Contract, an amount not to exceed $371,001,974.75 subject to the availability of funds, as follows: (1) The Managing Entity shall be paid on a monthly basis an amount not to exceed the total cost for the Contract year, as specified in the table below, subject to performance adjustments based on the Managing Entity's overall performance as specified in Sections B.7.b., and C.10. All invoices shall be reconciled on a regular South Florida Behavioral Health Network, Inc. Page 1 of 8 Southern Region SAMH Managing Entity September 20, 2013 Contract No. KH225 Amendment # 0012 basis as part of the Quarterly/Monthly Reconciliation and Performance Review specified in Section C.10., except that monthly reconciliations shall occur between April 1 stand June 301h of each state fiscal year (or during the final three months of a Contract if the ending date is not June 30). (2) The System of Care Administrative Cost is based on the System of Care's anticipated expenditures as approved and documented by the Line Item Budget and Narrative, which is maintained in the Contract Manager's file and incorporated herein by reference. Managing Entity Administrative Costs shall not exceed 5% of the total contracted dollar amount for each fiscal year. This document is to be updated and submitted for approval to the Department thirty (30) days prior to the anniversary date of the Contract. The System of Care administrative costs shall be paid or withheld as specified below. As stated in Section 8.6.a.(7)(b), any reductions in the System of Care Administrative Costs will be redirected as mutually agreed upon by the Department and the Managing Entity. Maximum System Fiscal Year Service Cost of Care Administrative Total Cost Per Administrative Cost Reductions Year Cost 2010-2011 $56,352,157 $56,352,157.00 2011-2012 $75,911,891 $75,911,891.00 2012-2013 $60,649,091 $13,061,520,27 $73,710,611.00 2013-2014 $61,955,694 $10,933,357.80 $2,128,162.47 $72,889,052.00 2014-2015 $63,022,572 $10,688,038.60 $245,319.21 $73,710,611.00 2015-2016 $15,847,781 $2,579,871.39 $92,138.26 $18,427,652.75 Totals $333,739,186.70 $37,262,788.05 $2,465,619.94 $371,001,974.75 (3) The parties agree that the Method of Payment to the Managing Entity under this Contract, including compensation for administrative costs, is governed by the terms of this Contract. (4) Based on the Performance and Outcome Measures specified in Exhibit A, the Managing Entity's overall performance will be assessed by the Managing Entity Accountability Unit during the Quarterly/Monthly Reconciliation and Performance Review, as detailed in Section C.10., with adjustments made to the next monthly fixed payment schedule. b. The Managing Entity shall provide local match through its Subcontractors up to the amount specified in Exhibit B. 4. Page 67, Attachment I, dated 07/01/2012, Section C. Method of Payment, Paragraph 13. Cost Allocation Plan, as previously added in Amendment#0011 is hereby deleted in its entirety. 5. Page 76, Attachment I, Section D., Special Provisions, is hereby amended to add the following paragraph D.25: 25. Health Insurance Portability and Accountability Act In compliance with 45 CFR s.164.5041, the Provider shall comply with the provisions of Attachment IV, to this Contract, governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the Provider or its South Florida Behavioral Health Network, Inc. Page 2 of 8 Southern Region SAMH Managing Entity g September 20, 2013 Contract No. KH225 Amendment # 0012 subcontractors incidental to Provider's performance of this Contract. The provisions of the foregoing Attachment supersede all other provisions of Attachment I regarding HIPAA compliance. 6. Pages 109 — 113, Attachment IV, HIPAA Attachment, is hereby inserted and attached hereto. Theis amendment shall begin on September 20. 2013 or the date on which the amendment has been signed by both parties, whichever is later. All provisions of the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform to this amendment. All provisions of the contract not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment i's hereby made a part of the contract. IN WITNESS THEREOF:, the parties hereto have caused this eight (8).,page amendment to be executed by their officials' thereunto duly authorized, PROVIDER: STATE OF FLORIDA SOUTH FLORIDA BEHAVIORAL HEALTH DEPARTMENT OF' CHILDREN AND NETWORK, INC. FAMILIES SIGNED SIGNED BY- BY: �-Mn/WVV11 NAME��J*.] _. Dow NAME: Gilda P. Ferradaz TITLE: President and Chief Executive Officer TITLE: Interim Regional Manaaing Director DATE: 3 DATE: Federal ID Number: 59-3380599 APPROVED AS TO FORM AND LEGAL F ENCY. t 31110 Carl rcia Da i e Regio aegal Counsel South Florida Behavioral Health Nletwork, Inc. Southern Region SAMH Managing Entity Page 3 of 8 September 20, 2013 Contract No. KH225 Amendment # 0012 ATTACHMENT IV This Attachment contains the terms and conditions governing the Provider's access to and use of Protected Health Information and provides the permissible uses and disclosures of protected health information by the Provider, also called "Business Associate." Section 1. Definitions 1.1 Catch-all definitions: The following terms used in this Attachment shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required by Law, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use. 1.2 Specific definitions: 1.2.1 "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103, and for purposes of this Attachment shall specifically refer to the Provider. 1.2.2 "Covered Entity" shall generally have the same meaning as the term "covered entity' at 45 CFR 160.103, and for purposes of this Attachment shall refer to the Department. 1.2.3. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164. 1.2.4. "Subcontractor" shall generally have the same meaning as the term "subcontractor" at 45 CFR § 160.103 and is defined as an individual to whom a business associate delegates a function , activity, service , other than in the capacity of a member of the workforce of such business associate. Section 2. Obligations and Activities of Business Associate 2.1 Business Associate agrees to: 2.1.1 Not use or disclose protected health information other than as permitted or required by this Attachment or as required by law; 2.1.2 Use appropriate administrative safeguards as set forth at 45 CFR § 164.308, physical safeguards as set forth at 45 CFR § 164.310, and technical safeguards as set forth at 45 CFR § 164.312; including, policies and procedures regarding the protection of PHI and/or ePHI set forth at 45 CFR § 164.316 and the provisions of training on such policies and procedures to applicable employees, independent contractors, and volunteers, that reasonably and appropriately protect the confidentiality, integrity, and availability of the PHI and/or ePHI that the Provider creates, receives, maintains or transmits on behalf of the Department; 2.1.3 Acknowledge that (a) the foregoing safeguards, policies and procedures requirements shall apply to the Business Associate in the same manner that such requirements apply to the Department, and (b) the Business Associate's and their Subcontractors are directly liable under the civil and criminal enforcement provisions set forth at Section 13404 of the HITECH Act and section 45 CFR § 164.500 and 164.502(E) of the Privacy Rule (42 U.S.C. 1320d-5 and 1320d-6), as amended, for failure to comply with the Page 109 South Florida Behavioral Health Network, Inc. Inserted 09/20/13 Page 4 of B Southern Region SAMH Managing Entity g September 20, 2013 Contract No. KH225 Amendment # 0012 safeguards, policies and procedures requirements and any guidance issued by the Secretary of Health and Human Services with respect to such requirements; 2.1.4 Report to covered entity any use or disclosure of protected health information not provided for by this Attachment of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware; 2.1.5 Notify the Department's Security Officer, Privacy Officer and 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; 2.1.6 Notify the Privacy Officer and Contract Manager within (24) hours of notification by the US Department of Health and Human Services of any investigations, compliance reviews or inquiries by the US Department of Health and Human Services concerning violations of HIPAA (Privacy, Security Breach). 2.1.7 Provide any additional information requested by the Department for purposes of investigating and responding to a breach; 2.1.8 Provide at Business Associate's own cost notice to affected parties no later than 45 days following the determination of any potential breach of personal or confidential departmental data as provided in section 817.5681, F.S.; 2.1.9 Implement at Business Associate's own cost measures deemed appropriate by the Department to avoid or mitigate potential injury to any person due to a breach or potential breach of personal and confidential departmental data; 2.1.10 Take immediate steps to limit or avoid the recurrence of any security breach and take any other action pertaining to such unauthorized access or disclosure required by applicable federal and state laws and regulations regardless of any actions taken by the Department ; 2.1.11 In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information. Business Associate's must attain satisfactory assurance in the form of a written contract or other written agreement with their business associate's or subcontractor's that meets the applicable requirements of 164.504(e)(2) that the Business Associate or Subcontractor will appropriately safeguard the information. For prior contracts or other arrangements, the provider shall provide written certification that its implementation complies with the terms of 45 CFR 164.532(d); 2.1.12 Make available protected health information in a designated record set to covered entity as necessary to satisfy covered entity's obligations under 45 CFR 164.524; 2.1.13 Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity's obligations under 45 CFR 164.526; South Florida Behavioral Health Network, Inc. Page 110 Southern Region SAMH Managing Entity Inserted 09/20/13 Page 5 of 8 September 20, 2013 Contract No. KH225 Amendment # 0012 2.1.14 Maintain and make available the information required to provide an accounting of disclosures to the covered entity as necessary to satisfy covered entity's obligations under 45 CFR 164.528; 2.1.15 To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and 2.1.16 Make its internal practices, books, and records available to the Secretary of the U.S. Department of Health and Human Services for purposes of determining compliance with the HIPAA Rules. Section 3. Permitted Uses and Disclosures by Business Associate 3.1 The Business associate may only use or disclose protected health information covered under this Attachment as listed below: 3.1.1 The Business Associate may use and disclose the Department's PHI and/or ePHI received or created by Business Associate (or its agents and subcontractors) in performing its obligations pursuant to this Attachment. 3.1.2 The Business Associate may use the Department's PHI and/or ePHI received or created by Business Associate (or its agents and subcontractors) for archival purposes. 3.1.3 The Business Associate may use PHI and/or ePHI created or received in its capacity as a Business Associate of the Department for the proper management and administration of the Business Associate, if such use is necessary (a) for the proper management and administration of Business Associate or (b) to carry out the legal responsibilities of Business Associate. 3.1.4 The Business Associate may disclose PHI and/or ePHI created or received in its capacity as a Business Associate of the Department for the proper management and administration of the Business Associate if (a) the disclosure is required by law or (b) the Business Associate (1) obtains reasonable assurances from the person to whom the PHI and/or ePHI is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person and (2) the person agrees to notify the Business Associate of any instances of which it becomes aware in which the confidentiality and security of the PHI and/or ePHI has been breached. 3.1.5 The Business Associate may aggregate the PHI and/or ePHI created or received pursuant this Attachment with the PHI and/or ePHI of other covered entities that Business Associate has in its possession through its capacity as a Business Associate of such covered entities for the purpose of providing the Department of Children and Families with data analyses relating to the health care operations of the Department (as defined in 45 C.F.R. §164.501). 3.1.6 The Business Associate may de-identify any and all PHI and/or ePHI received or created pursuant to this Attachment, provided that the de-identification process conforms to the requirements of 45 CFR § 164.514(b). 3.1.7 Follow guidance in the HIPAA Rule regarding marketing, fundraising and research located at Sections 45 CFR § 164.501, 45 CFR § 164.508 and 45 CFR § 164.514. South Florida Behavioral Health Network, Inc. Page 111 Southern Region SAMH Managing Entity Inserted 09/20/13 Page 6 of 8 September 20, 2013 Contract No. KH225 Amendment # 0012 Section 4. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions 4.1 Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate's use or disclosure of protected health information. 4.2 Covered entity shall notify business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate's use or disclosure of protected health information. 4.3 Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate's use or disclosure of protected health information. Section 5. Termination 5.1 Termination for Cause 5.1.1 Upon the Department's knowledge of a material breach by the Business Associate, the Department shall either: 5.1.1.1 Provide an opportunity for the Business Associate to cure the breach or end the violation and terminate the Agreement or discontinue access to PHI if the Business Associate does not cure the breach or end the violation within the time specified by the Department of Children and Families; 5.1.1.2 Immediately terminate this Agreement or discontinue access to PHI if the Business Associate has breached a material term of this Attachment and does not end the violation; or 5.1.1.3 if neither termination nor cure is feasible, the Department shall report the violation to the Secretary of the Department of Health and Human Services. 5.2 Obligations of Business Associate Upon Termination 5.2.1 Upon termination of this Attachment for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall: 5.2.1.1 Retain only that protected health information which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; 5.2.1.2 Return to covered entity, or other entity as specified by the Department or, if permission is granted by the Department, destroy the remaining protected health information that the Business Associate still maintains in any form; 5.2.1.3 Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information to prevent use or disclosure of the protected health information, other than as provided for in this Section, for as long as Business Associate retains the protected health information; 5.2.1.4 Not use or disclose the protected health information retained by Business Associate other than for the purposes for which such protected health information was retained and subject to the same conditions set out at South Florida Behavioral Health Network, Inc. Page 112 Southern Region SAMH Managing Entity Inserted 09/20/13 Page 7 of 8 September 20, 2013 Contract No. KH225 Amendment # 0012 paragraphs 3.1.3 and 3.1.4 above under "Permitted Uses and Disclosures By Business Associate" which applied prior to termination; and 5.2.1.5 Return to covered entity, or other entity as specified by the Department or, if permission is granted by the Department, destroy the protected health information retained by business associate when it is no longer needed by business associate for its proper management and administration or to carry out its legal responsibilities. 5.2.1.6 The obligations of business associate under this Section shall survive the termination of this Attachment. Section 6. Miscellaneous 6.1 A regulatory reference in this Attachment to a section in the HIPAA Rules means the section as in effect or as amended. 6.2 The Parties agree to take such action as is necessary to amend this Attachment from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law. 6.3 Any ambiguity in this Attachment shall be interpreted to permit compliance with the HIPAA Rules. South Florida Behavioral Health Network, Inc. Page 113 Southern Region SAMH Managing Entity Inserted 09/20/13 Page 8 of 8 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods orservices 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 ofreal 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 o period of 36 months from the date of being placed on the convicted vendor |ist." Guidance CareCen^er-SAMH ContractFY/4;page ,4 SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETH CS CLAUSE C-71�LjAaqwarrants that he/it has not employed, retained or oth rwise 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 or employee 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 of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. P, 'Go m (- (signature) 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 abc+F on this A / day of 20 f% `NOTARY PUBLIC My commission expires: YAW R.AMOLARD MoWy Public-State of F OMB - MCP FORM #4 My COMM.Expires Aug 5 Coeunhaioe#EE?^� Guidance Care Center-SAMH Contract FY14;page 15 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordancewith Florida Statute 287.087 hereby certifies that: a e of Business) 1. Publishes a 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 violations, 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 oonnrnodideg 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) orufany 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 a sanction on, or require the satisfactory participation in drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted, G. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the th i d to sigLQ thestatement, I certify that this firm complies fully with the above require! ents. STATE OF .. COUNTY OF /,071 PERSONALLY AP -AREO BEFORE ME, the undersigned authority, 41Z who, after first being sworn by me, (name of MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract # Contract with: Guidance/Care Center Effective Date: '10/01/13 Expiration Date: .9/30/14 Contract Purpose/Description: Provides funding for Baker Act transportation and community transportation for the disadvantaged in Monroe County. Contract Manager:Laura del-oach-Hartle 4482 QMBIGrants (Name) (Ext.) (Department) for BOCC meeting on IDLI&2013 Agenda Deadline: IDLQV2013 CONTRACT COSTS Total Dollar Value of Contract: $187,151.00 Current Year Portion: $187,151.00 Comm. Trnsp. Coord. (Match): $41,151.00 Baker Act Trnsp.: $146,000.00 Budgeted? YesE No M Account Codes: 001- 01509 -530340- Grant: $0.00 001-045903-530340- County Match: $_ ADDITIONAL COSTS Estimated Ongoing Costs: $ r For: (Not included in dollar value above) (e.g. maintenance, utilities, janitorial, salaries, etc.) J CONTRACT REVIEW Changes Date Out Date In Needed Reviewer Division Director YesEl Nor-l.-,_ Risk Management YesF-1 NoEar" O.M,B,/Purchasin YesEl No[71 9 County Attorney YesEl NoM Comments: OMB Form Revised 9/11/95 MCP #2 AGREEMENT This Agreement is made and entered into this 16 th day of October, 2013, between the BOARD {}F COUNTY COMMISSIONERS OF M{}NROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and the Guidance/Core Center, hereinafter referred to as "Provider." WHEREAS, the PROVIDER is a not-for-profit corporation established to provide transportation services to the citizens of Monroe County, and WHEREAS, it is a legitimate public purpose to provide transportation services to the residents o[ Monroe County, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and carrying out the duties of the Board, shall reimburse the PROVIDER for providing transportation services as billed by the PROVIDER for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures. The cost shall not exceed a total reimbursement of ONE HUNDRED EIGHTY SEVEN THOUSAND ONE HUNDRED FIFTY ONE DOLLARS ($187,151.00), during the fiscal year 2014, payable as follows: a) the sum of ONE HUNDRED FORTY SIX THOUSAND DOLLARS ($146,000.00) for Baker Act transportation services pursuant toFS394; and b) the sum of FORTY ONE THOUSAND ONE HUNDRED FIFTY ONE DOLLARS ($41,151.00), for Community Transportation Coordinatoprelated transportation services to residents of Monroe County. 2. TERM. This Agreement shall commence on October 1, 2013, and terminate September 30, 2014, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. Payment for Baker Act and Marchnnan Act transportation services shall be made according to the rate schedule set forth in Attachment D, subject tothe nnaxinnunn amounts set forth in Paragraph 1. a. above. Billing Summary Forms, certified monthly financial and service load reports will be made available to the Board to validate the delivery of services under this oontract. The monthly financial report is due in the office of the Clerk of the Board no later than the 15th day of the following nnonth. 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 1, above, during the term of this agreement. To preserve client confidentiality required by law, copies ofindividual client bills and records shall not be available tothe Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. The organizotion's final invoice must be received within thirty days after the termination date of this contract shown in Article 2 above. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State )avve and regulations and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain Guidance Care Center-Transpmtaoon:Baker Act and CDJFY,4;page notarized certification statement. An example of reimbursement request cover letter is included as Attachment B. The organ\zation'sMna| invoice must be received within thirty days after the termination date of this contract shown in Article 2above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of Said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 1, above, during the term of this agreement. 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. 5. 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 mf this Agreement; provided that all applications, requests, grant proposals, and funding solicitations shall be approved by each party prior to submission. 6. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant tustatutory requirements. RECORDKEEPING 7. RECORDS. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in acc�rdancevvith generally accepted accounting principles consistently applied. Each party to this Agreernentor their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER. S. PUBLIC ACCESS. The County and PROVIDER shall a||ovv and permit reasonable access to, and inspection of, all documents, papers, letters orother materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. 9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the COUNTY the following (items A-I must be provided prior to the payment of any invoices): (a) IRS Letter ofDetermination indicating 501(c)(3) status; (b) List of the Drganization's Board of Directors of which there must be five or more; 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 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 recornrnended/taken; (e) IRS Form 990 from most recent fiscal year for all organizations; (f) Drgan\zaUon's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; Guidance Care Center-Tmn«portation:Baker Act and CTDFY/4;page 2 (g) Orgmn|zaUon'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)| (i) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved; U\ Cooperation with County monitoring visits that the County may request during the contract year; and (k) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. RESPONSIBILITIES 10. SCOPE OF SERVICES., The Provider, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and carry out the duties of the Board in rendering counsel in the matter of mental health and guidance to the citizens of the Monroe County, Florida. The Provider shall provide Baker Act transportation services in compliance with Florida Statutes Chapter 394. Baker Act and Marchnnan Act transportation services which are covered under this agreement may be subcontracted, but are subject to the rates set forth in Attachment O, and the limitations above. The subcontractor shall be subject to all of the conditions of this contract, including but not limited to insurance and hold-harmless requirements, as is the Provider. 11. ACCESS TO FUELING FACILITIES. The County shall provide access to the Provider's vehicles at all County fueling facilities. The County shall grant the Provider license for the use of the real property and its improvements for each fueling site. The Provider agrees that only those individuals authorized by the County to use the fueling sites designated in this agreement shall have twenty-four hour access to said sites, and that they shall either be maintained open or access otherwise provided to them by a uniform key system on such a twenty-four hour basis. The County shall bill the Provider for fueling and other related services and materials utilized by the Provider at the fueling sites within the County'a immediate control and as previously set forth in this agreement. Said billing by the County tothe Provider shall include an administrative surcharge, as adopted by the Monroe County Board of County Commissioners annually, for processing, servicing, and handling. The Provider shall reimburse the County within thirty (30) days of the date of issuance of the bill. Access to the Fuel Sentry System shall be provided by an electronic memory hey, which shall be issued by the County to all authorized designated users of the fueling sites, and as contemplated by this Agreement. For purposes of uniformity, the Monroe County Fleet Management Department shall be responsible for establishing a uniform electronic key system for use by both the County and the Provider under this agreement, and shall establish and maintain policies and procedures for identification, control, and distribution of all keys issued. 12. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award GukdanmyCaneQsnuyr—Tranypontadnn:Bvker Act and CTDFv/4;page against the non-prevailing party, and shall include attornev'sfees, 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 ofCivil Procedure and usual and customary procedures required by the circuit court ofMonroe County. 13. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 14. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 15. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 16. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 17. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 18. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or |\censure of the PROVIDER'S program and staff. 19. NON-DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and itis expressly understood that upon a determination by 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) which VI of the Civil Rights Act of 1964 (PL 88-352) hich prohibits discrimination on the basis o' race, color or national origin; 2\ Tide IX of the Education Amendment of 1972, as amended (2O which se. 1681-1683, and 1685-1686), hi�h prohibits discrimination on the basis of sex| ' )� Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibit' discrimination on the basis ofhandicaps; 4) The Age Discrimination Act of1975, as amended (42 Guidance Care Center-Transportation:Baker Act and CTDFY/4;page USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5\ The Drug Abuse Office and Treatment Act of 1972 (PLQ2-255), 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 (PL91-516), as amended, relating to nondiscrimination on the basis of alcohol abuse oralcoholism; 7\ l-he 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 U8Cs. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10\ Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. AMENDMENTS, CHANGES, AND DISPUTES 20. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the COUNTY. 21. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. 22. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 23. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 24. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board/ which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 25. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. Guidance Care Center-Transponation:Baker Act and CTDFY1*;page 5 26. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- Free Workplace Statement. 27. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 28. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorneys fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 29. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers` compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 30. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 31. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 32. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third- party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 33. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall Guidance Care Center—Transportation:Baker Act and CTD FY14;page 6 constitute one and the same instrument and any of the parties hereto may execute this Agreement bysigning any such counterpart. 34. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand-delivered or mailed, postage pre-paid, by certified rnai|/ return receipt requested, to the other party a8follows: Fg[Board: Grants Administrator and Monroe County Attorney 110O Simonton Street PD Box 1O2h Key West, FL33O4O Key West, FL33O41 For PROVIDER Frank Rabbiim, Senior Vice President Guidance/Care Center Inc. 1205 Fourth Street Key West, Florida 33040 35. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES' This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will ||e in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the harrns or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 36. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 37. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by |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. 38. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FDLLDVV] Guidance Care Center-Tran«purtation:Baker Act and CTDFY14;page r IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as uf the day and year first written above. (SEAL) BOARD OF COUNTY COMMISSIONERS ATTEST: AMY HEAVILIN, CLERK DFMDNROE COUNTY, FLORIDA By Deputy Clerk Mayor/Chairman GUIDANCE/CARECENTER (Federal IONo. ) Witness Witness 4- 0 , gY�tre�~ ��Advocacy GuiUance/CareCenter MCDNROE COUNTY ATTORNEY ASSISTANT COUNTY ATTORNEY Date Guidance Care Center-Tronypoontion:BukerActandCTDFY/4;page 8 ATTACHMENT A Expense Reimbursement Requirements This document is intended to provide basic guidelines to Human Service Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from Florida Statute 112.061. Acnver letter summarizing the major line items on the reimbursable expense request needs to also contain a notarized certified statement such as: "I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this orgon\zntion's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all-inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to3O5-292-35]4. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter-company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount, If Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy ofthe rental or lease agreement \srequired. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number 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 Center-nanaportation:Baker Act and CTDpy14,page V Telefax, Fax, etc. Afux log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County [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 rece}pts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered reimbursable travel expense at the destination. Airport parking during business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall beatthe rate established by ARTICLE XXVI, TAAVEL, 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 reimbursable expense. Meal reimbursement shall beatthe rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY ofthe Munroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 8 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 Care Center-Tranapountiom:Baker Act and CTDFY1^;page 10 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date The following is a summary of the expenses for ( Organization name) for the time period of to Check # Payee Reason Amount 101 Company A Rent $ X'XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01 XXX.XX (A) Total $ X'XXX.XX (B) Total prior payments $ X'XXX.XX (C) Total requested and paid (A + B) $ X'XXX.XX (D) Total contract amount $ X'XXX.XX Balance of contract (D-C) $ X'XXXM I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of _ 20— by— who is personally known to me. Notary Public Notary Stamp Guidance Care Center-Transportation:Baker Act and CTD FY14;page 11 ATTACHMENT C Insert a list of the services that will be provided by your organization under this contract. Baker Act/Marchman Act transportation services and Community Transportation Coordinator- related services. Guidance Care Center—[mnupo/tatiom:Baker Act and CTDFY,4 page ,2 ATTACHMENT D Copy of Sub-Contract for Baker Act transportation services. See attached. Guidance Care Center-Transportation:Baker Act and CTO FY14,page 13 PUBLIC ENTITY CRIME STATEMEN "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under 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 ofbeing placed on the convicted vendor list." GuidanceCamCenter-Transportamon:Baker Act and C0FY,4;page ,4 SWORN STATEMENT UNDER ORDINANCE NO. 1O-1990 M{}NROE [DUNTY FLORIDA ETHICS CLAUSE L!L�,-warrantsthat he/it has not employed, retained or nm/se had act on h|s/|ts behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10-1990 or any County officer or employee 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 of any fee, commission, percentage/ gift, or consideration paid to the former County officer oremployee. STATE OF COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by rne/ affixed his/her signature | signing) in the space provided above on this day of NOTARY PbBLIC My commission expires: � OMB - MCP FORM #4 VAIN it Alwau" my cam.bon An 5,2016 io Guidance Care Center-Transpwrtatiom:Baker Act and CTDFY/4;page ,5 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: �a e of Business) 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 violations. 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 underbid, 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|m contende*e to, any violation of Chapter 893 (Florida Statutes) orofany controlled substance |avv of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in adrVg abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted, 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that thish the above STATE OF 4e of C 0 U N TY 0 F // 71 ,� PERSONALLY 84�AR'ED BEFORE ME, the undersigned authority, who, after first being sworn by e, (name of MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract # Contract with: Guidance/Care Center Effective Date: 10/01/13 Expiration Date: 9/30/14 Contract Purpose/Description: Provides services to persons in the ]ail In-House Program affected by substance abuse in Monroe County Detention Center. Contract Manager: Laura deLoach-Hartle 4482 OMB/Grants (Name) (Ext.) (Department) for BOCC meeting on 10J16 113 Agenda Deadline: 10101 13 CONTRACT COSTS Total Dollar Value of Contract: $107,363 Current Year Portion: $107,363 Budgeted? Yes® No 0 Account Codes: 001-045906-530340 Grant: $0.00 County Match: ADDITIONAL COSTS Estimated Ongoing Costs: $ Jyr For: (Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.) CONTRACT REVIEW Changes Date Out Date In Needed Reviewer Division Director YesEl NoF_1,,,",,'_ N7 Risk Management YesF_1 Nocr/4 O.M.B,/PurAa`sing !9- ( 13 YesF_1 Noff County Attorney I YesM No 41 pz Comments: OMB Form Revised 9/11/95 MCP #2 CD O n m rn 0 0 v r -a cn T-m 03 � m � —1 c -0 O O c 0 -I -Ti p ?! C) C) C) � n{i C O c o rn y O m O a oCD a c o w y a CO 0 V5 b m p 0 a 0 m c'o En m o m 0 0 v 3 CD sv M y w m N n w m z 0 r m 0 (n '11 � � v murrn m mo � Cn — mm nsC] ;z v n CD M m 17 D m c- a v O m CD c M 0 0 a) CA :fl O r o r 0 = m N-a N N � � � a < N c 0 u, M m c n � = a N CD m 0 0 C) CD D 3 G) v N `" 0 N a SN w CCD� o h m w N vi � c1 � m o a Q < " x m � T �Co 0 m CDr- w o fit g cr a p @ w CD w :3 {� oa — a ni v � n N U3 O o = a � ff3 C o O <D y N c rn cQ n Z Q CD to to 5 • j' C p EP O FD.N N O CND Z co_ o CCD M r 17 03 y O � CL o 0 C7 dCD 0' K m y O CD CA O 7 D) f}) N o n a m o < (D c W `� 69 lfl co OD _ v O W A U WN NW) W CWO 2a) cmv Q UULD � -4 0s -4W AA 00 wNW A " b0U -u coA -4 0 0 cn A O 0 ON) O 0 0 Oo p ? A O Q O G O O 00 O CD 0 co -A 000 W N000 b N ER EA N 1 W N N C O O'+ W N �' W N •� --i N i CD 1 �] -+ W A CO N m -' CD 0 (OO CD --4 --4 co A N N Ch (D(h 0 '4 W C) IU 1 0 0 U N M CD (D cn C) (.0 C) O b b O O) A OnW N CD A O CD N CD C) U y -� A -t V -4 ^I O 00 b 00 -4 0 OAA 0 N 0 0 0 3 t6 to v {q [fl O ,U�i ONO m O V V 4 s a) CpO DD A cD Cn 6) 3 CR A CAA C O "'� N O O) N A -4 0) 0 -4 U Q) N O U O)N CD N AO) V A A O 00 U W v W ti Oo ONfi71 OOU l w V A V J W O , O W O 00 0 0O W OD U ON W r4 000. 3 vi TI N C? co W 49 0 A su w N N C D „�, m CD CD 0 U3 7, U U O W w W U m (D c O_ Q cr O A Oo N N Oa 0) U O- p 0 _ V) O O b O CD O O 0 N :3 O N 0 0 0 N N O CD CD CD CD _ m (} O N C N W IE r O :3C C O N 'C fl) N N -•I a a 0 0 0 0 C) O W 0 w p C C A COW CO U O O CD C)p) 0 �C) 0 0 0 0 0 0 0 o an w m � m O N N N O O O O O O O a rn v 0. v 00 0 1V 0 �l IV 4� N W A o WO O O O U O U c 00 co O (D N p] o 0 3 N CL O (D � 0000 000 (Q 3 2. C.) CD Cl C) --1 i N 8 N CD N 30`) 0 0 N O 0 0 0 m cn cn N 3 3 U cr 5 O 3 AGREEMENT This Agreement is made and entered into this 16th day of October, 2013, between the BOARD OF COUNTY COMMISSIONERS OF MONKOECDUNTY, FLORIDA, hereinafter referred to as "Board" or"County," and Guidance/[are [enter, hereinafter referred to as "PROVIDER." WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of comprehensive services for individuals in the Jail In-House Program in the Monroe County Detention Center, and WHEREAS, it is a legitimate public purpose to provide facilities and services for the provision of comprehensive substance abuse services for individuals in the Jail In-House Program at the Monroe County Detention Center, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and carrying out the duties and obligations of the Board, shall reimburse the Provider for a portion of the Provider's expenditures for the ]a|| In- House Program services (including substance abuse and mental health services, such as counseling and therapy, vocational, education, and support services, to those incarcerated individuals that qualify for the program), as billed by the Provider. This cost shall not exceed a total reimbursement of ONE HUNDRED SEVEN THOUSAND THREE HUNDRED SIXTY THREE AND NO/100 DOLLARS ($107,363.00) during the fiscal year 2014. 2. TERM. This Agreement shall commence on October 1, 2013, and terminate September 30, 2014, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County [ode of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An mxonnp|e of a reimbursement request cover letter is included as Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 2 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 1, above, during the term of this agreement. 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to 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. S. CLAIMS FOR FEDERAL OR E;1[A7[E AID. PROVIDER and County agree that each shall be, and is, empowered to apply for/ seek, and obtain federal and state funds to further the Contract-Guidance Care Center-Jail Pm0mm'FY,4;page , purpose of this Agreement; provided that all applications, requests, grant proposals, and funding solicitations shall be approved by each party prior to submission. 6. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORKDKEEPING 7. RECORDS. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently app|ied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant to Sec. 55.03, FB, running from the date the monies were paid to PROVIDER. 8. PUBLIC ACCESS. The County and PROVIDER shall a||ovv and permit reasonable access to, and inspection of, all documents, papers, letters orother materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. 9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (itennsA-I must be provided prior to the payment ofany invoices): (a) IRS Letter ofDetermination and GUIOESTAR printout indicating current 501(c)(3) status; (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 e statement of deficiencies with corrective actions recommended/taken; (e) Copy of filed IRS Form 990 from most recent fiscal year with all attached schedules; (f) Drganization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (g) Organizotion'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); (|) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end dote.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved; (j) Cooperation with County monitoring visits that the County may request during the contract year| and (k) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. RESPONSIBILITIES Contract-Guidance Care Center-Jail Pmpram-FY,4;page 2 10. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 11. ATTORNEYS 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'sfees, courts costs, investigative, and out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. :12. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 13. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance ofgifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 14. NO SOLICITA7[ION/UmA8yMEN7[. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bone 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 nfsuch fee, commission, percentage, gift, or consideration. 15. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 16, COMPLIANCE WI1[KU 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. 17. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or |icensure of the PROVIDER'S program and staff. 18. NON-DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and itis expressly understood that upon a determination by 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 Contract-Guidance Care Center-JailProgramfY,4;page 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 of1975, as amended (42 US[ ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL92-255), 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 (PL91-616), 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 sm. 690dd-3 and 290ee-]), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIlI of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement, AMENDMENTS, CHANGES, AND DISPUTES 19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. 20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida |ovv. 21. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party/ in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 22- COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 23. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. Contract-Guidance Care Center-Jail Pmgram'FY,4;page 4 24. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any oornrnerC(a| liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 25. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- Free Workplace Statement. 26. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 27. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 28. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 29. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 30. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 31. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled torely upon the terms of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. Contract-Guidance Care Center-Jail Progem-FY,4;page 5 GENERAL 32. Execution in Counterparts. This Agreement may be executed in any number of counterparts, each of vvh(oh shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 33. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand-delivered or mailed, postage pre-paid, by certified rnd(|/ return receipt requested, to the other party as follows: For Board: Grants Administrator and Monroe County Attorney 11OO Simonton Street PO Box 1026 Key West, FL33O4O Key West, FL33O41 For P:,'OVIDER FrankRabb(to, Senior Vice President Guidance/CareCenter 1205 Fourth Street Key West, FL33040 34. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES;. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will |}e in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 35. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 36. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by |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 dose as possible to the intent of the stricken provision. 37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TD F{}LUOVV] Contract-Guidance Care Center-Jail pmgmm-FY/4;page e IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) BOARD DF COUNTY COMMISSIONERS ATTEST: AMY HEAVILIN, CLERK DFMONROE COUNTY, FLORIDA By B Deputy Clerk Mayor/Chairman Guidanoe/CareCenter (Federal I[) No. \ Witness Witness D|r(*tor, Outrdaoh 8�AUvooacy ' Gu(dance/CareCenter M[3NROE COUNTY ATTORNEY &P.PR Y':D AS ASSISTANT COUN-ry ATTORNEY Date Contract-Guidance Care Center-Jail Program-FY/4;pager ATTACHMENT EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community-Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate totravel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organizoUon's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all-inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305-292-3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter-company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary orhourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. /\ copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. Tellefax' Fax, etc. Afox log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement ofTravel Expenses. Travel reimbursement requests must besubmitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. 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 departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list ofcharges 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 rVmrn 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 reimbursable expense. Meal reimbursement shall beatthe rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after p.m. for dinner reimbursement. Non-allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non-sufficient check charges, penalties and fines. Contract-Guidance Care Center-Jail Prog m'FY14;pagee ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500VVh|tehead Street Key West, FL33O4O Date The following is a summary of the expenses for ( ) for the time period of-tn______.. Check # Payee Reason Amount 101 Company Rent $ X,XXX.XX 102 Company Utilities XXX,XX 104 Employee P/R ending 05/14/01 XXX.XX 105 Employee B P/Rend(ng 05/28/01 X>0(.XX (A) Total $~Xe8J� .XX (B) Total prior payments $ X,XXX.XX (C) TVta| requested and paid (A + B) $ X/XXX.XX (D) Total contract amount $ X/XXX.XX Balance of contract (D-C) $ X1XX)�M I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this orgenization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Chief Executive Officer Attachments (supporting documentation) Sworn to and subscribed before me this day of 20 b who is personally known tome. Notary Public Notary Stamp Contract-Guidance Care Center-Jail Pmgmm-FY/4;page /0 ATTACHMENT C Services to be provided: Guidance Care Center will provide substance abuse services, including assessment, case management, individual and group therapy, drug testing, and educational, parenting, and vocational workshops to men and women in the Monroe County Detention Center(also known as the Jail In-House program). Contract-Guidance Care Center-Jail Program-FY14;page 11 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of public building or public work, may not submit bids on leases ofreal property to public entity, may not be awarded or perform work asa 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 fora period of36 months from the date of being placed on the convicted vendor list." SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MDNROEC{}UNTY, FLORIDA ETHICS CLAUSE Lt;�'t� warrants that he/it has not employed, retained or ~-61henwise had act on his/its behalf any former County officer oremployee in violation of Section 2 of Ordinance No. 10-1990 or any County officer or employee 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 of any fee, commission, percentage, gift/ or consideration paid to the former County officer or employee. Date: o STATE OF 4�OAJC_�,,,) COUNTY OF ]cl AL),L, PERSONALLY APPE/NRE[} BEFORE ME, the undersigned authority, P who, after first being sworn by me, affixed his/her signature (name f individualsigning\ in the space day of , 201�_7. My connrn|ss|Vn expires: OMB - MCP FORM #4 ~ ^' PON_ Contract-Guidance Care Center-Jail poogrom-Fv/4;page 13 DRUG-FREE WORKPLACE FORM The undersigned vericlor in accordance with Florida Statute 287.087 hereby certifies that: TNhme of Business) 1. Publishes a 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 violations, ]. Gives each employee engaged in providing the commodities orcontractual services that are under bid e copy of the statement specified in subsection (1). 4. In the statement specified in subsection /1\, notifies the employees that, as a condition of working on the commodities orcontractual services that are underbid, 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 cnnbendere to, any violation of Chapter 893 (Florida Statutes) orofany controlled substance |avv of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted, 6. 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 oonlp|ies fully with the above requirements. ' STATE OF r_,�A AAUi PA P1 COUNTY OF c) � t ), v3 Date I PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, (name of individual signing) affixed his/ space provided above onthis