Item F39 jBIOARD of COUNTY COMMISSIONERS
Mayor David Rice, District 4
Mayor Pro Tern Kim Wigington, District 1
OUNTYHeather Carruthers, District 3
KEY WESTSoMONROE
LORIDA 33040 Sylvia J. Murphy, District 5
(305)294-4641 _ George Neugent, District 2
District 4 Office:
9400 Overseas Highway ®`'
Florida Keys Marathon Airport
Suite 210
Marathon, FL 33050
Ph: 305 289-6000 rr�ti
Fx: 305 289 4610
Em: > ,,4.d1, iu ,uw , mo,,
Interoffice Memorandum
Date: November 16, 2012
ClerkTo: Danny Kolhage,
"3.
From: ayor avi ice, istrict `
Re: Notice of Voting Conflict
Per Florida Statute 1 12.3143, I hereby disclose by written memorandum that I will
abstain from the vote on certain issues that are brought before the Monroe County Board of
Commissioners with entities that I am involved with.
I will abstain from the vote on issues concerning the 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 November 20, 2012 BOCC meeting, I will abstain from the vote on item(s).
#F38, F39, F40, F4 3, F44
These five items all pertain to the Guidance Care Center. You will find attached a
copy of page 6 of the November 20, 2012 Final Revised Agenda for reference as to the
specifics of each item.
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: November 20, 2012 Division: OMB
Bulk Item: No Department: Grants
Staff Contact/Phone#: Lisa Tennyson x 4444
AGENDA ITEM WORDING: Approval of agreement with Guidance Care Center for local match
funding for Substance Abuse and Mental Health services for the period from October 1, 2012 through
September 30, 2013.
ITEM BACKGROUND: The contract attached reflects Monroe County's minimum required portion
of SAMH local match of$570,792 plus an additional $86,274, for a total contract amount of$657,066.
Monroe County is providing local match funding pursuant to FS 394.76, for Substance Abuse Mental
Health (SAMH) services, inclusive of Baker Act services. This is a match for State funding for SAMH
services, which is managed by Florida Department of Children and Families (DCF). DCF contracts with
the South Florida Behavioral Health Network (SFBHN) to provide substance abuse and mental health
services in South Florida (a copy of contract is included as Attachment E.) SFBHN in turn contracts
with the Guidance Care Center to provide SAMH services in Monroe County (a copy of contract is
included as Attachment D.) "Exhibit H" in the SFBHN contract is a snapshot of the contract. It
indicates the SAMH services GCC will provide, state funding for those services, and the total local
match amount required to be provided.
PREVIOUS RELEVANT BOCC ACTION: In May 2012, BOCC approved subtracting$140,000 from
GCC's total local match request of$915,000; this action left $775,000 for GCC. In June 2012, BOCC
approved $570,792 as the minimum required local match for Monroe County. In September 2012, as part
of the final budget hearing for the FY 13 budget, the BOCC approved the SAMH match line item for
$570,792, and an additional line item of$205,000 for GCC, for a total amount of$775,792.
A portion of the line item for $205,000, in the amount of$118,726, is being applied toward funding for
GCC's Jail In House Program. (A JIP contract for $118,726 is also on today's agenda.) The remainder
after subtracting the JIP ftinding is $86,274, which has been added as additional discretionary match to
the GCC's SAMH contract attached.
CONTRACT/AGREEMENT CHANGES: Guidance Care Center's funding was moved from HSAB
item to a SAMH line item under the BOCC.
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $ 657,066 INDIRECT COST: BUDGETED: Yes X No
DIFFERENTIAL OF LOCAL PREFERENCE: - NA
COSTTO COUNTY: $657,066 SOURCE OF FUNDS:
REVENUE PRODUCING: Yes No A 0 NT PER MONTH— Year
/PuVAPPROVED BY: County Att rc asing Risk Management y- 14, 1
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM #
Revised 7/09
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Guidance/Care Center Effective Date: 10/01/12
Expiration Date: 9/30/13
Contract Purpose/Description: Local match for state funding to Guidance Care Center for
Substance Abuse Mental Health pursuant to FS 394.76.
Contract Manager: Lisa Tennyson 4444 OMB/Grants
(Name) (Ext.) (Department)
for BOCC meeting on 11/20/12 Agenda Deadline: 11/06/12
CONTRACT COSTS
Total Dollar Value of Contract: $657,066 Current Year Portion: $657,066
($570,792+$86,274)
Budgeted? Yes® No El Account Codes: 001-045902-530340
Grant: ----
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 Review er
Division Direct �
or YesEl NoE],—
Risk Mana en '
-LLL
t YesEl NoJZ
� YesF� No
O.M B./Pu�rPasing((* It 171 JZ,
(Q� E�
County Attorney It tAp YesEl No[Z 0,A!*4,
Comments:
OMB Form Revised 9/11/95 MCP #2
AGREEMENT
This Agreement is made and entered into this 20th day of November, 2012, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or"County," and Guidance/Care Center, hereinafter referred to as "PROVIDER."
WHEREAS, the County participates in funding substance abuse and mental health /SAMH\
services within the County pursuant to Section 394.76(3)(o), 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 ]94.76(9)(a), Florida Statutes, and the contract
between the PROVIDER and South Florida Behavioral Health Network (ME225-]-27) attached here
in (Attachment D) to provide substance abuse and mental health services; such funds shall be
expended for alcohol, drug abuse, or mental health service programs.
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 NO/100 DOLLARS ($657,066.00) in fiscal year
2O12-ZO13.
3. TERM. This Agreement shall commence on October 1, 2012, and terminate September
30, 2013, unless earlier terminated pursuant to other provisions herein.
4. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act and
SAMH Billing Summary Forms, certified monthly financial and service load reports will be made
available to the Board to validate the delivery of services under this contract. The monthly
financial report is due in the office of the Clerk of the Board no later than the 15th day of the
following month. After the Clerk of the Board pre-audits the certified report, the Board shall
reimburse the Provider for its monthly expenses. However, the total of said monthly payments in
the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term
of this agreement. To preserve client confidentiality required by law, copies of individual client
bills and records shall not be available to the Board for reimbursement purposes but shall be
made available only under controlled conditions to qualified auditors for audit purposes. The
Organization's final invoice must be received within sixty days after the termination date of this
contract shown in Article 3 above.
Payment will be made periodically, but no more frequently than monthly, as hereinafter sat
forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The
County shall only reimburse, subject to the funded amounts below, those reimbursable expenses
which are reviewed and approved as complying with Monroe County Code of Ordinances, State
laws and regulations and Attachment A - Expense Reimbursement Requirements. Any funds
Guidance Care Center-8AMHC»noact;FY13;page I
expended in violation of this Agreement or in violation of appropriate Federal, State, and County
requirements shall be refunded in full to the County. Evidence of payment by the PROVIDER shall
be in the form of a letter, summarizing the expenses, with supporting documentation attached.
The letter should contain a notarized certification statement. An example of a reimbursement
request cover letter is included as Attachment B. The organization's final invoice must be
received within thirty days after the termination date of this contract shown in Article 3 above.
After the Clerk of the Board examines and approves the request for reimbursement, the
Board shall reimburse the PROVIDER. However, the total of said reimbursement expense
payments in the aggregate sum shall not exceed the total amount shown in Article 2, above,
during the term of this agreement.
5. AVAILABILITY OF FUNDS. The County reserves the right to withhold/reduce the
funds to the Provider in the event that the Department of Children and Families
eliminates/reduces the State contract funding.
If funds cannot be obtained or cannot be continued at a level sufficient to allow for
continued reimbursement of expenditures for services specified herein, this agreement may be
terminated immediately at the option of the Board by written notice of termination delivered to
the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the
PROVIDER after the PROVIDER has received written notice of termination, unless otherwise
required by law.
S. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall
be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
purpose of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission.
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 to the
County the following (items A-M must be provided prior to the payment of any invoices):
(a) IRS letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status;
(b) 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;
Guidance Care Center-SAMH Contract;FY13;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 o 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) Qrganization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(g) Drganization's Policies and Procedures Manual which must include hiring policies for all
staff, drug and alcohol free workplace provisions, and equal employment opportunity
provisions;
(h) Specific description or list of services to be provided under this contract with this grant
(see Attachment C, per contract ME225-3-27);
(i) All legally required licenses;
(j) Any updates/a mend rnents throughout the fiscal year to the South Florida Behavioral
Network contract with the Department of Children and Families (KH-225) and with
Guidance/Care Center (ME225-3-27);
(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 2012-2013 fiscal year. Provider audits
shall be performed at no cost to the County and shall be provided to the County no later than
January 1, 2D14.
RESPONSIBILITIES
12. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and provide the services outlined
in Attachment C to residents of Monroe County, Florida.
13. A0-T0'RNEY'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 atturney'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 ofMonroe County.
14. BINDING EFFECT. The terms, covenants, conditions, and provisions of this
Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective
legal representatives, successors, and assigns.
15. CODE OF ETHICS. County agrees that officers and employees of the County
recognize and will be required to comply with the standards of conduct for public officers and
employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to,
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 ufcertain information.
Guidance Care Cenrop3AMH Contract;FY13;page n
16. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect
to ihae|[ it has neither employed nor retained any company or person, other than a bona fide
employee working solely for it, to solicit or secure this Agreement and that it has not paid or
agreed to pay any person, company, corporation, individual, or firm, other than a bona fide
employee working solely for it, any fee, commission, percentage, gift, or other consideration
contingent upon or resulting from the award or making of this Agreement. For the breach or
violation of the provision, the PROVIDER agrees that the County shall have the right to terminate
this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise
recover, the full amount of such fee, commission, percentage, gift, or consideration.
17. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement
contained in this agreement shall be construed so as to find the PROVIDER or any of its
employees, contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES
18. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the
PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating
the provision of such services, including those now in effect and hereinafter adopted. Any
violation of said statutes, ordinances, rules and regulations shall constitute a material breach of
this agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
19. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or |icensure of the PROVIDER'S program and staff.
20. NON-DISCRIMINA1[ION. County and PROVIDER agree that there will be no
discrimination against any person, and it is 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)
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
U8C 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
USC 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; S) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of1g70 (PLg1-516), nsamended, relating to nondiscrimination on the basis of
alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 US[
ss. 690dd'3 and 290ee-]), as amended, relating to confidentiality of alcohol and drug abuse
patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended,
relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with
Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to
nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any
Federal or state statutes which may apply to the parties to, or the subject matter of, this
Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
Guidance Care Centep&*MH Contract;FY13;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 in any manner
or degree with its performance under this Agreement, and that only interest of each is to perform
and receive benefits as recited in this Agreement.
25. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing
and with the prior written approval of the Board, which approval shall be subject to such
conditions and provisions as the Board may deem necessary. This agreement shall be
incorporated by reference into any assignment and any assignee shall comply with all of the
provisions herein. Unless expressly provided for therein, such approval shall in no manner or
event be deemed to impose any obligation upon the Board in addition to the total agreed upon
reimbursement amount for the services of the PROVIDER.
26. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28,
Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the
acquisition of any commercial liability insurance coverage, self-insurance coverage, or local
government liability insurance pool coverage shall not be deemed a waiver of immunity to the
extent of liability coverage, nor shall any contract entered into by the County be required to
contain any provision for waiver.
27. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug-
Free Workplace Statement.
28. AUTHORITY. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County
and corporate action, as required by law.
INDEMNITY ISSUES
29. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and all
claims for bodily injury (including death), personal injury, and property damage (including
property owned by Monroe County) and any other losses, damages, and expenses (including
attorney's fees) which arise out of, in connection with, or by reason of services provided by the
Guidance Care Center-SAMH Contract;FY13;page 5
PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the
PROVIDER'S employees, agents, or volunteers.
30. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'
compensation, and other benefits which apply to the activity of officers, agents, or employees of
any public agents or employees of the County, when performing their respective functions under
this Agreement within the territorial limits of the County shall apply to the same degree and
extent to the performance of such functions and duties of such officers, agents/ volunteers, or
employees outside the territorial limits of the County.
31. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe
County in his or her individual capacity, and no member, officer, agent or employee of Monroe
County shall be liable personally on this Agreement or be subject to any personal liability or
accountability by reason of the execution of this Agreement.
32~ LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
or Statutory Duties. This Agreement is not intended to, nor shall it be construed as/ relieving any
participating entity from any obligation orresponsibility imposed upon the entity by law except to
the extent ofactual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
33. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely
upon the terms of this Agreement to enforce or attempt to enforce any third-party claim or
entitlement to or benefit ofany 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
Agreement separate and apart, inferior to, or superior to the community in general or for the
purposes contemplated in this Agreement.
GENERAL
34. Execution in Counterparts. This Agreement may be executed in any number of
counterparts, each of which shall be regarded as an original, all of which taken together shall
constitute one and the same instrument and any of the parties hereto may execute this
Agreement bysigning any such counterpart.
35. NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the
other party aafollows:
For Board:
Grants Administrator and Monroe County Attorney
11OO Simonton Street PO Box 1026
Key West, FL33O40 Key West, FL33041
For PROVIDER
Frank Rabbito, Senior Vice President
(Suidance/CareCenter
1205 Fourth Street
Key West, FL 33040
Guidance Care C*nter-3AMY Contract;FY/3;page 0
36. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the laws of the State of Florida
applicable to contracts made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will
lie in the appropriate court or before the appropriate administrative body in Monroe County,
Florida.
The County and PROVIDER agree that, in the event of conflicting interpretations of the
terms or a term of this Agreement by or between any of them the issue shall be submitted to
mediation prior to the institution of any other administrative or legal proceeding.
37. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept
and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and
shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding
breach, either of the same conditions or covenants or otherwise.
38. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or
the application thereof to any circumstance or person) shall be declared invalid or unenforceable
to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions
and provisions of this Agreement, shall not be affected thereby; and each remaining term,
covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the
fullest extent permitted by law unless the enforcement of the remaining terms, covenants,
conditions and provisions of this Agreement would prevent the accomplishment of the original
intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace
any stricken provision with a valid provision that comes as close as possible to the intent of the
stricken provision.
39. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the PROVIDER and the Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW]
Guidance Care Center-SAMH Contract;FY13;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 OF COUNTY COMMISSIONERS
ATTEST: DANNYL. NJLHAGE, CLERK {}FM{}NROECOUNTY, FLORIDA
By By
Deputy Clerk Mayor/Chairman
Guidance/CareCenter
(Federal IONo. ) ^
Witness
By
Witness Director, Children & Families
Guidance/CareCenter
MONROE COUNTY ATTORNEY
APPROVED
ASSISTANTCOUNTY ATTORNEY
Date
Guidance Care Center-SAMHContract;FY13;page 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 or services to a public
entity, may not submit a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real property to public entity,
may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under
a contract with any public entity, and may not transact business with any public entity in excess
of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36
months from the date of being placed on the convicted vendor list."
Guidance Care Center-SAMH Contract;FY13;page 14
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
M{}NROE COUNTY, FLORIDA
ETHICS CLAUSE
warrants that he/it has not employed, retained or
otherwise had act on his/its behalf any former County officer nremployee 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.
(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 above on this day of
, 2O____.
NOTARY PUBLIC
My commission expires:
OMB - MCP FORM #4
Guidance Care Center-SAMH Contract;FY13;page ,5
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name 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 or contractual services that are
under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as condition of
working on the commodities or contractual services that are under bid, the employee will abide by
the terms of the statement and will notify the employer of any conviction of, or plea of guilty or
no|o contendene to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance
|avv of the United States or any state, for violation occurring in the workplace no later than five
(5) days after such conviction.
5. Imposes 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.
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, l certify that this firm complies fully with the
above requirements.
STATE OF
(Signature nfRespondent)
COUNTY OF
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
day of , 2O___.
My commission expires:
PUBLIC
Guidance Care ConmpSAMK Contract;Fv13;page 1V
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 organization.
Furthermore, these expenses are in compliance with this nrganization'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-]5]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 nrhourly 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 orexpress deliveries, the vendor invoice must be included.
Rents, Leases, etc.
A copy ofthe 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 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 nf the finished product are required.
Supplies, Services, etc.
For supplies Orservices ordered, a vendor invoice is required.
Guidance Care CentepSAMH Contract;Fv13;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 nrmeeting, a copy of
the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of
the airline ticket. Atnave| 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 e
taxi from one's residence to the airport for business trip is not reimbursable. Parking is
considered a reimbursable travel expense at the destination. Airport parking during a business
trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room
must be registered and paid for by traveler. The County will only reimburse the actual room and
related bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Mileage reimbursement shall 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
for business trip is not a reimbursable expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY ofthe Monroe County Code of Ordinances. Meal guidelines state
that travel must begin prior to 5 a.m. for breakfast reimbursement, before noon and end after 2
p.m. for lunch reimbursement, and before 6 p.m. and end after p.m. for dinner reimbursement.
Non-allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions/ depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
Guidance Care c*nte,SAMK Contract;Fv/3;page /0
ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board nf County Commissioners
Finance Department
500VVhitehead Street
Key West, FL33O4O
[}ate
The following is a summary of the expenses for ( ) for the time period
of- 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 P/R ending O5/28/O1 XXX.XX
(A) Total AMM
(B) Total prior payments $ X,XXX.XX
(C) Total requested and paid (Af B) $ X,XXX.XX
(D) Total contract amount $ X,XXX.XX
Balance nf contract (O-C)
I certify that the above checks have been submitted to the vendors as noted and that the
expenses are accurate and in agreement with the records of this organization. Furthermore,
these expenses are in compliance with this organization's contract with the Monroe County Board
of County Commissioners and will not be submitted for reimbursement to any other funding
source.
Chief Executive Officer
Attachments (supporting documentation)
Sworn to and subscribed before me this day of 20 by—
who is personally known tome.
Notary Public Notary Stamp
Guidance Care C»ntepSAMH Contract;fY1 3;page I/
ATTACHMENT C
Services to be provided:
(Insert a description of your organization including a list of the services that will be provided by
your organization under this contract.)
Local match portion of State-Funded Substance Abuse Mental Health Services, inclusive of Baker
Act services,_per Florida Statutes, and contract between Guidance Care Center and the South
Florida Behavioral Health Network (ME225-3-27).
Guidance Care Center-SAMH Contract;FY13;page 12
ATTACHMENT D
GCC's Contract
with South Florida Behavioral Health Network Contract
(ME225-3-27)
Guidance Care Center-SAMH Contract;FY13;page 13
. „
South Florida
Behavioral
Health (Network, Inc.
www.sfbhn.org
August 3, 2012
Marianne Benvenuti, Regional Controller
Guidance/Care Center
3000 41"Street Ocean
Marathon, Florida 33050
Dear Marianne:
Enclosed please find the executed signature pages for the contracts between South Florida Behavioral Health
Network, Inc. and Guidance/Care Center, Inc. contract number ME225-3-27 (main contract) and for the
Emergency Contract. I have also enclosed an original copy of the Lobbying form (Attachment III) for both
contracts and the SOAR Agreement for the main contract.
I look forward to working with your agency during FY2012—2013, and feel free to contact me to facilitate
ac ' i es pert ining to your contract.
in erely
Eve Kelly
Contract Manag
(786) 507-7461
ekell sfbhn.or
Enc. (5)
� �@
S4�u��mmm Florida
Behavioral
%�9d
����mm��� ��mN
Health Network, Inc.
STANDARD CONTRACT
THIS CONTRACT is entered into between the South Florida Behavioral Health Network, Inc., (SFBHN) hereinafter referred to as
the"Managing Enhty^ (ME) and Guidance Care Center, Inc., hereinafter referred to au the"Network Provider."
1. Contract Document
The Network provider shall provide services in a000n1anoo with the terms and conditions specified }n this contract including all
attachments and exhibits, and documents incorporated by reference which constitute the contract document.
2. Requirements of SaoUwn 287.058' Florida Statutoa(F.Sj
The Network Provider shall provide units of do|ivemb|oa, including reports, 8ndingu, and dnaftu, as specified in this contract.
These deliverables must be received and a000[tod by the contract manager and/or dooignou, 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 oxponuou are permitted in this contract, submit bills for any travel expenses in
accordance with section 112.001. F.S, oratsuch lower rates au may be provided in this contract. Tw allow public access ioall
documents, papers, |ottoru, or other public records audefined in uubuooUwn 119.011(12). F.S. and aa prescribed bysubsection
119�07(1) F.8., 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 dioo|wuum. It is oxpmuu|y understood that the Network Provider's failure tw
comply with this provision shall constitute an immediate breach of contract for which the ME may unilaterally terminate the
contract.
3. Provisions of the Primo Contract
All pmviu|ons, terms and owndhiwnu, or amondmonts, addondum, changes or revisions applicable twthe Network Provider made
subsequent to the initial execution of the Fhmo Contract, i.e., the Contract entered into between the DCF and SFBHN (K4E), not in
conflict with this Cmntmot, shall be binding upon the Network Provider and the Network Provider agrees to comply with same.The
Prima Contract is incorporated by reference in this Contract. In oaua of conflict with the pmvioiona, terms and conditions of The
Prime Contract and this Contract,the proviuiwnu, terms and conditions of this Contract will prevail.
4. Effective and Ending Dates
This contract shall begin wnJuIV4L�012. |t shall end at midnight. local time in Miami-Dade County, Florida onJune 30, 2013,
5. State of Florida Law
This contract |u executed and entered into in the State of Florida, and shall be construed, performed and enforced in all veupootu
in e000ndonoe with Florida |aw, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida
uhoU 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. |f this contract contains federal funds, the Network Provider shall comply with the provisions of fodom| law and regulations
including but not limited to, 45 Code of Fodom| Regulations(CFR). Part 74, 45 CFR. PartQ2. and other applicable regulations.
b� |f this contract contains over $1OO.0O0 of federal funds, the Network Provider shall comply with all applicable utmndarda,
ondonu, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et uoql
section
5OOofthe Federal Water Pollution Control Act, aa amended (33U.S.C. 1251 otuoq.). Executive Order 11738, au amended and
where applicable, and Environmental Protection Agency regulations (4OCFR. Part 3O). The Network Provider shall report any
violations cdthe above twthe ME.
o. No federal funds received in connection with this contract may be used by the Network Pvnvidor, or agent acting for the
Network Ppmvide,, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature,
If this onn\naut contains fodam| funding in oxooua of S100.000. the Network Provider muut, prior to owninoot execution, owmp|oUa
the Certification Regarding Lobbying form, Attachment a 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 Orderl1-2 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.
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 11.
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
Guidance Care Center,Inc. 2 Contract No.ME225-3-27
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 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, KH225 and all the requirements of this contract. A copy of the
contract KH225 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.
Guidance Care Center,Inc. 3 Contract No.ME225-3-27
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, 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
Guidance Care Center,Inc. 4 Contract No.ME225-3-27
the N\Ein this contract.
o. All deductions for social noourity, withholding taxes, income taxox, contributions to unemployment compensation funds and all
necessary insurance for the Network Provider, the Network Provider's o#\oom, omp|oyoox, agontx, ouboontmotom, or assignees
ohuU be the no|m responsibility of the Network Provider.
17. Sponsorship
As required by section 286.25. F3, if the Network Provider is u non-governmental organization which sponsors a program
financed wholly or in part by state fundx, including any funds obtained through this contract, it xho||, in pub|ioizinO, advertioinA, or
describing the sponsorship of the program state: "Sponsored by (Network Provider's Name) . Inc., South Florida Behavioral
Health NatwoMk, and the State of Florida, Department of Children and Families". If the sponsorship reference ioinwritten 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 ux the name of the organization.
18. Publicity
Without limitation, the Network Provider and its employees, agontx, and representatives will not, without the K4E'o prior written
consent in each inatanoo, use in advertixing, publicity or any other promotional endeavor any ME or State murk, the name of the
ME'a or State mark, the name of the ME . the State. or any ME or State affiliate or any officer oremployee of the ME or the State .
or vepmoent, d|nau |y or indiroot|y, 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 contractends or \xterminated.
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 ofthis 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 Legia|atum,judicial bxonoh, or state agency.
21. Public Entity Crime
Pursuant tu section 287.138. F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the
discriminatory vendor list. When u person or affiliate has been placed on the convicted vendor list following uoonvict\on for
public entity crime, nran entity or affiliate has been placed on the discriminatory vendor list, such person, entity oraffiliate may
not submit a bid, poopoxu|, or reply on u contract to provide any goods or services tou public entity; may not submit abid.
pmpoaa|, or reply on a contract with u public entity for the construction or the repair of a public building or public work; may not
submit bidx, pmpoxu|o, or mp|iox on |ousoa of real property to u public entity; may not be awarded or perform work as u
oon\ructqr, supplier, subcontractor, or consultant under a contract with any public entity; and may nottransact business with any
public entity in excess of the threshold amount provided in section 287.017. F.S, for CATEGORY TWO for u period /f thirty-six
(36) months from the date of being placed on the convicted vendor list. This provision applies tothe 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 u 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 on appropriate period. The Network Provider will ensure that its xuboontnaoom, if any, comply with
these provisions.
23. Intellectual Property
a. It is agreed that all intellectual pmporty, inventions, written or electronically created materials, including manuu|x, pmaentutiona,
films, or other cupyrightab|o mutoria|x, 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 o#ioem, uQwnto nor
subcontractors may claim any interest in any intellectual property rights accruing under orin connection with the performance of
this contract. It is specifically agreed that the ME ahuU have exclusive rights to all data processing software failing within the terms
of section 119.084. F.G., which arises or in developed in the course of or as u result ofwork or services pohnnnod 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 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 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.
Guidance Care Center,Inc. 6 Contract No.ME225-3-27
b Tnsnaitioning Young Adults: The Network Provider understands DCF'xOperation Full Employment initiative to assist young
odoKa aging out of the dependency system. The ME encourages Network Provider participation with the |000| Community-Based
Care Lead Agency Independent Living Program to offer gainful employment toyouth in foster care and young udultotmnaitioning
from the foster care system.
28. Health Insurance Portability and Accountability Act
The Network Provider shall, whore opp|ioub|e, comply with the Health Insurance Portability and Accountability Act (42 U. S. C.
1320dj as well as all regulations promulgated thereunder(45 CFR Parts 180. 162. and 164).
29. Emergency Preparedness
e. 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 cd the execution of this contract, submit to the contract manager on emergency preparedness plan
which ahuU include provisions for records pmtootion, alternative accommodations for clients in substitute ooro, 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 ofz child who |x under the jurisdiction ofu dependency court. Children may remain in their homes, be placed inanon-
licensed relative/non-relative home, or be placed in u licensed foster care setting,
b. The ME agrees to respond in writing within thirty (30) days of receipt of the plan a000pting, rejecting, or requesting
modifications. |n the event of an emergency, the N1E may exercise oversight authority over such Network Provider in order to
assure implementation of agreed emergency relief provisions.
o. An updated emergency preparedness plan ahuU be submitted by the Network Provider no later than 12 months following the
acceptance ofen 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
aerv|ooa provided through this contract or that may impact the Network Provider's ability to deliver the contractual xemicao, or
adversely impact the ME. The K8E'o contract manager will be notified within ten (1O) days of Network Provider becoming aware of
such actions or from the day cd the legal filing,whichever comes first.
31. Whistleblower's Act Requirements
In accordance with subsection 112,3187(2). F3.. the Network Provider and its subcontractors ahuU not retaliate against an
employee for reporting violations of |aw, ru|o, or regulation that oeutex substantial and apooif\o danger to the public's hoahh,
oujety, or welfare io on appropriate agency. Furthermoe, 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 agonoy, public o#ioor, or employee. The Network Provider and any
subcontractor ehu|| inform its employees that they and other persons may 0o e complaint with the Office of Chief Inspector
Gonona|. Agency Inspector General, the Florida Commission on Human Relations or the YVhixt|e-b|owe/oHotline number at 1'
80O-543'5353,
32. Proprietary or Trade Secret Information
a. Un|oxo exempted by iaw, all public records are subject to public inspection and copying under Florida's Public Records Lew'
Chapter 119, F.8, Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in
Network Provider's documents (mportn, do|ivonob|ox or work pupero, eto., 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 cdthe dooumento, data or records submitted that d considers exempt from
public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade 000et. 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 mba applicable to different portions ofthe protected information, the Network Provider shall include
information correlating the nature cd the claims tothe particular protected information.
o. The K8E, when required to comply with u public :»oondx request including documents submitted by the Network Pnovdor, 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 82. b, correlated apooifiou||y to redacted iniormution, 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. 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-Paint-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:
http://www.dcf.state.f1.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
$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.
35. Contract Payment
The ME has ten (10) working days, subject to the availability of funds, to inspect and approve goods and services, unless the bid
Guidance Care Center,Inc. 8 Contract No.ME225-3-27
specifications, purchase onder, or this contract opoohy otherwise. With the exception of payments to health oove providers for
hoapitd, modica|, or other health ouve oomicoo, if payment is not uvu|ub|o within forty (40) dayx, measured from the latter of the
gate a property completed invoice in received by the ME or the goods or services are neooived, inopeotod, and approved, o
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 cum providers for hoopita|, modioo|, or other health care aomiuoo, ohuU be mode 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 o Network Provider due to preparation errors will result in u non-interest bearing
payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment
ohuU be made only upon written acceptance by the ME and xhuU remain subject to the subsequent audit or review toconfirm
contract compliance.
36. Financial Consequences for Network Provider's Failure toPerform
If the Network Provider fails to meet the minimum |ovo| of oomioe or performance identified in this agmoment, 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 iocured, tendering only partial puymento,
imposition of penalties per Seotion39, and termination of contract and requisition cd services form an alternate source. Any
payment made in reliance onthe Network Provider's evidence of performance which evidence ia subsequently determined 1obo
errunooua, will be immediately duo as an overpayment in accordance with Section 13. above, entitled "Return of Funds" tothe
extent cd 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 Somioo or any expedited delivery
aomiue that provides verification of delivery or by hand delivery. Said notice shall be sent tothe representative of the Network
Provider responsible for administration of the progrum, 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 402J3(1). F.S, and Rule 85-29.001. F.A.C., corrective action plans may be
required for noncompliance, nonperformonoe, or unu000ptub|o 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 upp|y, unless the ME determines that extenuating circumstances exixt, xhu|| be
based upon the severity of the nonoomp|iunoo, nonporformunoo, or unacceptable performance that generated the need for
corrective action plan. The penu|4/, if impoxed, xhuU not exceed ton percent (10%) of the total contract payments during the
period in which the corrective action plan has not been implemented or in which u000ptub|e progress toward implementation has
not been made. Noncompliance that ia determined to have a direct effect on client health and safety shall vsauK in the imposition
ofaten penoent (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.
o. Noncompliance involving the provision of xomioe not having u d\eo1 effect on client health and safety ohuU result in the
imposition of five percent (5%) penalty. Noncompliance as result of unacceptable performance of administrative tasks shall
result in the imposition ofa 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 ouuao upon no less than xixty (6O) calendar days' notice in writing to
the other party unless a sooner time is mutually agreed upon in writing. Said notice xhu|| be delivered by U.S. Postal Service or
any expedited delivery oemion 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'e ability
to terminate this contract for cause according to other provisions herein.
b. In the event funds for payment pursuant to this contract become unuvuUub|o. the ME may terminate this contract upon no less
than twenty-four (24) hour notice in writing tothe Network Provider. Said notice shall be sent by U.S. Postal 8emioo or any
expedited delivery service that provides verification of delivery. The ME shall bo 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.
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
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. 10 Contract No.ME225-3-27
44. Official Payee and Representatives(Names,Addresses,Telephone Numbers and E-Mail Addresses):
a. The Provider name,as shown on page I of this Contract,and 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 41 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:ekellyO-sfbhn.or-q
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 program under this contract is:
Marianne Benvenuti
3000 41 Street Ocean Frank Rabitto,Sr.Vice President
Marathon,Florida 33050 3050 Biscayne Boulevard,Suite 900
Tel: 305-434-9043 Miami,Florida 33137
E-mail:Marianne.benvenuti@westewe.com E-mail:fizubbito@westcarc.com
Upon change of representatives(names,addresses,telephone numbers and e-mail addresses)by either party,notice shall be
provided in writing to the other party and the notification attached to the originals of this contract.
45. All Terms and Conditions Included
This contract and it attachments, 1.1111,M.N.V and any exhibits
referenced in said attachments,together with any documents incorporated by reference, including the ME prime contract KH225 (which
can be found at http:/ANww.sfbhn.org), contain all the terms and conditions agreed upon by the parties. There are no provisions,
terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications,
representations, or agreements, either verbal or written between the parties. If any term or provision of this contract is legally
determined unlawful or unenforceable,the remainder of the contract shall remain in full force and effect and such term or provision shall be
stricken. In the event of a conflict between the provisions of the documents,the documents shall be interpreted in the following order of
precedence:
a.Attachment 1,exhibits,and other attachments,if any;
b.Any documents incorporated into any attachment by reference;
c.The Standard Contract;
d.Any documents incorporated herein by reference
BY SIGNING THIS CONTRACT,THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT,AS
DESCRIBED IN SECTION 45.ABOVE.
IN WITNESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to be
executed by their undersigned officials as duly authorized.
PROVIDER: G Care Center.Inc. SOUTH FLORIDA BEHAVIORAL HEALTH
NETWORK,INC.
PROVIDER: CareOjenr
SIGNED SIGNED
BY: BY:
NAME: Frank Rabbito N/AME: ohn W.Dow
TITLE- Senior Vice President P President&CEO
DATE.- DATE: _17
Federal Tax ID#(or SSN) 59-1458324 Provider Fiscal Year Ending Date 06/30
Guidance Care Center,Inc. 11 Contract No.ME225-3-27
07/01/2012
ATTACHMENT .
A. SERVICES TO BE PROVIDED
1. Definition#fTerms
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) ^Aooeoaib|e" — Chi|dren, 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) ''Aohvi\y' is an educational process or procedure intended \ostimulate learning.
(3) "Adolescent" is a client who is receiving substance abuse treatment services who is
between the ages of12 and 17.
<4\ "Annual Action Plan" is on annual plan developed by the managing entity and approved
by the department that contains the deliverables for the ten baseline functions and
other requirements for the behavioral health services needs for the Southern Region.
(5) "Approaches" are the methods used in dealing with or accomplishing a task or goal.
(G)''Approved Regional Plan" is a plan established by the department in accordance with
section 304.674, F.S. and section 394.675, F.S. and updated annually oraa required.
(7) ''ASAM PPC-2R Florida Supplement" is the American Society of Addiction Medicine,
Patient Placement Criteria for the Treatment of Substance Related Dioordero, second
edition - revised, July 1. 2001. or the !a\eo\ revised edition thereof.
(@) "Assessment Instrument" is a tool used for collection of detailed information concerning
on individua[a substance abuse, emotional and physical hoa|th, social ro|en, and other
areas that may reflect the severity of the individua|'o abuse of alcohol or drugs, as a
basis for identifying an appropriate treatment regimen.
(9) "Attrition" is the loss of program participants during the course of the services due to
voluntary dropout or other reasons. Higher rates of attrition can potentially threaten the
validity of services and programming strategies. Attrition is one of the six criteria of
Quality of Research in the National Registry of Evidence-based Program (NREPP) used
to Evidence-based Programs and Practices.
(1O)''Avai|ab|e Appropriations" are State and other governmental funds allocated for mental
health and substance abuse oen/ioea including prevention and the associated local
matching funds.
(11)^Baoe|ine" is the initial time point in service interventions just before the intervention or
07/01/2012
treatment begins. The information gathered at baseline is used to measure change in
targeted outcomes over the course of the services.
(12) `Behavioral Health Services" are mental health services and substance abuse
prevention and treatment services as defined in chapters 394, 397 and 916, F.S. which are
provided using state and federal funds.
(13) "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.
(14)"Client" (synonymous with recipients of services/individual(s) served) is 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" is compensation to the managing entity's contracted network providers for
services rendered to the client, who has been authorized to receive services pursuant to
this contract, from any source of funds, including city, county, state, federal, private
sources and client paid.
(16) "Clinical Assessment" is the collection of detailed information concerning an individual's
behavioral health, emotional and physical health, social roles, and other areas that may
reflect the individual's overall health as a basis for identifying an appropriate treatment
regimen.
(17) "Clinical Pathways" is a method that charts relationships among project tasks illustrating
the sequence and interdependence of tasks over time. A "map" of preferred treatment/
intervention activities which outlines the types of information needed to make decisions,
the timelines for applying that information, and what action needs to be taken by whom.
They provide a way to monitor care "in real time," and are also designed to support
resource management, clinical audits and financial management.
(18) "Clinician" is a substance abuse or mental health professional that provides one or more
of the following services: assessment; individual, group, or family counseling services, or
case management.
(19) "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.
(20)"CODECATTM (Co-occurring Disorders Educational Competency Assessment Tool)" is a
tool used to evaluate clinicians' training needs based on a competency assessment to
determine knowledge, skills, attitudes, and values relative to persons with co-occurring
disorders. (Contract manager may delete if this is a prevention only contract)
(21) "Community' is a specific geographic or demographic population. Geographic includes
counties and municipalities. Demographic includes race, ethnicity, age, gender or any
combination thereof.
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(22) "Community-Based Services" are mental health and/or substance abuse services
provided outside of a state mental facility or inpatient settings, such as psychiatric
residential treatment facilities for children.
(23) "Community-Based Medicaid Administrative Claiming (CBMAC)" is the mechanism
whereby states are eligible to claim federal Medicaid funds/reimbursement for qualifying
Medicaid administrative activities.
(24) "Community Conditions" is circumstances that underlie underage drinking 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.
(25)"Community Events" are 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
(26) "Community-Focused" is the process of planning, management and decision- making to
ensure resources are designed to build on the unique strengths and meet the specific
needs of the local community.
(27) "Community Prevention" are strategies and activities aimed at changing community
conditions related to substance abuse. It is aimed at larger universal populations and
selected sub-populations, does not track specific individuals and includes environmental
strategies designed to change one or more community conditions.
(28)"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,
(29)"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.
(30)"Comprehensive Community Action Plan" means a plan developed by a local, department
recognized, community substance abuse coalition which is based on an assessment of
substance abuse related epidemiology data and the resources needed to address identified
needs. The plan includes goals to reduce the community's prioritized substance use
problems and the approaches to take to achieve them. 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:
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1) to achieve a long-term change in a substance abuse behavior pattern, and
2) to build community and organization capacity to effectively achieve the identified
outcome. The plan defines short term and intermediate objectives for tracking progress
toward goal achievement.
(31) "CQMPASSTM (Comorbidity Program Audit and Self-Survey for Behavioral Health
Services)" is a tool that can be used by behavioral health care systems to assess program
competencies in multiple areas that reflect the basic expectations of program performance
for mental health services, substance abuse disorder services and integrated systems of
care.
(32) "Comprehensive Community Action Plan" is a plan developed by a local, department
recognized, community substance abuse coalition which is based on an assessment of
substance abuse related epidemiology data and the resources needed to address
identified needs. The plan includes goals to reduce the community's prioritized substance
use problems and the approaches to take to achieve them.
(33) "Comprehensive Continuous Integrated System of Care (CCISC) model' is a system
design and implementation model for organizing services for individuals and families with
co-occurring disorders that is designed to improve services capability on a statewide or
regional basis to achieve: system level change; efficient use of resources; use of
evidence-based and consensus based practices; and integrated mental health and
substance abuse services throughout the system, by organizing a process in which every
program improves their provision of co-occurring disorder services, and every clinical staff
person improves their level of co-occurring disorder service competency based on their job
and level of training.
(34)"Consequences" are the social, economic and health problems associated with the use of
alcohol and illicit drugs. Any social, economic or health problem can be defined as a
substance use problem if the use of alcohol, tobacco, or drugs increases the likelihood of
the problem occurring.
(35) "Consolidated Program Description" is the combination of all of the managing entity
network providers' program descriptions and the managing entity program description.
(36) "Consumer Price Index" is a measure of the average change in prices over time of goods
and services purchased.
(37)"Continuous Quality Improvement" is the systematic on-going process of improving
performance, both in process and end of process indicators, in order to meet the individual
service recipient's valid requirements.
(38) "Continuum of Services" are recovery-oriented systems of care will offer a full array of
services, including pretreatment, treatment, continuing care and support throughout
recovery. Individuals will have a full range of stage-appropriate services from which to
choose at any point in the recovery process.
(39) "Contract Manager" is the managing entity employee who is responsible for enforcing the
compliance with administrative and programmatic terms and conditions of a contract. The
contract manager is the primary point of contact through which all contracting information
flows between the managing entity and the network provider. All actions related to the
contract shall be initiated by or coordinated with the contract manager.
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(40) "Contributing Factors" are more specific dimensions or aspects of constructs which
collectively can be used to measure the theory to which they are linked.
(41)"Co-occurring Disorder" is any combination of mental health and substance abuse in any
individual, whether or not they have been already diagnosed.
(42) "Co-occurring disordered family' is a family where one member has one kind of problem,
like a child with an emotional disturbance, and another member has another kind of
problem, like a family member or caregiver with a substance abuse issue.
(43) "Co-occurring Disorder Service Capability' is the ability of any program to organize every
aspect of its program infrastructure (policies, procedures, practices, documentation, and
staff competencies), within its existing resources, to be able to provide and/or coordinate
appropriately matched, integrated services to the individuals and families with co-occurring
disorders that are routinely presenting for care in that program.
(44) "Core components" is the most essential and indispensable components of a service
intervention (core intervention components) or the most essential and indispensable
components of an implementation program (core implementation components).
(45)"Cost Analysis" is the review of the proposed cost elements to determine if they are
necessary, allowable, appropriate and reasonable.
(46) "Cost Center" is a grouping of services that are similar in time, intensity and function
where the average cost for service is generally the same, and are specified in the State
Funding by Program and Activity which is incorporated herein by reference. See Rule 65E-
14.021, Florida Administrative Code (F.A.C.), and the Substance Abuse Recovery Support
Services (Individual and Group),Clinical Supervision for Evidence-Based Practices, and
the Children's System of Care Comprehensive Community Service Team are incorporated
herein by reference and may be obtained from the contract manager. The description for
the Adult System of Care Comprehensive Community Service Team, is specified in
Section D, Special Provisions.
(47) "Culturally Competent Services" means acknowledging and incorporating variances in
normative acceptable behaviors, beliefs and values in determining and individual's mental
wellness/illness and incorporating those variances into assessment and treatment that
promotes recovery.
(48) "Data Management" are activities that use data elements to track cost, utilization, quality
of care and access to services within the network of providers.
(49)"DCF PAM 155-2" is the Department of Children & Families, Pamphlet 155-2 - Mental
Health and Substance Abuse Measurement and Data, effective July 2010 (10th edition,
version 1),or the latest revised edition thereof, means a document promulgated by the
department that contains required data-reporting elements for substance abuse and
mental health services, and which can be found at:
http://www.dcf.state.f1.us/programs/samh/pubs_reports.shtm1, and is incorporated herein
by reference.
(50) "Department" means the State of Florida Department of Children and Families.
(51) "Direct Contact" for prevention services are activities conducted by a prevention services
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specialist while in direct contact with a child or adult. These services may be provided in a
one-to-one context, where the specialist is working with only one participant at a time or in
a group context where the specialist is working directly with more than one participant
(NOTE: This may include family members or other collateral contacts as indicated in the
program manual).
(52)"Direct Prevention" Level 1 Prevention Programs include persons participating in Universal
and Selective programs in cost center 16.
Level 1 Prevention Programs address subgroups of the general population that are at a
higher risk of substance abuse than the general population. The mission is to provide
individuals with the information and skills necessary to prevent the abuse of substances.
This is an unduplicated count of participants.
Level 2 Prevention Programs include persons participating in Indicated programs in cost
center 16 and all programs in cost center 17. Level 2 Prevention Programs are designed
to prevent the onset of substance abuse in individuals who do not meet the DSM-IV
criteria for addiction but who are showing early danger signs in the form of multiple risk
factors.
The mission of Level 2 Prevention Programs is to identify individuals who are exhibiting
early signs of substance abuse and other problem behaviors associated with substance
abuse and to target them with special programs. This is an un-duplicated count of
participants.
(53)"Dissemination" is the targeted distribution of program information and materials to a
specific audience. The intent is to spread knowledge about the program and encourage its
use.
(54)"Environmental Strategy' is a public health approach that strengthens policies and
practices related to alcohol and other drug access, availability, promotion, enforcement
and/or community norms. Grounded in the field of public health, which emphasizes the
broader physical, social, cultural and institutional forces that contribute to the problems that
coalitions address, environmental strategies offer well-accepted prevention approaches that
coalitions use to change the context (environment) in which substance use and abuse
occur. Environmental strategies incorporate prevention efforts aimed at changing or
influencing community.
(55)"Epidemiology data" are data relating to factors affecting the health and illness of
populations that serve as the foundation and logic of interventions made in the interest of
public health.
(56) "Evaluation Plan" is a written document which will identify the outcomes that will be
measured, data collection methods and instruments, and a plan for their collection.
(57)"Evidence-Based Assessment Instruments" are assessment instruments that include, but
are not limited to, one of the following for use in the completion of the Psychosocial
Assessment with adolescents: the Global Appraisal of Individual Needs (GAIN);
Adolescent Diagnostic Interview (ADI); the Mini-International Neuropsychiatric Interview
(Mini-Kid) or other instruments designated by the Managing Entity.
(58) "Evidence-Based" are those practices that are based on accepted practices in the
profession and are supported by research, field recognition, or published practice
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guidelines.
(59) "Family' is a target population of an evidence-based practice. Through this contract, any
person or group that supports the individual receiving services. A fundamental social group
in society typically consisting of one or two parents and their children or two or more people
who share goals and values, have long-term commitments to one another, and reside
usually in the same dwelling place.
(60)"Family Intervention Specialists/Adult Intervention Specialists (FIS)" are individuals
employed to provide adult behavioral health outreach, screening, intervention, and case
management to families involved in the child welfare system and/or the Abuse Hotline.
(61) "Family Intervention Specialist Services" are services designed to reduce the incidence of
child abuse and neglect resulting from parents' or caregivers' behavioral health and to
improve outcomes for families in the child welfare system and/or community based care.
(62) "Fidelity' is the degree to which the evidence-based practice implemented adheres to the
practice's implementation design.
(63)"Fidelity of Implementation" is ideality of implementation occurs when implementers of a
research-based program or intervention (e.g., teachers, clinicians, counselors) closely follow
or adhere to the protocols and techniques that are defined as part of the intervention. For
example, for a school-based prevention curriculum, fidelity could involve using the program
for the proper grade levels and age groups, following the developer's recommendations for
the number of sessions per week, sequencing multiple program components correctly, and
conducting assessments and evaluations using the recommended or provided tools.
(64)"Florida Department of Children and Families Strategic Intent" is the Secretary's Strategic
Intent gives guidance and summarizes the department's major initiatives. This document
provides the Secretary's intent on what the department and its partners must accomplish
during a specific period of time. The Secretary's guidance drives the development of the
department's Strategic Plan, which depicts how the department will achieve these
initiatives, when they will be accomplished and the metrics used to measure progress.
(65) "Florida System of Care (FSC)" is the Department's initiative to integrate substance abuse
and mental health service structures to promote co-occurring disorder service capability
throughout the system of care from the initial point of client contact at assessment through
conclusion of services.
(66) "Forensic Mental Health Services" are services provided to individuals with mental illness
pursuant to Chapter 916, Florida Statutes.
(67) "Global Assessment of Individual Needs (GAIN)" is one of the department approved
evidenced-based assessment instrument. Information regarding this instrument can be
obtained from the following website: http://www.chestnut.org/Ll/gain/
(68) "Governing Board" is the Commission, Board of Directors, Board of Trustees, Governing
Body, etc.
(69) "HIPAX is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C.
1320d, and 45 CFR Parts 160, 162, and 164).
(70) "Implementation" is the use of a prevention or service interventions in a specific community-
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based or other setting with a particular target audience.
(71) "Incompetent to Proceed (ITP)" as defined in chapter 916 F.S., means unable to proceed
at any material stage of a criminal proceeding, which shall include trial of the case, pretrial
hearings involving questions of fact on which the defendant might be expected to testify,
entry of a plea, proceedings for violation of probation or violation of community control,
sentencing, and hearings on issues regarding a defendant's failure to comply with court
orders or conditions or other matters in which the mental competence of the defendant is
necessary for a just resolution of the issues being considered.
(72) "Indicated" is one of the three categories (Universal, Selective, Indicated) developed by
the Institute of Medicine to classify preventive interventions. Indicated prevention strategies
focus on preventing the onset or development of problems in individuals who may be
showing early signs but are not yet meeting identified levels of a particular disorder.
(73) "Indicated Prevention" is education and other evidence-based practices conducted with
groups of individuals to reduce personal risk factors or substance abuse or strengthen
protective factors.
(74)"Indigent Drug Program (IDP)" is the program that allows the Department of Children and
Families to purchase medications for individuals who are indigent.
(75) "Indirect Prevention" are strategies and activities aimed at changing community conditions
related to substance abuse. It includes environmental strategies designed to change one
or more community conditions. Indirect Prevention is aimed at larger universal populations
and selected sub-populations and does not track specific individuals. Indirect Prevention
seeks to impact community conditions through media, policies, policy enforcement, or
other similar methods. Strategies utilized in Indirect Prevention may include education,
information dissemination, alternatives, and environmental activities. Environmental
strategies may also be known as "Environmental Prevention", "Environmental Programs",
or"Environmental Practices."
(76)"Intervention" is a strategy or approach intended to prevent an undesirable outcome
(preventive intervention), promote a desirable outcome (promotion intervention) or alter the
course of an existing condition (treatment intervention).
(77) "KIT Solutions" is the entity that maintains the database called Performance Based
Prevention System (PBPS).
(78) "Knight Information Software Database (KIS)" is the managing entity's online data system
which network providers are required to use to collect and report data and performance
outcomes on clients served whose services are paid for, in part or in whole, by the
managing entity's Substance Abuse and Mental Health (SAMH) contract, Medicaid, or
local match.
(79) "Local Match" are funds received from governing bodies of local government, including
city commissions, county commissions, district school boards, special tax districts, private
hospital funds, private gifts both individual and corporate, bequests and funds received
from community drives or any other sources. See section 394.67(14), F.S. and 65E-
14.005, F.A.C.
(80) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d), F.S., a
corporation that is organized in the State of Florida, is designated or filed as a non-profit
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organization under section 501(c)(3) of the Internal Revenue Code, and is under contract
to the Department to manage the day-to-day operational delivery of behavioral health
services through an organized system of care.
(81)"Mental health promotion" is an attempt to (a) encourage and increase protective factors
and healthy behaviors that can help prevent the onset of a diagnosable mental disorder and
(b) reduce risk factors that can lead to the development of a mental disorder. In this contract,
mental health promotion is associated with substance abuse prevention strategies to
promote wellness and reinforce protective factors that enhance wellbeing.
(82) "Monitoring Subcontracts" is the process whereby the managing entity conducts a
systematic organized review of a network provider's performance in order to give
reasonable assurance that the network provider is complying with subcontract
requirements, rules, regulations and laws applicable to contract performance.
(83) "Network Provider" is an entity that Contracts with the Managing Entity and receives
funding to provide services to clients; in this contract the network provider is
synonymous with provider or subcontractor.
(84) "Outcome" is a change in behavior, physiology, attitudes, or knowledge that can be
quantified using standardized scales or assessment tools. In the context of NREPP,
outcomes refer to measurable changes in the health of an individual or group of people that
are attributable to the intervention.
(85)"Outcome evaluation" is an evaluation to determine the extent to which an intervention
affects its participants and the surrounding environments. Several important design issues
must be considered, including how to best determine the results and how to best contrast
what happens as a result of the intervention with what happens without the program.
(86)"Overpayment" is for the purposes of this contract, the amount of money the department
has paid the managing entity and/or the managing entity has paid the network provider for
administrative expenses and/or program expense over and above what was properly
earned for these expenses by the managing entity according to the approved line item
budget.
(87) "Participant" is any individual who takes part in targeted substance abuse prevention
programs, activities or services which are paid, in part or in whole, by the Department
through the ME.
(88) "Payor class" means Medicare, Medicare HMO, Medicaid, Medicaid HMO, private- pay
health insurance, private-pay health maintenance organization, private preferred provider
organization, the Department of Children and Family Services, other government
programs, self-pay patients, and charity care.
(89) "PBPS" is the Performance Based Prevention System that collects data related to
community assessments and plans and substance abuse prevention programs and
activities. The system can be accessed by contacting technical support at 1-888-600-4777
or https:Hkitprevention.kithost.net/.
(90) "Performance Measures" are quantitative indicators, outcomes and outputs that are used
by the Department to objectively measure performance and are used by the managing
entity and network providers to improve services.
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(91) "Prevalence" is the count of all individuals affected by a disease/condition within a
particular period of time, compared with the entire population of concern.
(92) "Prevention" is a process involving strategies aimed at the individual or the environment
which preclude, forestall, or impede the development of substance abuse problems and
promote healthy development of individuals, families and communities.
(93) "Programs" are a structured Schedule of Activities (by instructors and participants)
designed so that participants will attain, so far as possible, certain educational and
behavioral objectives.
(94)"Program Planning Tool (PPT)" is the data collection module contained in the 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.
(95) "Prevention Program Description (PPD)" is the report generated as a result of completing
the PPT. The PPD contains the information required for a program description pursuant to
Rule 65E-14.021, Florida Administrative Code (F.A.C.).
(96) "Prevention Program" is a structured Schedule of Activities designed so that participants
will attain so far as possible, certain educational, attitudinal, social and behavioral
objectives. This is an unduplicated count of participants.
(97) "Prevention Service" is a structured schedule of activities designed so that participants will
attain certain educational, attitudinal, social, and behavioral objectives. Prevention
services are focused on enhancing protective factors and resilience (strengths and assets)
and reversing or reducing known risk factors (challenges).
(98)"Prime Contract" is the contract between the Department of Children and Families and the
Managing Entity.
(99)"Program Description" is the document the network provider prepares and submits to the
ME for approval prior to the start of the contract period, which provides a detailed
description of the services to be provided under the contract pursuant to Rule 65E-14.021,
F.A.C. It includes but is not limited to the network provider's organizational profile, a
detailed description of each program and cost center funded in the contract, the
geographic service area, service capacity, staffing information, and client and target
population to be served.
(100) "Projects for Assistance in Transition from Homelessness (PATH)" is a Federal grant to
support homeless individuals with behavioral health needs.
(101) "Promising Practices" is the use of practices that incorporate the best objective
information available regarding effectiveness and acceptability.
(102) "Prorated Share" is the total number of unpaid units or funds divided by the number of
months remaining between the time the prorated share is calculated and the end date of
the contract.
(103) "Protected Health Information" (PHI) relates to any information whether oral or
recorded in any form or medium that is created or received by a health care provider,
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health plan, public health authority, employer, life insurer, school or university, or health
care clearinghouse; and relates to the past, present, or future physical or mental health or
condition of an individual; the provision of health care to an individual; or the past, present,
or future payment for the provision of health care to an individual.
(104) "Provider Network" (subcontractor or network provider) refers to the direct service
agencies that are under contract with a managing entity and that together constitute a
comprehensive array of emergency, acute care, residential, outpatient, recovery support,
and consumer support services or other services as designated by this contract. See
section 394.9082, F.S.
(105) "Psychosocial Assessment' is a series of evaluative measures designed to identify the
behavioral and social factors involved in substance abuse and its symptoms, and in the
determination of placement and the development of the treatment plan, as defined in Rule
65D-30.002, Florida Administrative Code (F.A.C.).
(106) "Quality Assurance" is a process that measures performance in achieving pre-
determined standards, validates internal practice and uses sound principles of evaluation
to ensure that data are collected accurately, analyzed appropriately, reported correctly and
acted upon in a timely manner. The process may employ peer review, outcomes
assessment, and utilization management techniques to assess quality of care.
(107) "Quality Improvement/Continuous Quality Improvement' is a management technique to
assess and improve internal operations and network services. It focuses on organizational
systems rather than individual performance and seeks to continuously improve quality. The
process involves setting goals implementing systematic changes, measuring outcomes,
and making subsequent appropriate improvements. Quality improvement activities will
assess compliance with contract requirements, state and Federal law and associated
administrative rules, regulations, and operating procedures and validate quality
improvement systems and findings.
(108) "Recovery" is an on-going process which enables a person with behavioral health
issues to live a meaningful life in a community of his or her choice while striving to achieve
his or her potential. This allows individuals to improve their health, wellness, and quality of
life.
(109) "Recovery Based" is process built upon overcoming the negative impact of substance
abuse addiction or mental illness. A system of care provides treatment and supports that
promote recovery and functioning in the community.
(110) "Representative Payee" refers to an entity/individual who is legally authorized to
receive Supplemental Security Income, Social Security Income, Veterans Administration
benefits, or other federal benefits on behalf of an individual served.
(111) "Resource Assessment' is a written inventory of current resources available to apply
toward achieving a community long-term outcome and the identification of gaps in skills,
materials, facilities, community readiness and other capacities necessary to successfully
achieve a community long-term outcome.
(112) "SAMH" stands for the Substance Abuse and Mental Health Programs within the
Department.
(113) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers
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the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies
immigration status and eligibility of alien applicants for federal benefits. The alien status
verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as
described at 60 Federal Register 52694, 52697 (1995) administered by the Computer
Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVENIS
Program can and may provide assistance in verifying eligibility in cases where a client
does not possess sufficient documentation.
(114) "Schedule of Activities" is the written instructional content, materials, resources, and
processes in order to attain educational objectives.
(115) "Selective prevention" refers to strategies that are targeted to subpopulations identified
as being at elevated risk for a disorder.
(116) "Service Units" means 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.
(117) "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.
(118) "Stakeholder" are individuals/groups with an interest in the provision of behavioral
health services.
(119) "State Designated Prevention Evaluation Contractor" is a comprehensive drug
research center Contracted by the Department to evaluate prevention outcomes.
(120) "Statewide Inpatient Psychiatric Programs (SIPP)" are residential inpatient facilities
under contract with the Agency for Health Care Administration under the Medicaid IMD
waiver for children under age 18 to provide diagnostic and active treatment services in a
secure setting.
(121) "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.
(122) "Strategies" is a plan of action or policy designed to achieve a major goal.
(123) "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.
(124) "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)
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contract, Medicaid, or local match. Instructions on how to access the system can be found
in DCF PAM 155-2.
(125) "Supplemental Program Activities" are Schedule of Activities that are made
available to program participants in order to reinforce the participant's involvement in the
program and the knowledge presented in the Schedule of Activities. (Direct Prevention
only) NOTE: the nature and number of Supplemental Program Activities should not
threaten the fidelity of program implementation.
(126) "Sustainability' is the long-term survival and continued effectiveness of an intervention.
(127) "System of Care" are behavioral health services that are coordinated and developed
into an integrated network of services accessible and responsive to the needs of
individuals served, their families, and community stakeholders.
(128) "TANF Participant" is a person or family member of that person defined in 45 CFR
Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S.
(129) "Targeted Prevention" are education and other evidenced-based practices conducted
with groups of individuals to reduce personal risk factors or substance abuse or strengthen
protective factors.
(130) "Temporary Assistance to Needy Families (TANF)" are cash assistance for families,
including any family receiving cash assistance payments or TANF diversion services from
the state program pursuant to the provisions of section 414.045, F.S., and Part A of Title
IV of the Social Security Act.
(131) "Transformation" is a process that strives to change the form and function of the
behavioral health services delivery system to better meet the needs of the individuals and
families it is designed to serve.
(132) "Unit Measurement" is used in billing the managing entity for services. The definition of
each unit of measure can be found in Rule 65E-14.021, F.A.C.
(133) "Universal prevention" are strategies that can be offered to the full population, based on
the evidence that it is likely to provide some benefit to all (reduce the probability of disorder),
which clearly outweighs the costs and risks of negative consequences.
(134) "Utilization Management" is a system to ensure maximum, cost-effective, and clinically
appropriate utilization of behavioral health services. The goal of the program is to
eliminate waitlists and maximize utilization as well as diverting individuals served to more
clinically appropriate services when applicable.
(135) "Verifiable Service" is a service provision that is documented in compliance with the
requirements contained in Rule 65E-14.021, F.A.C.
2. General Description
a. General Statement
The services provided under this contract are community-based SAMH services for a
consumer-centered and family-focused coordinated system of care. The contract requires a
qualified, direct service, community-based network provider who will provide services for adults
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and/or children with behavioral health issues as authorized in section 394.9082, F.S., and in the
ME's contract with the Department, which is incorporated herein by reference, and which are
consistent with the Approved Regional Plan.
The network provider shall work in partnership with the Managing Entity to better meet the
needs of individuals with co-occurring substance abuse and mental health disorders. The
partnership process will 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 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. Approved Annual Action Plan
The ME will develop and operationalize an annual action plan, in partnership with the
Department and network providers upon request by the managing entity. This action plan
which is incorporated herein by reference, will be approved by the Department on an annual
basis and may be modified by mutual agreement and approved/dated by the Managing
Entity Executive Director and the approved Department Representative i.e., the SAMH
Regional Director. A copy of any revisions to the approved annual action plan shall be
provided to the Department's contract manager.
c. Authority
Section 394.9082, F.S., and the Prime Contract provides the Managing Entity with the authority
to contract for these services.
d. Scope Of Service
The following scope of service applies to the contract period and any renewal or extension:
(1) The network provider is responsible for the administration and provision of services to the
target population(s) indicated in Exhibit A, Clients and Participants to be Served, and in
accordance with the tasks outlined in Section 6.1.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
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e. Major Program Goals
(1) The intent of the Substance Abuse and Mental Health Programs are to reduce or prevent
substance abuse and promote and improve the mental health of the residents of the state by
making behavioral health services available through a community-based system of care.
(2) It is the goal of the Managing Entity and network provider to improve accountability, ensure
quality of care through best practice models and seek to ensure delivery of behavioral health
services across the provider network and across systems resulting in systematic access to a full
continuum of care for all children, adolescents and adults who enter the publicly-funded
behavioral health services systems.
(3) It is the goal to improve co-occurring capability and expertise in all programs.
(4)The intent of substance abuse prevention is to promote and improve the behavioral health of
Florida's Southern Region communities by assisting the Managing Entity in strategically
applying substance abuse prevention programs, and environmental strategies that are relevant
to community needs as defined in a Department approved Comprehensive Community Action
Plan. Once approved the plan can be obtained at: https://kitservices2.kithost.net/.
f. Minimum Programmatic Requirements
The network provider shall maintain the following minimum programmatic requirements:
(1) System Of Care
The consumer-centered and family-focused system of care will:
(a) Be driven by the needs and choices of the customers;
(b) Promote family and personal self-determination and choice;
(c) Be ethically, socially, and culturally responsible;and
(d) Be dedicated to excellence and quality results.
There is a commitment to expand clinical treatment to include the behavioral health
Transformation Initiative, evidence-based practices and recovery support services in
accordance with priorities established by the Managing Entity and the Department for
substance abuse, mental health treatment and/or co-occurring disorders, substance abuse
and mental health treatment capacity, children and families, criminal and juvenile justice, HIV
and hepatitis.
(2) Guiding Principles
Guiding principles specify that services are as follows:
(a) Inclusive - involve and engage families and consumers as full partners to
participate in the planning and delivery of services;
(b) Comprehensive - incorporating a broad array of service and supports (e.g.
physical, emotional,clinical, social, educational and spiritual);
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(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 seam lesslyas possible when
warranted, and
(f) Cultural and linguistic competence.
3. Clients to be Served
See Exhibit A, Clients and Participants to be Served .
B. MANNER OF SERVICE PROVISION
1. Service Tasks
The following tasks must be completed for each fiscal year covered in the contract period.
a. Task List
(1) Based on client needs, the network provider agrees to provide appropriate services from the list
of approved programs/activities described in Exhibit G, 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.
(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 comply with the provisions of Exhibit I, Substance Abuse Family
Intervention Services and the revised Family Intervention Guidelines, incorporated herein by
reference. All Family Intervention Specialist positions will be identified by the network provider
upon request by the managing entity.
(4) The network provider shall adhere to group size limitations not to exceed fifteen (15) individuals
per group for any clinical therapy service provided. In addition to other programmatic
documentation requirements, service documentation to evidence group activates shall include
the following:
(a) Data Elements:
1. 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)
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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 Section 25., Information Security Obligations,
of the Standard Contract. The network provider shall submit to the Managing Entities Contract
manager, by 08/01/2012, verification that all network provider employees and subcontractors
who have access to managing entity and Department information systems have completed the
Security Agreement form as identified in Section 25. Information Security Obligations, of the
Standard Contract.
(6) For licensable services,the network provider shall have and maintain 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 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.
(7) By 08/01/2012, 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.
(8) By 08101/12 establish a Quality Improvement Plan, which is herein incorporated by reference,
of quality improvement activities for fiscal year 2012-2013 to improve performance.The network
provider shall submit amendments to the Quality Improvement Plan, and quarterly reports on
the implementation of plan to the managing entitys contract manager.
(9) By 08/01/2012,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.
(10)The network provider shall use the GAIN, the approved utilization management assessment
tool for substance abuse, if substance abuse services are purchased through this contract. The
Managing Entity in conjunction with the Department may specify an alternate assessment tool
that may replace the current tool. Consumer placement criteria specific to mental health
services will be developed by the managing entity and approved by the Southern Region
SAMH Program Office. Standardized tools and assessments approved by the Department
through the ME must be used to determine placement and level of care.
(11) If the network provider provides medication management services,the network provider shall
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ensure that clients discharged from state mental health treatment facilities will be maintained on
the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676,
F.S. Maintenance includes performing required lab tests, providing the medication, and
providing appropriate physician oversight.
(12)By 08/01/2012, the network provider shall submit to the ME's contract manager a disaster plan
consistent with Section 29., Emergency Preparedness, of the Standard Contract.
(13)On an annual basis, within thirty(30) days of the beginning of hurricane season, the
network provider's emergency/disaster plan will be updated and activated upon notification of
a disaster from the ME.The managing entity will conduct post disaster assessments of
damage incurred by network providers.
(14) By 08/01/2012, the network provider shall submit to the ME's contract manager a
completed Civil Rights Compliance Questionnaire.
(15) Comprehensive Continuous Integrated System of Care (CCISC): The network provider will
participate in the Comprehensive Continuous Integrated System of Care (CCISC) Initiative.
CCISC participation will be considered in the allocation of lapse and/or new funding, subject
the availability of funds. Lapse funds and new funds will be allocated in accordance with
network providers' participation in the CCISC initiative.
(16)The network provider shall coordinate services for persons with co-occurring disorders.
(a)During the course of the contract period,the network provider shall design services
based on the recognition of the needs of individuals and families with co-occurring
disorders in the population served, and participate with the ME in a quality
improvement process to improve co- occurring disorder service capability in all
programs.
(b)The network provider shall develop and operate a system of care to ensure the
provision of appropriate services in the least restrictive setting for adults and children
with substance abuse, mental health and/or co-occurring disorders. Those services
are needed in order to provide a seamless Comprehensive Continuous Integrated
System of Care (CCISC) for this population that will increase access to services and
improve outcomes in the most cost effective manner.
(c)The network provider shall implement a "no wrong door" model by developing a
process for assessing, referring and/or treating clients with co-occurring disorders to
increase access of persons identified as co-occurring to provide services for both
disorders regardless of the initial point of contact. As used in conjunction with the
CCISC model, "no wrong door" (See http://www.kenminkoff.com/ccisc.html )
requires that systems develop policies and procedures that mandate a welcoming
approach to individuals with co-occurring psychiatric and substance disorders in all
system programs, eliminate arbitrary barriers to initial evaluation and
engagement, and specify mechanisms for helping each client (regardless of
presentation and motivation)to get connected to a suitable program as quickly as
possible.
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(17) By 08/01/2012, 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. The network
provider is responsible for tracking and ensuring that the proper linkages are made.
(18)The network provider shall submit to the managing entity a 6-month follow-up report on
their implementation of the co-occurring action plans.
(19) The network provider shall perform the following tasks related to the co-occurring disorder
service capability initiative:
(a) Develop and submit to the managing entity for approval an action plan for assessing and
referring clients with co-occurring disorders by June Uth of each year of the contract term
that details:
i. An overview of the network provider's co-occurring disorder service capabilities
with regard to service structure(assessment,stabilization,treatment, support,
and other services);
ii. Networking capacities with local network providers in the communityfor persons
with co- occurring disorders;
iii. Strategies and activities to develop or improve co-occurring disorder service
capability;
IV. Scope of services and programs to be included in the process;and
V. Timeframes for reviewing co-occurring disorder service capability within each
network provider program.
(b) Complete network provider co-occurring disorder service capability as directed by the
managing entity using theCOMPASS
(c) Following evaluation of each program using the COMPASS,evaluate clinicians' co-
occurring disorder service capabilities as directed by the managing entity using the
CODECAT.
(d) Develop and submit to the managing entity a summary report by June 30t"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;
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iv. The number of clinicians evaluated using the CODECAT;
V. Brief narrative detailing the findings from the CODECAT and action steps developed
to enhance clinicians'co-occurring attitudes, knowledge,values and skills; and
vi. Overall progress toward co-occurring disorder service capability development in
accordance with timef ram es specified in the action plan.
(20) Any network provider that attains or that already has attained co-occurring disorder service
capability must demonstrate prior use of the COMPASS and CODECAT assessment tools as
part of their overall process to improve co-occurring disorder service capabilities,and must:
(a) Submit to the managing entity for approval a compliance report by June 301"of each
year in lieu of repeating the administration of the COMPASS and CODECAT
assessment tools. The compliance report must provide detail on when and how the
assessment tools were used and the programs)and staff participating in the
evaluations. The COMPASS and CODECAT assessment tools can be found at:
www.ZiaPartners.com.
(b) The network provider must provide copies of training guidelines or curricula and co-
occurring policies to demonstrate attainment of co-occurring disorder service capability.
This compliance report and related documents shall be accepted, upon approval from
the managing entity, in lieu of the annual requirement for an action plan; and
(c) Submit a summary report by June 30t"each year that describes through brief narrative,
any changes to the co-occurring disorder service structure including new programs,
training,or changes in policy and procedures.
(21)The network provider shall evaluate co-occurring disorder service capabilities within their
agency and their clinical staff. Prevalence data shall be collected using the KIS. The network
provider shall include the number of co-occurring individuals from the previous fiscal year in
their annual action plans. Specifically, prevalence data will be collected via the Substance
Abuse Outcomes Admission, Mental Health Outcomes Admission, and Detoxification
Outcome forms which may be obtained from the ME's contract manager upon request.
(22)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.
(23)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:
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(a) Identification of at least two TIC Champions at the beginning of each contract term. If
any changes occur to the existing champions notice must go to the Contract
Manager, Director of CQI and Compliance and Director of Behavioral Health
Services;
(b) Participation in the regional Trauma Informed Care meetings to develop the process
for identifying and responding to those affected by trauma.
(c) Attendance at the regional trainings regarding Trauma Informed Care as
applicable. Applicable trainings will be documented in agency action plan.
(d) Completion and submission of an agency-wide self-assessment using the Trauma
assessment tool as identified by the Department and SFBHN by December 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:
I. An overview of the network provider's TIC capabilities with regard to service
structure (assessment, stabilization, treatment, support, and other services);
ii. Networking capacities with local providers in the community for persons with
trauma;
iii. Strategies and activities to develop or improve TIC service capability;
iv. Scope of services and programs to be included in the process; and
v. Timeframes for reviewing TIC capability within each network provider
program.
(f) Participation in all TIC related activities to ensure staff and agency become
competent in all areas of trauma informed care.
(g) Implementation Trauma Informed Care throughout the agency will be documented in
quarterly QA/QI Reports.
(24)The network provider will participate in the SOAR initiative to include the submission of SOAR
web-based data as outlined in the Working Agreement for SSI/SSDI Outreach, Access, and
Recovery(SOAR) Initiative Community Provider Agency found on Attachment IV, of this
contract.
(25)The network provider shall comply with Children and Families Operating Procedure 215-8,
OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD
DESIGNATION. The policy and guidance can be found at
htti)://www.dcf.state.fl.us/news/humanresearchpolic sy html.
Approval from the Department through the ME is mandatory for all research conducted by any
employee,contracted organization or individual, or any public or private vendor, even if the
aforementioned has their own Institutional Review Board which has granted approval.
(26)The network provider shall participate in the State's Peer Review process, when implemented,
to assess the quality, appropriateness,and efficacy of services provided to individuals pursuant
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to 45 CFR 96.136.
(27)The network provider shall execute a Memorandum of Understanding(MOU)with the
appropriate Federally Qualified Health Center within ninety(90)days of the effective date of this
contract. The MOU shall be submitted to the ME's Contract Manager on or before September 1'
of each fiscal year. The MOU provides for integration of primary care services to the medically
underserved. A network provider designated as a Federally Qualified Health Center is exempt
from this requirement.
(28) The network provider will demonstrate efforts to initiate and support local county
implementation of the Medicaid Substance Abuse Local Match Program in order to expand
community service capacity through draw down of Federal funding.
(29)The network provider shall maintain in one place for easy accessibility and review by the
ME's staff all policies, procedures, tools, and plans adopted by the network provider. The
network provider's policies, procedures,and plans, must conform to state and federal laws,
the Florida Administrative Code, state and federal regulations,state and federal rules, and
minimally meet expectations/requirements contained in applicable Department of Children
and Families and managing entity operating procedures.
(30)The network provider shall maintain a mechanism for monitoring, updating, and
disseminating policies and procedures regarding compliance with current government
laws, rules, practices, regulations, and the ME's policies and procedures.
(31)The network provider shall meet with the ME's staff at regularly scheduled or specially
called meetings when notified by the ME.
(32)The network provider shall assist the managing entity in the reporting and managing
of the Substance Abuse and Mental Health Waiting List for all levels of care.
(33)The network provider shall implement and maintain fiscal operational procedures. These
shall contain but, not be limited to procedures relating to overpayments, charge-backs
that directly apply to subcontractors and documentation of cost sharing (match) that
comply with state and federal rules, regulations and/or Managing Entity policies and
procedures.
(34)The network provider shall meet the standards for timely access to care along the lines
of those required by ME, accrediting bodies and the Medicaid prepaid plans as identified
below:
i. Immediate/Crisis: seen immediately for life behavioral health life threatening
emergencies
ii. Within 24 hours of initial contact for non-life threatening emergencies;
iii. Within 48 hours for urgent care;
iv. The offer of an appointment for routine care within 7 business days.
Non-compliance with timely access to care for services terms will result in a
corrective action.
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(35)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.
(36)The network provider shall develop and assure the delivery of services based on
Evidence-Based Practices/Promising Practices Guidelines in accordance with the
approved Program Description.
(37) The network provider shall ensure access to services that meet linguistic and cultural
needs of recipients.
(38)The network provider agrees to provide sign language, translation, and interpretive
services required to meet the communication needs of service recipients, including
English, Spanish and Creole. Services will meet the cultural needs and
preferences of the covered populations.
(39) 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.
(40) If not already accredited, the network provider shall take appropriate steps to
obtain/maintain national accreditation during state fiscal year 2012-2013 in order to
promote best practices and the highest quality of care. The network provider shall provide
the 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.
(41)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 managing entity 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 J, Assisted
Living Facilities With a Limited Mental Health License, if services to such
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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.
(42) Develop and Disseminate Consumer Manual
The network providers shall assist the ME in developing and maintaining a manual for
service recipients which includes information about access procedures, recipient rights
and responsibilities (including grievance and appeal procedures). This information will
be available for use by the consumers within each subcontractor location.
(43) 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.
(44) 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 and in the development of its Annual
Action Plan.
(45) Develop, Maintain and Improve Reporting
The network provider shall submit reports included in Exhibit C, Required Reports. In all
cases, the delivery of reports, ad hoc or scheduled, shall not be construed to mean
acceptance 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,
(46)The 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,
Prevention Services.
(47)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 managing entity's contract manager for approval within 30 days of contract
execution. The managing entity shall review and approve the Prevention Program Tool
(PPT).
(48)The network provider shall ensure that Prevention Program Coordinators and any other
personnel responsible for entering data into the Prevention data system, including
subcontractors who upload data from their own system, must register and complete
training on use of the PPT at least annually.
(49)The network provider contracted for HIV Early Intervention Services will designate a
representative to participate in the local Department of Health HIV/AIDS planning body's
meetings. The network provider shall ensure participation in a minimum of 50% of the
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meetings involving community service partners.
(50)Network providers shall collaborate with the local community substance abuse coalitions
(where available) to help develop and support capacity to address community substance
abuse needs. Activities shall be specified in the Prevention Activities Exhibit, which is
incorporated herein by reference, and as specified in the approved annual action plan.
(51) Based on the most recent local community anti-drug coalitions' action plan or the most recent
county Substance Abuse epidemiology data, the network provider agrees to administer and
deliver appropriate evidence-based strategies and approaches as specified in the Program
Description required by Rule 65E-14.021, F.A.C.,and is on file in the ME contract manager's
file and incorporated herein by reference.
(52) Client Satisfaction Survey
The network providers shall conduct client satisfaction surveys as per DCF PAM 155-2.
Failing to provide the required number of satisfaction surveys will result in a corrective
action.
(53) Forensic Service Program
The network provider will be responsible for ensuring the provision of mental health,
substance abuse and ancillary services to individuals charged with felony offenses and
have been committed or may be at risk of commitment to the Department of Children
and Families, pursuant to chapter 916, F. S. The network provider will participate in a
comprehensive forensic program that meets all requirements of chapter 916, F.S.,
Forensic Client Services Act, the Forensic Mental Health Services Exhibit and
established forensic performance measures.
(a) All individuals referred for admission to short-term residential treatment facility (SRT) by
the ME's SAMH Forensic Coordinator and/or Forensic Specialists shall be granted an
on-site face-to-face interview with 72 hours of referral. Written findings and
recommendations must be completed and submitted to the referral source and the
regional forensic coordinator.
(b) All individuals referred for admission to a residential treatment facility by the ME's
SAMH Forensic Coordinator and/or Forensic Specialists will be granted an on-site face-
to-face interview within a minimum of 72 hours of referral, if individuals reside within
Miami-Dade, Monroe and Broward County. For individuals who are referred for admission
and who live outside of the above referenced counties, the network provider shall
coordinate the interview date for the client with the Forensic Specialist and/or ME's SAMH
Forensic Coordinator. The network provider must submit written findings and
recommendations to the referral source and the ME's SAMH Forensic Coordinator within
48 hours of client interview.
(c) The community case manager will coordinate services and provide the court with
routine progress reports as required by the conditional release order Rule 65E-
15.051(14), F.A.C. The Forensic Specialist may accompany the case manager to all
court hearings regarding individuals on conditional release.
(d) The community case manager will consult with the Forensic Specialist regarding any
apparent conditional release violation. Network Provider staff will be responsible for
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notifying the court and the Forensic Specialist of any conditional release violations via
affidavit or sworn statement per s. 916.17(2), F.S.
(e) The network provider will not return individuals on conditional release to court
prior to consultation with the ME's Forensic Coordinator and/or assigned Forensic
Specialist, except in cases of physical aggression by the individual in question.
(f) Programs must provide services in English,Spanish and Creole.
(g) Conditional Release Monitoring —The network provider will ensure that individuals on
conditional release order in Dade and Monroe Counties, including individuals transferred
into the counties from other circuits are monitored.
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 SAMH 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 SAMH Forensic Coordinator.
iv. The network provider will ensure the distribution of copies of conditional release
orders and modifications to the agency providing mental health and substance
abuse services to the individual and to the SAMH Regional and Headquarters
Office in Tallahassee.
(h) Utilization Management
The network provider shall facilitate the Forensic Specialists' requirement to manage the
residential treatment beds funded by community forensic dollars in Circuit 11 and the
statewide community forensic beds located in Circuits 11 & 17. This includes a short -
term residential treatment facility and residential level 2 beds. The network provider will
be responsible for managing the appropriate utilization of community forensic residential
treatment beds.
(54) Projects for Assistance in Transition from Homelessness(PATH)
(a) The network provider shall submit an annual PATH application to the Mental
Health Program Office as requested.
(b) The network provider shall provide support services for individuals who have a
serious mental illness and/or substance abuse and are homeless or at imminent risk of
becoming homeless.
(c) The network provider shall implement services and provide deliverables as set
forth and described in each approved and signed Local Intended Use Application which is
Guidance Care Center,Inc. 37 Contract No.ME225-3-27
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a requirement of the PATH grant application.
(d) Eligible PATH local matching funds must be expended in the provision of PATH
eligible services to PATH eligible persons. The expenditures must match the types of
services outlined in the Local Intended Use Plan. The formula to be followed is cited in
Section 524 of the Public Health Services Act, as amended by Public Law 101-645.
(e) The network provider will complete PATH activities as follows:
(i) Submit Annual Data Report to SAMHSA
(ii) Submit the Annual reapplication for the PATH Grant
(55)Children's Mental Health Services, including services for Severely Emotionally
Disturbed Children, Emotionally Disturbed Children and their Families
(i) The key strategic objectives and strategies that support the department's mission
and direct the provision of services to Florida's residents are detailed in the
Substance Abuse and Mental Health Services Plan 2010-2013, which is
incorporated herein by reference. They represent the primary focus of the
Substance Abuse and Mental Health programs, and it is expected that the network
provider will ensure adherence to them, including but not limited to the following:
(a) Ensure that families and youth are full partners in the development and
implementation of individual recovery plans and have a prominent voice in
designing supports and services.
(b) Prioritize services and supports for children who are involved with the child
welfare and juvenile justice systems. Within these priority groups, children
birth to five years of age, youth transitioning to adulthood and children at
risk of residential treatment are the focus of specific activities and initiatives.
System transformation is the driving force for current and future activities,
with an emphasis on evidence based practices that are culturally
competent, focused on prevention, early identification and intervention, and
family-centered.
(c) Ensure that services and supports for children, youth, and families are
sensitive to the impact of trauma, and are designed to address treatment
issues and minimize system elements that might produce further trauma.
(d) Address the critical need for better information, planning, and assistance for
eligible children transitioning into the adult mental health system.
(e) Develop coordinated systems of care for children that provide services
and supports that promote recovery and resiliency by being:
(i) Community-based
(ii) Culturally competent
(iii) Strength-based
(iv) Evidenced-based practices for children and adolescents - including
Multi-systemic Therapy for children and youth with or at risk of
juvenile justice involvement, Therapeutic Foster Care, Family
Support and Education, Cognitive Behavioral Therapy for
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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 managing entity will agree to ensure that its subcontractors provide a
full continuum of services to address the needs of Severely Emotionally
Disturbed Children, Emotionally Disturbed Children and their Families.
These services must include but not be limited to:
(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.
b.Task Limits
The network provider shall perform services in accordance with applicable, rules, statutes, licensing
standards and policies and procedures.
Services shall only be provided in the Southern Region (Miami-Dade and Monroe Counties), with the
exception of clients residing in state hospitals, or Short-Term Residential Treatment programs that are
Southern Region clients, or by exception with approval by the department through the ME.
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. If applicable, the
network provider, with managing entity written approval, may unbundle Medical Services from the
Substance Abuse Residential Levels II, III, and IV cost centers for clients with co-occurring disorders,
unbundle Psychological Evaluations from the Children's Mental Health Residential Levels I and II, and
unbundle Psychological Evaluations from the Children's Substance Abuse Residential Levels II, III, and
IV cost centers. The network provider shall ensure that services are performed in accordance with
applicable rules, statutes, and licensing standards.
2. Staffing Requirements
a. Staffing Levels
(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 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
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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.
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 not
obligated nor will it pay for any services delivered prior to its written approval of the act of
subcontracting. The act of subcontracting shall not in any way relieve the 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 Managing Entity policies and procedures, in addition to identifying the
managing entity's pre- approval process for approving the network providers act of
subcontracting.
(3) The network provider shall maintain individual subcontractor files for each subcontractor and
provide a copy of all subcontracts prior to the execution of those 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,
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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 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:
http,/Y'www,dcf. tat .tl. simontalh aith/ blicatio sisamhfund,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 managing entity within 48 hours of
conditions related to subcontractor performance that could impair continued service delivery.
3. Service Location and Equipment
a. Service Delivery Location
The location 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.
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(2) The network provider shall notify the ME'm contract manager, in writing, at least tan (10)
calendar days prior to any changes in days and times where services are being provided pursuant to
Rule G5E-14.O21(8)(d)G,F.A.C.
o. Changes|nLocation
The network provider shall notify the K8E'a contract manager, in writing, at least ten (18) calendar
days prior toany changes in location where oen/ioea are being provided pursuant to Rule 85E-
14.021(8)(d)d(U|), F.A.C.
d. Equipment
The network provider shall furnish all appropriate equipment necessary for the effective delivery of the
services purchased.
In the event that the network provider is allowed to purchase any non-expendable property with funds
under this contraot, the network provider will ensure compliance with the Tangible Property
Requirements, Department operating Policies and Procedures as outlined in CFOP 40-5. CFOP80-2.
Rule 65E'14. F.A.C., which are incorporated herein by reference and may be obtained from the ME'a
contract manager. The provider shall submit an inventory report, as specified in Exhibit K. Network
Provider Inventory List and by the date(o) listed in Exhibit C, Required Reports.
4. Deliverables
a. Services
The network provider aho|| deliver the services specified in and described in the Program Description
submitted bythe network provider and as set forth in ExhibitG. 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 ao. 397.S01(7), 394.4GG(3). 3S4.4615. and 4142S5. 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
Where this contract requires the delivery of reports to the managing enhty, 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 enhty, at its opUnn, 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, by the dates specified.
(2) The network provider shall ensure that its audit report will include the standard schedules that are
outlined in RuiaG5E-14.003, F.A.C.
07/01/2012
(3) All children's mental health network providers shall complete a typed quarterly progress report, as
specified in Exhibit M, Child Welfare Quarterly Clinical Report, that is filed in the medical record. The
network provider is required to provide 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.
(4) 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.
(5) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF
PAM 155-2, Appendix 2, the network provider is directed to utilize the 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
(6) Service Provision Requirements for Substance Abuse Prevention and Treatment Block
Grants
(a) The network provider agrees to comply with the data submission requirements outlined in DCF
PAM 155-2 and with the funding restrictions outlined in "SAMH OCA's And Funding Restrictions"
which can be found at:
http://www.dcf.state.f1.us/programs/samh/contractingMore.shtmI and which are
incorporated herein by reference. For services
(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
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.
Guidance Care Center,Inc. 43 Contract No.ME225-3-27
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(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.
(7) Data for services shall be submitted electronically to the ME by the 8th of each month into the
Knight Information Software database (KIS).
In addition, the network provider will submit data on prevention activities in the Performance Based
Prevention System (PEPS) by the 8th of each month following the month of service.
The network provider shall also:
(a) Ensure that the data submitted clearly documents all client admissions and discharges which
occurred under this contract;
(b) Ensure that all data submitted to the KIS is consistent with the data maintained in the network
provider's clients'files;
(c) Review the managing entity's File Upload History screen in SAWS 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;
(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 10% or higher of the number of monthly records submitted
will require the network provider to submit a corrective action plan describing how and when the
missing data will be submitted or how and when the rejected records will be corrected and
resubmitted;and
(e) In accordance with the provisions of section 402.73(1), F. 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 Managing Entity and after receiving due notice, shall be grounds
for contract termination.
(8) In addition to utilizing the modifiers to procedure codes for block grant funds identified in paragraph
4.(6) (b) above, the network provider, upon request by the Managing Entity or the Department, shall
submit information regarding the amount and number of services paid for by the Community Mental
Health Services Block Grant and/or the Substance Abuse Prevention and Treatment Block Grant.
(9) A facility designated as a public receiving or treatment facility under this contract shall report the
following Payor Class data to the ME, unless such data are currently being submitted into KIS. Public
receiving or treatment facilities that do not submit data into KIS, shall report these data annually as
specified in Exhibit C, Required Reports, even if such data are currently being submitted to the
Agencyfor Health Care Administration:
(a) Number of licensed beds available by payor class;
(b) Number of contract days by payor class;
(c) Number of persons served (unduplicated)in program by payor class and diagnoses;
(d) Number of utilized bed days by payor class;
Guidance Care Center,Inc. 44 Contract No.ME225-3-27
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(e) Average length uf stay bypayor class; and
UU Total revenues bypayorclass.
(10)The network provider shall obtain the format and directions for submitting Payor Class data from the
managing entity.
(11)The network provider shall submit Paynr C|eaa data tothe managing entity no later than 90 days
following the end nf the facility's fiscal year.
5. Performance Specifications
a. Performance Measures
(1) The network provider shall meet the performance standards and required outcomes aospecified
in Exhibit D. Substance Abuse and Mental Health Required Performance
Outcomes/Outputs.
(2) The network provider agrees that the Knight Information Software (N|S) Data System and
GAMH|S will be the source for all data used to determine compliance with performance
standards and outcomes in Exhibit D, Substance Abuse and 08emtm| Health Required
Performance Outcomes/Outputs o/ other data system as specified by the Managing Entity.
Any conflicts will be clarified by the Managing Entity and the network provider shall adhere to
the Managing Entity's resolution. The network provider shall submit all service related data for
clients funded in whole orin part bySAK8H funds, local match, orMedicaid,
(3) 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 0, Substance Abuse and Mental
Health Required Performance Outcomes/Outputs or other data system specified by the
Managing Entity. The network provider ohui| submit all aan/ioo related data for clients
funded, in whole orin part, bySAK4Hfunds,
(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 hine, and annually thereafter. The network providers shall maintain the certificate of
attendance for all participants for all traininga. This does not apply to network providers
who have their own data system and upload data to PBPS.
(5) In addition to the performance standards and required outcomes specified in Exhibit D.
Substance Abuse and Mental Health Required Performance Outcomes and Outputs, the
network provider shall meet requirements set forth in Section D. 10. Special Proxisimno,
Performance Measures for Continuous Quality Improvement Programs, and Attachment V,
Prevention Services.
b- Performance Measurement Terms
OCF PAKn 155'2 provides the definitions of the data elements used for various performance measures
which are quantitative indicators, outuomea, and outputs used by the managing entity to objectively
measure anetwork provider's perfnrmanne, 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
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(1) The network provider shall collect information and submit performance data and individual client
outcomes, to the managing entity data system in compliance with DCF PAM 155-2 requirements.
The specific methodologies for each performance measure may be found at the following
website: http://dashboard.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, in Section D. 10. Performance
Measures for Continuous Quality Improvement Programs, and in Attachment V, Prevention
Services, 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.f1.us/. Additional 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)The network provider is responsible for the satisfactory performance of the tasks referenced inf
this contract. By executing this contract, the network provider recognizes its responsibility for the
tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all
relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to
be fully 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 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 through the managing entity, 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.
(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.
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(5) Pursuant to s. 394.74(3)(e), F.S., the network provider shall maintain data on the performance
standards specified hn 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 inAttachment V, Prevention Services, for the types of prevention strategies under this
contract, The network provider shall submit such data to the K8E 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 11 of
Part Bof Title XiXofthe Public Health Service Act, a. 42 U.S.C. 300x-21 etoeq. (as approved
September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR
Part96).
(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) \f required by45CFR Parts 1G0. 1G2. or1G4; the following provisions shall apply[45CFR
184.504(e)(2)(i|)]:
(m) The network provider hereby agrees not to use or disclose protected health information (PHI)
except ao permitted nr 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 toall manual and electronic data.
(o) The network provider agrees to report tothe Department any use ordisclosure of the
information not provided for by this contract or applicable |avv.
(d) The network provider hereby assures the Department and the Managing Entity that if any PHI
received from the Department or the Managing Entity, or received by the network provider on
the Department's or the Managing Entity's behalf, is furnished to network provider's
subcontractors or agents in the performance of tasks required by this contract, that those
subcontractors or agents must first have agreed to the same restrictions and conditions that
apply tothe network provider with respect tnsuch information.
(e) The network provider agrees tomake PHI available in accordance with 45C.F.H. 164.524.
(f) The network provider agrees to make PHI available for amendment and to incorporate any
amendments to PHI in accordance with 4SC.F.R. 164.526.
(8) 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 Managing Entity or created or
received by the network provider nn behalf nf the Department or the Managing Entity
available for purposes of determining the network provider's compliance with these
assurances.
(i} The network provider agrees that at the termination of this contract, if feasible and where not
inconsistent with other provisions of this contract concerning record retention, it will return or
Guidance Care Center,Inc. 47 Contract No.Mc225-3-27
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destroy all PHI received from the Department or Managing Entity or received by the network
provider on behalf of the department that the network provider still maintains regardless of
form. 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.
(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.
(19)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 July 15th 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
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establishment and management of individual client trust accounts (20 CFR 416 and 31 CFR
240). (Circuits may delete paragraphs (b)—(d) if not applicable.)
(c) Any network provider assuming responsibility for administration of the personal property
and/or funds of clients shall follow the Department's Accounting Procedures Manual 7 APM,
6, Volume 7, incorporated herein by reference. Department or the ME personnel or their
designees upon request may review all records relating to this section. Any shortages of
client funds that are attributable to the network provider shall be repaid, plus applicable
interest, within one (1) week of the determination.
(d) All reports specified in the Department's Accounting Procedures Manual 7 APM, 6, Volume 7
shall be maintained onsite and available for review by Department or ME staff, and shall be
submitted to the ME upon request.
(e) The network provider shall also maintain and submit documentation of all payment/fees
received on behalf of SAMH clients receiving Supplemental Security Income, Social Security
Administration, Veterans Administration, or other federal benefits upon request from the ME.
(20)The network provider agrees to comply with Exhibit N, Missing Children, if the network
provider is providing services to children where the care of the child is assigned to the Department or
network provider.
(21) Upon request, the ME will assist with the development and implementation of client admission,
continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and
the establishment of review dates.
b. Coordination with other Providers/Entities
(1) The network provider shall develop, maintain, and improve care coordination and
integrated care systems as follows:
i. Develop Initial Service Agreements
(a) The network provider shall fulfill their designated role in implementing and/or
maintaining a system of care in support of the cooperative agreements with the
judicial system and the criminal justice system which define strategies and
alternatives for diverting persons from the criminal justice system and address
the provision of appropriate services to persons with substance abuse, mental
health and/or co- occurring disorders who are involved with the criminal justice
system, as specified in the approved annual action plan. These agreements
address the provision of appropriate services to persons who have behavioral
health problems and leave the criminal justice system.
(b) The network provider agrees to fulfill their designated role in implementing
and/or maintaining a system of care in support of the Southern Region's
SAMH Program Office's -approved working agreement with the Department's
contracted Community Based Care (CBC) providers. The intent of the working
agreement is to establish a formal linkage of partnerships with a shared vision
for improving outcomes for families involved in the child welfare system by
providing integrated community support and services.
(c) The network provider may be required to develop and implement cooperative
agreements with other external stakeholders as described in the approved Annual
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Action Plan.
(d) 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.
(2) Plan for Care Coordination
(a) The network provider agrees to coordinate services with other providers and
state entities rendering services to children, adults, and families as the need is
identified by either the ME, the Department or as defined in the approved annual
action plan.
(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.
(c) The network provider will make efforts to initiate and support local county
implementation of the Medicaid Substance Abuse Local Match Program in order to
expand community service capacity through draw down of Federal funding.
(3) The failure of other providers or entities does not 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 managing entity will provide administrative and programmatic oversight to ensure that
network providers comply with all consumer-related services and other requirements of this
contract.
(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 designed
to preclude the development and/or exacerbation of substance abuse problems and mental
health disorders by addressing risk factors with adults, children and families and in the
community at large are a part of the behavioral health services.
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(4) The managing entity shall monitor and take action when necessary so that services which
meet the standards defined herein will be provided throughout the contract period.
(5) The ME will ensure that subcontractors use the GAIN, when appropriate, as the behavioral
health assessment and placement tool for ages 12 and up in the Southern Region, or as
otherwise specified in the approved annual action plan.
b. Monitoring Requirements
(1) The ME will monitor the network provider in accordance with this contract and the
managing entity's Contract Monitoring Operating Procedures which can be obtained from the
designated ME contract manager, and is incorporated herein by reference. The network
provider shall comply with any coordination or documentation required by the managing entity's
evaluator(s) to successfully evaluate the programs, and shall provide complete access to all
budget and financial information related to services provided under this contract, regardless of
the source of funds.
(2) The ME will monitor the network provider on its performance of all tasks and special
provisions of the contract.
(3) The ME will provide a written report to the network provider within thirty (30) calendar days
of the monitoring. If the report indicates corrective action is necessary, the network provider
shall have ten (10) calendar days from receipt of the monitoring report to respond in writing to
the request. In the sole discretion of the managing entity, if there is a threat to health, life,
safety or well-being of clients, the ME may require immediate corrective action or take such
other action as the ME deems appropriate. Failure to implement corrective action plans to the
satisfaction of the Managing Entity and after receiving due notice, shall be grounds for contract
termination.
c. Training and Technical Assistance
(1) The ME's contact manager, or designee, will provide training and technical assistance
concerning the terms and conditions of this contract.
(2)The ME will provide technical assistance and support to the network provider to ensure the
continued integration of services and support for clients, to include but not limited to, quality
improvement activities to implement evidenced-based practice treatment protocols, the
application of process improvement methods to improve the coordination of access and
services that are culturally and linguistically appropriate.
(3) The managing entity will provide technical assistance and support to the network provider
for the maintenance and reporting of data on the performance standards that are specified in
Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs
and in Attachment V, Substance Abuse Prevention Services. In addition, the ME may
convene cross-organizational training and assistance to help non-accredited network providers
become accredited.
(4)The managing entity implements a training program for its staff and the network provider
staff. The trainings assure that staff receives externally mandated and internal training. The
managing entity may coordinate training or directly provide training to network provider staff.
d. Review Compliance with Utilization Management Criteria
(1) As part of the quality improvement program, the ME will provide or coordinate reviews of
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service compliance with criteria and practice guidelines, such as retrospective reviews to
ensure the level of placement of clients is appropriate. The managing entity 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) Authorize Services
(a)The ME shall conduct authorization and reauthorizations for applicable levels of care
as described in the approved Annual Action Plan in order to ensure 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 Section B.1.a.(35) 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) 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.
(4) The ME has the right to review the network provider's policies, procedures, and plans.
Once reviewed by the managing entity, 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.
(5) The managing entity may request supporting documentation and review source
documentation of units billed to the managing entity.
e. Managing Entity Determinations
Through the Department, the ME has exclusive authority to make the following 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, 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
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Exhibit E-1 Substance Abuse and Mental Health Services Monthly Request for Non-TANFPayment
/Admmoe
Exhibit C@, State Funding by Program and Activity
Exhibit N. Funding Detail and Local Match
D. Special Provisions
1. The network provider is expected to reduce its administration cost to 13% nr less for Fiscal Year
2012-2O13 for SAKAH services purchased under this contract. The cost savings shall be reallocated to
support the increase nf 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 shall adhere to the deliverables as set forth in Attachment V, Substance
Abuse Prevention Services.
3. Renewals
For prevention services awarded through the SFBHN Solicitation #003' Prevention Invitation to
Negotiate, Prevention of Substance Abuse and Related Conaequenoen, this contract may be renewed
annually for period not to exceed three (3) years with a projected end date of June 30, 2015, subject to
the availability offunds. Renewals for two (2) years and three (3) shall be made by mutual agreement
and shall be contingent upon satisfactory performance, monitoring and evaluations an determined by
SFBHN, subject to the availability nffunds. Any renewal shall be in writing.
4' Utilization Management Program
The network provider agrees to:
(a) Utilize atrannmitta| ayatem, which maybe a computerized management information system,
for submitting/receiving and recording information and documentation required an port of
the Substance Abuse Utilization Management Program.
(b) Request and receive an authorization number from the managing entity for all clients requiring
admission into a substance abuse service prior tnthe client being admitted tothe program for
treatment.
(c) Complete all required assessment components outlined in the SAUM Manual for all
ohi|dren/adolesoen1o|ien1s requiring substance abuse treatment services. The information will be
submitted to the managing entity prior to the authorization request.
(d) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies
and procedures outlined in the SAUMManual.
(e) Provide to the managing entity Treatment Plans within 30 days of admission, Tnyu1m*n\ Plan
rovi*vva within 14 daya, and a discharge summary within S days of discharge for all High-
Risk/High Users as defined in the SALIM Manual. Treatment Plans and Discharge Summaries will
comply with the requirements set forth in Rule G5D-3U. F.A.C.
5- Waiting List and Interim Services
In the event that waiting lists deva|op, the network provider will collaborate with the Managing Entity
and community partners, to develop and implement procedures for managing the substance abuse and
mental health waiting list for all applicable |ewa|a of oana including provision of interim services. The
authorization of services are specified in Section B. 7. Managing Entity Responsibilities.
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6. Prior-authorized client's Roster-Adult & Children's Substance Abuse Residential Level I &
Level 11.
The network provider shall submit a request for reimbursement on the approved ME invoices found on
Exhibit E-1 of this contract.. 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 P. Pre-Authorization Residential Utilization
Management Roster, of this contract and attached to the approved Managing Entity's invoice, Exhibit
E-1 as a prerequisite for payment. The network provider shall maintain back-up documentation for
step-down services for a period of six (6) years from the expiration date of the contract per Section 7. of
the Standard Contract.
7. Utilization Management Program(Adult&Children SAMHUM)
(a) The Managing Entity will comply with and implement the policies and procedures of the
District 11 Utilization Management Program, detailed in the `Substance Abuse Utilization
Management (SAUM) Policies and Procedures Manual, January 2004-updated Edition' (or
latest revised edition thereof). The network provider will comply with the policies and
procedures of the District II Utilization Management Program, detailed in the `Substance Abuse
Utilization Management (SAUM) Policies and Procedures Manual, January 2004-updated
Edition' (or latest revised edition thereof). The network provider will offer clients a multi- level
continuum of care services for treatment of substance abuse. Each level of care has the
following duration or length of stay:
Cost Center Maximum Service Period
Residential Level I & II Children (No more than 6 months)
Residential Level I & II Adults (No more than 61 days or No more than 90 days
for clients Identified as "high risk" by the Managing
Entity)
Residential Level 11 Families in Transition Program: Families & Pregnant
Woman (No more than 5 months)
Residential Level IV Adults and Children (No more than 3 months)
Day/Night Adults and Children (No more than 3 months)
Outpatient Adults and Children (No more than 6 months)
(b) The network provider shall obtain written authorization from the ME prior to providing
Residential Level I & 11 services. A written authorization will also be required, prior to the
expiration of the initial length of stay, in order to extend Residential Level I & II services. The
request for an extension must be justified in accordance with GAIN criteria and in accordance
with the SAUM Policies and Procedures Manual.
(c) Case management services may be provided to clients receiving residential services as a
separate service pursuant to other terms and conditions in this contract. Post-residential
clients may continue to receive case management services only if they are receiving outpatient
or day-night services.
(d) When a client has been provided residential services as a non-Managing Entity 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.
(e) The managing entity will be responsible for managing the utilization of residential treatment
beds funded by community forensic dollars in Circuit 11 and the statewide community forensic
beds located in the Southern Region. This includes a short -term residential treatment facility
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and residential level 2 beds. The managing entity will be responsible for managing the
appropriate utilization of community forensic residential treatment beds.
8. Adult System of Care Comprehensive Community Service Teams Case Management(CCST)
(1) Adult System of Care Comprehensive Community Service Team (CCST) services must continue
to provide Adult Mental Health Case Management Services as defined by the Continuity of Care
Guidelines for Geo Care, Inc./South Florida State Hospital (on file at the Southern Region SAMH
Program Office). Additionally, CCST must provide appropriate Adult Mental Health services to
CCST clients with the availability to increase or decrease intensity and frequency of similar
services, as needed. Programs must provide services in English, Spanish, and Creole as required
by the population served.
(2) Description
Comprehensive Community Service Team (CCST) services take place in either an outpatient or
community-based setting and provide consumers with mental illness and/or substance use
disorders assistance in identifying goals and making choices to promote resiliency and facilitate
recovery. For consumers with mental health and/or substance abuse problems, recovery is the
personal process of overcoming the negative impact of a psychiatric and/or substance abuse/use
despite its continued presence. CCST services are intended to restore the individual's function and
participation in the community. The services are designed to assist and guide consumers in
reconnecting with society and rebuilding skills in identified roles in their environment. The focus is
on the individual's strengths and resources as well as their readiness and phase of recovery. A
team approach for delivery of services will be used to guide and support the consumer's served with
development of a recovery plan focusing on the areas of individual and family living, learning,
working and socialization. The expectation is that therapeutic services and supports will be
determined based on the clinical needs of the consumer. Therefore, not every consumer will require
involvement of all members of the team. The type(s) and intensity of clinical services and supports
will be determined by the consumer and is based upon a full clinical assessment.
(3) CCST should prioritize the following populations:
(a) Persons who are being admitted to, or discharged from, a state treatment facility or are
awaiting admission to or discharge from a state treatment facility;
(b) Persons who are in a state treatment facility regardless of admission date;
(c) Persons who are at-risk of institutionalization or incarceration for mental health reasons;
(d) Persons who have had one or more admissions to a crisis stabilization unit (CSU), short-
term residential facility(SRT), or inpatient psychiatric unit;
(e) Persons who reside or have been discharged from a mental health residential treatment
facility;
(f) Persons who are at-risk or have been adjudicated as incompetent to proceed or not guilty
by reason of insanity due to their mental illness and are being released to the community
under a conditional release plan;
(g) Persons who are experiencing long-term or serious acute episodes of mental impairment
that may put them at-risk of requiring more intensive services
(4) CCST Team Composition
The treatment approach must be delivered by staff working in a Multi-Disciplinary Team. At a
minimum the Multi-Disciplinary Team must consist of:
(a) A CCST Supervisor— 1 FTE
(b) Two Part-time Peer Specialists—0.5 FTE each
(c) A Care Coordinator/Targeted Case Manager— 1 FTE
(d) A Therapist/Clinician — 1 FTE
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(e) Vocational/Employment/Housing Manager— 1 FTE
Members of the team can be added to include a Psychiatrist etc. based on the needs of the
consumer. All members of the team must meet at least monthly and staff must be trained and
competent in utilizing evidence-based practices, recovery concepts and language. The consumer's
voice and choice should be seen throughout, starting with a recovery-based self-assessment tool
and continuing with statements of needs, goal-setting and decision-making.
The Peer Specialist(s) must be working towards a certification by the Florida Certification Board
and must be a true peer; which means that the peer specialist is also (or has been) a consumer of
public or private mental health or substance abuse services. A Peer Specialist provides peer
mentoring to consumers. They also assist consumers by teaching them how to navigate the mental
health and substance abuse service system to achieve resiliency and recovery.
In order to provide the full complement and quality of services and supports offered through the
CCST, each team must maintain a full staffing pattern as specified in the approved program
description, incorporated herein by reference, which aligns with the allocation of contracted dollars.
However, failure to maintain a full complement of staff may result in the reallocation of contracted
dollars. While SFBHN understands that staff turnover is common in the social service industry, it is
the responsibility of the provider to ensure that all positions are filled within six weeks of the position
becoming available. In addition, a full complement of staff allows the provider to receive maximum
reimbursement for services provided. Additionally, given that CCST is reimbursed based on staff
availability, any position(s) that remains vacant for extended periods of time will negatively impact
the provider's ability to draw down allocated funds. It is expected that temporary staff trained in the
services delivery model and implemented evidence-based practices will be re-assigned to vacant
position(s)to ensure that the full array of services and supports are provided to all consumers.
(5) System of Care Values
The system of care values including those listed below must be embedded within all aspects of the
CCST:
(a) Consumer-Centered
(b) Family Driven Care
(c) Cultural and Linguistic Competence
(d) Individualized
(e) Evidence-Based practices
(f) Streamlining and expediting access to services
(g) Continuous Quality Assurance
(h) Collaborative
(i) Community-Based
(j) Integrated Services
(k) Trauma-Informed Care
(1) Trauma-Specific Care
(6) Documentation
There must be evidence that staff are aware of consumer's needs and documentation in the service
record that identified needs are addressed by the CCST and the person receiving services. Staff
must assist consumers with obtaining benefits (insurance, Social Security and income).
Documentation in the service record must reflect efforts, progress and barriers to individualized
goals and treatment objectives, including school performance. Documentation is necessary to
identify changes in services, supports and continuity of those services and supports (i.e., treatment
plan updates indicating new/revised/achieved goals). A crisis plan must be developed with the
consumer and contained within the case record.
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There must be evidence that supports were offered to the consumer receiving services. Supports
are necessary in self-managing wellness via activities such as, but not limited to, education,
supportive counseling, or skills training. The consumer needs to be aware and involved in
appropriate self-help or support groups. Evidence is required that the people receiving services
actively takes part in achieving his/her service goal(s) and chooses the people who are involved in
their recovery(as in Wellness Recovery Action Plan "WRAP Plans" Crisis Management tools).
These persons could be family members, friends or significant others, CCST staff, or other Peer
support. There should be evidence that the CCST staff partners with the consumer, assisting and
building confidence in their decision-making ability. Furthermore, documentation must reflect the use
of natural supports and the Peer Specialist must document all contact with the consumer.
(7) Data Requirements
Data submission to SFBHN is required for all services provided under the CCST cost center. These
services must be submitted as directed by SFBHN. All service data must be entered every month in
keeping with contractual requirements.
(8) Services Array
Services and supports provided includes but is not limited to Assessment, Case Management,
Intensive Case Management, Outpatient, In-home/On-Site, Intervention, Information and Referral,
Prevention, Prevention/Intervention, Outreach and other transition, and Therapeutic Recreational
Activities (non-traditional support services) as identified on the treatment plan and outlined in the
policy governing the use of flexible funding. The above listed services are reimbursed in a bundled
staff hour rate and may not be contracted for separately. Incidental Expenses may be utilized as
specified in Rule 65E-14.021(2)j, F.A.C., for persons served through CCST to purchase medications
and other enhancement and support services not included in this bundled rate that are in concert
with the individual's treatment plan.
(9) Minimum Training Requirements
(a) Motivational Interviewing. - All clinicians/therapist assigned to the CCST team are
encourage to complete the Motivational Interviewing training within one year of
employment with the CCST team.
(b) Wellness Recovery Action Planning (WRAP) - All CCST team members are required to
complete the initial three day WRAP training and utilize the strategies with all consumers
enrolled in CCST. This training must be completed within six months of joining the CCST
team.The WRAP facilitator five day training is available to all CCST team members but is
not a required training.
(c) SSI/SSDI, Outreach, Access and Recovery(SOAR)training -Targeted Case
Managers/Care Coordinators, and Peer Specialists are required to attend this training.
This training must be completed within six months of joining the CCST team.
(d) Peer Specialist Training—All Peer Specialists are required to complete the Peer
Specialist training as outlined by the Florida Certification Board within six months of
employment with the CCST team and attempt certification within one year of employment
with the CCST team.
(e) Person to Person Training—All case managers seeking to become Care Coordinators
must complete and acquire the Person to Person certification within 90 days.
(f) Other Best Practices as approved by SFBHN—The CCST team can utilize other
evidence-based practices approved by SFBHN. However, all evidence-based practices
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utilized by the provider must be implemented with fidelity checks to ensure that the model
is being correctly utilized.
(10) Programs: Adult Mental Health & Substance Abuse
(a) Unit of Measure: Staff Hour
(b) Maximum unit cost rate: $ 37.86
(c) Data Elements: Service Documentation —CCST Duty Roster(Exhibit L)
(i) Staff name and identification number
(ii) Service Date
(iii) Hours scheduled to work—Beginning & Ending Time
(iv) Cost Center
(v) Program
(vi) Signature of Supervisor
(d) Audit Documentation—Time Sheet
(i) Staff name and identification number
(ii) Date
(iii) Hours Worked—Beginning & Ending Time
(iv) Program
(v) Cost Center
(vi) Signature of Supervisor
(e) Some of the additional elements SFBHN will be reviewing include the following:
(I) Number of consumers linked to Medicaid and tracking the length of time for approval of
benefits (SOAR Data submission)
(ii) Type of therapeutic services provided
(iii)The frequency of each therapeutic service
(iv) Number of consumers receiving Evidence-Based Practices (EBP) and which EBPs are
used
(v) Staff productivity, which is the amount of direct care hours provided monthly
(vi) Fidelity to the treatment model utilized
(11) Adult CCST Caseload
CCST provides therapeutic services and supports to consumers with varying and complex needs.
Therefore, it is anticipated that caseloads will vary widely in intensity and types of services and
support provided to consumers. While some cases may involve one therapeutic session per week
others may warrant significantly more clinical services in order to address the changing and complex
needs of the consumer. For that reason, at least an average of 60.19%of each member of the
CCST team's time must be spent providing direct care services.
For purposes of determining staff productivity, provision of a group only counts for one hour of staff
productivity per hour of group. For example, staff productivity is not measured by counting a
separate hour of productivity for each consumer in the group. It is expected that only one staff
member will be providing each group.
For purposes of determining staff productivity, provision of a group only counts for one hour of staff
productivity per hour of group. For example, staff productivity is not measured by counting a
separate hour of productivity for each consumer in the group. It is expected that only one staff
member will be providing each group. In order to track that group size limitations and staff
productivity levels are being met, the documentation requirements listed in Section B. 1.a.(3) are
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required for CCST group in addition to the duty roster and time sheet service and audit
documentation requirements for CCST Individual.
(12) Invoicing Requirements
The network provider shall ensure that the monthly billing and the data submitted into KIS support
the 60.19% direct care services requirement as stated above. Failure to adhere to this requirement
may cause the ME to withhold payment until such requirement is met.
9. Continuous Quality Improvement Programs
(1) Each service 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) For each service network provider, a written plan must be developed with a copy made available
upon request to the managing entity 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 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.
(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 network provider.
(4) Each director shall designate a person who is an employee of or under contract with the service
network provider as the network provider's continuous quality improvement manager.
(5) The quality improvement program must also:
(a) Composition of quality assurance review committees and subcommittees, purpose,
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.
Guidance Care Center,Inc. 59 Contract No.ME225-3-27
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(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.
(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.
(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 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.
10. 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 QA/QI plan reports by the dates specified in Exhibit C, Required Reports:
(1) 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-Out atient Group
12- Medical Services (psychiatric) 39-Short-term Residential Treatment
14-Out atient Individual 44- CCST Individual
18- Residential Level 1 45- CCST Group
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(a) Average number of calendar days between a request for service and the date of the
initially scheduled face-to-face appointment, tracked by assessment,
counseling/psychotherapy and psychiatric appointments.
(b) Percent of clients who do not appear for their initial appointment tracked by assessments,
counseling/psychotherapy and psychiatric appointments.
(c) Percent of appointments cancelled by the client tracked for all initial appointments for
assessments, counseling/psychotherapy and psychiatric services.
(d) Percent of appointments cancelled by the staff for all initial appointments for
assessments, counseling/psychotherapy and psychiatric services.
(e) Medication error percentage, as documented during the reporting period
including: wrong medication, wrong dose or wrong time of administration as reported in
inpatient/CSU and residential settings.
(2) Substance Abuse Services (Admission type):
Cost Centers
01-Assessment 21-Residential Level 4
06 Day/Night 24-Detoxification
08- In Home/On-Site 35- Outpatient Group
12- Medical Services (psychiatric) 44- CCST Individual
14-Out atient Individual 45- CCST Group
18- Residential Level 1
19- Residential Level 2
20- Residential Level 3
(a) Average number of calendar days between a request for services and the date of the
initially scheduled face-to-face appointment, tracked by assessment and counseling
services.
(b) Percent of persons who do not appear for their initial appointments tracked by
assessments and counseling services.
(c) Percent of appointments cancelled by the client for initial appointment for assessments
and counseling.
(d) Percent of appointments cancelled by the staff, tracked by initial appointment,
counseling/psychotherapy and psychiatric appointments.
(e) Medication error percentage, as documented during the reporting period
including: wrong medication, wrong dose or wrong time of administration as reported in
JARF/Detox and residential settings.
11. Incident Reports
(a) The network provider shall submit incident reports into the Incident Reporting and Analysis
System (IRAS) on all reportable incidents per CFOP 215-6, within 24 hours of receiving
notification of a reportable incident.
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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 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.
(b) All network providers (inpatient and outpatient) will report seclusion and restraint events in
SAMHIS and in accordance with Rule 65E-5.180(7)(g), F.A.C.
12. Mandatory Reporting Requirements
(a) The network provider and any subcontractor must comply with and inform its employees of
the following mandatory reporting requirements. Each employee of the network provider, and of
any subcontractor, providing services in connection with this contract who has any knowledge of
a reportable incident shall report such incident as follows:
(1) Reportable incidents that may involve an immediate or impending impact on the health or
safety of a client shall be immediately reported to the contract manager; and
(2) Other reportable incidents shall be reported to the ME and Department's Office of
Inspector General by completing a Notification/Investigation Request (form CF 1934) and
emailing the request to the Office of Inspector General at ig_complaints@dcf.state.f1.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.
13. 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 is 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.
14. 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
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Rule 65E-14N8(4). F.A.C. shall be furnished to the managing entity within thirty 00days of contract
execution.
15' Transportation Disadvantaged
The network provider agrees to comply with the provisions of ohapter427, F.8.' Part i Transportation
Services, and Chapter41-2, 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 40-5O (CF{}P40-5) 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. (Contract managers delete if not
applicable)
16. Agreements with Health Maintenance Organ izatio ns/Man aged Care Organizations
(a) The network provider shall notify the managing onht}/a contract manager' in writing, prior to
entering into a contract for the provision of substance abuse and mental health services with a
health maintenance organization or other managed care organization that is oapi\ated by
Medicaid to provide substance abuse and/or mental health services or an agent of any such
health maintenance organization or other managed care organization.
(b) Copies of the contract shall be furnished to the managing entity's contract manager within
thirty (3O)days ofexecution.
17. Medicaid Enrollment
(a) Those network providers with SAMH contracts in excess of $5U0,OU0 annually and rendering
` substance abuse services shall enroll aaa Medicaid provider. This process shall beinitiated
within ninety(8O)days of contract execution. A waiver of the ninety(A0) day requirement may be
granted, in writing, by the Department's Director of Substance Abuse, through the ME.
(b) All network providers whose contracts are $500,000 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 (CBK8AC) program. The CBK4ACprogram allows participating
network providers to claim reimbursement for administrative activities performed while providing
eligible Federal Medicaid Title X|Xservices.
(o) Participation in the CBK8AC program by Substance Abuse and Mental Health providers who
are enrolled aa Medicaid providers with contract amounts less than $500.00U annually, and who
have the technological capability to participate electronically is optional.
18. y4mt|mna| Provider Identifier(NP|)
(a) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier
for health care providers.
(b) An application for anNP| may be submitted online ek
hKps://nppoo�omm.hha.gow/NPPES/StaticFonward.do?fonmand=ata1io.npistert.
(c) Additional information can be obtained from one of the following weboitea:
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(1) The Florida Medicaid HIPAA located at:
http://\wwwjdho.sbaa�.ua/hipaa/index.ahhn|
` '
The National Plan and Provider Enumeration System (NPPES) located at:
httpo:Hnppea.nmn.hha.Qov/NPPES8Nelcome.dn
(3) JYwww.cmo,hhagov/Na1iona|Prov\dentSBand/
19. Indigent Drug Program
(a) The network provider shall ensure that all funds allocated for use of purchasing psychotropic
medications, or medications used to treat addictions, or medications accessed through line of
credit from the Indigent Drug Program (IDP) are used for individuals who meet any of the
following criteria:
(1) Have an annual income that ioator below 150% (f the Federal Poverty Income
Guidelines, ao published annually in the Federal Register.
(2) Have no liable third-party insurance or other source of psychotropic medications
available, nor is the individual a participant in aprogram where payohotropio medications are
paid for by any other funding source.
(3) If the individual has third party insurance for psychotropic medications but has
temporarily been denied benefits for these medications, they may receive IDP medications
until such time aa eligibility has been reestablished.
(b) The network provider shall actively participate in manufacturer's patient assistance programs
for medications needed by a significant portion of clients served by the network provider.
(c) The network provider shall participate in any regional training events made available by the
Department. The network provider shall also participate in any training events made available by
the Florida Louis OeLa 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 vvebaho: .
(d) 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 a. 4B9.012(l)(d). F.S.
2l Ethical Conduct
The network provider understands that performance under this contract involves the expenditure of
public funds from both the state and federal govornmento, 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 emp|oyeo, director, officer, agent of the network provider shall engage in any
businaos, financial or legal relationships that undermine the public huot, 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 roouoe
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 ounahine, pursuant to section 288.011. F.S., and chapter 118,
Florida Law, and that all issues relating to the business of the department, the managing entity and the
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network provider are public record and subject tofull disclosure. The network provider understands that
attempting toexercise 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 negctiated, publicly disclosed
amendment, is prohibited by the State of Florida, pursuant to aeotion28G.O11. 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 togovernment.
21. Liability Insurance Coverage
The network provider shall notify the managing entity's Contract Manager within thirty(3O) calendar days
if there is a modification to the terms of insurance,to include but not limited to, cancellation or
modification to policy limits.
22. Information Technology Resources
If app||oab|e, the network providers must receive written approval from the managing entity prior to
purchasing any Information Technology Resource (|TR) oontraot 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 ony |TH purchases made prior to obtaining the managing entity's written approval.
23. Programmatic,Fiscal&Contractual Contract File References
All of the documentation submitted by the network provider which may ino|ude, but not be limited to
the network provider's original proposal, Program Description, Program/Cost Center Actual Expenses
and Revenues Sohedu|o, Projected Coot Center Operating and Capital Budget, Agency Capacity
Report and Personnel Detail Reoord, 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.
24' Employee Loans
Funds provided by the ME to the network provider under this contract shall not be used by the
network provider to make loans to their employees, offiooro, 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 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.
25. Trs»e|
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 farao, must be maintained on 0e by the Network provider. Section 287.058 (1) (b)
F.9., requires that bills for any travel expense shall be maintained in accordance with Section
112-061. F.S. governing payments for traveling expenses. CF[)P 40-1 (Official Travel of State
Employees and Non-Employees) provides further explanation, o|arifioa1ion, and instruction regarding
the reimbursement of traveling expenses necessarily incurred during the performance of business.
The network provider must retain on file documentation cd all travel expenses to include the following
data elements: name of the traveler, dates oftravel, travel destination, purpose cftravel, hours of
07/01/2012
departure and return, per them or meals allowance, map mileage, incidental expenses, signature of
payee and payee's supervisor.
28 Incidental Funds for Adult Mental Health
(o) The network provider agrees to use incidental funds allocated under this contractfor housing,
medication and other emergency expenses for indigent clients.
(b) The network provider agrees to keep in the clients'file a record of all client expenses charged
against the funds.
(u) The network provider shall keep a record to log all incidental funds expenditures as specified in
Exhibit 0, Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health.
(d) The network provider shall submit as back to the monthly invoice an expenditure report as
specified inExhibit 0. Incidental Expense Fund Invoice and Expenditure Log for Adult
Mental Health.
(e) The KAE reserves the right to reduce the contract amount by the incidental funds projected
surplus.
27. Evidence Based Prevention
All network providers rendering substance abuse prevention services are required to use an evidence
based prevention program. Network provider agencies involved in the validation process for
prevention programs must notify the circuit SAMH Program Office of progress annually.
28. Property and Title toVehicles
a. Property
(1) Nonexpondab|eproperty is defined as tangible personal property of a nonconsumable
nature that has an acquisition value or cost of $1.000or more per unit and an expected
useful life of at least one year, and hardback covered bound books that are not circulated to
students or the general public, the value orcost of which ia $Q6Uormore. Hardback books with a
value or cost of $100 or more should be classified as nonexpenclable property only if they are
circulated to students orto the general public. All computers, including all desktop and laptop
oompuio/o, regardless of the acquisition cost or value are classified as nonexpenclable property.
Motor vehicles include any automobi|e, huok, airp|ane, boat or other mobile equipment used for
transporting persons orcargo.
(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 K4E'o contract manager. When property is transferred to the provider, the department
shall pay for the title transfer. The provider's responsibility starts when the fully accounted for
property or 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 tn
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 CF(}P80-2.
(3) If any property is purchased by the provider with funds provided by this oonhaot, the
provider shall inventory all nonexpendable property including all computers. A copy of which shall
Guidance Care Center,Inc. 66 Contract No.mszz5-a'zr
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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 inventory(see Exhibit K, Network Provider Inventory List) shall include, at a minimum,
the identification number; year and/or model, a description of the property, its use and condition,
current location, the name of the property custodian, class code (use state standard codes for
capital assets), if a group, record the number and description of the components making up the
group, name, make, or manufacturer, serial number(s), if any, and if an automobile, the VIN and
certificate number; acquisition date, original acquisition cost, funding source, information needed to
calculate the federal and/or state share of its cost.
(5) The ME's contract manager must provide disposition instructions to the provider prior to the
end of the contract period. The provider cannot dispose of any property that reverts to the ME
or department without the contract manager's approval. The provider shall furnish a Closeout
Inventory Form no later than 30 days before the completion or termination of this contract. The
Closeout Inventory Form shall include all nonexpendable property including all computers
purchased by the provider. The Closeout Inventory Form shall contain, at a minimum,the same
information required by the annual inventory.
(6)The provider hereby agrees that all inventories required by this contract shall be current and
accurate and reflect the date of the inventory. If the original acquisition cost of a property item is
not available at the time of inventory,an estimated value shall be agreed upon by both the provider
and the ME and shall be used in place of the original acquisition cost.
(7) Title (ownership)to and possession of all property purchased by the provider pursuant to this
contract shall be vested in the ME upon completion or termination of this contract. During the term
of this contract, the provider is responsible for insuring all property purchased by or transferred to
the provider is in good working order. The provider hereby agrees to pay the cost of transferring
title to and possession of any property for which ownership is evidenced by a certificate of title.
The provider shall be responsible for repaying to the ME the replacement cost of any property
inventoried and not transferred to the ME upon completion or termination of this contract. When
property transfers from the provider to the ME, the provider shall be responsible for paying for
the title transfer.
(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 indemnifythe ME or the department against any claim or loss arising out of the
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operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract
29. Verification of Employment Status(E-Vmrif )
1. Employment Eligibility Verification
bA Definitions.Ao used in this clause-
"Employee assigned to the contract"means all persons employed during the contract term bythe
provider/grantee tn perform work pursuant to this contract within the United States and its territories,
and all persons(including subcontractors)assigned by the provide r/g rantee to perform work pursuant
to the contract/grant with the department.
^Guboontraoy'means any contract entered into byasubcontractor
to furnish supplies or services for performance of a prime contract or a subcontract. It includes but is not
limited to purchase orders, and changes and modifications to purchase orders.
"Subcontractor"means any supplier, distributor,vendor, or firm that furnishes supplies or services to or
for 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 now/ employees. Within 80 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
prov(der/orantme/auboonhaotorto perform work pursuant to the contract with the DCF shall be verified
ua employment eligible within 3 business days after the date of hire; and
(2) The 9rovider/orantee shall comply, for the period of performance of this contract,with the
requirement of the E-Verify program enrollment.
(U The Department of Homeland Security (DH8) or the Social Security Administration (SSA) may
terminate the provider'a/orantee'o enrollment and deny a000aa to the E-Verify system in accordance with
the terms of the enrollment. In such oaxe, the provider/grantee will be referred to a DHS or SSA
suspension ordebarment official.
(iU During the period between termination of the enrollment and a decision by the suspension or
debarment official whether to suspend or debar, the provide r/orantee is excused from its obligations
under paragraph (b) of this clause. If the suspension or debarment official determines not to suspend or
debar the provider/grantee,then the provide r/g rantee must reenroll in E-Verif y.
(c) Web site. Information on registration for and use of the E-Verify program can be obtained via the
Internet a1the Department of Homeland Security Web site: .
(d) Individuals previously verified.The provider/grantee is not required by this clause toperform
additional employment verification using E-Verify for any employee whose employment eligibility was
previously verified by the provider/grantee through the E-Vehfyprogram.
(e) Individuals performing work prior&o the E-ven7yrequirement. Employees assigned toand
pert o,minQ work pursuant tothio contract prior to February O4` 2U11do not nequ ire emp|oyment
Guidance Care Center,Inc. 68 Contract No.mmos'a-z7
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eligibility verification through E-verify.
(f) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file.
(g) Subcontracts.The provider/grantee shall include the requirements of this clause, including this
paragraph (g) (appropriately modified for identification of the parties), in each subcontract."
E. List of Exhibits
The following exhibits, or the latest revisions thereof,are incorporated in and made a part of the
contract.
1. Exhibit A, Clients and Participants to be Served
2. Exhibit B, Method of Payment
3. Exhibit C, Required Reports
4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and
Outputs
5. Exhibit E-11, Substance Abuse and Mental Health Monthly Request for Non-TANF
Payment/Advance
6. Exhibit F, Minimum Service Requirements
7. Exhibit G, State Funding by Program and Activity
8. Exhibit H, Funding Detail &Local Match Plan
9. Exhibit 1, Substance Abuse Family Intervention Specialist Services
10. Exhibit J, Assisted Living Facilities With a Limited Mental Health License
11. Exhibit K, Network Provider Inventory List
12. Exhibit L, CCST Duty Roster
13. Exhibit M, Child Welfare Quarterly Clinical Report
14. Exhibit N, Missing Children
15. Exhibit 0, Incidental Fund Invoice and Expenditure Log for Adult Mental Health
16. Exhibit P, Pre-Authorization Residential Utilization Management Roster
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EXHIBIT A
CLIENTS AND PARTICIPANTS Client Non-specific
Performance Contract
TO BE SERVED Performance
Services Program
A. General Description
The network provider shall furnish services funded by this contract to the target
population(s) checked below:
Non-Prevention Prevention
ZAdult Mental Health-Forensic Involvement ❑ Adult at Substance Abuse
ZAdult Mental Health-Severe& Persistent Mental Illness E] Children's at Substance Abuse
Z Adult Mental Health-Serious&Acute Episodes of Mental Illness E] Community Prevention-Adult at SA
Z Adult Mental Health-Mental Health Problems Z Community Prevention-Children at SA
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 and 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.
(2) Crisis stabilization, substance abuse detoxification, and addiction
receiving facility services shall be provided to all persons meeting the
criteria for admission subject to the availability of beds and/or funds.
C. Client and Participant Determination
(1) Determination of client eligibility is exclusively the responsibility of the
network provider.
(2) Participant eligibility (Direct Prevention) and target population eligibility
(Community Prevention) shall also be based upon the community action plan
or on the relevant epidemiology data.
D. Contract Limits
(1) The network provider is not authorized to bill the department for more
units than are specified in Exhibit G, State Funding by Program and
Activity, or for more units than can be purchased with the amount of funds
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specified in Exhibit G, State Funding by Program and Activity,
(2) The network provider agrees that funds provided in this contract will not be
used to serve persons outside the target population(s) specified in the
paragraph above. NOTE: Prevention funds allocated to underage drinking
programs and activities targeting eighteen (18) to twenty (20) year old
individuals may be taken from Adult Substance Abuse Prevention funds.
(3) Services provided under this contract are limited by the availability of
funds. The network provider may not authorize or incur indebtedness on
behalf of the Managing Entity or the Department.
Guidance Care Center,Inc. 71 Contract No.ME225-3-27
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 $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. 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.
c. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local
matching funds in the amount of$933,952.00 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
i. 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
operated by a public receiving facility)
FACT Teams
ii. CMH Programs (100435 Category& 102780 (PRTS) Category) that are not grant
funded.
Guidance Care Center,Inc. 72 Contract No.ME225-3-27
07/01/2012
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
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
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:
i. 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
Ill. The Department through the ME (only if none of the above are available or
eligible for payment).
Guidance Care Center,Inc. 73 Contract No.ME225-3-27
07/01/2012
iv. The network provider shall identify and report Medicaid earnings separate
from all other fees;
V. Medicaid earnings cannot be used as local match;
vi. The network provider shall ensure that Medicaid payments are accounted for
in compliance with federal regulations;
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.
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 department.
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 within twelve(12)days following the end of the
month for which payment is being requested for the delivery of service
d. The network provider shall submit a monthly Incidental Expense Fund Invoice and
Expenditure Log for Adult Mental Health, Exhibit O, to the ME's Contract Manager
Guidance Care Center,Inc. 74 Contract No.ME225-3-27
07/01/2012
and by the dates specified in Exhibit C, Required Reports. The report shall identify
by client, the category of the expense (pursuant to Rule 65E-14.021(7), F.A.C.), the
program, month of service and amount billed per category.
e. If no services are due to be invoiced from the preceding month,the network provider
shall submit a written document to the ME indicating this information within twelve(12)
days following the end of the month.
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-1 4.021(1 0)(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.
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. Proper service
documentation for each SAMH cost center is outlined in Rule 65E-14.021(7), F.A.C., in
Section D., Special Provisions for Adult System of Care Comprehensive Community
Service Teams services, Exhibit O, Incidental Expense Fund Invoice and
Expenditure Log for Adult Mental Health.
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
data system designated by the managing entity.
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 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
Guidance Care Center,Inc. 75 Contract No.ME225-3-27
07/01/2012
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 K8E'o Lapse Policy io incorporated herein byreference.
07/01/2012
Exhibit C
Required Reports
#of
Required Reports Due Date copies Send to.*,
Response to Monitoring Reports and Corrective Action Within 10 days from the day the report is SFBHN Contract
Plans received. 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. Manager
Final FY 2012-2013
(1)Network Providers Agency Service Capacity Report,
(2) Projected Cost Center Operating and Capital Within 30 days after Contract execution or SFBHN Contract
Budget(If applicable),(3)Cost Center Personnel Detail upon request of the Contract Manager Manager
Report(If applicable),&
(4)Program Description.
Monthly Data Required by DCF PAM 155-2 Electronic SFBHN MIS Office
Within 8 days after end of month Submission
Incident Report Within 24 hours of occurrence 1 IRAS
Audit Schedules for Network Providers
(for client non-specific unit cost performance contracts)
Due 180 days after the end of the fiscal year SFBHN Contract
Schedule of State Earnings or 45 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 45 days upon completion of audit, 1 Manager
whichever comes first. I
Program/Cost Center Actual Expenses&Revenues Due 180 days after the end of the fiscal year SFBHN Contract
Schedule or 45 days upon completion of audit, 1 Manager
whichever comes first.
Due 180 days after the end of the fiscal year SFBHN Contract
Schedule of Bed-Day Availability Payments or 45 days upon completion of audit, 1 Manager
whichever comes first.
180 days after the end of the managing
Financial&Compliance Audit per Attachment I I entity's fiscal year or 45 days after its 1 SFBHN Contract
completion,whichever comes first. Manager
(See Attachment 11)
Reports Required for Substance Abuse Providers
SFBHN Contract
Annual Report for HIV Early Intervention Services, Upon Request 1 Manager&
SAPT Block Grant Set Aside Funded Services Only Substance Abuse
Program Office
Annual Report for Evidenced-based Injection Drug User SFBHN Contract
Outreach Services,SAPT Block Grant Mandate, 1 Manager&
Designated Providers Only Upon Request Substance Abuse
Program Office
Annual Report for Pregnant Women and Women With SFBHN Contract
Dependent Children SAPT Block Grant Set Aside Upon Request 1 Manager&
Funded Services Only Substance Abuse
I Pro ram Office
Guidance Care Center,Inc. 77 Contract No.ME225-3-27
07/O1/2O12
Required Reports Due Date #of end to:
Copies IS
Other Reports
FBHN Contract
Monthly Service Invoice Monthly,by the 12" after the month of service 1 Manager
FBHN Contract
Invoice Review Supporting Documentation As requested by the contract manager 1 Manager
oi i monthly
with th d itt b ume we mony invoice FBHN Contract
Prevention Services Report printed from PBPS S 1 Manager
October 12,2012
January 12,2013 1 SFBHN Contract
Coalition Activities Report April 12,2013 Manager
June 15,2013
By July 15 of each fiscal year and/or 15 days 1 SFBHN Contract
Final Invoice after contract end date Manager
Wait list FBHN Contract
(until departments automated system is operational) Monthly by the 15`h after the month of service 1 Manager
Within 30 days of contract execution.Submit
Provider's Grievance Procedures updates as amended within 30 days of 1 SFBHN Contract
execution of the amendment Manager
Provider Informed Consent Forms FBHN Contract
Within 30 days of contract execution 1IManager
Manager
Provider's Emergency Preparedness Plan 1FBHN Contract
Within 30 days of contract execution
1 SFBHN Contract
Provider's Civil Rights Compliance Questionnaire
Within 30 days of contract execution Manager
Provider's Security Agreements,per Standard Contract 1 FBHN Contract
Within 30 days of contract execution Manager
Annually,prior to contract FBHN Contract
Affidavit Regarding Debarment execution,or as requested by the contract 1
manager. Manager
Inventory Report Within 30 days of contract execution 1 FBHN Contract
Manager
`No Wrong Door'Policy and Procedure August 1,2012 1 FBHN Contract
Manager
Quality Improvement Plan August 1,2012 1 FBHN Contract
Manager
October 15,2012 1
Quarterly Report on Implementation of Quality January 15,2013 SFBHN Contract
Improvement Plan April 15,2013 Manager
July 15,2013
August 1,2012 1 SFBHN Contract
Quality Assurance Plan g Manager
October 15,2012 1
Quarterly Report on the Implementation of Quality January 15,2013 SFBHN Contract
ssurance Plan April 15,2013 Manager
July 15,2013
Guidance Care Center,Inc. 78 Contract No.ME225-3-27
07/01/2012
Co-occurring Action Plans 06/30/2013 1 SFBHN Contract
Manager
ODECAT 06/30/2013 1 SFBHN Contract
Manager
COMPASS Follow-up Self-Assessment for all Network 06/30/2013 1 FBHN Contract
Providers Manager
Cooperative Agreements Within 30 days of execution of the 1 FBHN Contract
agreements Manager
ANF SAMH Program Logs and Service Data As per the contract and/or as requested by 1 FBHN TANF
the contract manager Supervisor
DA Client Communication Assessment Auxiliary Aid by the 4th business day following the 1 FBHN Contract
Service Record Monthly Summary Report reporting month Manager
External Quality Assurance Reviews, Monitoring As per the contract and/or as requested by 1 FBHN Contract
Reports,Surveys&Corrective Action Plans the contract manager Manager
Bent Trust Fund Letter August 1,2012 1 FBHN Contract
Manager
Children's Mental Health
Children's Mental Health Quarterly clinical reports on all
Per the contract and Exhibit S. 1 Copy in chart
dependent children
Children's Mental Health Quarterly clinical reports on all As per the contract and/or as requested by 1 Copy in chart
community children the contract manager
Adult Mental Health'
SFBHN Contract
m
Incidental Expense Fund Invoice and Expenditure Log for Monthly by the of each month following the 1 Manager and ME
Exhibit Adult Mental Health O month of service
� ) System of Care
Per PATH Grant
PATH Annual Data Report to SAMHSA Per PATH Grant Application Instructions 1 Application
Instructions
Drafts to be submitted to managing entity for Contract Manager,
PATH Annual Reports Southern Region SAMH Program Office,
g� 9 1 and ME System of
DCF Central Office in Tallahassee in April or Care Staff
May of each fiscal year as requested
Forensic Services
Forensic
Monthly Report for Individuals on Conditional Release By 15th of each month 1 eamCoordinat
Guidance Care Center,Inc. 79 Contract No.ME225-3-27
07/01/2012
Exhibit D
MENTAL HEALTH & SUBSTANCE ABUSE REQUIRED OUTCOMES/OUTPUTS
(Part 1)
Provider Name: Guidance Care Center,Inc.
Contract#: ME225-3-27
Date: 07/01/2012
Revision#: NA
1. Mental Health Contracted Services
A. Required Performance Output Standards for Each Target Population Minimum
(including all clients paid for by SAMH,Medicaid and Local Match) Numbers to Be Served
1.Adult Mental Health
a.Adults with Severe and Persistent Mental Illness (SPMI)(MOO I 6)/(MHOI 6) 1,200
b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) 40
c.Adults with Mental Health Problems (M05302)/(MH5302) 250
d.Adults with Forensic Involvement(MOO I 8)/(MHO 18) 4
2.Children's Mental Health
a.Children with Serious Emotional Disturbances(SED)(M003 1)/(MH03 1) 150
b.Children with Emotional Disturbances(ED)(M0032)/(MHO32) 225
c.Children at-risk of Emotional Disturbances(M0033)/(MHO33) 0
Minimum Contract
B.Required Performance Outcome Standards for Each Target Population Standard
1.Adult Mental Health-Adults with Severe and Persistent Mental Illness
a.Percent of adults with severe and persistent mental illnesses who live in stable 93%
housing environment will be at least(M0742)/MH742)
b.Average annual number of days (post admission assessments)worked for pay 30
for adults with severe and persistent mental illness will be at least(M0003)/(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 90%
will be at least(M0744)/MR744)
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 15%
will be at least(M0703)/MH703)
4.Adult Mental Health-Forensic Involvement
a.Percent of adults in forensic involvement who live in stable housing 70%
environment will be at least(M0743)/MH743)
S. Children Mental Health-Seriously Emotionally Disturbed
a.Percent of children who live in stable housing environment will be at least 95%
(M0779')/(MH779)
Guidance Care Center,Inc. 80 Contract No.ME225-3-27
07/01/2012
b.Percent of children who improve their level of functioning will be at least 65%
(M0378)/MH378)
c.Pet-cent of school days seriously emotionally disturbed children attended will be 86%
at least(MOO I 2)/(MH404)
6.Children Mental Health-Emotionally Disturbed
a.Percent of children who live in stable housing environment will be at least 95%
(M0778)/(MH778)
b.Pet-cent of children who improve their level of functioning will be at least 64%
(M0377)/(MH377)
7. Children Mental Health-At-Risk of Emotional Disturbance
a.Percent of children who live in stable housing environment will be at least 90%
(M0780)/(MU780)
C.Required Internal Measures
1.Data Submission Outcomes for Mental Health
a.Percent of persons receiving state-contracted mental health service event records
which have matching mental health initial (purpose 1)admission records in the
Substance Abuse and Mental Health Information System will be at least(SAMHIS) 95%
(M0759)
Guidance Care Center,Inc. 81 Contract No.ME225-3-27
07/01/2012
Exhibit D
MENTAL HEALTH &SUBSTANCE ABUSE REQUIRED OUTCOMES/OUTPUTS
(Part 11)
11.Substance Abuse Contracted Services
A. Required Performance Output Standards for Each Target Population Minimum
(including all clients paid for by SAMR,Medicaid and Local Match) Numbers to Be Served
1.Adults with Substance Abuse Problems
a. Number of Adults Served(M0063)/(SA063) 415
2. Children with Substance Abuse Problems
a.Number of Children Served(M0052)/(SA052) 176
3. Adult At-Risk of Substance Abuse Problems- (NonGAA)
a.Number of adults participating in Prevention Services 25,309
(M0785)/(SA785)
b.Number of adults participating in Level I Prevention Programs NA
(M0767)/(SA767)
c.Number of adults participating in Level 2 Prevention Programs NA
(M0768)/(SA768)
d. Number of adults participating in Level I Prevention Programs who NA
complete 75 percent of the program's schedule of activities (M0769)/(SA769)
e.Number of adults participating in Level 2 Prevention Programs who NA
complete 75 percent of the program's schedule of activities(M0770)/(SA770)
4. Children At-Risk of Substance Abuse Problems - (Baseline-NonGAA)
a.Number of children participating in Prevention Services 5,000
(M0762)/(SA762)
b.Number of children participating in Level I Prevention Programs 1,123
(N1076 1)/(SA76 1)
c.Number of children participating in Level 2 Prevention 50
Programs(M0695)/(SA695)
d.Number of children participating in Level I Prevention Programs who 954
complete 85 percent of the program's schedule of activities(M0763)/(SA763)
e.Number of children participating in Level 2 Prevention Programs who 42
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 50%
services will be at least(M0755)/SA755)
b.Percent change in clients who are employed from admission to 20%
discharge will be at least(M0753)/SA405)
c.Percent of adults who live in a stable housing environment at the time 80%
of discharge will be at least(M0756)/SA756)
d.Percent change in the number of adults arrested 30 days prior to
35%
admission versus 30 days prior to discharge(M0754/SA754)
2.Adult At-Risk of Substance Abuse Problems- (Baseline-Non GAA)
a.Percent of adults participating in Level I Prevention Programs who
complete 85 percent of the program's schedule of activities will be at least 50%
(N1077 1)/(SA77 1)
Guidance Care Center,Inc. 82 Contract No.ME225-3-27
07/01/2012
b.Percent of adults participating in Level 2 Prevention Programs who
complete 85 percent of the program's schedule of activities will be at least 50%
(M0772)/(SA772)
3.Children with Substance Abuse Problems
a.Percent of children who successfully complete substance abuse 55%
treatment services will be at least(SA725)/(SA755)
b.Percent of children who live in a stable housing environment will be at 85%
least(M0752)/SA752)
c. Percent change in the number of children arrested 30 days prior to 20%
admission 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 participating in Level I Prevention Programs who
complete 75 percent of the prograrn's schedule of activities will be at least 50%
(M0765)/(SA765)
b.Percent of children participating in Level 2 Prevention Programs who
complete 85 percent of the program's schedule of activities will be at least 50%
(M0766)/(SA766)
5. Data Submission for Prevention Program Tool(baseline-Non GAA)
a. Percent of approved Prevention Descriptions completed within 30 days 50%
of contract execution.
C.Required Internal Measures
1. Data Submission Outcomes for Substance Abuse
a.Percent of persons receiving state-contracted substance abuse service
event.records which have matching substance abuse initial (purpose 1) 95%
admission records in the Substance Abuse and Mental Health Information
System will be at least(SAMHIS)(M0758)
Guidance Care Center,Inc. 83 Contract No.ME225-3-27
07/01/2012
Exhibi D T E ALHEALTH
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MONTHLY RAYS NTiApVA..N GH REQUEST
Ni On
TAN'fU.Wna YID Total YTO SAMM ROO-Dt RO-OCd(YT CS #flti Nart�TANF
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sakx,is R^w Si'*?,^f3 K`l'PX 3"a `$0 CIO X 0. x K $000 -w 0'
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Data inspentod and Approvod:
Guidance Care Center,Inc. 84 Contract No.ME225-3-27
07/01/2012
Exhibit E
�a.AGENCY NAME: CLIENT NON-SPECIFIC PERFORMANCE CONTRACT
I
WORKSHEET FOR REQUEST FOR PAYMENT
lb.CONTRACT No.: Adult Mental Health Forcost Genders pa c.FROM TO: �' id for on the basisof
a PROGRAM Alizatton,Columns D&J MUST NOT
le FEDERAL ID#: BE>than,and Col f t E MUST NO'T be
�g.vENDOR U(ff aiffereot than Fed ID): <than,the#of unit reported to the
h.ADDRESS(Number,City,State,Zip): MHSA Data Warehouse
Non-TANF-Units&Earnings TANF-Units&Eamin
YTD Total Units YTD Local
to Enrolled YTD Billable Match Units to YTD Total Non- YTD Total Non-YTD Total TANF YTD Total
Clients&Non- Medicaid Units Enrolled Clients YTD Total Units TANF Units TANF$Amount Units Eligible to TANF$Amount
Contracted Client-Specific to Enrolled &Non-Client- Eligible to be Eligible to be for Eligible be Billed to for Eligible
AICTMTY Rate Units Clients Specific Units Billed to SAMH Billed to SAMH Units SAMH Units
Cost Center D-(E+F) (CxH) (CxJ)
AlB C D E F G H I J K
Emergency Stabilization-502004
Crisis Stabilization(No TANF) $0.00 0.000G0 0,00000 0.00000 0.00000 0.00000` $0.00
Crisis Support/Emergency $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000, $0.00� 0.00000 $0.00
Inpatient(No TANF) $0.00 0.00000 0.00000 Own' 0.00000 0.00000' $0.00
Recovery&Resiliency Services-502018
Residential Level 1 $0,00 HOW 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Residential Level I-Enhanced Rates $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0.00000 $0.00
Residential Level 1 $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0.00000 $0.00
Residential Level 111 $0.00 0.00000 0.00000 0.00000 0,00000 0.00000, $0.00 0,00000 $0.00
Residential Level N $0.00 0,00000 0.00000 0.00000 0.00000 0.06000' $0.00 0.00000 $0.00
Room&Board w/Supervision Lev 1 $0.00 0,00000 0.00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00
Room&Board wlSupervision Lev 11 $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000' $0,00 0.00000 $0.00
Room&Board wlSupervision Lev III $0.00 0,00000 0.00000 0.00000 0.00000 0.00000, $0,00 0.00000 $0.00
Short-tern Residential Treatment $0.00 HOW 0.00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00
Case Management $0,00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0,00
Intensive Case Management $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000' $0.00 0.00000 $0.00
Assessment $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0,00000 $0.00
Day Care $0.00 HOW 0.00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00
Day/Night $0.00 0.00000 0.00000 0,00000 0,00000 0.00000, $0.00 0.00000 $0.00
Intervention-Individual $0.00 0.00000 H0000 0.00000' 0,00000 0.00000, $0.00 0.00000 $0.00
Intervention-Group $0.00 0.00000 0.00000 0.00000, 0,00000 0,00000, $0.00 0.00000 $0.00
Medical Services(No TANF) $0,00 0,00000 0.00000 0,00000, 0,00000 0.00000' $0.00
Outpatient-hrdividual $0.00 0.00000 0,00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00
Outpatient-Group $0.00 0.00000 H0000 0,00000, 0.00000 0.00000' $000 0.00000 $0.00
Sheltered Employment(No TANF) $0.00 0.00000 0,00000 0.00000 0.00000 0.00000, $0.00[
Drop-In/Self-Help Centers(No TANF) $0.00 0,00000 0.00000 0.00000, 0.00000 0.000001 $0.00
ki-Horne and On Site $0.00 0.00000 0.00000 0,00000` 0.00000 0.00000, $0.00 0.00000 $0.00
Outreach $0.00 0.00000 0.00000 0.00000' 0.00000 I 0.00000' $0.00 0.000G0 $0,00
Prevention $0.00 HOW 0.00000 0.00000' 0.00000 0.00000` $0.00 0.00000 $0.00
Respite Services $0.00 0,00000 0.00000 0.00000' 0,00000 0.00000, $0.00 0.00000 $0.00
Supported Employment $0.00 0,00000 0.00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0,00
SupportiveHousingtLiving $0.00 0.00000 0.00000 0.00000, 0.00000 1 0.00000, $0.00 0.00000 $0.00
Aftercare-individual $0.00 0.00000 0.00000 0.00000' 0.00000 1 0.00000` $0.00 0,00000 $0.00
Aftercare-Group $0.00 0,00000 0.00000 0.00000, 0.00000 0.00000, $0.00 0,00000 $0,00
Information&Referral(No TANF) $0.00 0.00000 HOW 0.00000, 0,00000 0.00000' $0.00
Mental Health Clubhouse Services $0,00 0.00000 0,00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00
Recovery&Resiliency-FACT Teams-502018
Fact Team(No TANF) $0.00 0,00000 0.00000 0.00000 0.00000 0.00000' $0.00
Recovery&Resiliency CCST-502018
CCST-Individual $0,00 0.00000 0.00000 0.00000 0,00000 0.00000, $0,00 0,00000 $0,00
CCST-Group $0.00 0,00000 0,00000 0,00000 0.00000 0.00000, $0,00 0.00000 $0.00
Recovery&Resiliency -Incidental Expenses $0.00
Incidental E nses $0,00 0.00000 0,00000 H0000 0,000001 0.00000, $0.00 0.00000 $0.00
Guidance Care Center,Inc. 85 Contract No.ME225-3-27
07/01/2012
Exhibit E
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C N4 R.rJREt�f'S B,fE'fd 7AT..HEALTH(Fs9a TANF
MONTHLY PAYMEN T1ADVANCE REQUEST
T ANF fna3tlo1j; YTO ttlo YTp aAlo x
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t use +ax XXXXXXX $000 $0,00 SX.00 XXXXXXX "wfa.£€a 090000
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Guidance Care Center,Inc. 86 Contract No.ME225-3-27
07/01/2012
Exhibit E
a. AGENCY NAME CLIENT NONSPECIFIC PERFORMANCE CONTRACT
b. CONTRACT No,: WORKSHEET FOR REQUEST FOR PAYME For cost renters paid for on the basis of
c. FROM: T0: Children's Mental Health utilization,Columns D&J MUST NOT BE>
d PROGRAM: than,and Column E MUST NOT be<than,
e FF.DERAI_ID# --- the#of units reported to the MU SA Data
g. VENDOR ID(If different than Fed ID): _ Warehouse
h. 'ADDRESS(Number,City,State,Zip):
Non TANF'Uniti&Earnm s T%WF-Units&Earriin s
YTD Total YTD Local
Units to Match Units
Enrolled YTD Billable to Enrolled YTD Total YTD Total YTD Total YTD Total
Clients& Medicaid Clients& Units Non-TANF YTD Total TANF Units TANF$
Non-Client- Units to Nan-Client- Eligible to Units Eligible Non-TANF$ Eligible to Amount for
Contracted Specific Enrolled Specific be Billed to to be Billed to Amount for be Billed to Eligible
ACTIVITY Rate Units Clients Units SAMH SAMH Eligible Units' SAMH Units
Cost Center D-(E+F) (CxH) (CxJ)
A-7 � B C D E F O H I J K
Emergency Stabilization-503001
Crisis Stabilization(No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000` $0.00
Crisis SupportlErnergency $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00 $0.00
Inpatient(No TANF) $0.00 0.00000 0,00000 0.00000 0.00000 0.00000 $0.00 -
Recovery&Resiliency Srvs-503013
Residential Level 1 $0.00 0,00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00
Residential Level I-Enhanced Rates $0.00 0,00000 0,00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00
Residential Level11 $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0.00' $0.00
Residential Level III $0,00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0.00, $0,00
Residential Level IV $0.00 0.00000' 0.00000 0.00000, u0000 0.00000' $0.00 0.00' $0,00
Room&Board w/Supervision Lev 1 $0.00 0.00000 0.00000 0.00000 0,00000 0.00000, $0.00 0.00' $0.00
Room&Board wlSupervision Lev II $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00, $0.00
Room&Board wfSupervision Lev III $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00
Case Management $0.00 0.00000 0.00000 0.00000 0.00000 0.00000. $0.00 0.00, $0.00
Intensive Case Management $0.00 0.00000 0.00000 0,00000 0.00000 0.00000` $0,00 0.00' $0.00
Assessment $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000' $0.00 0.00. $0.00
Day Care $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00. $0.00
Day/Night $0,00 0.00000 0.00000 0.00000, 0.00000 0.00000' $0,00 0.00 r $0.00
Intervention-Individual $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00
Intervention-Group $0.00 0,00000 0.00000 0.00000` 0.00000 000000' $0.00 0.00 $0.00
Medical Services(No TANF) $0,00 0.00000 0.00000 0.00000' u0000 0.00000' $0.00
Outpatient-Individual $0,00 0.00000 0.00000 0.00000' 0.00000 0.00000 $0.00 0.00 $0.00
Outpatient-Group $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 OAO' $0.00
In-Home and On Site $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000' $0.00 0.00' $0.00
Outreach $0.00 0.00000 0,00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00
Prevention $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00
PreventioNtntervention day $0.00 0.00000 0.00000 0.00000' 0.00000 0,00000 $0,00 0.00' $0.00
Respite Services $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000` $0.00 0.00' $0.00
Supported Employment $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00, $0.00
Supportive Housing/Living $0.00 0,00000 0.00000 0.00000' 0,00000 0,00000' $0.00 0.00' $0.00
Aftercare-Individual $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0,00 0.00' $0.00
Aftercare-Group $0.00 0.00000 0,00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00
Information&Referral(No TANF) $0.00 0,00000 0.00000 0.00000' 0.00000 0.00000' $0.00 $0,0
Mental Health Clubhouse Services $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00
Recovery&Resiliency Comprehensive-
Community Service Team-503013
CCST-Individual $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000, $0.00 0.00, $0.00
CCST-Group $0.00 0.00000 0.00000 0,00000 0.00000 0,00000 $0.00 0.00' $0.00
Recovery&Resiliency -incidental Expenses
Incidental Expenses $0.00 0.00000 0.00000 0.00000' 0.000001 0.00000 $0.00 0.00 $0.00
Guidance Care Center,Inc. 87 Contract No.ME225-3-27
07/01/2012
Exhibit E EX"tell E12
�............. „.m ,.. ADULT SUBSTANCE ABUSE
TA0
MORTHLYPAYMENTakDVARCE REQUEST
..`b"F.,PCS iGtr:,Re✓r �+�`....aH rJ .... ........... ...._ _..�.........._..w. �w.v»..._ .....
Sga€acSAetR Tmlf ._ ......_.._.,.,__...... __....., m.....m �...,.�- ,....,._...,,.....,___,
t utxttss g Level Y%;r Tas1a4 Y"'St?SR3.tH DIfettnee a of TAtt l"Umite
sarlheActa^�ay Ehgpble T. dYS TPO f*ardfor fY'TO Unpixt .Amountaue Cost conutr Pao fortlus
PART t,-_E�N1He"S _ _ tin faarred Earn{m Ternm Ptix tedShare :ovmd unaapme Mlmth
x$¢nat the f,("at f
'G enaea a Trom 1
tf >X. '0 af, euh lw,tY ea;
tTudgetEonty6,3<a4K6ia JaW'R9f "-Ontha R le,S. ..rof tCoi.c 0
t a t!7 �ssx 4 f»t tees ttr}^2Ee r,' tr'a43i ht 1e.0€.3�ax�z�.,t -M
Y rYtu#,arY¢$ Afferr+aa� ralSC,BtXI .
aRe ,are i 1XT n 3 #XXX $ rfP � f
t�fam aR ?XX »t6a : "3.D xK'X,x.,XA S000 6s`"t`o
a a € a X _, r t 0 a
r aT O,, XXXXX S00 � oaf TAX, so'do 66,50
,s
e tam a-ti' ua1 t x X a XX P X+S $P aT& X XX Xt
,u 00 tb`f3606 i
a0 lok"W*lt Pz was€ X XX,-"'X sq 60 S001 XXx X X X X S' 00 0
„i
E
10 1"' � �X� ta:1 !r
Yt
.5 sx _ 13 i.x SO IM, t) va
)ReS a# e€-fnss ^.ca fF Eee 4;,fXXX4 z000 so er€ xeXXXXL 'a00 CY.r'J 00
p# 141 5 tz <"A:',7'X
fRE� ,a€te ,XXX X$0, $000 XX +tXX S =03 "GO000
�5 'rX „ < $2€0 X;a.
Re,
ate cerm s x2X X XX ^1000 '. 0'SO rax5`ZXX 00 0`r000
OF £
^.rasa r rt eaXs� aa �<�'X XX n 66 a0 a 5 t Xx X X X 50 0,00000
Xti < S 3
IX erca M4"'4uW Y xXXX A X 0,A $O S XXdXXXX soho 0 WOOD
r am&. ra"f m'X Xe sS .a,eat "XX R XX. it S R j .n a
a 0 > trX 500 X 00
_^rfJ
R tm^,A o 3,1 mSvaw nUe fr XXX10 XX so011D SOW XXXa;XXX
€restervM&Affemmre Tq&ai E.XO .taSf.€i3<'i
$t}.pCt Stt Gt> 5€F.€3Q Sfl.OU $U.t3d?
Fexee
os:araea'txsare@�� �i,it .��.
naruieuNs&f xgreaasa�
aE,
t+ apt a"I""a a.`tXX.a.X,r $010 so GO M X XX"),XX 1.000
l ncoenw EXpen aT*lot 3tT.G S ,cN3 SOAR S040 Std_4c4
00 SC i 0 SRk S bA SQ,00
h,Less Recoupment of Mterest= $0,00
t,LessRsacavpmentatA&ance $0,00
i
TOTAL Ah1MMT M 9,4E DAYP:9ENTaA t§fANCE 54D.CtC3
€ VTp aaXamr YTN+Wteettv I YT iY bua1a 11 YTp ArkraraeTa
€arnecA € Recces¢ ed Advanced 8ahsnee
PART 2 Fi RDIN DI
STRIBUTION
N
e srmtk.&ercat
a
...m.... N.,.o.;�.,... TOIALAt9 kLEjT f P.€E,ts'sttCrt3f. ... ..........P.i.'q)
8, DIALW tPdT OF to P`YYd x T 5,.:
PART T.t ERFkTM�"AYiJ�!�APPRt'34'#iL
NT,. f r r«ar ti' T'=u.P to. "e 2r„Rar ate na ne ar€ae1r*r€t:Xath ttxs WRF1,t s ar®'S rArh"air MOf Of 3 cr�rtt l w'is E..
4ztrataez f.,t=ss"W,'fhA a+,a ra and r.aeaz..r'ct rtala naa 04 M E€et u,,,„s3r !zt"AWhe caz'arart.
.,. ...... , e .. .,.. ....,w,. .�,................4
«tt i �_ Ttt as
Date§xdsr+SS:S`$eCm tdgXN
.. ........... ....a„m.,,.m..,......,....,,: .,,.,.�.�.,,,..
Date fn,ttec€ns#and Apprtoted,
Guidance Care Center,Inc. 88 Contract No.ME225-3-27
07/01/2012
Exhibit E
a AGENCY i3t &' CUENT NON-SPECIFIC PERFORMANCE CONTRACT
WORKSHEET FOR REQtIEST FOR PAYMENT I For cost cen irm paW for on 441
b. CONTRACT No.: Adult Substance Abuse basis of W"&udnn,Norio rws,D&
c. FRONt. To: J MUST NOT i than,and
d PROGRAM Column E ANJS'rr P4 T the<tairt,
e FEDERAL ID#: the#of units rep the
g. VENDOR O(If differ than Fod ID): � MHSA Data' erphou e ,
h. ADDRESS(N mber-City,State,Zip):
Non-TANF Units&Earnings TANF-Units&Earnings
YTD Total YTD Local
Units to Match Units YTD Total
Enrolled YTD Billable to Enrolled YTD Total Non-TANF YTD Total YTD Total
Clients& Medicaid Gents& Units Units YTD Total Non TANF Units TANF$
Non-Client- Units to .Non-Gent- Eligible to Eligibleto TANF$ Eligibieto Amountfor
Contracted Specific Enrolled Specific be Billed to be Bifled to Amount for be Billed to Eligible
ACTIVITY Rate Units Clients Units SAMH SAMH Eligible Units SAMH Units
cost Center D-(E+F) (CxH) (Cxd)
A 1 C D E7 F G H i J K
Treatment&Aftercare-603007
Assessment $0.00- 0.00000 0.0000o. 0.00000 0.0woo 0.00000 $0,00 0.00000 $0,00
Casektan��gcxnrxrt $000 0.00000 0.00000 000000 0.00000 0-00000 $0,00 0.00000 SHO
Crisis SuppWkmergency $0.00 0,00000 0,00000 0,00000 0.00000 0,00000 $0,00 0,00000 $0,00
Days C are S0.00 0,00000 000000 0.00000 0.00000 0.00000 $000 0,00000 S0.00
Day�NgM $0,00 0.00000 HOW 0,00000 0.00000 0.00000 $0.00 0,00000 $H0
In-Hone&On Ste S0.00 0,00000 0.00000 0,00000 0.00000 000000 S0,00 000000 So.00
ntensive Case Wrogement $0,00 0-00000_ 0,00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0,00
ntervenWn-Indmckiel S000 0,00000 0,00000 0,00000 0,00000 0.00000 So.00 0.00000 $0,00
nterventnn-Group $0,00 0.00000 0,00000 0.00000 0,00000 0.00000 %00 0,00000 $0.00
Medcai Se"ces(No TANF) S0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0,00
Whadone Wntanance(No TANF) $0,00 0,00000 000000 0,00000 0.00000 0,00000, $0,00
Ou paent-Indiv,dwi So.00 0 00ooa 000000 0,00000 000000' 0,00000 $0.00 0,00000 $0.00
Ou"hent-cioup $0.00 0.00000 0.00000 0.00000 0.00000 0.000oo $0,00 0,00000 $0,00
OtAreach S0,00 0.00000 0_00000 0-00000 0.00000 0.00000 $0,00 0,00000 S0.00
Residenhal Level $0.00 0,00000 0_00000 o.o0000 0,00000 0,00000 $0,00 0,00000 $0.00
Resrienual Level I-EntoNed Rates S0.00 0.00000 000000 000000 0,00000 0.00000 $0.00 000000 $0.00
Residential Level ti $0,00 0,00000 0.00000 0,00000 HOW' 0,00000 $0,00 0,00000 $0,00
Residential Level III S0,00 0-00000 000000 0.00000 0.00000 000000 $0.00 000000 S0.00
Res idenW Level IV $0.00 0,00000 0.00wo 0.00000 0,00000 0,00000 $0,00 0.00000 $0.00
Pespte se"L es S0.00 0,00000 0,00000 0,00000 0 o0o0a 000000 $000 0.00000 S0.00
Supported Emoayment $0,00 0,00000 0.00000 0.00000 0.00000 0.00000 $0,00 0.00000 $0,00
supp,-Uve Hc�sincvtwng $0,00 0,00000 0.00€,00 0,00000 0,00000 000000 S0.00 0.00000 S0-00
TASC $0,00 0.00000 0,00000 H0000 0,00000 0,00000 $0,00 0,00000 $0.00
A1te�r e e-IrdIw,ual $0.00 0.00000 0,00000 0.00000 0.00000 0.00000 S0_00 0,00000 So.00
Arem are-Group $0,00 U0000 0,00000 0,00000 U0000 H0000 $0,00 0.00000 $0,00
Room&Board w,Su sin Lev I S0.00 0,00000 0.00000 0.00000 0.00000 000000 S0.00 0.00000 $0,00
Room&Board w/Supemwn Lev ii $0.00 0.00000 0,00000 0.00000 0.00000 0.00000 $Ho 000000 $0.00
Room&Bald W SL€peruSK n Levi1 $0.00 0.00000 0.00000 0.00000 0.00000 0,00000 $0,00 0,00000 S0.00
Recovery Support-Irdvaual $0,00 U0000 0,00000 0,00000 H0000 0,00000 $0,00 0.00000 $H0
Recoyef rj s plo!-G(rkp S0.00 0.00000 0.00000 0-00000 0.00000 0.00000 $0,00 000000, S0.00
ntormation&€�eferai(No TANF) $0,00 0,00000 H0000 0,00000 0,00000 0.00000 $0.00� _ .
Detoxification-603006
SubstanceAbuseDe#ox(No TANF) $0,00 0=00 0.00000 H0000 0,00000 0.00000 $0.00�
otAparierd Detouficarion(No TANF) $0.00 0.00000 0,00000 0,00000 0,00000 0,00000 $0,00
Prevention-603006
Prevenfton $0,00 0,00000 0,00000 0,00000 0,00000 U0000 $o,a0 0,00000 $0,00
nformation&Referrai(No TANF) S0-00 0.00000 0.00000 0,00000 0,00000 0-00000 $0.00
FACT Teams-xxxxxx
Fact Teen(No TANF) $Uo 0,00000 0,00000 0,00000 0,00000 0,00000 $0.00.
Incidental Expenses
wRjeo.ai E,penses S0,00 000000 0,00000 0-00000 0,00000 0.00000 $000 0,00000 $0,001
Guidance Care Center,Inc. 89 Contract No.ME225-3-27
07/01/2012
Exhibit E
EXHIBIT E-t
CC ll±P�.u:T It. CH<LOREN SUBSTANCE ABUSE
re+�rr*nh:L,,.yt yip: N.-TANF
m ontn�rSm y" t2 MONTHLY PAYNlEHT/ADVANCE REQUEST
PE tTE re,�l i0 fi
44 elO CR a3 taarrant tnat Pea tom- -
.•c>Z N E as ilium tar,c ar'.Mate,apt:
P AR41-EA!{H lN4 a��T^��'3p�4CItEtItl NOfl- YTO I.- YT6 tARAN 4- OMIr ". FfOref4q SRa�f f.4tl>Unlf3YA Ctlif C4niM YCf NOn-T A/tP
TARP 1,ira(og EI(Q(WQNOR TA PPaia SOr iYT0 Unpaid (.-a) UNt not. Utkta Pa[d for
L-t IOr ttte TARP SEamad e-oiriga EarNnQiS Enla hio'M
Achy sty o rtry
rot Ana
mjust fhi coat
r c.r cxmv sty any o.antena from
[(eoLY-ew alr CoeS ao atlat
5 WQet E.My 60Jt OeQ3 rronEte One tataf z
AC TOATY+Coat Cen Wre (ttgmEMtS C'i) (.gitOt l^3iWglAt} (SW.$-zci tj r9Fn81r[(rtp7• A®Cn F�[F�I to E'irtOStAt G01-7%CPl 1
taa turn aa107
<aeaaamant �'�N,X X;t-< so 00 $OOO a'X"4XXX'X $000 0L414O6
C aae Management XXXXXXX 50.00 $000 XXXXXXX $0.00 0.00000
'Z re
�a suy-parcB narge�ct x X:X XXX $0 00 S000 XXXXXXX .$0 00 0 00000
Oay Care XXXXXXX $0.00 i000 XXXXXXX $0.00 0.00000
C ay'!t�}nr Xx a' '-- K 5000 $00rj 'X X,,,X" so 00n{d}000
m i+amea0 SHa XXXXXXX $000 50.00 XXXXXXX $0.00 000000
N fenawa Lnee r-<ana�amarr XX XXXXX $000 SO.00 XX,XXXX 5000 00'1000
trs tAnenttco-Fn6ttsuai :XXXXXXX $0-00 $000 XXXXXXXX 50.00 0.00000
.auH .is XXX XX SO CIO so CIO X.XX''+:XXk $000 000000
ea El tcai S-Q..
XXXXXXX $0.00 $000 XXXXXXX $0.00 0.00000
llttnaaooa<llaicnnanrnt ".,XXX," $000 S000 ":.c<i:XI1 5000 000000
a UiRaft t-�ndi actual XXXXXXX $000 $000 XXXXXXX SO-00 0-00000
u�p artaw,Graop XXxYsXX so 00 sow ;(''XXXX\ S0,00 000000
0 utreaan XXXXXXX 5000 $000 XXXXXXX $0,00 0.00000
aaaei*taiLt-.air XX,,XX $06O $000 XXXXXXX $0.00 01-11000
R ennennal town -t nnaocco Nate XXXXXXX $000 $0-00 XXXXXXX SOOnOt�� 0.00000
R ABNaPttat La;Bk=Y ;�;kx hXXX SO OO $0 UO k"-lX"I XIX SO.00 000000
R AatleAtlAs t.avai XXXXXXX $000 S0.00 XXXXfXxx 50.00 000000
eaa anxa�ta.-e�'u :XXhh X7CX $000 S0 00 XCXxxxx SO 00 000000
R Aepse sar<.+oaa XXXXXXX SOOO $0.00 XXXXXXX $0.00 0.00000
$ucc4nra EmGrnymaol CXXXXAX 50.00 $'000 ,0'X'XY.x $000 0'iOQO0
s uppPnNa HcuarnyLlvmg XXXXXXX SOOO $000 XXXXXXX $000 000000
T-3C '%.a"'N: X $
O00 $000 XXl(%\ ?C $0 00 0w000
,Xaeraarc-ndivuuat XXXXXXX SO00 $0.00 XXXYYIXX $c00 0.00000
-atroa*a-ti,rrkp iX XXXXX $ X 0 00 S0 00 :1 K XXXX 50.00 G. 0000
R-a e cars.vtt upenacwe Lal i XX.XXXXX $000 $000 XXXXXXX $000 000000
P aora a eo ti-S�.0an�a,un L.,U XXXXXXX so 00 S000 XXXXXVc 50.00 0 W000
Rcara ad cant XVSvfxrXtawrs t- XXXXXXX $0.00 5000 XXXXXXX 2000. 0.00000
w aca,-arr s4ncorz-rt 7t1-1 XX X T.X tX $0.00 1000 XXXXXXX $000 0.00000
P I, w+p ScF�oI-oroay x RXx7.X S000 S000 k;U XXX-X S000 0 Ea1000
xe mrm aeon a Nahrrat XXXXXXX
10 $0 XXXX'XXX 1000 0.00000
T-i-ta Atteoa-Totm- $.00 $0,04
$0.00 S0.00
•toxitlCBflWt-C61A03
sic-.zasce.wuee catcA ?c.XXXa;ex $000 $000 XXXXXXX S0.00 0,00000
as*parceniaamMnCatwn xx XxXx'X �n0 10m XYCxxxX $0-00 0,00000
O a(OXlmatfdO Totaf• £$:Q2...._._-_ 00 4G QP WOO $0-00
SP-MOO NOn- YT0 TOtat YTO SAMti HO OfnipmnGM PrOra{ed SRAre AtTqunt 6Le CaAt Linter aOf HOn TAMP
-MITI-E ARNINCA Conn-d; TARP Pand[nQ Eilu'wo H0' TA FPaid for (YT0 Urpa10 (0-0) UNt Rate UW.Paid rot
Lives for itfa TANT SEemed EArof ng• E tole Month
_T^ o"N"YP rvfy -
adjUat At4i Coat
r Or 4ciiYsty dnty Cinlero Agrrr
CfcG1.7-<at40 CW 5 that
s Wgel EnfPtySg210QP? (CO1.M of tT-ttie FTrA total tar t001.s Or
T (• n ( 1• tx¢ 1 P+
P raventtga XXXXXXX S000 SO 00 X.XX?CX}(X 5000 0.00000
n iprtn at[ana QaRtrrat XXXXXXX $0-0R SO QO x'X,YRXXX $0-00 0.00000
Pr-niton TOW SO.00 $0.00 50.00 WOO S0_00
ACT T wrne-YA%%taX
�Pact-eam AC Xx,XX XXXSri t7� iXX XXX' $4.00 0.00006
PT Total+ SO.60 $0.00 $0.00 $OA0 SOAO
neidintai Expanaea
�tncwmtai Ex=X#I 10 06 0 00004
lncraedtAl It zpenre T oat= $0,00 sow-
-AL. SO.- $0.00 $0.00 SO DO SOW $0.00
C.kya sa ttee corssAssor ricP.a-x-and ot.P.tE aPPxwea d>A1T*ren[in irneas ofthe prorated strive
h.Lana Raaoup tot intrrcus
i.L-RRcottorrf.9 Ad-d
T t t f P
YTO Ittbreak YTO Mt.-" YTa Fonda YID Ad-
L_
P plT 2-_IUN01N 3 O�ST/t i6 i)TfOH 'PAr AfC vee iPor ArE uae tPAt'PMv wAe Per Prpv.Ua♦ (P Or sit:UAt) O.Od $O CU Soo.
C[trrAllt,W VAR Re
so OQ
soon
G�t�iZr-���t.0 i��� 1rE li ttll o:cl k.iimC&r --.,- ___.. _.� » EQs TNlP4Ri tfe R uaYd treca x-�,tnt UDR PVRd
U
k TOTAL AMOUNT tFfM AQV ANCE= SO 00
r- I. TOTAL A/.taUNI Ef18PAYME NTH $0A0
PARTS-CBR7IFICAT�Ni6 a'�wip`'wN°'ROVb$,L
m, icarttYy the AbW*mto Aec X-Brid to agraen*era vrittr stole A-%roVS records andwiththe term-oftNa ageneVse Mva Ydth tfre NE
e .
Pckdmnnaty.I cenrtXttwt ma atierA dmgg-d--d AirviCe eves date ha¢t g-Auto--d to the M11E in atocordanc«_O-i the aantr
TiOt Oate
For ME Contract Manauar one only; r Y
Oahe Htyniae R vicrov t
DAt4 Csooete/SRn/IOef R6HA'ed:
Dmat bwpoctad and Appr-d:
Apprqv*d
Guidance Care Center,Inc. 90 Contract No.ME22S-3-27
07/01/2012
Exhibit E
a. AGENCY NAME: CLIENT NON-SPECIFIC PERFORMANCE CONTRACT ,
WORKSHEET FOR REQUEST FOR PAYMENT For cost centers paid for on the
b. CONTRACT No.: Children's substance abuse basis of utilization,Columns 0&J
c. FROM To: i MUST NOT BE>than,and Column
d PROGRArr � EM LIST NOT be<than,lhe#of
e FEDERAL ID#:
g. VENDOR ID(if different than Fed ID): ( units reported,to, le MHSA Data
h. ADDRESS(Number,City,State,Zip): Warehouse
I
Non-TANF-Units&Earnings TANF-Units&Earnin s
YTD Total YTD Local
Units to Match Units YTD Total
Enrolled YTD Billable to Enrolled YTD Total Non-TANF YTD Total YTD Total
Clients& Medicaid Clients& Units Units YTD Total Non TANF Units TANF$
Non-Client- Units to Non-Client- Eligible to Eligible to TANF$ Eligible to Amount for
Contracted Specific Enrolled Specific be Billed to be Billed to Amount for be Billed to Eligible
ACTMTY Rate Units Clients Units SAMH SAMH Eligible Units SAMH Units
Cost Center D•E+ (CxH) (CxJ
A B C D E F G H 1 J K
Assessment $0.00 0.00000 0.00000 0.00000 0.00000 0,00000 KOO 0,00000 $0,00
Case Management $0,00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 OD0000 $0.00
Crisis Suppory Emergency $0.00 0.00000 0.00000 0.00000 0.00000 0,00000 $0,00 0.00000 $0,00
Day Care KOO 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0,00
Day/Night $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0.00 0,00000 $0.00
In-Home&on Site $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Intensive Case Management $0.00 0,00000 0.00000 0.00000 0+00000 0.00000 $0.00 0.00000 $0.00
Intervention-Individual $0.00 0.00000 0,00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Intervention-Group $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0,001 0.00000 $0.00
Medical Services(No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00
Methadone Maintenance(No TANF) $0.00 0.00000 0.00000 0.00000 0,00000 0.00000 $0.00{'
Outpatient-Individual $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.GO 0.00000 $0.00
Outpatient-Group $0,00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0,00
Outreach $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Residential Level 1 $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0.00 0.00000 $0.00
Residential Level I-Enhanced Rates $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Residential Level 11 $0.00 0.00000 0.00000 0.00000 0,00000 0.00000 $0,00 0.00000 $0.00
Residential Level 11 $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Residential Level N $0.00 0,00000 0.00000 0.00000 0,00000 0.00000 WOO 0.00000 $0,00
Respite Services $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Supported Employment $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0.00 0.00000 $0.00
Supportive Housing/Living WOO 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
TASC $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 WOO
Aftercare-Individual $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0.00 0.0000 $0.00
Aftercare-Group $0.00 0.00000 0.00000 0.00000 0.00000 0,00000 WOO 0.00000 $0.00
Room&Board w/Supervsion Lev 1 $0.00 0.00000 0.000GO 0,00000 0.00000 0.00000 $0.00 0.00000 $0.00
Room&Board w/Supervision Lev A $0,00 0.00000 0.00000 0.00000 0.00000 0,00000 $0.00 0.00000 $0.00
Room&Board w/Supervsion Lev q $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 WOO
Recovery Support-Individual $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0,00 0,00000 $0.00
Recovery Support-Group $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00
Information&Referral(No TANF) $0.00 0,00000 0,00000 0.00000 0.00000 0.00000 $0.00
Detoxification-602001
Substance Abuse Detox(No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00
Outpatient Detoxification(No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00?
Prevention-602002
Prevention $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0,00000 $0,00
Prevention/Intervention-Day $0.00 0.00000 0.00000 0.00000 OA0000 0.00000 $0.00 0.00000 $0.00
Information&Referral(No TANF) $0.00 0,00000 0.00000 0.00000 0.00000 0.00000 $0.00
Incidental Expenses
Incidental Expenses $0.00 0.00000 0.00000 0.00000 0,00000 0.00000 $0.00 0.00000 $0.00
Guidance Care Center,Inc. 91 Contract No.ME225-3-27
07/01/2012
Exhibit F
Minimum Service Requirements
The provider and its subcontractors shall be knowledgeable of and fully comply with all
applicable state and federal laws, rules and regulations, as amended from time to time,
that affect the subject areas of the contract. Authorities include but are not limited to the
following:
I. PROGRAMMATIC AUTHORITY (FEDERAL)
A. Mental Health
42 U.S.C. 300x to 300x-9 (Block Grant for community Mental Health Services)
httr)://www4.law.corneI1.edu/uscode/42/ch6AschXVIIpB.htmI
B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes)
httr)://www4.law.corneI1.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)
httr)://www4.law.cornell.edu/uscode/html/uscode42/usc sup 01 42 10 6
A 20 XVII 30 Q 40 ii.html
42 CFR, Part 54 (Charitable choice)
htto://www.access.ar)o.gov/nara/cfr/waisidx 03/42cfr54 03,html
45 CFR 96.120 — 137 (SA Treatment& Prevention Block Grants)
/45cfr96 03,html
Restrictions on expenditures of SAPTBG
45 CFR 96.135
/45cfr96 01.html
C. Substance Abuse-Confidentiality
42 CFR, Part 2
htt ://www.access. o.gov/nara/cfr/waisidx 03/42cfr2 03,html
D. Health Insurance Portability and Accountability Act (HIPAA)
45 CFR 164
/45cfr164 03.html
Guidance Care Center,Inc. 92 Contract No.ME225-3-27
07/01/2012
E. Social Security Income for the Aged, Blind and Disabled
20 CFR 416
http://www.access.gpo.c
://www.access.gpo. ovinara{cfr/waisidx__03f20cfr416 03.html
F. Endorsement and Payment of Checks Drawn on the United States Treasury
31 CFR 240 relating to SSA
htto://www.access.gpo.gov/nara/cfr/waisidx 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:Hwww.access.gpo.gov/nara/cfr/waisidx 03/45cfr260 03.html
Section 414.1585, F.S.
http://www.leq.state.fl.us/statutes/index.cfm?App mode=Display Statute&Search
_String&URL=0400-0499/0414/Sections/0414.1585.htmI
H. Positive Alternatives to Homelessness (PATH)
Public Health Services Act, Title V, Part C, Section 521, as amended
42 U.S.C. 290cc-21 et. seq.
htto://www.law.corneI1.edu/uscode/htm1/uscode42/usc sup 01 42 10 6A 20 111
-A 30 C.htmI
Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public
Law 101-645
http:Hwww4 law.cornell.edu/usc-cai/get externals gi?type=pubL&target=101-645
42 CFR, Part 54
httiD://www.access.ar)o.aov/nara/cfr/waisidx 03/42cfr54 03.html
1. Americans with Disabilities Act of 1990
42 U.S.C. 12101 et seq.
httr)://www,law.corneI1.edu/uscode/htm1/uscode42/usc sec 42 00012101----000-
.html
11. FLORIDA STATUTES
All State of Florida Statutes can be found at the following website:
ode=ViewStatutes&Subme nu=1
Guidance Care Center,Inc. 93 Contract No.ME225-3-27
07/01/2012
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
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
Guidance Care Center,Inc. 94 Contract No.ME225-3-27
07/01/2012
Section 985.24, F.S. Interstate Compact on Juveniles; Use of detention;
prohibitions;
F. Florida Assertive Community Treatment (FACT)
General Appropriations Act
htti)://www.fIsenate.gov/Welcome/i ndex.cf m?Q FI D=1 05701865&CFTOKE
N=34016817
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 them 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
http,//www,myfloridacfo.com/aadir/reference%5Fguide/reference guide.htm
111. FLORIDA ADMINISTRATIVE CODE (RULES)
A. Child Welfare and Community Based Care
All references to F.A.C. may be found at the following website:
httos-Hwww.f Irules.org/def ault.as
Rule 65C-12, F.A.C. Emergency Shelter Care
Rule 65C-13, F.A.C. Substitute Care of Children
Rule 65C-14, F.A.C. Group Care
Rule 65C-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
Guidance Care Center,Inc. 95 Contract No.ME225-3-27
07/01/2012
C. Financial Penalties
Rule 65-29, F.A.C. Penalties on Service Providers
Reduction/withholding of funds
Rule 65-29.001, F.A.C. Financial Penalties for a Provider's Failure to Comply With
a Requirement for Corrective Action
IV. MISCELLANEOUS
A. Department of Children and Families Operating Procedures
CFOP 155-10, Services for Children with Mental Health & Any Co-occurring
Substance Abuse Treatment Needs In Out of Home Care Placements
htto://www.dcf.state.fl.us/admin/publications/policies/155-10,Pdf
CFOP 215-6, Incident Reporting and Client Risk Prevention
htto://www.dcf.state.fi.us/publications/policies/215-6.pdf
B. Federal Cost Principles
OMB Circular A-21, Cost Principles for Educational Institutions
litto://www.whitehouse.gov/omb/circulars a021 2004
OMB Circular A-87, Cost Principles for State, Local and Indian Tribal
Governments
2004
OMB Circular Al 02, Grants and Cooperative Agreements with State and Local
Governments
litto://www.whitehouse.gov/omb/circulars a102
OMB Circular A-122, Cost Principles for Non-profit Organizations
2004
C. Audits
OMB Circular A-133, Audits of States, Local Governments and Non-Profit
Organizations
b/assets/a133/a133 revised 200
Z,pdf
Section 215.97, F.S., Florida Single Audit Act
ute&Search
Stria g=&Q RL=0200-0299/021 5/Sections/0215.97,htm I
Guidance Care Center,Inc. 96 Contract No.ME225-3-27
07/01/2012
Comptrollers Memorandum #03 (1999-2000): Florida Single Audit Act
Implementation
httr):Hwww.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
htti)://www,access.aDo.gov/nara/cfr/waisidx 06/45cfr74 06.html
45 CFR, Part 92 - Uniform Administration Requirements (State and Local
Governments)\
httiD://www.access.aoo.gov/nara/cfr/waisidx 06/45cfr92 06.html
OMB Circular Al 10, Uniform Administrative Requirements for Grants and Other
Agreements
htto://www.whitehouse.gov/omb/circulars/al 10/a110.html
E. Data Collection and Reporting Requirements
Rule 65E-14.022, F.A.C.
htti)s://www,flruies.org/gateway/ruieNo.asp?ID=65E-14,022
Section 397.321(3)(c), F.S., Data collection & dissemination system
httr)://www.leg.state.f 1.us/Statutes/i ndex.cf m?App,. mode=Display Statute&Searc
h Strina=&URL=0300-0399/0397/Sections/0397.321.htmI
Section 394.74(3)(e), F.S., Data Submission
htto://www.leg.state.f1.us/Statutes/index.cfm?Ai)r) mode=Disr)lav Statute&Searc
h Strina=&URL=0300-0399/0394/Sections/0394,74.htmI
Section 394.77, F.S., Uniform management information, accounting, and
reporting systems for providers.
ute&Searc
h String=&URL=0300-0399/0394/Sections/0394.77,htmI
CFP 155-2, Mental Health and Substance Abuse Data Measurement Handbook
ml
Guidance Care Center,Inc. 97 Contract No.ME225-3-27
07/01/2012
Exhibit G
ExhilitG:STATE FUNDING BYPROGRAM&ACTIVITY
Fiscal Year 2012-13
Provider NarneAQod.mce C.ae Center,Inc(GCC) „� Contract#j ...... .__ .,..... ...—
Adult Mental Health Children Mental Health
Activity/Cost Cemer TANF$ Unit TANF$ Chit
X=Yes Rate X=Yes Rate
1 2 3 4 5 6 7
Emergency Stabilization '502004 5030ot-
03. Crisis Stabilization (NoTANF)
.........,...F ,,. -__
Unit bed-day aru $323.77
(9,Crisis Support/13rergency
Unit:staff hour rr/yi�i�,
M. Inpatient(NOTANPI -
Uuit:'_-0-hrdoy If"�/>g�ilg%
Non-TANF= $I,112,03 Non-TANF= $15.677
Total Emergency Stabilization= $1,112,903 Total Emergency Stabilization= $15,677
Uncompensated Units= $222581 Uncompensated Units= $1,135
Recovery&Resiliency � iii .
01.Assessment _
Unit:contact hour
02.Case Management
..._ 2 ...—...._f
Unit:direct staff hour
o .* $60.45 _a
05.Day Care .,
Uoir:a-hod+ty
(X,. Day/Night
Unit:d-hrday
07.Drop•WSelflielpCenters(No-TANF) _
O8. Una:l r ery day .. 291.15
Unit:facility c" :�*. �
.._
and On Sie
direct staff hour
10, Intensive Case Managemrent
l;n it:ditectstaffhour i .,,,i .. .............. �% ��% i
It. Inter.entlon-Individual
Unit
:direct staff hour
12.Medical Services (NoTANF)
Unit:contact hour s f 390.47 ,r
....,..._... '� ] $390.47....�
14.Outpatient-Individual
Unit:contact horn
15.Outreach -
-
Unit:nond'uectstaffhour
16. Prevention
Unicnon-direct staffhour
17, Neventionlintervention-Day
Unit:4-hrday � '�✓ D�%/°�i/1 O%�f�✓���% -.._.�
18. Residential Level 1 f .. _...... _..
Unit:24-hr day
19.Residential Level lt
Caw24-hrday
20.Residential Level 111 .w -.,.�,.,...,..._,..z
Unit:24-hr day _.. .. .. ���
2L Residential Level IV - _ .�,--i/✓✓I//„v✓/
Unit:24-hr day
22, Respite Services
Unitconwct hour
21.Sheltered Employnient (NoTANF)
I hilt:4-hr day ,wro ...... ..f loom ,'� ,�
25. Supported Firprloyment -
Quit direct staffhour -� �( �, ,,
26,Supportive HousinglLiving -
_.,4 ,�
Unil:dircct staff hour
29.Aftercare-Individual , f
Unirdirect staffhour ��✓////lf/ $63.21--
30. Information and Referral(No TANF) -� --"
Unit staff hour
35.Outpatient-Group
Unir:cuntact hour
36, Raomand Board w/Supery is ion Level I -
._
Unit:24hrday
37. Roomand Bard w/Supervision Level ll
Unit:'_4hrday ........ _...', �
38, Room and Board w/Supervision Level 111
Unitr24hrday .� $88.25 �` � ...,
39. Short-term Residenli:d Treatment
[`-nit:Bed-Day _ ._ _ '%✓% %�/�/ ��n��,> PMtmmm
Guidance Care Center,Inc. 98 Contract No.ME225-3-27
07/01/2012
Exhibit G
Adult Mental Health Children's Mental Health
Activity/Cost Center TANF$ Unit TANF$ Unit
X=Yes Rate X=Yes Rate
1 2 4 6 7 9 11
40.Mental Health Clubhouse Services
Unit:Clubhouse staffhour i [ $37 71 � �� i�j �
_.
42.Intervention-Group
Unit:contact hour $15.49.,..,
43.Aftercare-Group
Unit:contact hour $15.80 t
.......
Non-TANF= Non-TANF= $440 00
TANF=E TANF
Total Recovery&Resiliency= $556,889 Total Recovery&Resiliency= $440,000
Uncompensated Units= $111,378 Uncompensated Units= $88.000
Recovery&Resiliency-FACT Team E 7$i1", ='I
34. FACT Temm (No TANF)
Unit:staffhour
FACT=
Total FACT= $0.00
Uncompensated Units=
Recovery&Resiliency-CCST 'm'
44. CCST-Inalividual
Unit:StaffHour i....$41 65,.. t „l�f%�%i0�'
Non-TANF= T714.331 Non-TANF=
TANF
_ $0( TANF
Total COST Services= $714,331 Total COST Services= $0
Uncompensated Units= $142,866 Uncompensated Units=
Recovery&resiliency-CCST-RACES. E:5'q�;;� Il',
44. CCST-Individual
Unit: Staff Hour ue
Non-TANF=
TANF=<.":
Total F.A.C.ES.Services= $0
Uncompensated Units=
Recovery&Resiliency-Commmdty Forensic k2 5030
19. Residential Uvel 11
�.
Unit:24-hr day
39.Short-term Residential Treatment
Unit:Bed-Day .,..
Non-TANF= Non-TANF=
TANF TANF
Total Forensic Services= $0 Total Forensic Services= $0
Uncompensated Units= Uncompensated Units=
Recovery&Resiliency-Incidental Expenses0
28.Incidental Fxpenses:General
- .� 5 ._ .....
_
Uuiteach$50spent $50.00 _-----
__$13,900€
28. Incidental Expenses:CCST-RACES.h W spent
-
Unit:eac
-
28. Incidental Fxpenses:Forensic
Unit:each$50 spent $SO.OQ $]0.00.0;
_
Non-TANF= $23,900 Non-TANF= $0
TANF $Ok TANF I;
Total Incidental Expenses= $23,900 Total Incidental Expenses= $0
Uncompensated Units= $4,780 Uncompensated Units= $0
Total Non-TAN F= $2,408,023 Total Non-TAN F= $455,677
Total TANF $Oi Total TANF 411,r ,
114
Total Mental Health Funds= $2,408,023 Total Mental Health Funds= $455,677
Guidance Care Center,Inc. 99 Contract No.ME225-3-27
07/01/2012
Exhibit G
Adult S ubs lance Abuse Children's Substance Abuse
Activity/Cost Center TANF$ Unit TANF$ [hit
X=Yes Rate X=Yes Rate
1 2 3 4 5 6 7
Detoxification
24. Substance Abuse Detoxification (No TANF)
Unit:bed-day
32. OutpatientDetoxi6cation (NoTANF)
Unit:d-hr day
" —
Total Non-TANF= 186,643 Total Non-TANF=
Total Detoxification= $186,643 Total Detoxification= $0
Uncompensated Units= $37,329 Uncompensated Units= ry
Prevention
16.Prevention
Unit:non d rect staffhour i % % /i l%%h $43.20
17. Prevention/Intervention-Day
Unit:4-hrday i% f L `; _ y
30. information and Referral(No TANF)
Unit:stat4'hour
Total Non-TANF= Total Non-TANF= $172,262
Total Prevention= $0 Total Prevention= $172,262
Uncompensated Units= Uncompensated Units= $34,452
Treatment and Aftercare 1w0I L 0119 3
01. Assessment
Unit:contact hour $7947
02,Case Management
Unit:direct staffhour i _.
04. Crisis Support/Buergency
Unit:staffhour _.....,.,3 .......$43.17.........„.,,
05. Day Care
Unit:4-hrday a
06, Day/Night
Unit:d-hrday
08.In-Home&On Site
Unit duct staffhour ? $70 11 ._ ..__._ _? i_._$70.11
10. Intensive Case Management
Unit:direct staffhour
It. Intervention-Individual
Unit:direct.vtaffhour $61.95 e'$6195 „
12.NledicalServices (NoTANF)
Unit:contact hour �ii ff� �� .
lii /%i` $390.47...i $390.47
__J
13. Methadone Maintenance (NoTANF)
Unit dosage ,,._...
14.Outpatient-Individual
Unit contact hour
$91.09 ' $91.09 j
15.Outreach
Unit:non direct staffhour ; $43.20 s $43.20
18. Residential Level I
Unit:24-hr day
19. Residential Level Il
Unit:24-hr day ? i
e
20. Residential Level IR
Unit:24-hr day
21. Residential I-evel IV
Unit:24-hr day =
9
22 Respite Services
..,_.. ...._,_,.. ,
Unit:contact hour
25. Supported FITloymant
Unit:direct staffhour
26_ Supportive Housing/living
... ...............
Unit:direct staffhour i
27,TASC
Unit:direct staffhour $59.22 $59.22r
29. Aftercare
Unit:direct staff hour } $63 21
Guidance Care Center,Inc. 100 Contract No.ME225-3-27
07/01/2012
Exhibit G
Adult Substance Abuse Children's Substance Abuse
Activity/Cost Center TANF$ Unit TANF$ Unit
X=Yes Rate X=Yes Rate
2 3 4 5 6 7
35.Outpatient-Group
Unit:Contact Hour
22.77 $22.77
36. Room and Board w/Supery is ion Level I
Unit:24-hr day fa
37.Room and Board w/Supervision Level H
............
Unit:24-hr day
.............
38. Roomand Board w/Supervision Level ill
.................
Unit:24-hr day
J
42.Intervention-Group
Unit:Contact hourry
$15.49�15.49 i
43.Aftercare-Group
Unit:contact hour
$15.80
..............
46.Recovery Support-Individual
Unit:direct staff hour
47.Recovery Support-Group
Unit:contact hour
48.Clinical Supervision for Evidence-Based Practices
Unit:contact hour
Total Non-TANF $345,979 Total Non-TANF $309.139
Total TANF E $0i Total TANF j $O�
Total Treatment&Aftercare= $345,979 Total Treatment&Aftercare= $309,139
UricompensatedUaits %9,196 Uncompensated Linits $61.828
Treatment&After-CCST
IINw
44. CCST-Individual
Unit: Staff Hour
Non-TANF= Non-TANF
TANF QV TANF=i
L-----------
Total CCST Se"ces= $0 Total CCST SeNces= $0
Unconipens ated LWts= $0 UncompensatedLinits=
Incidental Expenses E::w=1ow
28.Incidental Expenses
Unit:each$50 spent
$50.00
Total Non-TANF= $44,154 Total Non-TANF= $0
Total TANF $0i
Total TANF= $0
Total Incidental Expenses= $44,154 Total Incidental Expenses= $0
Total Non-TANF= $576,776 Total Non-TANF= $48 1 AOI
TOW TANF W
Total TANF=i Sol
Total Substance Abuse Funds= $576,776 Total Substance Abuse finds= $481,401
Guidance Care Center,Inc. 101 Contract No.ME225-3-27
07/01/2012
Exhibit H
FY 2012-2013 Ix1IIB IF H:I'UNI)IN(;DE.FAIL
Pco �dct Naatx Cd d,rnc i nv(c�t I (CX'C) l Cont u-#r N4 225 3 2-7I Rev i,i....4Ft _
_ MINTAI.Hr AUTI-I _.
Rudgct N}tity 60910506-Atx,les M—tw Health OCA AMOUNT lln(Iget U.0ty 60910506-Cn idr—'S MentW Henim OCA AMOUNT
502004-1114I72GENCY STAB 11 1ZATION 50-1001-1 WI17i(;lNCY S TAII R.PLATION
(;"A-Al)UI,I'COMM MEN'FAL HLAI:CII (100610) (JA-ClIIIJ)RIN'S MINFAl.HIA1,141 (100435)
AI-)A MII TiI Func(T'F t0' �— ..__
?7005)` >*,I St'47 _ � ADAMH Tn�sr Pun�l]'f�(02"7CX)5)'"
C ;ne I R . (0(X)326)`" A 1 ;S I �$ _ 108,264( (w:—al R---((XX)326)' 1 �"0. 15_677
i ciT (122023?' 3I.SS I FUFF Tit le XXI(261015)
(.-n.-.tl (CKX)326)' `;n11EA1 CcnetalR venue((XX)326)'*
(✓A-t1 AKI:i2 A("1'S ER V IC'ES L 100611) <;/A-CHII�DKI+N'S II AKER ACT (104257)
Ciu-nca,,I Rcuc.utu>((X?0326)' AtStiS1 �F 1,(X)4,639 (--aI Rcvunae(((X)3267'
ES'rmrgcncy Statriil�ation Total= $ 1,112,903 1}n¢rg—cy StxtWi—ti—%'1'iAW= `F iS,K77
I7 t...... nvaked Unit. $ 222.581 pcn_ea"d Units S 3,135
_5020 t8-KI•)CO VI+'RV�c Ftl�i(I.IINCY 503/ll3-Il[X'OVI12Y Re RIS II.IINC:Y
(JA-AllUI:1'COMM MEV'I'AL NIAI:FH (100610) (;/A-CHII�DRISN'S M""I'AL HIAIA'H (100435)
AI?AM}{'Fru-st Flntd TF(027005) A1xRS( ADA MH i'eust.F'uud TF(0270053* tP.I'F`xl '�'$ I53,752€
0&-N,ITF (027(051) ARf> I _ j Ge..»ntnl R--- L kt€:47 `5 28fi 24}#0
IR -.na (CK)0;:6) APRI,t S 7038,348( (' ,alai Re.--. O 11 nAtR k'.i FD((XX)326) t64I
(TKfA C.A[1.Faan Mau+-(ay C(X703263' '�i�R-TNEfx E tGIP-MIAMI�-DA DF.Wntp Atou ud P. YR i(261()1,`r? G`"�ti rtiV
(:R/C tun F>tx.nv as Beds Adult Svc((XX)326) ('I 13�y,S 1`$ 160,)(X) Fcdl-tal Chant F—'t Fund(261015) C NW,I 3 i
Al AMFi T" ..F d FA< F A J :ut(027(XX5) I-F.^v I, ' -. 0--al R---((XX)3 6)
(�snw t ACT A t ((X))32fi) GR-JV R t t I—...n7,r,,Pro(((X)326)'
C�(TF LMCIP*MA Mcd(v lAdtnin (261015) FY'A tY � 9
R., t-- — FAC_`I' i t'-'GPR-Tit], C._6J 013�
c¢((XX)32Fi) 1:.I..S 19 � _. ..
FCI F F C,C X FtY �D J !D w P (261015) cJDTi � (;/A-PURC'HAS[•])Rt-II7—'1'tAL
:fx1>"t Sazna ta.mHnnxt.. �n..�a 1261015) t,�r)t .•y. 1 'X)ti27 'IRIA'I'hll N'I'SIRVICIS (102780)
OBcMII (0270()`') ",II IS I2. ( GR/MCAID&N MCA ID MOE((XX);26)- "PRI'M �
Cx-nvtal ltv♦�,nuc((XX):1261 4\1SIA ��,.,, - _ C."[2/Pu rc.h R— [t'catnx nl-Mcdtcatd Svcs OXX).326) `)i RI'N
W TTF"T'ANF(d010)1)
(X
lX]3:76) Ll'1'ME _.... .,
Toni eee'S Sn,t Fund(122(Y23)
F-I dG,,—I'T ust Fund(261015) A€t)2.I
GfA-INDIGENT PS VCH MW)S PRO(;RAM (101350) _
Cc-nc .1 T2e.v.;nu a•1(XX)32(W ARRS1 ?p$ 5945?
Total Non-TANF $ 1,295.120 Total Non=F'ANF $ 440,(XX)
I(ec—y 8e R—iH,--y'F,,tai= $ 1,295,120 I4--try&e Resiliency'rotij= $ 440,000
U icc>mp tsated Units $ 259,024 Units S 88,m)
TOTALADULT'S MENTALIU1,AI:FH= $ 2,408,023 "CO'CAI.C'H1I.DRIN'S ME TA1.141A1:FH= $ 455,677
.m S URS7'ANCE:AR US E
iludget i3ttity 60910604-A(Hdt',Sul2at—Alxtse OCA AMOUNT IIll(Eget U)fity 60910604-C.h 11- W,i Sul tance Al-- OCA AMOUN'F
603005-131KFOXIFICA`FION 602001-DETOXIFICATION/.ARF
(✓A_COM1IMS1Rl S'FAN(EABU:SESVCS (1006181 G/A-CHlld)/AD()I,S UKS'FANC.E All US E S VCS (100420)
ADAMII'T'—,l Fun,i'1'F(027005)*°^' 1>1_KA, ;°'$ _ 84.359'' ADAMH Trust Fund'1"F(027(X)5)-- I,I X,•�, i #�
Ckm at R.e>ve-nu.-(000326)' i-Y'X:1s x.$ 102284 C ae-ral Kcva.nue((XX)326)**
_..
TS"FF(122023)*"
DeG.xitication Total= $ 186,643 Uctasi ticatl on'Total_ $
Unc Units $ 37.329 Uncnmlxcns ated Chit. `b
603(106-PRI:V I NI'K)N S FR V ICIS 602002-PRE:V EN'I`EON S ER V ICES
(WA-COMM
SIttI S'CANCUA73 CI,SES VCS (100618) (WA-CHILD/ADOI.SURS'FAN1UEAIILNESVCS(100420)
en _
(ii 1R.vc.n tIXX)316)""" t'6Z'6'�+..o � AI)A MHT tF 1 FF'(027(X)5)'** 3 ttb( `h I?2.2621}
A DA MTt l—,t Fund I'F(027()).5)*="""^" rIK ((XX)326)""* 1 t\( M1
__.
C.--lR---((XX)326)' ",III(S
Yre(ention S—ic—Total= $ Pre.Tntio)S—vicer.'Fotad= $ 172,262
13 J -tt--d Units $ - Un Y+c;nsatv<I Unit, S. 34A4S2
603007=CR1A 1`ME3V'F AITFRCARE 602003-TREATMENT&AE'FIRC'ARE
(WA-('ONIMSUI%S'I'ANCE;AIIUSESV(.'S (100618) G7A-CHII.U/ADOI,SUt3S'1'ANC'E ARIAS I?SV(:S(100420)
ADA MH i .t F 1 FF'M27(X)5)— 3K'I'A ) $ {2i J38' ADAMHTrt—Ft dTF(02'7(X)5 �-
3 ,...A 64,595 CR---
O n� IEtuve>E�vt�tlXX)326)"" fS2:F�1*, uatul lL .,nuc((X X)326)*"` 3(ya,I34
SAT IF(51601 E't{'7 A E _ TSTF(1_.A<3)*- "tltt(S ?
.ADA MI1 1':, Fund TF(027CX)5)^"'"'" 71I11 3,61X)I O.S:.MTP (516075)'"' "1 Ft WY'} - t
nd'I'F(0'27(X).5)""* 't'1 i`�
ADAMHT -.tf ud TP((127(N)5)""* 7tY(1M A[)AMHF i.Ft _
Chu—I I",
.. _.. - ... .{
�n 1001)2,fi) sIFC'0 WTTF FANN(401(X)1) t}tt
W T'E F`FA NF(<1()t(X7i) R---,((XX)326)" i" S ..
GEL-inda}„wnt F>ru x(Pm MOP,((XX)3'26)*"` Ix§*C.-x)s: _ � ADAMk17'rust Fund TF((Y27(X)5)1"'*
: TF YL Avsrvs t,a Rvv(2610T4) 1 A C'Ftf� .. '' 55E3(i TF(G39(X)2) 17.0
F("I% Mcd icr id Ad-(261015) _.
FGFI `a-1—111—1 In'T 1-1.Pto(261015)
C7.^n..a(Revcnu<((XX)326)'"'"
ADAM1f'I'-_,t Fund TF(027(X)5)-1
Tol al Non=i'A NF 9: 3aX).133 Total N,-TANF $ 309.139
'Freat(nent&AFtcrcare'1'ntai= $ 390.133 'Treatment&Aftercare Totnl= $ 309,139
U tce>mP mated Units $ 79,027 Un egaen�at.-d Lin its $ 61 828
TOTAL ADUTA"S SU13S'FANCE ABUSE— $ 576,776 'TOTAL CIIII,DRIN'S SUR S'1'ANCEAI3C.S'1i-- $ 481401
'FOTAI.ALL PRO(;RAMS= $ 3,921,877
TOTAL ALL UNCOMPI7'4SA'IE9)UNITS= $ 784,375
FUNDS N(7i'Rf'QUIR1N(;MATCH GRAND'T'OTAL OF PROGRAMS&UNCOMPUNSA'1E3)UNITS= $ 4,706„252
11—,At--Scrvi— _ $ 534,050 TOTALFUNDS REO,UIRING MA TCFI== $ 2,800857
[?v,cnst( 1 talvat Ptnlu-t y '210.0(X) I_OCAL..MATc,if REQUIRED= $ 9313,952
C M I P Frxnrn $- ;75,970? ADDITIONAL LOCAL MA TCH=(_. _. _._._ _.... _....3
M H,ESIo�k Chaut $
I'()J'ALFI7NDS NO'I RPX;i RR1NGMATCI-I= $ 1,120,020 GRA ND TOTA L I_OCA L M A'T'CH $ 933,952
'"I:xP 1'a.r.. .c fx VEtvt:aa �Mi•.n 1 t .i�l 1 t nine IItock Grant vI i,,W,
+=ean -v Ana< z a od I r.- t l31«-k -Fs»,d�ny,nR<.._a, a -11-11M(I'1-11 ArPLY.
Guidance Care Center,Inc. 102 Contract No.ME225-3-27
07/01/2012
Exhibit H
LOCALNIA WI-I MAN
AMHT- 6.;4,109.00
CIA.T,, NA
Conruut N ME225-27 ASAT-1 $ 187A00.00
a,- 711/2012 CSAT—I $ 91,643,04)
(k--dT,AW s 913,952,(X)
CR%pXW$MWTALIWAUM
I A—,—W I.Av-,—.1 1,A,,-,—"I I
T,,A M-1, T., T—)M-1,
h R:,:c
U"- Units P—h,—d P—h.'cvl
2,C— 2X—m—w—nt 2.C—Nh"—e 2,C—kla.W—t
" ...... TwWNI-h u.To-W-h T,-I MN,h
I, R h,R, Os ,,h.R,c ,,Rrc
, — -U"v" "U""RrcchnsalI nWa c.U-,R—h-,d Units R—h-,,A
J.C,14,SWUH-d- 1.Crlslx SfWilbatlm 3,C,W,St.NlWd- 3,CH 6 stwfi-fl—
Isn.T,,AM,-h T,,l,,IM—h
h
U,ri,,R-h,-d R—h'—d 7 .u,,o,P—hv—d U f,N.h,—1
4 C,ii,,S.pp.Vb—g—y 4 CH4,S.ppxI/E—g—y 4.CH S.pp-UPh—g—y 4.CH,t,S.pp."H..,X—y
u.T-el Mn h rS 15.6Kg,(1) n.T,,,,I NI,-h Is u.T—I Match Tu W NI-h
h I — — —R b�R R
Units: P—h'—d U"",N,ch,-d r ,U,,it,P,,h,,,d ljn,I,P,..h,,,,d
5.D.V wy("', I
T,,ud Nl,,I,h Tonal March T,,,,,,Nl,,,,h s
h
1 Rl�l, i S b-------------------
U-,R--d
6,Day—Night 6,Day-Night &My Night 6,MY-Night
a.I NL-h 'S T"r,l M,"l, Total M—h rs ,To,rl M-1, S
h.R— s b.R—
R, S I,
-------------
thr,,,P,-h-,d U,,-M—i....d Unir.c N—h-,d UrineP""I—'d iJa
7 1*VWsAUWpC., 7 -p-hl/S"r-WpC—t— 7 D,,pWSOUM[pC—.- 7
T7 -,i M, h ToM Nl,,I,h T T-0 Nt,,Ih
I R R w S 1,Rnrc ?, R—
(;: Units N'6—j nla tha'R-h-'d nfa U,I,P,h—d nlu
1.th——,10.11;lk Sari— 7"I"Si.Si dO.'iW S-A— 8,hlk——1(l-M.S-4—
Z6M—h T, ,
b.
R,, I Renos
h.R— 7—$
L"",
Una,P—h,-d 7/ Unit,Phased 'r qa c.U,l,Pl.h—d
9 I.Ifi—I 9.Imwd nt I.Pd-t 9 blpfl-1
a.Tulvl Much I u.ZA Marchs T.fl M-1, s
R,� R.:�, s R,
LJ,.,,R—h,—d U'_P-,h—d Units F—h'—d vlu c.Units N,h—d iUu
10 tn'm ix C—MmM—t 10,bt—i�(—Nh�—t 10,h—iw C—NI—w—t Iff bt—lw C7 Nl�—nt
F" h:R I�
KI-1, T,-I M-h s T—INI-h T,-I Nl-h
b Rare R,tc
Units P—h'—d lj,,i,,P-1,...d P-'h—d
I I b-—11- H.Int—nd- 11,lh.—H- 11,k,.—.d—
To 0 Mv-h S I Matchs u,T.IANI—h ,T,,1,1 Marchb.I,,: R." S h.R— S h,R—
R-h,—d Ll-,P—h.—d :r/u 'Uuna ""'('p"",—,
L WdlW S-A— 12,Nk&eW S—i— l2.MedeW Serdce.v 12 NkN,W S"'k-
T—d M,-h T—d M,�,h T—d Nl,,I,h s NI,,d,
I, R b.R— i s 1:R—
Ua,l,Pl-h,—d q/v Uul,,P-,h,-d
H'hk.h-k 'Nu-- I I Nk�M.I.k— 13.Nkth.4—NlWn.—. 13�Nk�N L9111-1
F', T,,,d M,,I,h iS Tu-]M—h S a.Tonal
n.Ra h,R— s If R— I, R—
P—h—d
[4(wpfl—1-1,140,6W 14 t Wpfl—t w,o.qat-k",jtw 14,(uqd—t hfiid.W
i.Toi:il March �S v.Turin Murch .'S v.Turvl hi etch {5 ?O.q p.(A1 v.Total Match F
h h,R,- $ b,R- R—
U!"",R—h""d , U0,N"J"—d P—h—d 229.W c.Lhnl,,N I,-,d alit
11 0.01—h IS.0.tr—h 15,O.W—h 15 0.--h
T,1 kl,t,h S a.T(,1A M—h s T,,l,dM—h 73 M), (0
R'- I,I Rxc
I"""R—h—j L................1,,/,, N,,h R-h—d
166 Pr—tim 16.P—nd- 16.P'fl—
M""h 'L T,,,,,]NN[,h
h.Rarc h,Rarc S IL R—
Uiuts P—h-,d n/a "U ira R—h-,d Ruch,—d Ruch-'d
17 11--fil.V1,1WI—d'. Wy 17 Pl—tI,.Vlft—nfi— My 17 P—W.Winivr—thm Wy 17. Wy
T,,,d M,-h M,-h
R,- S h R,- S h,R,- h.R",
Un,,R-1,...d Ph"'J alit "lj"ni"1—h—d Wit Pa,h—d
Ik R-"'.Iiw 1-111 18L W,,id-dW I—I I N Resid-fll i—I I
a.T,,lad N1,16, r",'I T,,1AM—If T-dht lch S
I,—
h.Rn(e i S h,FWu b
Ifiv"'R—h""d nJ, c.lhrits P—h...d N—h—d N.h,—d n/a
19.W,d-H.]1-1 n 19 wAd-thd 1-111 19,Rcxi&.Ol 1-111 MR-i
'Coral Match s NI,l,h s T,.l,0kI,,,h T-d Nl,lah 5
b R,- s h,R,- R,,,. I
Units P—h—d alit ,U,r,I,M—h—d W., c.Units P-h,—d vd,, c.Urns P—h.—d alit
R,ientiw i,wI 111 20,W,id-tiW I—I 111 .10,Reid-dw 1-4 In 10 R-i&nUM 1,M III
T,-W—h
Ra R— R,,Ic b,R4 lLLc
LRUnit. —h'—d Units N-h...d th�"'P—h'd V,
—————— ——————
Guidance Care Center,Inc. 103 Contract No.ME225-3-27
07/01/2012
Exhibit H
21.ResihkntlW I<fel IV _ _ _ 21,ReNilkntlal l-e+el IV _ __ 21_Reskje tlW". I IV _ ?I.ResihMinl lxwl IV
a.T,,d Mnich 'S a.Toml Mulch r5 u.Total Match S a.Tolnl Mwch S
Ru;c S I, Raio $ b.Rmc 5 h.R S
Unn.s Pta�haned 'M c.Unit,Puch-,d n/u c.Units Ptshu.ai nfa c.Uual,n.Puvhascd n!a
22.Reaplk S-A- 2r.Respite S-kt' 22.Respite Serdres 22 Respite S-i-
a.TotalMatch �$ -- u_Total Match rS-�_- --� n.Total Match r5 --- a.Total Match S
-Rate s b.Rme $ b.Rote -S b.Rate S
(inns P--h,-d a Unu.Puchus,d u!a c.Units P,-h.,W V, c.U,i,,Pl-h,-d n/a
A.Sheltered Phpoyment 9 Sheltered lft. q eot „3 ShdterM Fippk,y-ttt 23.Sheltered PSnploymeot
�.Toi.tlMnich S .Total Match .5 :.T tat}retch S v_Towl Mulch $
Rota '.S h.Rmc S h.Rmc :S h.Rate $
Ututs N,,h,-d u.(Inn,.Pl-h,-d n/a c.Uldte Punhaa W n/u c.Units P-h-d n!a
Sutrshuhe Aline lkt dfk d,. 24.Suitt-Ahtne lkhaiflcadm 24.Sutat-,Ab-Ddoaiflentlm 24,Suiutance Ahme Uennlfkatfon
a-1'ot;J Alntch g a.Total Match $ a.Tw,lFfntch S 112,5IX)09 a.Taal Match -S
P-, `S h.Rme �,r'z? '� h.Rae -C
Uaae Pl-h-d ilia c.Unite Rtrcha.cd u/n c.Units Rtrcha.al 448.94 c.Units Plrthascd n(n
15.Sappa'ted Figioymem e _ ---.___...25,Snperted Fspltr-nt _... 23.Sapprml Fhgimmhent ...,_... ....... 'S Sapped F-,gwy-M
a-Total Al 'foul Match 5 TotalMwch f ...._.......,__......
u =5 a.Total Mnich $
A.Rutc :$ b.Rwe S h.Rw, =S
c.Unn.Ptn-h'-d nIa c.Uau.v Ruchas d n/a c.Units P,-hns W Nh u.Unn,e P+r<huced ilia
26.SaI4-dlkanitWINng 2a Supp�dllu I.WIJAn _ 26,Snp, ,!H-ig/Iidne 26,tin�rcea FWminvludnq
r
a.TotutMnlch -5 +.'Coral Match :S a.Tat ul Match 'S
a.Tulai Mulch S
S h.R+uc t S b.Rutc $ b_R- -C
Units Ptnha.W n/a c.Units P-ha-d tNT c.Uoifs Pucho.d n!n Uiut_v P-has,d n!u
17.TASC 27,T'A.SC 27,FASC 2T TASC
a.Total Mulch S a.Total Match Tot al Match Total Match IS
b.Rwe Rate $
c.U"',P-h" ;Jn c.Unn.Purchased n/u c.Units Pwch' d Na c.Uun'Wrch-d n/a
2s-irwidenw Fk�m<a 28.1.6d-w Fees 2R.h w Fk pkknp,- 18,i cihwW-n F.,
a-'futvt ll.uuh S _... ._. u.Total Match Total Match S n,Total Match
b,Rate !S h.R+uc ?S b.Rmc S b.Rniu -S
I lnits P-hasul u(a c.Units Pt A,-d n/a c.U'i"'Pirt-ha"d nht c-Units Nu hascd n/n
19.After 29,Aftercare 29,Afterehve 29.Aftercare
u.Tutel Match 3 a.Total Match i S It_Total Match S :�Total Match S
b.Woe F b.Rate S h.Rate �S b.R+ue S
Units N,h.-d n/a c.Unu.s Rtrchuscd u/u c.Unha Pashu.W n/a c.Units Puahased u!a
WO InRr,mntlm and Wferral 30 htf em/im a W Re&-W 30.Inkrmatlm and Referral .+0.(n(rr w--1 ltelerrd
a.Total Match 5 +_'Coral Mwch 3 a.TotalMwoh 3 a.Tutai Mmch S
RNc S b.Rai, i h.Rmc =S h.Rw, S
tla-Rtmhased o/a c_Ul tv PtrchavW n/a c.Unify Pfch'-d n/a .:.Units Purchased n!o
31.Reser.ed 31.Reserved 31,Reserwd 31.Raserwd
11 onipolfent Ihtoadfkatm --- 32,O tpgent uetotdfleanm 32.outpatient oekmlkatm 31 natp d-t�mdfleatm
Tnlnl A1ar,h a S a.Te1alMamn %s a Total nlalen `s
b.Rate =S h.Rate S h.Rate $ b.Rote z 5
thtrta P-hasud nfa c.Uaita Puchascd n/n c_Una.P-h-I n!a ,.Units P-has,d iJa
33.Resersed 33.Reaerwd 33.Res-1 33_Reserved
34.FA''I Team 34,FACTTeam 34.FACTTeam 34.FACTTeam
n.TotatMatch =5 a.Total Match =S a Total Mauch S a.Total Match S
b_R.ile S h.Role 3 S b.Role 5 h.Ralc S
Uan.F--h,,,J n/a c.Units Parch+-d tJa c.Unify P-h-d tJa c.Unl(s Wrthu.+cd No
35.oattwiem-(xahp 35.(hdpWlenl-G-p 35,0,01"em-(4'mp 3s.adpw tit-(r(p e P
a.Total Match -S u.Tolni S n.Total Match .S --- 30,f1(10.(10 n.'Coral Mwch 4 - -
Rate. S b.Rate S h.Rate ,l''+I". '".6.Rw, S
UniU Rtrchaaad n(a c.Unus Prahmed o/o c.Unit.Pl-ha,W 1,317 iS c.U In Rnahascd n/a
M( Ram&Hoard with Sup-islet l<hell _ 36,Reim&HoardWt.Sup-tMk._I<5e11 .W Ram&Road with Supersidm 1-11 36.Rapp&Board with Sup Wr l<fel,l
e.Total Match S n.Total Mniuh `S n.Total Match S a.Total Match S
b.Stvte Ru;, =S h.Sta nte te R S h.Sl atu Raf, S h.Slat,Rate 3
Hou ha or Unus Ptr 1,-d n!u c.Hums or Unh.Rt 1-d n!a c.Hours or Units Rtn hus-ud n/a c.1-kturn or Units Ptccha.al n(a
37.Ram&B-d.dth Sttp-Wm 1<fe18 37,Wpm&Raurd Mth Sap-ANim l<felH ., 37.M-&Bawd with SutxMsim I-Ia 3T Rmm&Romd with SuperN.vim 1<fe111 -.._
u Total Aterclh +i a.TuialMaich i a,Tole)Mafch $ n.Total Mwch _S
b.Sti1,R.uc -S b.State Rate b.State Rafe S h,S"-Rme S
Hours oc Un;(s Ptmhn.cd n/a c.Hours or Uuit.Ptn-hasccl Na c.Huufn or lhol,Pueh,-d n/a c.Hotta,,Mott.,P-h,-d n/u
_.._ ..__.._ ohm&H-d Wth Sup-As iw I<.e1 m
N. aan RarA whh SaperHsim l<hel lLL 3x.Haan&Board witlh Supermim l<w:I IB +A.Roam&Btprd with Sup:Mvim l<selm iR R
u.Total Match S _-. -. -_.
a.Total Match -S u.Total Match =S n.Toiu7Match S
h.S[nte Rute S h.State Rat, =S h.Slate Rate =S b.Slate Rnic S
Htsury or(:`t111.�Ptcch;ueA n(a e_Hours or(hdfa Phchased n!a ,.Hours oe Units Penh,-d Hour or Units Purcltaseel rile
t9.S1art-term Re'kkntW prelm.t _ 39.Short-Term ResideoftW'IYeabhc_ot., 39.Sha1-lerm RenihntW Tremwttt 39.SMrt-term KeskkotW Treutmrnt
u.Tutnl Alweh 4 G5,77A.W a.Total Al-atuh 9 Total Mwoh -........ ... _ _._..
a. 4 n.Total Much S
Rmc- SM n. b.Rmc- S b.R.- 5
lili(s Rucht-d 291,41 c.Units P-h,scd I n/a c-Units P U-d u/a c.fruits Pu.hascd n/a
4U.Aknw Ikalih C lutiwxase Serdces 40.Afenw Newth C7uliwme Seri- 40.MennJ pedth C7ullt-Ser4ces 40.Aknlal MAW Clutha S-4-
+-Tutei Match S 1?17>(0 a.Total Match iS � � I_Total Alntch =C _ �.Total Mmch S _
,.Rate i h.Rai, S h.Ref, S b_R.ae -S
trails Rirt hosed #322.94 c.Units P,fii-d nh c.Unil.Prchas W nfa c.U is Pin-ha.scd V.,
44_CCST ._.41.07"hemite Uahmahnify Serike ream(c(-sr,.... Hqn ty _. -... �tpehemiw('+emm�oity S,"-Te„ (CST)e n 41.C+ heml�e('taunaml SerNce Te®fC(ST) 41-('t
_'Coral Mafch Tobtl Mn+ch =:4 a.Total Matclt �4 a.Total Mnich s S
b.Rotei b.Rate S h.Rm, S b.R+a, S
(ht'ns Pttchescd 463785 c.Units Purhasul Wa c_ULs P-hv..d u/u �Un�is_P�hyr«I u!n
AMIT 1"to S 654.5(x.(K) 0111 Ttinl S I i_\'A'figN S 187,9WA) ('SA VAal S 91,64).W
Guidance Care Center,Inc. 104 Contract No.ME225-3-27
07/01/2012
EXHIBIT I
SUBSTANCE ABUSE FAMILY INTERVENTION SPECIALIST SERVICES
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.
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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 locations of Key West, Marathon, and Key Largo or in the field
(i.e. client's home, community service center, etc.).
b. FIS services should be located in a place where they will be easily available
and accessible to child welfare personnel. FIS locations must be licensed for
Intervention: General Intervention and Intervention: Case Management as
required by Rule 65D-30, F.A.C.
5. SERVICES & TIMES
FIS provide adult substance abuse outreach, screening, intervention, and case
management. FIS do not provide direct treatment services. Services will be
provided, at a minimum, Monday through Friday, with flexible hours to meet the
needs of clients.
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 pare nt(s)/ca regive r(s) referred by child welfare or a
dependency court in which substance abuse is suspected during the initial child
abuse/neglect investigation, or at any point during child protective supervision or out-
Guidance Care Center,Inc. 106 Contract No.ME225-3-27
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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 pare nt(s)'/caregive r(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 dependency court or a child welfare worker
suspects that parent(s)'/caregiver(s)' alcohol and/or drug abuse may be
contributing factors in a situation where a child's safety or well-being is at risk.
Priority referrals are those children at risk for immediate removal or when
children have been removed.
b. The FIS shall attempt contact with the client within three (3) working days
from receipt of the complete referral package. A phone contact or face-to-face
visit is acceptable for the initial contact. During this contact, the FIS will conduct
a screening or set an appointment to conduct a screening.
c. The network provider is responsible for determining what constitutes a
complete referral package and conveying the requirements for a complete
referral package to the referral agents.
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 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.
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11.FIS REFERRAL OF CLIENT TO SERVICES
a. If the client or a client's family member is in need of services, the FIS shall
refer and schedule an appointment within 48 hours for the client to be seen within
seven (7) working days after completion of the screening with the most
appropriate local provider for an assessment and subsequent services.
b. Upon completion of the client referral, the FIS shall provide a summary to the
referral agent/child welfare worker. FIS can provide the summary to the referral
agent/child welfare worker through electronic transmissions. The FIS must use
appropriate safeguards to prevent use or disclosure of protected health
information.
c. The primary referrals may be to substance abuse treatment providers for
more in-depth evaluation and substance abuse treatment, if needed. Other
referrals may include referrals for mental health screenings, assessments or
treatment, referrals for medical or physical problems, other social or assistance
services, legal, educational, housing, vocational, or employment services.
d. Referrals shall be based upon the client's needs, available community
resources, and financial considerations.
e. Each FIS shall maintain a directory of treatment resources, eligibility criteria,
and referral procedures for available prevention and treatment resources in each
community. The network provider agrees to mutually define, with child welfare,
the role of the FIS positions within the system of care. The FIS will establish and
maintain a working relationship with Our Kids, DCF, SFBHN, and all DCF
licensed providers within the community(ies).
12.CASE PLANNING
a. The FIS are responsible for developing the substance abuse intervention plan
as required by Rule 65D-30, F.A.C. The FIS are required to provide a copy of
the intervention plan to the child welfare worker for incorporation into the child
welfare case plan.
b. The FIS are responsible for reviewing and updating the substance abuse
intervention plan as required by Rule 65D-30, F.A.C. An updated intervention
plan is also required when there is a major change of status regarding the client's
participation in substance abuse treatment. The FIS are required to provide a
copy of the updated intervention plan to the child welfare worker for incorporation
into the child welfare case plan.
13.CASE MANAGEMENT
The FIS shall perform continued case management related to the substance
Guidance Care Center,Inc. 108 Contract No.ME225-3-27
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abuse portion of the plan. This will continue throughout the duration of the
client's participation in substance abuse services. FIS should make contact,
preferably face-to-face, at least monthly with the client. This may include
participation in formal staffing or informal contact.
Case management activities shall include:
I. Monitoring client's condition and progress in treatment;
11. Linking clients to services as dictated by their needs; and
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 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:
1. 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
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FIS shall provide said report to the department's Legal Counsel for filing with the
court. Client/family requests for an FIS to appear on their behalf will be taken into
consideration.
16. LENGTH OF SERVICE & DISCHARGE
a. FIS services shall be provided to an eligible client receiving substance abuse
treatment or substance abuse aftercare treatment to ensure linkage with and
support for the child welfare case plan. The network provider may continue to
provide FIS services to clients in active substance abuse treatment, or in
substance abuse aftercare after the child welfare case is closed.
b. The client may be discharged from FIS services upon any of the following:
I. Substance abuse treatment is completed;
11. The case is closed by the child welfare agency;
111. The client refuses to participate in the program; or
IV. The client is incarcerated, or moves to another geographic area.
c. Decisions about when to close a case or keep it open should be made by the
FIS in consultation with the substance abuse provider, child welfare worker,
and/or the court.
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 department's 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.
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.
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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 funds
should primarily be used to fund clients' needs to remove barriers to treatment.
d. Criteria for use of the incidental funds, procedures for accessing them, and
the accounting for expenditures will be developed cooperatively between the
provider, the FIS, and the contract manager. The department's contract
manager will have final approval of the criteria, procedures, and accounting for
these funds.
e. Each month, the network provider shall submit a report to the department's
contract manager, which details year-to-date expenditures and the balance of the
FIS incidental funds, along with the corresponding incidental fund request
form(s). The expenditure of FIS incidental funds will be reflected in the incidental
expenses cost center on the monthly invoice. This information must be monitored
by the network provider agency to ensure that the funds allocated at the
beginning of each fiscal year are not exceeded.
f. The total amount of FIS funding for this contract is $100,000.00. This
includes $0.00 that the network provider agrees to make available for Incidentals
funds.
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;
11. 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
VI11.FIS and approving authority signature with date.
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Exhibit J
Assisted Living Facilities with Limited Mental Health License
Authority: a. 384.4574, 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-LK4Hshall:
1) Ensure that all mental health residents as defined in s. 394.4574 (1) F.S. are assessed by a
peychiatrist, clinical psychologist, clinical social worker ur psychiatric nurse or individual who in
supervised by one of these professionals, to establish that all residents are appropriate to reside in
the ALF. A copy of that documentation shall be provided to the ALF administrator no later than 30
days following admission.
2) Ensure that case managers are assigned to all ALF-LW1H residents who meet criteria ao amenta|
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. U the mental
health resident continues to decline services, they must be encouraged to do so in writing, unless that
ia 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-LK8H.
3) Ensure that individuals living inALF-L[WH and meeting the definition ufamental health resident
served by the network provider are offered mental health services needed, including but not limited to
case management, psychiatric medication treatment, access to drop-in centers, clubhouses and other
services where available.
4) Ensure that a cooperative agreement to provide mental health services, including case management
as required in s. 429.075 F.S, is developed between the network provider and administrator of the
ALF-LK8H.
6) Ensure that the cooperative agreement identifies, at a minimum: mental health services available;
contact information for both the ALF Administrator and mental health p/ovider, including after-hours
emergency access; transportation provision; and services and activities available at the ALF-LMH.
The ALF'LK8H 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 afUe for each ALF-
LK4H client with copies ufall required documentation. A||ALF-LMH client records must beavailable
for production by the network provider for monitoring purposes.
S) Ensure that the Cooperative Agreement is annually updated between the provider and the ALF-LMH
Administrator.
7) Ensure that an annual community living support plan, as defined in s. 429.02 F.S., is prepared by the
assigned case manager and the resident served, in consultation with the ALF-LMH administrator of
the facility infaoe-to-hanemeetings. ytaminimum, meetings will be held for initial plan development
and annual updates to the plan. More frequent meetings shall be held as necessary to resolve
concerns expressed by the resident, case manager, or ALF-LMH Administrator. The plan should be
individualized and should include information about support services and special needs.
8) Report all concerns related to health and safety violations to appropriate uMinia]n at the Agency for
Health Care Administration and the Department's Abuse Hotline.
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Exhibit K,
Network Provider Inventory List
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EXDHDBDT L
CCST DUTY ROSTER
[[ST DUTY ROSTER FOR THE WEEK OF:
*PnOGRxKx:Axoo/Cxxo/ASA/C3A(circle one) COST CENTER:o*.cCST—individual/4s.cCST-Group
*Funding Source:Nnu'TANP/TANF(circle one)
-*.- Remember to exclude Holidays tLinless staff is scheduled to work)
PartTime Does this staff Hours/Scheduled to Work
CCST STAFF NAME/ID# or work in any other MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Full Time cost center or Beginning& Beginning& Beginning& Beginning& Beginning& Beginning& Beginning&
program? Ending Time Ending Time Ending Time Ending Time Ending rime Ending Time Ending Time
2.
3.
4.
5.
7.
8.
10
SIGNATURE DFSUPERVISOR:
Date:
Note: * Fill out a separate Duty Roster for each program and funding sources combination.
Guidance Care Center,Inc. 114 Contract mv.mszos-3zr
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EXHIBIT M
CHILD WELFARE QUARTERLY CLINICAL REPORT
Date of Report:
Name of Person Completing Report: Title:
Child's Name: DOB: DOA:
School: Grade: School Placement:
School Performance:
Full Case Management Agency:
Full Case Manager's Name: Phone#: Cell#:
Relevant Incidents:
Type of Service(s): Frequency: Location:
Presenting 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
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EXHIBIT N
MISSING CHILDREN
The network provider agrees when services are for children who are adjudicated
dependent where the care of the child is assigned to the department or network
provider, to follow the procedures outlined in Rule 65C-30.019, F.A.C. and Rule 65C-
29.01 3, 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.
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c. The network provider agrees to instruct caregivers, including relative and non-relative
caregivers, and all other staff that might be required to report a child as missing to
local law enforcement to immediately undertake the following activities, as applicable,
and document all actions and activities related to any efforts made to report and/or
locate any child who is determined to be missing from their care or supervision:
d. If exigent circumstances exist, the caregiver, family services counselor, or until the
family services counselor is engaged, the network provider employee, who has
identified that a child is missing from their care or supervision shall immediately call
local law enforcement as soon as a determination has been made that a child is
missing and they shall request that the responding office:
(1) Take a report of the missing child.
(2) Assign a case number to the missing child report and provide the
case number back to the caregiver or person who is reporting the
child missing.
(3) Provide local law enforcement with a recent high quality photo of
the child, or provide local law enforcement with a recent high quality
photo when one becomes available.
(4) Request that a copy of the police report be provided to the family
services counselor once a police report becomes available.
(5) If the responding law enforcement officer refuses to take a missing
child report, for any reason, the individual attempting to report the
child as missing will document the officer's name and specific local
law enforcement agency name and request to speak to the law
enforcement agency Watch/Shift Commander. If the law enforcement
agency Watch Commander refuses to take a missing child report and
it is a caregiver that is attempting to report the child as missing, the
caregiver will immediately contact the family services counselor or on-
call staff and provide them with all information related to local law
enforcement not issuing a missing child report. Once the family
services counselor or on-call staff have learned that a local law
enforcement agency will not issue a missing child report they will
immediately seek assistance from the local area Community Based
Care (CBC) Child Location Specialist or the Department of Children
and Families Regional Criminal Justice Services Coordinator on
resolving any issue related to reporting the child as missing to local
law enforcement.
(6) If it is a caregiver who has reported the child as missing to local
law enforcement or attempted to report a child as missing to local law
enforcement, they shall immediately notify the child's family services
counselor or emergency on-call staff and provide them with the
following information:
(a) The law enforcement agency name that the child was reported as missing
to or attempted to be reported as missing to;
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(b) The law enforcement missing child case number if one was issued by
local law enforcement;
(c) A copy of the law enforcement report when one is made available;
(d) Detailed information on the child's overall state of mind and behavior prior
to the child going missing;
(e) Detailed description of what the child was last seen wearing;
(f) Detailed information on possible locations that the child might be going to;
and
(g) Detailed information on any individuals that the child might be traveling
with.
e. If exigent circumstances do not exist, the caregiver , family services counselor, or
other network provider staff will within the first four (4) hours of learning that a child
might be missing check to see what, if any, of the child's personal belongings are
missing or if the child left a note; and, the caregiver , family services counselor, or
other staff (if the family services counselor is not yet engaged), will:
(1) Contact the following persons as appropriate to ascertain if the child has
been seen, or has given any indications that may explain the child's missing
status:
(a) School/child's teachers and school resource officer;
(b)The child's relatives/parents, both local and non-local, if appropriate,
and the caregiver has the means for such contact;
(c) Any friends or places that the child generally frequents, the local
runaway shelter, if there is one in the community; and,
(d) The child's employer, if applicable.
(2) Write down any information gathered that might help locate the child.
(3) Provide telephone/beeper numbers and ask for the individuals above to call
back and share information if they have further information or see the child.
a. If at any time during the initial four (4) hour search for the child, if the caregiver,
family services counselor, or any other network provider employee (if the family
services counselor is not yet engaged), becomes concerned about the immediate
safety and well-being of the child, or the child's location remains unknown after four
(4) hours from the time that the caregiver, family services counselor, or network
provider employee learned that the location of the child was unknown, they shall
immediately call local law enforcement and they shall follow the steps outlined in
Section 2.a., above.
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b. If at any time, the child is located or returns to the caregivers home after law
enforcement has been notified of the missing child case, all law enforcement
agencies and other agencies that were notified of the missing child episode must be
contacted immediately by the caregiver, family services counselor, or other network
provider employee who made the report. If at any time new information is obtained
on a possible location of the missing child, the caregiver, family services counselor,
or any other employee of the network provider shall immediately contact all law
enforcement agencies and other agencies that were notified of the missing child
episode as to the possible location of the child. If the Family Services Counselor
has been engaged, the network provider shall also inform them and the legal
guardian of the new information once law enforcement has been notified.
c. All of the department's documentation related to the missing child episode shall be
completed and entered into the department's approved missing child reporting
system within one working day of the family services counselor, on-call staff, or
Community Based Care (CBC) Child Location Specialist learning of a missing child
episode regardless of whether local law enforcement has issued a missing child
report number. This includes the uploading of a recent high quality photograph of
the child into the department's approved missing child reporting system. If local law
enforcement has refused to issue a missing child report a dummy local law
enforcement case number of 00000 and the name of the local law agency that
refused to issue the missing child report shall be used to complete and enter the
missing child episode into the department's approved missing child reporting
system.
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EXHIBIT O
INCIDENTAL EXPENSE FUND INVOICE AND EXPENDITURE LOG FOR ADULT
MENTAL HEALTH
Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health
Reporting Month:
Network Provider: Contract No. Cost Center:
Amount Allocated: Amount Remaining:
Recipient Program Civil or Description Requisition Status(Date request Amount Check#&
Name&ID# Forensic of Date approved/pending/denied) Disbursement Date
Expenses Staff name&Title
T
Total Amount for Housing$ $
Total Amount for Medication$
Total Amount for Emergency Expenses$
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EXHIBIT P
SAMH PRE-AUTHORIZATION RESIDENTIAL UTILIZATION MANAGEMENT ROSTER
(1)Provider Name and Address:
(2)Contract No:
(3)SAMIJ Program:
(4) Invoice Period:
(5)Page__of
(6)Client (7)Authorization 18)Client Name (9)Social (10)Placement (11) (12) (13) (14) (15)Total
Count Number Last,First) Security Authorization No.of Units of Service
Number No. Service Period Cost Center Unit Rate Services Cost
Rendered (Col.13 x 14)
1.
2.
3.
4.
5.
6,
7.
S.
9.
10.
11. i
12.
13.
14.
15,
17,
18.
19.
20.
Totals
Provider's Authorized Representative
I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT
Provider's Signature Date
Name(Print or Type) Tittle
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ATTACHKNENTU
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 |: FEDERAL REQUIREMENTS
This part|aapplicable if the recipient ioa State or local government ora non-profit organization as
defined in OMB Circular A-133. aarevised.
In the event the recipient expends $500,000 or more in Federal awards during its fiscal year,the recipient
must have a single or program-specific audit conducted in accordance with the provisions of OMB
Circular A-133. aorevised. |n 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, aorevised. 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 ofthis pad. 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—G) (Recovery Act) aa required by Congress and in
accordance with 2CFR 215.21 ''Uniform Administrative Requirements for Grants and Agreements" and
OMB Circular A-102 Common Rules proviaiono, 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.vvhhohouoe.gov/omb/oirou|aro/o102/a102.htm|.
(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
Guidance Care Center,Inc. 122 Contract No.Msz25-s'or
07/01/2012
Awards (SEFA\ and the Da�/Co|�o\�nForm (S required by(�K�B Qncu�nA-133. OKXBQroubo
A_133 | available ://www.whhehouao.gov/omb/orou|ana/a133/a133.htniThioaha|| bo
accomplished byidentifying 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
ofMhepofix ''ARRA-'' iniden\U\ingthenamoofthoFndena| pnogmmlontheSEFAand
ao the first characters in Item 9dof Part ||| on the SF-SAC.
(u) Recipients agree to separately identify to each oubreoipient' and document at the time of submword
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 regu|araubowando under the existing program.
(d) Recipients agree to require their nubreoip\en\a\o include on thoirGEFA information tospecifically
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 III: 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 (|ooe|
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 aaaiotanoe, including state financial ooaio\anoo received from the Managing
Entity, other state agencies, and other nonotskeentities. 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 ofSection 215.97(8). Florida Statutes. This includes
submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and
Chapters 10.550or10.8G0. 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|ettor, if
issued )
07/01/2012
B. Reporting packages for audits conducted in accordance with OMB Circular 4r133' aa revised, and
required by Part | of this agreement shall be submitted, when required by Section .828k1). (���B
Qrcu|arA'133' ao revised, byoronboha�of the recipient tothoFodena| Audit�Clearinghouse
using the Federal Audit Clearinghouse's Internet Data Entry System at:
and other Federal agencies and pass-through entities in accordance with Sections .320(e) and (f),
OMB Circular A-133. aarevised.
C. Copies of reporting packages required by Part 11 of this agreement shall be submitted by or on behalf
of the recipient directl to the following address:
Auditor General
Local Government Audits/342
Claude Pepper Building, Room 401
111 West Madison EKnyet
Tallahassee, Florida 32390-14GO
Email address: Uaudgnn_|ooa|govt@aud.atatejiuo
Network providers, when submitting audit report packages to the Managing Entity for audits done in
accordance with OMB Circular A'133or Chapters 10.550 (local governmental entities) or10.SG0
(nonprofit or for-profit organizations), Rules of the Auditor General, should include, when available,
correspondence from the auditor indicating the date the audit report paokaoewas delivered tothem.
When such correspondence is not avai|ob|e, the date that the audit report packagewas 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) orChapter 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
io issued, unless extended in writing by the managing entity.
Guidance Care Center,Inc. 124 Contract No.Ma2z5-3-2r
07/01/2012
Attachment III
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or an employee of any agency, a
member of congress, an officer or employee of congress,or an employee of
a member of congress in connection with the awarding of any federal contract,the making of
any federal grant,the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal,amendment,or modification of any federal
contract,grant loan,or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of
congress, an officer or employee of congress,or an employee of a member of congress in
connection with this federal contract,grant, loan,or cooperative agreement,the undersigned shall
complete and submit Standard Form-LLL,"Disclosure Form to Report Lobbying,"in accordance
with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers(including subcontracts,subgrants,and contracts under
grants, loans and cooperative agreements)and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352,Title 31, U.S.Code. Any person who fails to
file the required certification shall be subject to a civil penalty of not less than$10,000 and not more
than 0 0 for e h such failure.
7/9/12
Signaturl Date
FRANK RABBITO ME225-3-27
Name of Authorized Individual Application or Contract Number
GUIDANCE CARE CENTER,INC.
Name of Organization
Address-of—Organization
Guidance Care Center,Inc. 125 Contract No.MEW-3-27
07/01/2012
Attachment 111
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or an employee of any agency, a
member of congress, an officer or employee of congress, or an employee of
a member of congress in connection with the awarding of any federal contract,the making of
any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any federal
contract,grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a member of congress in
connection with this federal contract,grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance
with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to
file the required certification shall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
Signature Date
FRANK RABBITO ME225-3-27
Name of Authorized Individual Application or Contract Number
GUIDANCE CARE CENTER, INC.
Name of Organization
Address of Organization
Guidance Care Center,Inc. 125 Contract No.ME225-3-27
07/01/2012
Attachment IV
Worldrig Agreement for SSI/SSDI Outreach,Access,and Recovery(SOAR)Initiative Community Provider
Agency
The Con umumty Pry viderAg ency shag ha ve des*wted SOAR owned staff who agree to do the Mo wmg*
1. Contact the identified Social Security Administration(SSA)liaison according to the Community Provider Agency's zip
code and create an individualized application submission procedure that will be utilized for all Initial SOAR applications.
The procedure should include the agreed upon preferred method of communication with the SSA liaison and how the
protective filing date will be established for each claim.
2. Submit claims for SOAR applicants as soon as possible but within two weeks of the notification,at the latest.
3. Complete and submit a SSA 1696 Appointment of Representative form that will list the name of the Individual and the
agency that will serve as the SOAR claimant's representative. This form will be submitted with the application.
4. Follow up on any additional needed non-medical information for SSA within two working days of notification of the need
for information. This follow-up will either provide the documentation needed or notify SSA of the steps being taken to
obtain the notification.
5. Receive notification from the SSA claims representative once the claim has cleared the non-medical process and has
been sent to the Division of Disability Determinations(DD/D). This notification will take piece within 24 hours of sending
the claim to the ODD.
6. Obtain all existing medical information and submit it to the DDD,once the application for SSYSSDI is completed.
7. Contact the DDD office within one week of notification of the claim having gone to the ODD to determine who the disability
adjudicator is and make contact by phone With that adjudicator,notifying him/her of working with a SOAR claimant,
confirming the authorized representative status,and informing the examiner of the records being collected.
8. Maintain contact with the DOD adjudicator as appropriate,to check on the status of the claim and to continue to submit
information.
9. Submit all existing medical information and additional evaluation information to the DOD within 30 calendar days of the
submission of the application to the DDD by SSA.
10. Submit the medical summary report to the DDD within 30 calendar days as well.
11. Collect data regarding SOAR applications and submit it on an ongoing basis,via the Policy Research Associates'(PRA)
web-based data entry program,
Frank C.Rabbito,Sr.VP Guidance/Care Center,Inc.
Ex I {Print Name) Community Provider Agency
719112
Signature Date
Guidance Care Center,Inc. 126 Contract No.ME225-3-27
07/01/2012
Attachment V Prevention Services
DESCRIPTION OF SERVICES(include overall intention of program,outline of program activities,target population:
to be seared,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 CLAP for Monroe County:
Goal 1: Reduce the Monroe County prevalence rate of past 30-day alcohol use among youth.
Goal 2: Increase youths'attitudes and beliefs about the risk of harm of underage drinking
The long term goal is to reduce DUI crashes countywide amongst 18-20 year olds by 10%in 2015 by reducing
parent acceptance and approval of behavior and increasing the perception of harm and risk in youth.
TARGET POPULATION OR PARTICIPANTS(Include numbers in tables and a narrative description of participant
characteristics below):
Level 1 and Level 2 Number of Participants
Youth living in Monroe County 1,123
Teens living in Monroe County 50
Environmental Strategy: "Parents Who Host,Lose the Most" 60,619
Description of participants to be served(describe criteria for program enrollment eligibility,geographic
areas/neighborhoods or schools to be served,risk factors,as well as any other significant demographics
information,if serving children with disabilities,include type of disabilities):
Male and female youth ages 10-17 years and their parents who reside in Monroe County.Services will be provided
at all three high schools,the alternative high school,three middle schools and two elementary schools.The TGFDV
Program will be available to all 101h graders attending any one of the three Monroe County High Schools,as well as s
youth attending the alternative school or living at Florida Keys Children's Shelter in Tavernier.The TGFD Program
will be available to 61h and 7th graders attending Big Pine Academy,7th and 81h graders attending Key Largo Middle
School,and Plantation Key Middle School,and 5"'graders attending Stanley Switlik School and 61h graders at
Marathon Middle School.
Site Name Street Address City Zip Code Children/ Parents Other>
Youth
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 1 190 0 0
Florida 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. 127 Contract No.ME225-3-27
07/01/2012
PERFORMANCE MEASURES
Quantity
Activities/Service Name E+Description(include #'Children/ # # #Required %To Meet Activity
frequency,intensity,&duration of sessions,as well as the Youth Parents Others Sessions Required Level(1
number of cycles expected to be offered and tentative or 2)
schedule)
Too Good For Drugs Tao Good For Violence 1,123 0 0 10 sessions 85% 1
Total=1,123 served from July 1,2012 through June 30, for
2013
Teen Intervene 50 0 0 1 85% 1
50 served from July 1,2012 through June,30,2013 assessment
3 sessions
for 1.5
hours each
Environmental Strategy—Parents Who Host,Lose 5,000 20,109 5,000 822 50% NA
The Most
Enviran
Public education,Social Marketing,Media Advocacy mental
400 Public Service Announcements on radio and cinema Strategy
10 press releases
1 kickoff event
1 media campaign
10 presentations in the community
20 campaign posters in windows of local businesses 20
stickers pasted in businesses that sell and serve alcohol
that you must be 21 to purchase or use throughout the
county
Posters and other information regarding serving to those
without ID will be available to vendors at the over 650
festivals in Monroe County each year serving alcohol
Quantity Performance Measures
Activity/Service Name and #of participants to Required#of sessions for of participants'
Description receive'service participants to achieve results to meet required
Coal 1:Reduce the Monroe County prevalence rate of past 30-day alcohol use among youth.
Coal 2: Increase youths`attitudes and beliefs about the risk of harm of underage drinking
Too Good For Drugs Too Good For 1,123 12 sessions 85%=955
Violence Participants
Teen Intervene 50 1 assessment and 85%=43
3 sessions for 1.5hours each participants
Coal 1:Reduce the Monroe County prevalence rate of past 30-day alcohol use among youth.
Coal 2: Increase youths'attitudes and beliefs about the risk of harm of underage drinking
Environmental Strategy 60,619 822 50°l0=30,309
Guidance Care Center,Inc. 128 Contract No.ME225-3-27
07/01/2012
Parents Who Host Lose the Most participants
Quality Description of the required program Quality measures.
Quality Measure Measurement and Reporting Tool liming
Average number of sessions attended 85%of 1,123 participants or 955 will • At the end of each cohort of
(Participant Retention) complete Too Good For Violence Too group sessions
Good For Drugs post test and a
minimum of 12 sessions
• Ten(10)by September 30,
85%of 50 or 43 participants complete 2012,an additional 10 by
the Teen Intervene sessions—a January 15,2013,for a total
minimum of 3 sessions of 20;an additional 10 by
Measure:(Survey and Logs) March 2013 for a total of 30;
and additional 20 by May 31,
2013 for a total of 50 youth.
#and%of youth satisfied with services 90% r At the end of each TGFD V
provided Satisfaction survey sessions for youth in TG FDV
• At the end of each Teen
Intervene session—or by June
15,2013 for youth in Teen
Intervene
Observation of service delivery/Fidelity Curriculum fidelity checklist One time for each cohort(school)
checklist in September and March
Documentation of structured supervision Supervisory Tool/Checklist and Notes During regular supervisory
sessions for each staff and not
less than one time per month
#and%of staff with necessary 100% At the time of contract
training/certification monitoring
Participant Outcomes
Outcome Data Source/Measurement Timing Associated Activity
1,123 youth will receive the 1. Data entered into the At admission into Staff trained;Program
TGFDV/TGFD curricula annually PBPS system&The GCC program timelines developed;
database Database set-up;
2.Client enrollment forms At end of sessions TGFCV/TGFD
3.Pre/post surveys sessions facilitated;
Data collected and
entered in database;
Data analyzed;
Program improvement
activities
Outputs:10 of 12
sessions
50 youth will receive Teen 1. Data entered into the At admission into the Prior to delivery of 1'
Intervene annually PBPS system&GCC program session
database
2.Client enrollment forms At end of sessions youth Sessions delivered
will complete a post Survey administered
survey
Guidance Care Center,Inc. 129 Contract No.ME225-3-27
07/01/2012
85%of the youth will complete 1.Attendance records 1.Youth sign attendance Youth sign the
at least the required 10 sessions 2.Service deliver data records for each session attendance record at
of FGFDV/TGFD curricula entered into GCC database 2.Staff enter service the beginning of each
delivery data daily session
3. Post surveys Post surveys
administered at the end administered and data
of the sessions collected and analyzed
85%of the high school students 1.Attendance records 1.Youth sign attendance Youth sign the
will complete at least the 3 2. Data entered into GCC records at each session attendance record at
required sessions of Teen database 2.Staff enter service the beginning of each
Intervene delivery data daily/based session
on services rendered
3. Post surveys Post surveys
administered at the end administered and data
of the sessions collected and analyzed
85%of the youth will improve TG FDV/TG I'D pre/post tests Collected immediately During the first/last
their attitudes and beliefs prior to the 1"session sessions of the
related to risk of harm of and immediately curriculum;for youth
underage drinking following the last session only completing the
required 10 sessions,
the research assistant
will contact/meet with
youth to collect the
post test
85%of the youth will report no Timeline follow back Collected immediately Youth will complete
alcohol use in past 30-day by prior to the 1"session the surveys; for youth
curriculum completion and immediately only completing the
following the last session required 3 sessions,the
research assistant will
contact/meet with
youth to collect the
post test.Data will be
analyzed and reported.
Staff shall enter 100%of data PEPS and/or SFBHN data Monthly Research and
requested into the 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
Increased collaboration with the Increase by 2015 the Sept. 1,2012-June Increased DUI arrests
State Attorney's Office, conviction rate from 26%to 30,2013 by Law Enforcement&
campaign materials targeting 36%,promote Parents Who Monthly reporting form Increased prosecution
parents,increase/sustain EBP's, Host Campaign from SAO by SAO of DUI cases by
and increase Law Enforcement 100/0,
capacity for Saturation Patrols in MOU's with SAO,GCC,
the Lower,Middle and Upper Monroe coalition and
Keys HSA. All to attend
monthly Monroe
Increased enforcement County Coalition
/prosecution of parents Monitor police 2 parties Meetings to increase
Guidance Care Center,Inc. 130 Contract No.ME225-3-27
07/01/2012
providing alcohol enforcement/monitor targeted/monthly collaboration.
prosecutions Monthly meeting with
SAO to monitor
Increased Saturation prosecution activity
Patrols/arrests in Lower,Middle Key West Police,Monroe Sept. 1,2012-June and time expended to
and Upper Keys County Sheriff 30,2012 log data.
HSA(if funded by PPG)
Increase arrests by Key West to monitor
For Monroe Co.Sheriff by 10 County Coalition to
Lower Keys,by 12 Middle Keys, Monitor prosecutions.
and by 22 Upper Keys Data collected monthly
by reporting forms and
analyzed by Committee
named by Coalition(to
be determined)
Monitor#of increased
arrests by Key West
Police and for Monroe
Co.Sheriff through
HSA(if funded by PPG)
and share report with
the Coalition at
monthly meetings.
r------------' --------------------'------- ---------''--------�- -
EVIDENCE BASED PROGRAMS(EnP) \
|- - ----- ------------- -------'------------- --------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 i
community o,can�imte best nmoucesthat have been appmvedbv South Hn,idaBehavioral Health Network because,when performed with fidelity,they should deliver analogously high quality
|
/
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(TG F D)
Teen Intervene SAMSHA approved,NREPP Option 1
Parents Who Host,Lose the Most Promising Practice with research to support it Option 2
TASK LIST
Activities
Year 1 Activities/Service Name&Description #&Type of EBP %to
Participants Recommended Meetthis
Sessions or Outcome
Hours
Too Good For Violence/Too Good For Drugs 1,123youth 1hourfor12 85%
Activity Description:Participants will be recruited from designated schools sessions
and will receive a pretest assessment of their risk and protective factors.The
curriculum will be administered once per week for 12 sessions and the
-posttest will be administered at the end of the sessions
ov/amnca�m,eomp�vr-�/evenuon ��omaorm
Guidance Care Center,Inc. 131 Contract No.ME225-3-27
07/01/2012
Frequency:One time upon program entry.
Intensity:10-12 sessions
Duration: 1 hour per session.
Activity Title:Teen Intervene Curriculum 50 3 sessions @ 85%
Activity Descriotion:Participants will be required to attend 90 minute 1.5 hour per
sessions session
Frequency:One time per week
LILEalLOL Three sessions
Duration:One 90 minute session
Activity Title: Parents Who Host,Lose the Most 60,619 422 50%
Activity Description:. Participants will be reached by ads, radio and cinema
PSA's,mailings,community meetings,posters placed at local businesses
Frequency:PSA's 44 weeks
Intensity:3x1dayfor 3 days per week
Duration:30 seconds each
Activity Title:Parents Who Host,Lose the Most 15-20 10 sessions 85%
Activity Description: Community Meetings parents,
Frequency,1x monthly Sept 2012-June 2013 teacherscit
Intensity: 10 meetings y&,county
Duration:60 minute meetings personnel,
business
leaders,
community
members
AEkMj Title: Parents Who Host,Lose the Most 50 mailings Mailings=36 100%
P , Mailings&Poster placement each Cycle hrs/Cycle-
Freauencv&Intensity:6x Mailings,Poster placement U cycle 1,Ix cycle2 to key Posters=40
Duration:6 months contacts in Firs.
community
for
outreach
support,20
Poster/Stick
er
Placements
at local
businesses.
Guidance Care Center,Inc. 132 Contract No.ME225-3-27
ATTACHMENT E
Contract
Between Florida Department of Children and Families and
South Florida Behavioral Health Network Contract
(KH-225)
Guidance Care Center-SAMH Contract;FY13;page 94
Contract No. K11225 Client 0 Non-Client El
CFDA No. 93..9_59
FLORIDA DEPARTMENT OF CIIILDREN AND FAMILIES STANDARD CONTRACT
THIS CONTRACT is entered into between the 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".
1. UIIE PROVIDER AGREES:
A. Contract Document
To provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits,winch constitute the contract
document.
B. Requirements of Section 287.058,Florida Statutes(F.S.)
The provider shall provide units of deliverables,including reports,findings,and drafts,as specified in this contract. These deliverables must be received and
accepted by the contract manager in writing prior to payment. 'The provider shall submit bills for fees or other compensation for services or expenses in sufficient detail
for proper pre audit and post-audit;
where itemized payment for travel expenses are permitted in this contract,Submit bills for any travel expenses in accordance with
section 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 11 9.07(t)F.S.,made or received by the provider in conjunction with this contract except that
public records which are made confidential by law must be protected from disclosure, It is expressly understood that the provider's failure to comply with this provision
shall constitute an immediate breach of contract for which the department may unilaterally terminate the contract.
C. Governing Law, Jurisdiction and Venue
1. 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 as provided in PUR 1000, (see Section LBB)
2. Federal Law
ir if this contract contains federal funds,the provider shall comply with the provisions of 45 Code of Federal Regulations(CFR),Part 74,45 CFR,part 92,
and other applicable regulations.
b. If this contract contains over$100,000 of federal funds,the provider shall comply with all applicable standards,orders,or regulations issued Linder section
306 ofthe Clean Air Act,as amended(42 United States Code(U.S.C.)7401 et seq.),section 508 ofthe Federal Water Pollution Control Act,as amended(33
1 J S,C, 1251 et seq.),Executive Order 11738,as amended and where applicable,and Environmental Protection Agency regulations(40 CFR,Part 30). The
provider shall report<my violations ofthe above to the department.
c. No federal funds received in connection with this contract may be used by the provider,or agent acting for the provider,or subcontractor to influence
legislation or appropriations pending before the Congress or any State legislature. Ifthis contract contains federal funding in excess of$100,000,the provider
must,prior to contract execution.Complete the Certification Regarding Lobbying form,Attachment II. If Disclosure oft.obbying Activities form,Standard
Form 1.11,is required,it may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form Must be
completed and returned to the contract manager,prior to payment Linder this contract.
d. Unauthorized aliens shall not be employed. The department 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 lot ofthe Immigration Reform and Control Act of 1986. Such violation shall be cause for
unilateral cancellation ofthis contract by the department.
e. If this contract contains$10,000 or more of federal funds,the provider shall comply with Executive Order 11246,Equal Employment Opportunity,as
amended by Executive Order 11375 and others,and as supplemented reutCd 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 provider shall comply with the Pro-Children Act of 1994(20 U.S.C.
608 1), Failure to comply with the provisions ofthe law may result in the imposition of civil monetary penalty ol'up to$1,000 for each violation or the
imposition of an administrative compliance order on the responsible entity,or both.
1). Audits,inspections,Investigations,Records and Retention
I, The provider shall establish and maintain books,records and documents(including electronic storage media)sufficient to reflect all income and
expenditures of funds provided by tile department under this contract.
2. Retention of all client records,financial records,supporting LIOCUrnents,statistical records,and any other documents(including electronic storage media)
pertinent to this contract shall be maintained by the provider for a period of six(6)years after completion ofthe 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 ol'six(6)years after the audit report is issued or until
resolution of any audit findings or litigation based on the teens of this contract,at no additional cost to the department.
3. Upon demand,at no additional cost to the department,the provider will facilitate the duplication and transfer of any records or documents during the
required retention period in Section 1,Paragraph D.2.
4 These records shall be made available at all reasonable times for inspection,review,copying,or audit by Federal,State,or other personnel duty authorized
by the department.
CF Standard Contract 06/2010 1 Contract# K11225
5 At all reasonable times for as long as records are maintained,persons duly authorized by the department and Federal auditors,pursuant to45 CFR,section
rig 36(i)(10),shall be allowed full access to and the right to examine any of the provider's contracts and related records and documents,regardless of the
form in which kept.
6. A financial and compliance audit shall be provided to the department as specified in this contract and in Attachment III.
7, The 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.).
E. Monitoring by the Department
The provider shall permit all persons who are duly authorized by the department to inspect and copy any records,papers,dOcUalelltS,facilities,goods and
services of the provider which are relevant to this contract,and to interview any clients,employees and subcontractor employees of the provider to assure the department
of the satisfactory performance of the terms and conditions of this contract. Following such review,the department will deliver to the provider a written report of its
findings,and request for development,by the provider,of corrective action plan where appropriate, The provider hereby agrees to timely correct all deficiencies
identified in the corrective action plan,
F. Indemnification
I. The provider shall be fully liable for the actions of its agents,employees,partners,or Subcontractors and shall fully indemnify,defend,and hold harmless
the department and its officers,agents,and employees,from suits,actions,damages,and costs of every name and description,including attorneys'fees,
arising from or relating to any alleged act or omission by the provider,its agents,employees,partners,or subcontractors,provided,however,that the
provider shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or emission of the department.
1 Further,the provider shall,without exception,indemnify and save harmless the department and its employees from any liability of any nature or kind
whatsoever,including attorneys fees,costs and expenses,arising out of,relating to or involving any claim associated with any trademark,copyrighted,
patented,or unpatented invention,process,trade secret or intellectual property right,information technology used or accessed by the provider,or article
1-nanUtactured or used by the provider,its officers,agents or subcontractors in the performance of this contract or delivered to the department for the use of
the department,its employees,agents or contractors. The provider may,at its option and expense,procure for the department,its employees,agents or
contractors,the right to continue use Of,replace,or modify the product or article to render it non-in fringing, if the provider is not reasonably able to
modify or otherwise secure the department the right to continue using the product or article,the provider shall remove the product and refund the
department the amounts paid in excess of a reasonable rental for past use. However,the department shall not be liable for any royalties. The provider has
no liability when such claim is solely and exclusively due to the department's alteration of the product or article or the department's misuse or
modification of the provider's products or the department's operation or use of vendor's products in a manner not contemplated by this contract. The
provider shall provide prompt written notification to the department of any claim of copyright,patent or other infringement arising from the performance
of this contract,
3. Further,the provider shall protect,defend,and indemnify,including attorneys'fees and costs,the department for any and all claims and litigation
(including litigation initiated by the department)arising from or relating to provider's claim that a document contains proprietary or trade secret
information that is exempt from disclosure or the scope ofthe provider's redaction,as provided for under Section LEE.
4. The provider's inability to evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only all
adjudication orjUdgluent after tile highest appeal is exhausted finding the department negligent shall excuse the provider of'performance Linder this
provision,in which case the department shall have no obligation to reimburse the provider for the cost of their defense if the Provider is all agency Or
subdivision of the State,its obligation to indemnify,defend and hold harmless the department shall be to the extent permitted by law and without waiving
the limits of sovereign immunity,
G. Insurance
Continuous adequate liability insurance coverage shall be maintained by the provider during the existence of this contract and any renewal(s)and extensions)
Of it,13V execution Of this contract,unless it is a state agency or subdivision as defined by subsection 768.28(2),F,S.,the provider accepts full responsibility for
identifying and determining the type(s)and extent of liability insurance necessary to provide reasonable financial protections for the provider and the clients to be served
under this contract. fhe limits of coverage Linder each policy maintained by the provider do not limit the provider's liability and obligations tinder this contract.Upon the
execution of this contract,the provider shall furnish the department written verification supporting both the determination and existence of such insurance coverage.Such
coverage may be provided by a Self-insurance program established and operating Linder the laws of the State of Florida.'rhe department reserves the right to require
additional insurance as specified in this contract.
H. Confidentiality of Client Information
The 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.
1. Assignments and Subcontracts
I. The provider shall not assign the responsibility for this contract to another party without prior written approval of the department,upon the department's
sole determination that such assignment will not adversely affect the public interest;
however,in no event may provider assign or enter into any transaction
having the effect of assigning or transferring any right to receive payment Linder this contract which right is not conditioned on foll and fintlitul
performance of provider's duties hereunder.Any Sublicense,assignment,or transfer otherwise Occurring without prior approval ol'the department shall be
null and void. The provider shall not Subcontract for any of the work contemplated under this contract without prior written approval of the department,
which shall not be unreasonably withheld.
2 To the extent permitted by Florida Law,and in compliance with Section I.F.ofthis Standard Contract,the provider is responsible lot all work performed
and for all commodities Produced pursuant to this contract whether actually furnished by the provider or its subcontractors. Any Subcontracts shall be
evidenced by a written document. File provider further agrees that the department shall not be liable to the subcontractor in any way or For any reason.
The provider,at its expense,will defend the department against such claims.
Cl'Standard Contract 06/2010 2 Contract# K11225
3 The provider shall make payments to any Subcontractor within seven(7)working days after receipt of full or partial payments from the department in
accordance with section 287.0585,VS.,unless otherwise stated in the contract between the provider and subcontractor. Failure to pay within seven(7)
working days will result in a penalty that shall be charged against the provider and paid by the 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,
4, The State of Florida shall at all times be entitled to assign or transfer,in whole or part,its rights,duties,or obligations Linder this contract to another
governmental agency in the State of Florida,upon giving prior written notice to the provider. In the event the State of Florida approves transfer of the
provider's obligations,the provider remains responsible for all work performed and all expenses incurred in connection with the contract. This contract
shall remain binding upon the successors in interest of either the provider or the department.
5. The 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.
J. Return of Funds
The provider shall return to the department any overpayments due to unearned funds or funds disallowed that were disbursed to the provider by the department
and any interest attributable to such funds pursuant to the terms and conditions of this contract. In the event that the provider or its independent auditor discovers that an
overpayment has been made,the provider shall repay said overpayment immediately Without prior notification from the department. In the event that the department first
discovers an overpayment has been made,the contract manager,on behalf of the department,will notify the provider by letter of such findings. Should repayment not be
made forthwith,the provider will be charged interest at the lawful rate of interest on the Outstanding balance after department notification or provider discovery.
K. Client Risk Prevention and Incident Reporting
I, If services to clients are to be provided under this contract,the provider and any subcontractors shall,in accordance with the client risk Prevention system,
report those reportable situations listed in CFOP 2 15-6 in the manner prescribed in CFOP 215-6 or circuit or region operating procedures.
2. t fie provider shall immediately report any knowledge or reasonable suspicion of abuse,neglect,or exploitation of child,aged person,or disabled adult to
the Florida Abuse I lotime on the statewide toll-free telephone number(I-800-96ABUSE). As required by Chapters 39 and 415,F.S,,this provision is
binding upon both the provider and its employees.
L. Purchasing
I Articles which are the subject of or are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and Diversified
F,riteiprises,Inc,,(PRIDE)identified under Chapter 946,F,S,,in the same manner and under the procedures set forth in subsections 946.5 15(2)and(4),
F.S. For purposes of this contract,the provider shall be deemed to be Substituted for the department insofar as dealings with PRIDE. This clause is not
applicable to subcontractors unless otherwise required by law. An abbreviated list ofproducts/services available from PRIDE may be obtained by
contacting PRIDE,(800)643-8459.
2. The provider shall Procure any recycled products or materials,which are the subject of or are required to carry out this contract,in accordance with the
provisions of sections 403.7065,and 287,045,F.S.
M. Civil Rights Requirements
I, In accordance With Title VII of the Civil Rights Act of1964,the Americans with Disabilities Act of 1990,or the Florida Civil Rights Act of 1992,as
applicable the provider shall not discriminate against any employee(or applicant for employment)in the performance of this contract because of race,
color,religion,sex,national origin,disability,age,or marital status. Further,the provider agrees not to discriminate against any applicant,client,or
employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80,83,84,90,and 9 1,'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,
1 Complete the Civil Rights Compliance Checklist,CF Form 946 in accordance with CFOP 60-16 and 45 CFR 80. This is required of all providers that
have fifteen(15)or more employees.
3. Subcontractors who are on the discriminatory vendor list may not transact business with any public entity,in accordance with the provisions of287 134,
F.S.
N. Independent Capacity of the Contractor
1. In performing its obligations Linder this contract,the provider shall at all times be acting in the capacity 0 I'm 1 independent contractor and not as Lin officer,
employee,or agent of the State of Florida,except where the provider is a state agency. Neither the provider nor its agents,employees,Subcontractors or
assignees shall represent to others that it has the authority to bind the department unless specifically authorized in writing to do so.
2. This contract does not create any right to state retirement,leave benefits or any other benefits of state employees as a result ot'performing tile duties or
obligations of this contract.
3. The provider shall take Such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be an independent contractor
and will not be considered or permitted to be an agent,servant,joint Venturer,or partner ofthe State of Florida.
4, The department will not furnish services of support(e.g.,office space,office Supplies,telephone service,secretarial or clerical support)to the provider,or
its subcontractor or assignee,unless Specifically agreed to by the department in this contract,
5. All deductions for social security,withholding taxes,incorne taxes,contributions to unemployment compensation funds and all necessary insurance for the
provider,the provider's officers,employees,agents,subcontractors,or assignees shall be the sole responsibility of the provider.
CF Standard Contract 06/20 10 3 Contract# K11225
O. Sponsorship
As required by section 286.25,F.S.,if the provider is a non-governmental organization which sponsors a program financed wholly or in part by state funds,
including any funds obtained through this contract,it shall,in publicizing,advertising,or describing the sponsorship of the program state:"Sponsored by(provider's
name)and the State of Florida,Department of Children and Families". If the sponsorship reference is in written material,the words"State of Florida,Department of
Children and Families"shall appear in at least the same size letters or type as the name of the organization,
P. Publicity
Without limitation,the provider and its employees,agents,and representatives will not,without prior departmental written consent in each instance,use in
advertising,publicity or any other promotional endeavor any State mark,the name of the State's mark,the name of the State or any State affiliate or any officer or
employee of the State,or represent,directly or indirectly,that any product or service provided by the provider has been approved or endorsed by the State,or refer to the
existence of this contract in press releases,advertising or materials distributed to the provider's prospective customers.
Q, Final Invoice
Fhe final invoice for payment shall be submitted to the department no more than 31 days after the contract ends or is terminated. If the provider falls to do so,
all rights to payment arc lorfeited and the department 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 provider and necessary adjustments thereto,have been approved by the department.
R. Use of Funds for Lobbying Prohibited
Flie 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,
S. Public Entity Crime
pursuant to section 287.133,F.S.,the following restrictions are placed on the ability of persons convicted of public entity crimes to transact business with the
department.When a person or affiliate has been placed on the convicted vendor list fol lowing a conviction for a public entity crime,he/she may not Submit a bid,
proposal,or reply on a contract to provide any goods or services to a public entity;may not submit a bid,proposal,or reply on a contract with a public entity for the
construction or the repair of public building or public work,may not submit bids,proposals,or replies on leases of real property to a public entity;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.
T. Gratuities
The provider agrees that it will not offer to give or give any gift to any department employee.As part of the consideration for this contract,the parties intend
that this provision will Survive the contract for a period of two years.In addition to any other remedies available to the department,any violation of this provision will
result in referral of the provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the provider's
name on the suspended vendors list for an appropriate period.The provider will ensure that its subcontractors,if any,comply with these provisions.
IT. Patents,Copyrights,and Royalties
1. It is agreed that all intellectual property,inventions,written or electronically created materials,including manuals,presentations,films,or other
copyrightable materials,arising in relation to provider's performance under this contract,and the performance of all of its officers,agents and
subcontractors in relation to this contract,are works for hire for the benefit of the department,fully compensated for by the contract amount,and that
neither the provider nor any of its officers,agents nor subcontractors may claim any interest in any intellectual property rights accruing Linder or in
connection with the performance of this contract. It is specifically agreed that the department shall have exclusive rights to all data processing software
falling within the terms ol'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 anyway connected herewith. Notwithstanding the foregoing provision,if the provider is a University and a member of the State University
System ofFlonda,then section 1004,23,F.S.,shall apply.
2. If the provider uses or delivers to the department for its use or the use of its employees,agents or contractors,any design,device,or materials covered by
letters,patent,or copyright,it is Mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all
royalties or costs arising from the use ol'such design,device,or materials in any way involved in the work contemplated by this contract.
3. All applicable Subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention
that arises or is developed in the course of or under the subcontract.
V. Construction or Renovation of Facilities Using State Funds
Any state funds provided for the purchase of or improvements to real property are contingent upon the provider granting to the state a security interest in the
property at least to the Mount 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 provider agrees that,if it disposes of the property before the department's interest is vacated,the
provider will reftind the proportionate share of the state's initial investment,as adjusted by depreciation,
W. Information Security Obligations
I. An appropriately skilled individual shall be identified by the provider to function as its Data Security Officer. The Data Security Officer shall act as the
liaison to the department's security staff and will maintain an appropriate level of data security for the information the provider is collecting or using in the
perf'orniance ofthis contract. An appropriate level of security includes approving and tracking all provider employees that 17CCILICSt or have access to any
departmental data system or information.The Data Security Officer will ensure that user access to the data system or information has been removed from
all terminated provider employees,
2. The provider shall provide the latest departmental Security awareness training to its staffand subcontractors who have access to departmental information,
CF Standard Contract 00/20 10 4 Contract 4 K11225
3 All provider employees who have access to departmental information shall comply with,and be provided at copy ofC FOP 50-2,and shall sign the DCF
Security Agreement form CF 0114 annually. A copy of CF 0114 may be obtained from the contract manager.
4, llie 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 provider shall assure that unencrypted
personal and confidential departmental data will not be stored on unencrypted storage devices.The provider shall require the same ofall subcontractors,
5. The provider agrees to notify the contract manager as soon as possible,but no later than five(5)business days following the determination of any breach
or potential breach of personal and confidential departmental data.The provider shall require the same notification requirements of all Subcontractors.
6 The provider shall provide notice to affected parties no later than 45 days following the determination of any potential breach offiersonal or confidential
departmental data provided in section 8 17,5681,F.S. The provider shall require the same notification requirements of all subcontractors.
X. Accreditation
The department is committed to ensuring provision ofthe highest quality services to the persons we serve. Accordingly,the department has expectations that
where accreditation is generally accepted nationwide as a clear indicator of quality service,the majority ofthe department's providers will either be accredited,have a
plan to meet national accreditation standards,or will initiate a plan within a reasonable period of time.
Y. Provider Employment Opportunities
1. Agency for Workforce Innovation and Workforce Florida: The provider understands that the department,the Agency for Workforce Innovation,and
Workforce Florida,Inc.,have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter
and remain in gainful employment.The department encourages provider participation with the Agency for Workforce Innovation and Workforce Florida.
2, Fransitioning Young Adults: The provider understands the department's Operation Full Employment initiative to assist young adults aging Out of the
dependency-system. The department encourages 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,
Z. I lealth Insurance Portability and Accountability Act
The provider shall,where applicable,comply with the I lealth Insurance Portability and Accountability Act(42 U S.C. 1320d.)as well as all regulations
promulgated thereunder(45 CFR Parts 160,162,and 164).
AA. Emergency Preparedness
1. If the tasks to be performed pursuant to this contract include the physical care or Supervision of clients,the provider shall,within 30 days ofthe execution
of this contract,Submit to the contract manager an emergency preparedness plan which shall include provisions for records protection,alternative
accommodations for clients in substitute care,supplies,and a recovery plan that will allow the provider to continue functioning in compliance with the
executed contract in the event of an actual emergency. For the purpose of disaster planning,the term supervision includes the responsibility ofthe
department,or its contracted agents to ensure the safety,permanency and well-being of child who is Linder thejUriscliction of dependency court.
Children may remain in their homes,be placed in a non-licensed relative/non-relative home,or be placed in a licensed foster care setting.
1 The department agrees to respond in writing within 30 days of receipt ofthe plan accepting,rejecting,or requesting modifications.fit the event of an
emergency,the department may exercise oversight authority over Such provider in order to assure implementation ofagreed emergency relief'provisions.
3. An updated emergency preparedness plan shall be submitted by the provider no later than 12 months following the acceptance of an original plan or
acceptance of an updated plan. The department agrees to respond in writing within 30 days of receipt ofthe updated plan,accepting,rejecting,or
requesting modification to the plan.
Bill. PUR(Purchasing)1000 Form
The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the PUR 1000 Form,and any terms or conditions of this
contract(including the department's Standard Contract),the terms or conditions of this contract shall take precedence over the PUR 1000 Form. However,if the
conflicting terms or conditions in the PUR 1000 Form are required by any section ofthe Florida Statutes,the terms or conditions contained in the PUR 1000 Form shall
take precedence.
CC. Notification of Legal Action
The provider shall notify the department of legal actions taken against them or potential actions such as lawsuits,related to services provided through this
contract or that may impact the provider's ability to deliver the contractual services,or adversely impact the department, The department's contract manager will be
notified within 10 days of provider becoming aware ot'such actions or from the day ofthe legal filing,whichever comes first.
DD. 'llo'histleblower's Act Requirements
In accordance with subsection 1123 187(2),F,S.,the 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 ot'governmental office,gross waste of funds,
or any other abuse or gross neglect of duty on the part of an agency,public officer,or employee. The provider and any Subcontractor shall inform its employees that they
and other persons may tile a complaint with the Office of Chief Inspector General,Agency Inspector General,the Florida Commission on IlUnlan Relations or the
Whistle-blower's Hotline number at 1-800-543-5353.
CF Standard Contract 06/2010 5 Contract# K11225
EE. Proprietary or Trade Secret Information
f, Unless exempted by law,all public records are Subject to public inspection and copying Linder Florida's Public Records Law,Chapter 119,F.S. Any claim
by provider of proprietary or trade secret confidentiality for any information contained in provider's documents(reports,deliverables or workpapers,etc.,
in paper or electronic form)submitted in connection with this contract will be waived,unless the claimed confidential information is Submitted in
accordance with paragraph 2 below.
2. The 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 ajustification citing specific statutes and facts that
authorize exemption of the information from Public disclosure. 1fdifferent exemptions are claimed to be applicable to different portions of the protected
intoirnation,the provider shall include information correlating the nature ofthe claims to the particular protected information.
3. The department,when required to comply with a public records request including documents Submitted by the provider,may require the provider to
expeditiously Submit redacted copies of documents marked as confidential or trade secret in accordance with paragraph 2 above. Accompanying the
SUbrurssion shall be all Updated version of the justification under paragraph 2,correlated specifically to redacted information. The redacted COPY]trust
CXCIUde or obliterate only those exact portions that are claimed to be proprietary or trade secret. Ifthe provider fails to promptly submit a redacted copy
and updated justification in accordance with this paragraph,the department is authorized to produce the records sought without any redaction of
proprietary or trade secret information.
4 'fire department is not obligated to agree with the provider's claim of exemption on the basis of proprietary or trade secret confidentiality and the provider
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,
FF. Support to the Deaf or Hard-of-Hearing
The 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.7 12131,as implemented by
C.F.R.8 CR,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-flearing."
1. If the provider or any Of its subcontractors employs 15 or more employees,the provider shall designate a Single-Point-of-Contact(one per finn)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 provider's Single-Point-of-Contact shall be furnished to the department's Grant or Contract Manager within 14
calendar days of the effective date of this requirement.
2, 'Fhe provider shall,within 30 days of the effective date of this requirement,Contractually require that its Subcontractors comply with section 504,the
ADA,and("FOP 60-10,Chapter 4, A Single-Point-of-Contact shall be required for each subcontractor that employs 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 provider's Single-Point-of-Contact.
3, 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 providers and its subcontractors with 15 or more employees
shall attest in writing that thev are familiar with the requirements of Section 504,the ADA,and CFOP 60-10,Chapter 4. This attestation shall be
maintained in the employee's personnel file.
4. The provider's Single-Point-of-Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids
and services at no-cost to the deaf or hard-of-hearing customers or companions are posted near where people enter or are admitted within the agent '
locations. Such Notices must be posted immediately by providers and subcontractors. 'File approved Notice can be downloaded through the Internet at:
IMPJ/www.ticf.state.11.us/admin/ig/civilrights.shtml
5. The provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary
aids/services provided in the Customer's record. Documentation,with supportingjUStification,must also be made ifany request was not honored. The
provider shall Submit compliance reports monthly,by the 5 1h business day following the reporting mouth,to the department's Grant or Contract Manager.
The provider shall distribute Customer Feedback forms to Customers or companions,and provide assistance in completing the forms as requested by the
Customer or companion.
6. It customers or companions are referred to other agencies,the provider must ensure that the receiving agency is notified of the customer's or companion's
preferred method ofcommunication and any auxiliary aids/service needs.
Ill. I[IF DEPARTMENT AGREES:
A. Contract Amount
The department shall pay for contracted services according to the terms and conditions of this contract of an amount not to exceed$362,976,259.00 or the rate
schedule,subject to the availability of funds, The State of loricla's performance and obligation to pay under this contract is contingent upon an annual appropriation by
the Legislature. Any costs or services paid for Linder any other contract or from any other source are not eligible for payment under this contract,
B. Contract Payment
Pursuant to section 2 15 422,FS_the department has five(5)working days to inspect and approve goods and services,unless the bid specifications,purchase
order,or this contract specify otherwise. With the exception of payments to 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 department 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 provider due to preparation errors will result
in a non-interest bearing payment delay. Interest penalties less than one(I)dollar will not be paid unless the provider requests payment.
CF Standard Contract 06/20 10 6 Contract# K11225
C. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Financial Services, The duties ofthis office are found in section 215A22,F S.,which
include disseminating inibrination relative to prompt payment and assisting vendors in receiving their payments in a firriely manner from a state agency. 'Fire Vendor
Ombudsman may be contacted at(850)413-55 16,
D. Notice
Any notice that is required Linder 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 ofthe provider responsible for administration ofthe program,to the designated address
contained in this contract.
Ill. 'IT I E PROVIDER AN D DEPARTMENT MUTUALLY
A. Effective and Ending Dates
This contract shall begin on October 12010 or on the date on which the contract has been signed by the last party required to sign it,whichever is later. It
shall end at midnight,local time in Miami Dade County,Florida,on September 30,2015.
B. Financial Penalties for Failures to Comply with Requirement for Corrective Actions
I In accordance with the provisions of section 402.73(1),F.S.,and Rule 65-29.001,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.
2. Fhe increments of'penalty imposition that shall apply,unless the department determines that extenuating c irc am stances exist,shall be based upon the
severity ofthe noncompliance,nonperformance,Or unacceptable performance that generated the need for corrective action plan.The penalty,if imposed,
,shall not exceed ten percent(I WIN)ofthe total contract payments during the period in which the corrective action plan has not been implemented or in
which acceptable progress toward implementation has not been made.Noncompliance that is determined to have a direct effect on client health and safety
shall result in the imposition of-a ten percent(10%)penalty ofthe total contract payments during the period in which the corrective action plan has not
been implemented or in which acceptable progress toward implementation has not been made.
3 Noncompliance involving the provision of service not having a direct effect on client health and satiety shall result in the imposition of five percent(5%)
penalty, Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of two percent(2%)penalty.
4. ]'he deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the department may deduct the
amount ofthe penalty from invoices submitted by the provider.
C. Termination
I. This contract may be terminated by either party without cause upon no less than thirty(30)calendar days notice in writing to the other party unless a
sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S.Postal Service or any expedited delivery service that provides
verification of delivery, or by hand deliver y to the contract manager or the representative ofthe provider responsible for administration of the program.
2, to the event funds for payment pursuant to this contract become unavailable,the department may terminate this contract upon no less than twenty-four
(24)110UrS notice in writing to the provider. Said notice shall be sent by U.S.Postal Service or any expedited delivery service that provides verification of
delivery. 'the department shall be the final authority as to the availability and adequacy of funds. In the event of termination ofthis contract,the provider
will be compensated for any work satisfactorily completed.
3, 11iis contract may be terminated for the provider's non-performance upon no less than twenty-four(24)hours notice in writing to the provider. If
applicable,the department may employ the default provisions in Rule 60A-1,006(3),F.A.C. The department's failure to demand performance of any
provision ofthis contract shall not be deemed a waiver of such performance. The department's waiver of any one breach of any provision ofthis contract
shall not be deemed to be a waiver of any other breach and neither event shall be construed to be a modification ofthe terms and conditions ofthis
contract. 'llre provisions herein do not limit the department's right to remedies at law or in equity.
4, Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient cause for
termination. To be terminated as a provider under this provision,the provider must have: (I)previously failed to satisfactorily perform in a contract with
the department,been notified by the department ofthe unsatisfactory performance,and failed to correct the unsatisfactory performance to the satisfaction
ofthe department,or(2)had a contract terminated by the department for cause.
D. Renegotiations or Modifications
Modifications of provisions ofthis contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment
and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the
appropriations process and subsequently identified in the department's operating budget,
CF Standard Contract 00/20 10 7 Contract# K11225
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ATTACHMENT I
A. SERVICES TO BE PROVIDED
1. Definition of Terms
a. Contract Terms
Contract terms used in this document can be found in the Florida Department of
Children and Families Glossary of Contract Terms, which is incorporated herein
by reference.
b. Program/Service Specific Terms
(1) "Accessible" — Children, families and community members should be
helped to become knowledgeable about how to ask for and receive
services that are timely, comprehensive and family-friendly without
facing unreasonable barriers,
(2) "Activity" means an educational process or procedure intended to
stimulate learning.
(3) "Annual Action Plan" means an annual plan developed by the
managing entity and approved by the department that contains the
deliverables for the ten baseline functions and other requirements for
the behavioral health services needs for the Southern Region.
(4) "Approaches" mean the methods used in dealing with or
accomplishing a task or goal.
(5) "Approved Regional Plan" means a plan established by the
department in accordance with section 394.674, F.S. and section
394.675, F.S. and updated annually or as required,
(6) "ASAM PPC-2R Florida Supplement" means the American Society of
Addiction Medicine, Patient Placement Criteria for the Treatment of
Substance Related Disorders, second edition - revised, July 1, 2001, or
the latest revised edition thereof.
(7) "Assessment Instrument" means a tool used for collection of detailed
information concerning an individual's substance abuse, emotional and
physical health, social roles, and other areas that may reflect the
severity of the individual's abuse of alcohol or drugs, as a basis for
identifying an appropriate treatment regimen.
(8) "Available Appropriations" means State and other governmental
funds allocated for mental health and substance abuse services
including prevention and the associated local matching funds.
South Florida Behavioral Health Network, Inc. 9 KH225
10/01/2010 Managing Entity
(9) Behavioral Health Services" means mental health services and
substance abuse prevention and treatment services as defined in
chapters 394, 397 and 916, F.S. which are provided using state and
federal funds.
(10) "CFP 155-2 Department of Children & Families, Pamphlet 155-2 -
Mental Health and Substance Abuse Measurement and Data,
effective September 2008 (9th edition, version 1)", or the latest
revised edition thereof means a document promulgated by the
department that contains required data-reporting elements for
substance abuse and mental health services, hereafter referred to as
"CFP 155-2", and which can be found at:
http:// ww.dcf,state.fl.us/mentalheaIth/publications/inde .shtm1, and is
incorporated herein by reference.
(11) "Client Fees" means compensation to the managing entity's
contracted network providers for services rendered to the client, who
has been authorized to receive services pursuant to this contract, from
any source of funds, including city, county, state, federal, private
sources and client paid.
(12) "Clinical Assessment" means the collection of detailed information
concerning an individual's behavioral health, emotional and physical
health, social roles, and other areas that may reflect the individual's
overall health as a basis for identifying an appropriate treatment
regimen.
(13) "Clinician" means a substance abuse or mental health professional
that provides one or more of the following services: assessment;
individual, group, or family counseling services; or case management.
(14) "CODECATTM (Co-occurring Disorders Educational Competency
Assessment Tool)" means a tool used to evaluate clinicians' training
needs based on a competency assessment to determine knowledge,
skills, attitudes, and values relative to persons with co-occurring
disorders.
(15) Comprehensive Community Action Plan" means a plan developed
by a local, department recognized, community substance abuse
coalition which is based on an assessment of substance abuse related
epidemiology data and the resources needed to address identified
needs. The plan includes goals to reduce the community's prioritized
substance use problems and the approaches to take to achieve them.
(16) "Community-Based Services" means behavioral health services
provided outside of a state facility.
South Florida Behavioral Health Network, Inc. 10 KH225
10/01/2010 Managing Entity
(17) "Community-Focused" means the process of planning, management
and decision-making to ensure resources are designed to build on the
unique strengths and meet the specific needs of the local community.
(18) "Community Prevention" means strategies and activities aimed at
changing community conditions related to substance abuse. It includes
environmental strategies designed to change one or more community
conditions. Community prevention is aimed at larger universal
populations and selected sub-populations and does not track specific
individuals.
(19) "CQMPASSTM (Comorbidity Program Audit and Self-Survey for
Behavioral Health Services)" means a tool that can be used by
behavioral health care systems to assess program competencies in
multiple areas that reflect the basic expectations of program
performance for mental health services, substance abuse disorder
services and integrated systems of care.
(20) "Comprehensive Continuous Integrated System of Care (CCISC)"
means the model for improving service system wide to individuals with
co-occurring psychiatric and substance disorders. "Comprehensive,
Continuous, Integrated System of Care (CCISC) model" means a
system design and implementation model for organizing services for
individuals and families with co-occurring disorders that is designed to
improve services capability on a statewide or regional basis to achieve:
system level change; efficient use of resources; use of evidence-based
and consensus based practices; and integrated mental health and
substance abuse services throughout the system, by organizing a
process in which every program improves their provision of co-occurring
disorder services, and every clinical staff person improves their level of
co-occurring disorder service competency based on their job and level
of training.
(21) Consolidated Program Description" means the combination of all of
the managing entity network providers' program descriptions and the
managing entity program description.
(22) "Continuous Quality Improvement" means continuous internal
improvements in service provision and administrative functions. These
include the systematic ongoing process of improving performance, both
in process and end of process indicators.
(23) "Continuum of Services" Recovery-oriented systems of care will offer
a full array of services, including pretreatment, treatment, continuing
care and support throughout recovery. Individuals will have a full range
of stage-appropriate services from which to choose at any point in the
recovery process.
South Florida Behavioral Health Network, Inc. 11 KH225
10/01/2010 Managing Entity
(24) "Contract Manager" means the department employee who is
responsible for enforcing the compliance with administrative and
programmatic terms and conditions of a contract. The contract
manager is the primary point of contact through which all contracting
information flows between the department and the provider. All actions
related to the contract shall be initiated by or coordinated with the
contract manager.
(25) "Co-occurring Disorder" means any combination of mental health and
substance abuse in any individual, whether or not they have been
already diagnosed. Families impacted by co-occurring disorders are
characterized by a family where one member has one kind of problem,
like a child with an emotional disturbance, and another member has
another kind of problem, like a family member or caregiver with a
substance abuse issue.
(26) "Co-occurring Disorder Service Capability" means the ability of any
program to coordinate every aspect of its program infrastructure
(policies, procedures, practices, documentation, and/or staff
competencies), within its existing resources, to be able to provide
and/or coordinate appropriately matched, integrated services to the
individuals and families with co-occurring disorders that are routinely
presenting for care in that program.
(27) "Cost Analysis" means the review of the proposed cost elements to
determine if they are necessary, allowable, appropriate and reasonable,
(28) "Cost Center" means a grouping of services that is similar in time,
intensity and function where the average cost for service is generally
the same, and are specified in the State Funding by Program and
Activity which is incorporated herein by reference. See Rule 65E-
14.021(7), Florida Administrative Code (F.A.C.), and the Substance
Abuse Recovery Support Services (Individual and Group),
Comprehensive Community Service Teams, and Clinical
Supervision for Evidence-Based Practices (which are incorporated
herein by reference) for a complete listing of services that comprise the
cost centers. The Children's Mental Health Comprehensive Community
Service Team (CCST) cost center is described in Exhibit H, Children's
Mental Health Community Service Team.
(29) "Data Management" means activities that use data elements to track
cost, utilization, quality of care and access to services within the
network of providers. "CFP 155-2 Department of Children & Families,
Pamphlet 155-2 - Mental Health and Substance Abuse Measurement
and Data, effective September 2008 (9th edition, version 1)", or the
latest revised edition thereof means a document promulgated by the
department that contains required data-reporting elements for
substance abuse and mental health services, hereafter referred to as
"CFP 155-2", and which can be found at:
South Florida Behavioral Health Network, Inc. 12 KH225
10/01/2010 Managing Entity
http://www, cf.state.fl,us/mentalhealth/publications/index,shtml, and is
incorporated herein by reference.
(30) "Epidemiology data" means data relating to factors affecting the
health and illness of populations that serve as the foundation and logic
of interventions made in the interest of public health.
(31) "Evidence-Based Practices" means those practices that are based on
accepted practices in the profession and are supported by research,
field recognition, or published practice guidelines.
(32) "Family Intervention Specialists/Adult Intervention Specialists
(FIS)" means individuals employed to provide adult behavioral health
outreach, screening, intervention, and case management to families
involved in the child welfare system and/or the Abuse Hotline.
(33) "Family Intervention Specialist Services" means services designed
to reduce the incidence of child abuse and neglect resulting from
parents' or caregivers' behavioral health and to improve outcomes for
families in the child welfare system and/or community based care.
(34) "Florida Department of Children and Families Strategic Intent"
means the Secretary's Strategic Intent gives guidance and summarizes
the department's major initiatives. This document provides the
Secretary's intent on what the department and its partners must
accomplish during a specific period of time. The Secretary's guidance
drives the development of the department's Strategic Plan, which
depicts how the department will achieve these initiatives, when they will
be accomplished and the metrics used to measure progress.
(35) "Forensic Mental Health Services" means Forensic Mental Health
Services provide services to individuals with mental illness pursuant to
Chapter 916, Florida Statutes.
(36) "Global Assessment of Individual Needs (GAIN)" means one of the
department approved evidenced-based assessment instrument.
Information regarding this instrument can be obtained from the following
website:
htt ://www.chestnut.or /U/ gain/
(37) "Governing Board" means the Commission, Board of Directors, Board
of Trustees, Governing Body, etc.
(38) "HIPAA" is the acronym for Health Insurance Portability and
Accountability Act.
(39) "Incompetent to Proceed (ITP)" as defined in chapter 916 F.S.,
means unable to proceed at any material stage of a criminal
South Florida Behavioral Health Network, Inc. 13 KH225
10/01/2010 Managing Entity
proceeding, which shall include trial of the case, pretrial hearings
involving questions of fact on which the defendant might be expected to
testify, entry of a plea, proceedings for violation of probation or violation
of community control, sentencing, and hearings on issues regarding a
defendant's failure to comply with court orders or conditions or other
matters in which the mental competence of the defendant is necessary
for a just resolution of the issues being considered.
(40) "Indigent Drug Program (IDP)" means the program that allows the
Department of Children and Families to purchase medications for
individuals who are indigent.
(41) "Individual(s)Served" is (synonymous with recipients, individual(s),
and persons who are receiving services, also synonymous with
client/consumer) — Any individual who is receiving services in any
substance abuse treatment or prevention program or mental health
treatment program whose cost of care is paid, in part or in whole, by the
department, Medicaid, Medicaid capitated managed care entities, or
local match.
(42) "Juvenile Incompetent to Proceed (JITP)" means a "child" or
"juvenile" or "youth" as defined in chapter 985, F.S., as any unmarried
person under the age of 18 who has not been emancipated by order of
the court and who has been found or alleged to be dependent, in need
of services, or from a family in need of services; or any married or
unmarried person who is charged with a violation of law occurring prior
to the time that person reached the age of 18 years.
(43) "KIT Solutions" means the entity that maintains the database called
Performance Based Prevention System (PBPS).
(44) "Local Match" means funds received from governing bodies of local
government, including city commissions, county commissions, district
school boards, special tax districts, private hospital funds, private gifts
both individual and corporate, bequests and funds received from
community drives or any other sources. See section 394.67(14), F.S.
and 65E-14.005, F.A.C.
(45) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d),
F.S., a corporation that is organized in the State of Florida, is
designated or filed as a non-profit organization under section 501(c)(3)
of the Internal Revenue Code, and is under contract to the department
to manage the day-to-day operational delivery of behavioral health
services through an organized system of care.
(46) "Monitoring Subcontracts" is the process whereby the managing
entity conducts a systematic organized review of a network provider's
performance in order to give reasonable assurance that the network
South Florida Behavioral Health Network, Inc. 14 KH225
10/01/2010 Managing Entity
provider is complying with subcontract requirements, rules, regulations
and laws applicable to contract performance.
(47) "Overpayment" means for the purposes of this contract, the amount of
money the department has paid the managing entity for administrative
expenses and/or program expense over and above what was properly
earned for these expenses by the managing entity according to the
approved line item budget.
(48) "Participant" means any individual who takes part in targeted
substance abuse prevention programs, activities or services which are
paid, in part or in whole, by the department.
(49) "Payor class" means Medicare, Medicare HMO, Medicaid, Medicaid
HMO, private-pay health insurance, private-pay health maintenance
organization, private preferred provider organization, the Department of
Children and Family Services, other government programs, self-pay
patients, and charity care.
(50) "PBPS" means the Performance Based Prevention System that
collects data related to Substance Abuse Prevention programs and
activities. The system can be accessed by contacting technical support
at 1-888-600-4777 or tt s:f�kit revention.kithot.netf.
(51) "Performance Measures" means quantitative indicators, outcomes
and outputs that are used by the department to objectively measure
performance and are used by the managing entity and network
providers to improve services.
(52) "Prevalence" means the count of all individuals affected by a
disease/condition within a particular period of time, compared with the
entire population of concern.
(53) "Prevention" means a process involving strategies aimed at the
individual or the environment which preclude, forestall, or impede the
development of substance abuse problems and promote healthy
development of individuals, families and communities.
(54) "Prevention Program Description (PPD)" means the report
generated by the PPT that contains the information required for a
program description pursuant to Rule 65E-14.021, Florida
Administrative Code (F.A.C.).
(55) "Program Planning Tool (PPT)" means the data collection module
contained in the Performance Based Prevention System that collects a
variety of program information. It is designed to assure substance
abuse prevention contracts reflect best practices and level of effort,
inform the department's provider support system, and set the stage for
determining effectiveness in achieving prevention outcomes.
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10/01/2010 Managing Entity
(56) "Program" means a structured Schedule of Activities designed so that
participants will attain so far as possible, certain educational, attitudinal,
social and behavioral objectives. This is an unduplicated count of
participants.
(57) "Program Description" means the document the provider prepares
and submits to the department for approval prior to the start of the
contract period, which provides a detailed description of the services to
be provided under the contract pursuant to Rule 65E-14.021, F.A.C. It
includes but is not limited to the provider's organizational profile, a
detailed description of each program and cost center funded in the
contract, the geographic service area, service capacity, staffing
information, and client and target population to be served.
(58) "Projects for Assistance in Transition from Homelessness (PATH)"
means the Federal grant to support homeless individuals with
behavioral health needs.
(59) Promising Practices" means the use of practices that incorporate the
best objective information available regarding effectiveness and
acceptability.
(60) "Prorated Share" means the total number of unpaid units or funds
divided by the number of months remaining between the time the
prorated share is calculated and the end date of the contract.
(61) "Protected Health Information" (PHI) means any information whether
oral or recorded in any form or medium that is created or received by a
health care provider, health plan, public health authority, employer, life
insurer, school or university, or health care clearinghouse; and relates
to the past, present, or future physical or mental health or condition of
an individual; the provision of health care to an individual; or the past,
present, or future payment for the provision of health care to an
individual.
(62) "Provider Network" (subcontractor or network provider) means the
direct service agencies that are under contract with a managing entity
and that together constitute a comprehensive array of emergency,
acute care, residential, outpatient, recovery support, and consumer
support services or other services as designated by this contract. See
section 394.9082, F.S.
(63) "Quality Improvement/Continuous Quality Improvement" means a
management technique to assess and improve internal operations and
network services. It focuses on organizational systems rather than
individual performance and seeks to continuously improve quality. The
process involves setting goals implementing systematic changes,
measuring outcomes, and making subsequent appropriate
South Florida Behavioral Health Network, Inc. 16 KH225
10/01/2010 Managing Entity
improvements. Quality improvement activities will assess compliance
with contract requirements, state and Federal law and associated
administrative rules, regulations, and operating procedures and validate
quality improvement systems and findings.
(64) "Readiness Assessment" means a formalized process to determine
the operational capacity of a managing entity to satisfactorily perform
required duties.
(65) "Recovery" means an on-going process which enables a person with
behavioral health issues to live a meaningful life in a community of his
or her choice while striving to achieve his or her potential. This allows
individuals to improve their health, wellness, and quality of life.
(66) "Recovery Based" is based upon a personal process of overcoming
the negative impact of substance abuse addiction or mental illness. A
system of care provides treatment and supports that promote recovery
and functioning in the community.
(67) Representative Payee" means an entity/individual who is legally
authorized to receive Supplemental Security Income, Social Security
Income, Veterans Administration benefits, or other federal benefits on
behalf of an individual served.
(68) "SAMH" means the Substance Abuse and Mental Health Programs
within the department.
(69) "Schedule of Activities" means the defined instructional content,
materials, resources, and processes in order to attain educational
objectives.
(70) "Service Units" means those units of measure specified in Rule 65E-
14.021(7), F.A.C. and in Substance Abuse Recovery Support
Services, Comprehensive Community Service Teams, and Clinical
Supervision for Evidence Based Practices.
(71) "SOAR" stands for "SSI/SSDI Outreach, Access and Recovery" and is
a technical assistance initiative. This strategy helps States and
communities increase access to SSI and SSDI for people through
training, technical assistance and strategic planning.
(72) "Stakeholder" means individuals/groups with an interest in the
provision of behavioral health services.
(73) "Statewide Inpatient Psychiatric Programs (SIPP)" means
residential inpatient facilities under contract with the Agency for Health
Care Administration under the Medicaid IMD waiver for children under
age 18 to provide diagnostic and active treatment services in a secure
setting.
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(74) "Substance Abuse and Mental Health Information System
(SAMHIS)" means the department's online data system which providers
are required to use to collect and report data and performance
outcomes on persons served whose services are paid for, in part or in
whole, by the department's Substance Abuse and Mental Health
(SAMH) contract, Medicaid, or local match. Instructions on how to
access the system can be found in CFP 155-2.
(75) "System of Care" means behavioral health services that are
coordinated and developed into an integrated network of services
accessible and responsive to the needs of individuals served, their
families, and community stakeholders.
(76) "TANF Participant" means a person or family member of that person
defined in 45 CFR Part 260.30 and section 414.1585 and subsection
414.0252(9), F.S.
(77) "Targeted Prevention" means prevention programs or other Schedule
of Activities conducted with individuals or groups of individuals to
educate them on personal prevention concepts and skills and consists
of prevention programs or curricula.
(78) "Temporary Assistance to Needy Families (TANF)" means cash
assistance for families, including any family receiving cash assistance
payments or TANF diversion services from the state program pursuant
to the provisions of section 414.045, F.S., and Part A of Title IV of the
Social Security Act.
(79) "Transformation" means a process that strives to change the form
and function of the behavioral health services delivery system to better
meet the needs of the individuals and families it is designed to serve.
(80) "Utilization Management" means a system to ensure maximum, cost-
effective, and clinically appropriate utilization of behavioral health
services. The goal of the program is to eliminate waitlists and maximize
utilization as well as diverting individuals served to more clinically
appropriate services when applicable.
2. General Description
a. General Statement
This contract is for the purchase of the administration, management, and oversight
of a consumer-centered and family-focused comprehensive coordinated system of
care by a managing entity. The contract requires the managing entity to subcontract
with qualified, direct service, community-based network providers who will provide
services for adults and children with behavioral health issues as authorized in
section 394.9082, F.S. and which are consistent with the Approved Regional Plan.
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The managing entity will provide administrative and programmatic oversight to
ensure that network providers comply with all consumer-related services and other
requirements of this contract.
b. Approved Annual Action Plan
The managing entity will develop and operationalize an annual action plan in
partnership with the department, which is incorporated herein by reference. This
action plan will be approved by the department on an annual basis and may be
modified by mutual agreement and approved/dated by the managing entity
Executive Director and the approved department Representative i.e., the Southern
Region SAMH Program Supervisor. A copy of any revisions to the approved annual
action plan shall be provided to the department's contract manager.
c. Baseline Functions
There are ten (10) baseline functions that the Managing Entity must provide.
Performance on these functions will be provided in the Approved Annual Action
Plan. The deliverables are outlined in the Annual Action Plan. These functions are
as follows:
(1) Function 1. System of Care Development and Management
Behavioral health services that are coordinated and developed into an integrated
network of services accessible and responsive to individuals in need of substance
abuse and mental health services, families, and community stakeholders. To
accomplish this, managing entities support the application of evidence based
practices through contracting requirements, program development and design,
training, quality improvement activities, and the development of mechanisms for
care management and service coordination.
(2) Function 2. Utilization Management
Systems to ensure cost-effective and clinically appropriate utilization of treatment
services. For the purposes of this contract, the specific goals of utilization
management include the elimination/management of wait lists, the maximum
utilization of treatment resources, and the delivery of clinically appropriate
services. Utilization management systems will include preauthorization for some
services as well as retrospective reviews and focused reviews of individuals
receiving services and subcontractors whose utilization of services is outside of
expected parameters. Utilization management includes methods used to manage
the system of care to ensure access to the appropriate level of care. These
methods may include programs of intervention and/or diversion. Utilization
management includes not only managerial and supervisory strategies, methods
and tools to ensure timely access to care, but also includes processes to promote
continuous improvement to manage resources. The managing entity will develop
an automated utilization management system that includes treatment
authorization and management reports for the system of care as outlined in the
approved annual action plan.
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(3) Function 3. Network/Subcontract Management
The process whereby the managing entity conducts a systematic organized
review of a subcontractor's operations and service provision in order to give
reasonable assurance that the subcontractor is complying with subcontract
requirements, rules, regulations and laws applicable to the subcontractor's
contract performance.
For the purposes of this contract network management includes processes by
which accountability for performance and quality of services from subcontractors
will be ensured.
(4) Function 4. Quality Improvement
A series of management techniques and processes used to assess and improve
internal managing entity operations and network services. Quality improvement
focuses on organizational systems of network members' performance and seeks
to continuously improve quality of services provided. The managing entity will
establish a clearly delineated quality improvement program that provides for the
meaningful involvement of managing entity staff members, subcontractor
organizations, and individuals served and other stakeholders.
(5) Function 5. Technical Assistance/Training
The managing entity will provide technical assistance and training in two broad
areas. First, they will provide training and technical assistance to help
subcontractors perform network-functions, such as invoice submission and
participation in network quality improvement activities. The second area is
training and technical assistance to help subcontractors implement quality of care
including the implementation of evidence-based practices, such as the application
of process improvement methods to improve coordination and access, the use of
evidence-based treatment protocols, and providing services that are culturally and
linguistically appropriate. The managing entity will provide the technical
assistance and training directly or arrange for the provision of technical assistance
or training in the most fiscally responsible manner.
(6) Function 6. Data Collection, Reporting, and Analysis
The managing entity will manage activities that use data elements to track cost,
utilization, quality of care, access to services, and individuals served outcomes
within the network of subcontractors. The managing entity will describe the
implementation of the electronic health records (EHR) for the subcontractors in
the approved annual action plan.
(7) Function 7. Financial Management
Financial management activities include the following elements:
(a) Negotiating and developing administrative costs and service rates within
the parameters established by the department;
(b) Developing contracts that allocate funds according to department
utilization targets and reallocating funds according to shifts in utilization
patterns, all funds are allocated in accordance with the approved operating
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budget and approved annual action plan, incorporated herein by reference.
Paying invoices in a timely manner and verifying the accuracy of the invoices
submitted by subcontractors. The managing entity will pay subcontractors
within 15 working days of receiving a valid invoice, based upon or subject to
the availability of funds.
(c) Managing contracted funds according to State and Federal
requirements;
(d) Complying with Local Match requirements.
(e) Securing, managing and leveraging other sources of funding. Resource
maximization to include pursuit of third party payments prior to the billing of
SAMH funding;
(f) The managing entity will pursue additional sources of revenue
particularly grant applications in accordance with the approved annual action
plan;
(g) Achieving efficiencies by consolidating subcontractor operational
functions;
(h) Reinvesting efficiencies into the system of care or infrastructure
development designed to continuously improve the quality of services and
maximize capacity in partnership with department staff; and
(i) Redirecting service dollars from restrictive care settings (as defined in
the approved annual action plan) to community-based recovery services.
(8) Function 8. Planning
The managing entity will be the source of performance, utilization, and other
network information used by the department in formulating its plans, including the
Annual Action Plan. The managing entity's approved annual action plan, subject
to the approval of the department, is the vehicle for identifying the network's
goals, objectives, and improvements. The managing entity will participate in
departmental planning processes at the State, regional, and circuit levels as
appropriate.
(9) Function 9. Board Development and Governance
The managing entity will maintain a governing body that is representative of the
community and that includes individuals served and family members, relevant
community stakeholders and organizations, and subcontractors of behavioral
health services.
(10) Function 10. Disaster Planning and Responsiveness
Includes working collaboratively with the department and taking direction from
department staff for any disaster-related preparedness, response activities, and
the Regional Disaster Plans and/or as specified in the approved annual action
plan.
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d. Minimum Programmatic Requirements
The managing entity, either individually or through the management and oversight of
services provided by subcontractors, shall maintain the following minimum
programmatic requirements:
(1) System Of Care
The consumer-centered and family-focused comprehensive coordinated system
of care will:
(a) Be driven by the needs and choices of the customers;
(b) Promote family and personal self-determination and choice;
(c) *Be ethically, socially, and culturally responsible; and
(d) Be dedicated to excellence and quality results.
There is a commitment to expand clinical treatment to include the Behavioral
Health Transformation Initiative, evidence-based practices and recovery support
services for the full continuum of care based on priorities established by the
department for substance abuse, mental health treatment and/or co-occurring
disorders, substance abuse and mental health treatment capacity, children and
families, criminal and juvenile justice, HIV and hepatitis.
(2) Guiding Principles
Guiding principles specify that services are as follows:
(a) Inclusive - involve and engage families and consumers as full partners to
participate in the planning and delivery of services;
(b) Comprehensive - incorporating a broad array of service and supports
(e.g. physical, emotional, clinical, social, educational and spiritual);
(c) Individualized - meeting the individual's exceptional needs and
strengths;
(d) Community-based - provided in the least restrictive, clinically appropriate
setting; and
(e) Coordinated - both at the system and service delivery levels to ensure
that multiple services are provided and change as seamlessly as
possible when warranted.
(f)Cultural and linguistic competence.
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e. Programmatic Authority
Sections 20.19, 39.001(2), 39.001(4), 394.457(3), 394.74, 394.9082, 397.305(2) and
397.321(5), 916, F.S, provide the department with the authority to contract for these
services.
f. Scope Of Service
The following scope of service applies to each fiscal year of this five (5) year
contract and any renewal or extension:
The managing entity is responsible for the administration, management, and
oversight, and through sub-contracts, the provision of behavioral health services in
Miami-Dade and Monroe counties as stipulated in this contract. Prevention services
designed to preclude the development and/or exacerbation of substance abuse
problems and mental health disorders by addressing risk factors with children and
families and in the community at large are a part of the behavioral health services.
g. Major Program Goals
(1) The primary goal of the Substance Abuse and Mental Health Programs is to
reduce or prevent substance abuse and promote and improve the mental
health of the citizens of the state by making behavioral health services
available through a community-based system of care.
(2) It is the goal of the managing entity to improve accountability, ensure quality
of care through best practice models and seek to ensure delivery of
Behavioral Health Services across the provider network and across
systems resulting in systematic access to a full continuum of care for all
children, adolescents and adults who enter the publicly-funded behavioral
health services systems.
(3) Construct a system of care design that will facilitate and improve co-
occurring capability and expertise in all programs and for all service
network providers.
(4) Promote and improve the behavioral health of Florida's Southern Region
communities by strategically applying substance prevention programs,
activities and services available as part of the community-based system
action plan.
3. Clients to be Served
a. Client General Description
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Pursuant to section 394.9082(7)(b), F.S., the managing entity shall ensure that
services funded by the contract are furnished to eligible adults and children with or at
risk of developing behavioral health disorders .
Z Adult Mental Health — Forensic Involvement
Z Adult Mental Health — Severe and Persistent Mental Illness
Z Adult Mental Health — Serious and Acute Episodes of Mental Illness
Z Adult Mental Health — Mental Health Problems
Z Children's Mental Health — Seriously Emotionally Disturbed
Z Children's Mental Health — Emotionally Disturbed
Z Children's Mental Health —At Risk of Emotional Disturbance
Z Adults with Substance Abuse Problems
Z Children with Substance Abuse Problems
Z Adults at Risk of Substance Abuse Problems
Z Children at Risk of Substance Abuse Problems
b. Client Eligibility
(1) The managing entity shall ensure that all persons meeting the target
population descriptions in paragraph A.3.a. above, and as described in CFP
155-2, receive services through its subcontractors based on the availability of
resources. However, department funding shall be targeted for the medically
indigent. A detailed description of each target population is contained in CFP
155-2.
(2) The managing entity shall ensure that substance abuse detoxification and
addiction receiving facility services are provided to all persons meeting the
criteria for admission, subject to the availability of funds.
(3) Mental Health Crisis: The managing entity shall ensure that all crisis services
are provided for both children and adults meeting criteria pursuant to chapter
394, F.S.; Rule 65E-5, F.A.C.; and Rule 65E-12, F.A.C. This includes but is
not limited to, mobile crisis services and inpatient hospitalization at receiving
facilities and crisis stabilization units.
c. Client Determination
The department is exclusively responsible for defining client eligibility for services
provided through this contract. The managing entity shall apply this definition to
persons on a case-by-case basis, and the managing entity may delegate the client
eligibility determinations to the network providers.
The department reserves the right to make final determinations of client eligibility. If
the managing entity disputes the department's determination regarding eligibility of a
client, dispute resolution, as described on in Section D.2. shall be implemented.
Services shall be provided to the client unless and until the dispute resolution process
reverses the department's determination.
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The managing entity shall work with the Southern Region to coordinate admissions
and discharges from state forensic hospitals and residential treatment centers.
d. Client Contract Limits
(1) The managing entity is not authorized to receive funding from the department
for more dollars than are allocated.
(2) The managing entity shall ensure that funds provided in this contract will not
be used to serve persons outside the target population(s) specified in Section
A.3.a. and A.3.b. above.
(3) Services provided under this contract are limited by the availability of funds,
with the exception of Section A.3.b(3) above. The managing entity may not
authorize or incur indebtedness on behalf of the department.
B. MANNER OF SERVICE PROVISION
1. Service Tasks
a. Task List
The following tasks shall be completed for each fiscal year of the contract unless
otherwise noted:
(1) Develop, Maintain, and Improve the Provider Network
The managing entity shall develop and maintain a network of qualified, direct
service, community-based providers to provide services for adults and
children with behavioral health and/or co-occurring disorders as authorized in
section 394.9082, F.S. This network shall deliver all services in accordance
with the Consolidated Program Description on file in the department contract
manager's file. The managing entity shall continue to assess the adequacy of
the network and modify the network as indicated by department plans and
requirements, consumer and stakeholder needs and preferences, data
analysis and best practice findings scientific findings, and improvement
opportunities identified in the managing entity approved annual action plan
based upon the most current Florida Department of Children and Families
Strategic Intent 2008-2010, or the latest revision thereof, and through quality
management processes.
The exact array of services, the required features of particular services,
priorities for service development and improvement, and service coordination
efforts are made at the Regional level within the broader framework of
Department of Children and Families (DCF) priorities and policies. Each
year, the department, with the assistance of the local regional planning
councils, will identify the service requirements that the managing entity will
address in its approved annual action plan. The managing entity will develop
the network according to the general values and features described in this
contract and the specific dimensions that follow:
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(a) Ensure Timely Access to Care for Services
The standards for timely access to care are along the lines of those required
by managing entity accrediting bodies and the Medicaid prepaid plans:
(i) Immediate/Crisis: seen immediately for life behavioral health life
threatening emergencies
(ii) Within 24 hours of initial contact for non-life threatening emergencies;
(iii) Within 48 hours for urgent care;
(iv) The offer of an appointment for routine care within 7 business days.
The managing entity shall monitor compliance with the timely access
standard, and if a pattern of noncompliance develops with any network
provider, the managing entity will take corrective action and monitor the
results of corrective action. Please refer to approved annual action plan for
deliverables.
(b) Ensure Geographic Access to Services
Aspects of geographic access include drive times, the location of services on
public transportation routes, and proximity to other services and locations
often used by members of the covered population. Standards for acceptable
geographic access are:
(i) Thirty (30) mile drive for outpatient services in Miami-Dade County
and fifty (50) mile drive within Monroe County;
(ii) Sixty (60) mile drive for inpatient and residential services in Miami-
Dade County and one hundred twenty (120) mile drive for Monroe
County;
(iii) Services located on available public transportation routes where
public transportation is available.
As with the timeliness standards, these standards define acceptable
performance that when not achieved trigger corrective action, consistent with
the approved annual action plan.
(c) Promote Family and Personal Self-Determination
The managing entity will promote personal self-determination and choice by:
(i) Providing oversight so that the needs and preferences of consumers
and their families drive treatment planning and service delivery, and
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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.
(d) Develop and Assure the Delivery of Services Based on Evidence-
Based Practices/Promising Practices Guidelines
The managing entity shall identify specific services provided by the network
and service features in the managing entity's department-approved annual
action plan. These include such service features as evidence-based
practices (EBPs) and promising practice guidelines, as specified in the
approved annual action plan, endorsed by expert panels. The managing
entity shall assure that the service requirements are identified in subcontracts
and that the services are provided according to service guidelines (see
Section 13.a(2)).
(e) Ensure Access to Services that Meet Linguistic and Cultural Needs
of Recipients
The managing entity shall assure that the network provides sign language,
translation, and interpretive services required to meet the communication
needs of service recipients, including English, Spanish and Creole. Services
will meet the cultural needs and preferences of the covered populations. The
managing entity shall identify, through the approved annual action plan,
specific service characteristics that will include features designed to meet the
needs and preferences of cultural groups. In addition, the managing entity
will address in its approved annual action plan, improving the ability of the
network to provide services that meet the cultural needs, languages and
preferences of the covered populations.
The managing entity shall provide processes so that the contracted network
providers engage in recruitment to maintain as much as possible staff with the
ethnic and racial composition of the clients served.
(f) Facilitate National Accreditation of Network Providers
The department intends that most of the services it purchases through
managing entities be delivered by nationally accredited provider
organizations. To that end, the managing entity will subcontract with
organizations that are accredited, or working towards accreditation, in order to
promote best practices and the highest quality of care, as specified in the
approved annual action plan. However, national accreditation might not be
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realistic or useful for some smaller niche providers of such important services
as recovery support services, and consumer operated services.
Consequently, the department may grant exceptions to the requirement for
accreditation on a case-by-case basis.
(g) Coordinate Services for Persons with Co-occurring Disorders
The managing entity shall develop and operate a system of care to ensure
the provision of appropriate services in the least restrictive setting for adults
and children with substance abuse, mental health and/or co-occurring
disorders. Those services are needed in order to provide a seamless
Comprehensive Continuous Integrated System of Care (CCISC) for this
population that will increase access to services and improve outcomes in the
most cost effective manner. The managing entity shall implement a "no wrong
door" model by developing a process for assessing and referring clients with
co-occurring disorders to increase access of persons identified as co-
occurring to provide services for both disorders regardless of the initial point
of contact. As used in conjunction with the CCISC model, "no wrong door"
(See http://www.kenminkoff.com/ccisc.html ) requires that systems develop
policies and procedures that mandate a welcoming approach to individuals
with co-occurring psychiatric and substance disorders in all system
programs, eliminate arbitrary barriers to initial evaluation and engagement,
and specify mechanisms for helping each client (regardless of presentation
and motivation) to get connected to a suitable program as quickly as possible.
The managing entity must collect and review Required Reports as identified
in Exhibit G and as identified in the Annual Action Plan submit these reports
to the department's contract manager and the SAMH Program Office in
Tallahassee.
(h) Ensure Provision of Services to Clients with Special Needs
The managing entity shall ensure the coordination of specialty services
including employability skills training and linkage, victimization and trauma
services, infant mental health services, the elderly, and services to families in
recovery. The managing entity shall also ensure the availability of
appropriate services to consumers with special needs such as those who are
blind, deaf or hard of hearing, developmentally disabled, physically handicap,
criminally involved, or forensic clients. The department reserves the right to
modify this list as the needs of the consumers change.
(i) Providing early diagnosis and treatment intervention to enhance
recovery and prevent hospitalization
(ii) Promote specialized behavioral health services to residents of
assisted living facilities.
(iii) The managing entity shall work with the state and other stakeholders
to reduce the admissions and the length of stay for dependent
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children and adults with mental illness in residential treatment
services.
(2) Develop, Maintain, and Improve Contract Management and Provider
Relations
The managing entity will rely on national accreditation and State licensing to deal
with the network providers' compliance with the rules and regulations covered by
accreditation and licensing requirements. The managing entity will focus its
contract management and oversight activities on the contract requirements.
Network providers will be required to provide the managing entity with their full
accreditation and licensing reports upon request.
(a) Establish Contract Management Procedures
The managing entity shall develop and implement procedures for
subcontract procurement, development, performance, and management that
meet contract management and provider relations requirements and
establish a process to regularly update contract procedure directives as
specified in the in the approved annual action plan. The managing entity
shall submit a copy of the procedures and any updates to the department's
contract manager for department approval.
(b) Establish a Process for Approving Subcontracted Organizations
and Terminating Contracts
The managing entity's formal processes for approving subcontracting
organizations and terminating contracts shall include:
(i) Responding to provider organization inquiries
(ii) Formal applications, reviews, and approvals as well as onsite visits,
primary verifications of licensing and accreditation status, receipt of
liability insurance documents, and, for non-accredited providers,
verifications that the organization's credentialing process meet the
requirements outlined in this task list
(iii) A grievance or appeal procedure to the managing entity's governing
body or highest ranking local officer for adverse decisions
(iv) Contract termination
The managing entity shall not terminate a subcontract agreement
between a network provider and the managing entity without prior
written approval from the department. To the extent possible, the
managing entity will confer with the department regarding any
potential termination of contracts as soon as identified. The
managing entity shall submit to the department's Contract Manager,
a written request for approval at least 15 fifteen days prior to the
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intended notification of the network provider of termination of a
subcontract between a network provider and the managing entity.
This request for approval shall include evidence of due diligence on
the part of the managing entity to address the performance
deficiencies of the network provider, including, but not limited to,
provision of technical assistance and the implementation of
Corrective Action Plans.
(v) The specific make-up of the network, including the organizations
identified to provide services, is subject to the prior written approval
of the department.
(c) Develop Terms of Subcontracts with Subcontracted Organizations
The managing entity shall enter into subcontract agreements with network
providers for the provision of substance abuse, mental health and/or co-
occurring, and prevention services which adopt the applicable terms of the
managing entity's contract KH225 with the department and abide by all
terms of the department's standard contract. The managing entity will
develop contracts with subcontracted organizations that include:
(i) A Detailed Scope of Work with Clear and Specific Deliverables
[a] Service delivery requirements, features, and improvements
as specified in the Consolidated Program Description and
approved annual action plan, including the staffing levels and
qualifications needed for particular services
[b] Access to care, coordination of care, and service integration
requirements
[c] Requirements for the involvement of consumers and other
stakeholders
[d] Recipient eligibility requirements
[e] Client rights and grievance procedures
[f] Performance outcomes and outputs
(ii) Performance Standards and Administrative Requirements
[a] Detailed documentation requirements
[b] Requirements that subcontractors meet Substance Abuse
Prevention and Treatment Block Grant (SAPTBG) and
Community Mental Health Services Block Grant (CMHSBG)
requirements applicable to their organizations and services
along with a listing of these requirements
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[c] Reporting, service, and administrative requirements from the
department, federal block grants and other funding streams
[d] Liability insurance requirements
[e] Accreditation and licensing requirements, and, for non-
accredited providers, the additional credentialing
requirements presented in this task list. Also, a requirement
that subcontracted providers provide the managing entity with
their full accreditation and licensing reports upon request
[f] Agreements to participate in network training events
[g] Agreements to follow the procedures outlined in the network's
provider manual, as specified in the approved annual action
plan, or similar document which outlines network procedures
and policies
[h] Requirements for security agreements (incorporated herein
by reference)
[i] Requirements for emergency plans
(iii) Monitoring and Sanctions for Non-Performance
[a] Programmatic and fiscal monitoring requirements, including
requirements to allow the department to review client,
programmatic, and fiscal records
[b] Sanctions for non-performance and processes for problem
correction
[c] Agreement to participate in managing entity and the
department quality assurance and quality management
activities, including peer reviews, critical incident reporting,
and evaluations, including reviews of client and administrative
records, and to comply with contract management
requirements
[d] The process for contract termination, including the transfer or
continued treatment of recipients
(iv) Fiscal Requirements
[a] Funding activity levels and rates for each cost center will be
negotiated in accordance with rule and statute.
[b] Sliding fee scale amounts and procedures
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[c] Financial management, billing and invoice verification
requirements
[d] Innovations leading to the reduction of administrative costs
as specified in the approved annual action plan
(d) Conduct Contract Monitoring
The managing entity shall monitor the performance of all subcontractors and
perform follow up actions as necessary. The managing entity shall notify the
department verbally within 24 hours and in writing within 48 hours of
conditions related to subcontractor performance that could impair continued
service delivery and/or include a health and safety violation. The managing
entity shall monitor subcontracts, according to the departments operating
procedure 75-8, Contract Monitoring, using a systematic review of the
subcontracted organization's compliance with their subcontract
requirements. Contract monitoring may include desk audits and onsite
reviews. Onsite reviews will occur at least annually, for high risk network
providers, with more frequent visits triggered by patterns of compliance
problems. Within 30 days of contract execution, and by July 30th of each
subsequent fiscal year of the contract, the managing entity shall develop
and distribute a monitoring schedule to network providers. The managing
entity shall submit a copy of the monitoring schedule and any revisions to
the monitoring schedule to the department's contract manager and to the
SAMH Program Office. The managing entity shall submit copies of the
monitoring reports, including any requests for corrective action plans, to the
contract manager within 30 calendar days of the completed contract
monitoring exit conference with the network provider. Copies of corrective
action plans received from subcontractors shall be forwarded to the contract
manager and to the SAMH Program Office within 30 days of receipt. While
contract monitoring addresses compliance with all requirements, the
managing entity's reviews shall focus on the subcontracted providers'
compliance with section 13.1.a(2)(c) above particularly:
(i) Federal Substance Abuse Prevention and Treatment Block Grant
requirements or Community Mental Health Block Grants.
(ii) Primary source verification that the subcontracted organization is
maintaining their licenses and national accreditation. (The
managing entity shall submit to the department's contract manager
(6) six-month reports containing each of the network providers
name and expiration date of their license and accreditation.);
(iii) Performance outcomes;
(iv) Service delivery requirements;
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(v) Access to care, coordination of care, and service integration
requirements;
(vi) Invoice verification and financial management;
(vii) Recipient eligibility.
(e) Establish Fiscal Operations and the Invoice Payment Process
(i) Develop and implement fiscal operational procedures as specified
in the approved annual action plan. These procedures shall
contain, but not be limited to, procedures relating to overpayments,
charge-backs that directly apply to subcontractors and
documentation of cost sharing (match) that comply with state and
federal regulations, and invoice review procedures. The managing
entity shall submit a copy of the procedures to the department's
contract manager.
(ii) Prior to entering into any subcontract, or an amendment which
modifies the negotiated unit cost rate or adds additional cost
centers, the managing entity shall conduct a cost analysis for said
subcontract, in accordance with Rule 65E-14.021. These
analyses may be based on projections for new or significantly
modified services and on retrospective cost studies for current
services. All requests to the department by the managing entity
for approval of subcontracts must include evidence of cost
analysis.
(iii) Establish quantifiable units of deliverables that must be received
and accepted in writing by the managing entity before payment.
Each deliverable must be directly related to the scope of work and
must specify the required minimum level of service to be
performed and the criteria for evaluating the successful completion
of each deliverable.
(iv) Verify client eligibility and avoid payment for those not included in
the service population.
(v) Reimburse network providers within 15 working days of receiving a
valid invoice based upon or subject to the availability of funds.
(vi) Enforce requirements for sliding fee scales.
(vii) Manage flexible funding administration, such as capitation and
case rates, as may be specified in the Annual Action Plan.
(viii) Monitor expenditures by subcontracted organization, service level,
and funding source.
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(ix) Reallocate funds (with prior department approval) to respond to
utilization trends and needs throughout the contract year.
(x) Assure the fiscal integrity of all funds under this contract, and for
demonstrating that a comprehensive audit and tracking system
exists to account for funding by client, by region, by network
provider.
(f) Develop and Distribute a Provider Manual Outlining Processes for
Network Participation
The managing entity shall develop a provider manual that summarizes
network procedures for subcontracted provider organizations and provide a
copy of this manual to the department as specified in the approved annual
action plan. managing entity will be responsible for keeping the manual up
to date and informing the subcontracted providers of changes.
(g) Identify a Subcontractor Provider Liaison
The designated contract manager for the managing entity will serve as point
of contact between the managing entity and subcontractor.
(h) Provide Technical Assistance
The managing entity will provide technical assistance to help subcontractors
meet the reporting and other contract requirements for participating as a
network provider.
(i) Maintain Subcontractor Records and Reports
The managing entity shall provide copies of all subcontracts and any
amendments to the subcontracts to the department's contract manager
within ten (10) days of execution of those documents. In addition, the
managing entity will provide a quarterly report listing all active subcontracts
and all outstanding invoices, including service period and invoice amount.
6) Coordinate Network Services and Operations
The managing entity is responsible for all of the network services and
operations required under this contract including the approved annual action
plan. Any failure to perform on the part of a network provider does not
relieve the managing entity of any accountability for tasks or services that the
managing entity is obligated to perform pursuant to this contract.
(k) Substance Abuse Prevention and Treatment Block Grant
Requirements and Community Mental Health Block Grants for the
Managing Entity
(i) The managing entity shall comply and agrees to ensure that its
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network providers that receive federal Substance Abuse
Prevention and Treatment Block Grant and/or Community Mental
Health Block Grants, comply with Subparts I and 11 of Part B of
Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x-21 et
seq. (as approved September 22, 2000) and the Health and
Human Services (HHS) Block Grant regulations (45 CFR Part 96).
(ii) The managing entity shall ensure that a network provider that
receives funding from the Substance Abuse Prevention and
Treatment Block Grant certifies compliance with all of the
requirements of the Substance Abuse and Mental Health Services
Administration (SAMHSA) Charitable Choice provisions and the
implementing regulations of 42 CFR54a.
(iii) Guidance for contracting SAPTBG funds can be obtained from the
SAMH Funding Restrictions Resource Guide at the following
website:
http://www.dcf.state.fl.us/programs/samh/pubiications/samhfund.doc
(1) Adhere to Prohibitions Against Subcontracting with Certain Entities
See Section.B.2.d.
(m) Incident Reporting
The managing entity will be responsible for the review, input, follow-
up/corrective action, and tracking of monthly reports related to client risk
prevention and incidents. Lotus Notes will be used unless another
acceptable format is mutually agreed upon.
(i) The managing entity will establish an electronic system utilizing
Lotus Notes for the usage of the incident report system.
(ii) Each Network provider will submit an incident report (Circuit 11 &
16 SAMH Incident Report, incorporated herein by reference) on all
reportable incidents per CFOP 215-6 within 24 hours via fax
machine to the managing entity. The managing entity will review
incident reports for completeness and input into the system. If a
report is incomplete, the managing entity will contact the provider
for additional information. The managing entity shall ensure that
timely notification is/has been made by the provider in the incident
report to the appropriate individuals and agencies. Such
notifications may include, but are not limited to: the Florida Abuse
Hotline; Law Enforcement; Fire Department; parent, guardian,
relative; Death Review Coordinator; Building Manager; Safety
Coordinator; Local Advocacy Council; etc. Within forty-eight (48)
hours, incident reports with any corresponding follow- up should be
forwarded to the department's Regional Incident Report Liaison.
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[a] In the event an incident has an immediate impact on the
health or safety of a client, has potential media impact, or
involves employee-related incidents of criminal activity
(CFOP 180-4), the managing entity must notify the
Department of Children and Families (DCF) Substance
Abuse and Mental Health (SAMH) Program Supervisor as
soon as possible after notification but not to exceed 24
hours.
[b] Employee related incidents of criminal activity or other types
of serious wrongdoing per CFOP 180-4 must be submitted to
the Office of the Inspector General utilizing the Notification/
Investigation Request form CF 1934 after notifying the DCF
SAMH Program Supervisor. This must be e-mailed to the
Office of Inspector General at ig_complaints@dcf.state.fl.us.
The provider and subcontractor may also mail the completed
form to the Office of Inspector General, 1317 Winewood
Boulevard, Building 5, 2nd Floor, Tallahassee, Florida,
32399-0700; or via fax at (850) 488-1428. A reportable
incident is defined in CFOP 180-4, which can be obtained
from the contract manager.
[c] For all deaths, the managing entity should request the
following information from all providers:
1) Cause of Death;
2) Medication(s) consumer was taking;
3) Medical Examiner's report;
4) What services was the consumer receiving from your
agency; and
5) Dates of contact by case manager and/or therapist with
consumer for the last 3 months; include a summary of the
consumer's status during this time.
(iii) The managing entity shall ensure that appropriate corrective action
is/was taken to minimize both immediate and future risk. If a plan
for corrective action is necessary, the administrator or designee
shall oversee plan development and implementation.
(iv) It is the responsibility of the managing entity to maintain a monthly
log listing all incidents including those submitted to the Office of the
Inspector General with the following information: the Provider
name, IR tracking number from Lotus Notes, or another agreed
upon format, client's initials, incident report category number, date
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and time of incident, and description of follow-up action taken. In
addition, a monthly report needs to be generated by provider the
total number of incidents by category, number of untimely reports,
and description of follow-up action necessary.
(v) Certain incidents may require managing entity staff to conduct a
monitoring of the facility or other types of investigation.
(vi) A quarterly trends analysis regarding incident reports will be
developed by the managing entity that analyzes and reports on the
quality improvement mechanisms in place to ensure that providers
successfully correct deficiencies. This needs to be submitted to the
SAMH Program Office quarterly upon which a meeting will
commence to review the results of the quarterly trends analysis
between the managing entity and the department.
(3) Develop, Maintain and Improve, Utilization Management (UM)
The managing entity shall apply UM systems and processes to: ensure
maximum, cost-effective, and clinically appropriate utilization of substance
abuse and mental health treatment services. All items will be addressed more
specifically in the managing entity's approved annual action plan.
(a) Establish Utilization Management Procedures
The managing entity shall develop and implement written utilization
management procedures inclusive of and not limited to agreed upon
behavioral health services which meets the department's requirements and
which details what process will be utilized to prevent over and under
utilization of services. The Utilization Management procedures minimum
requirements are specified in the managing entity's approved annual action
plan.
(b) Submit Utilization Management Reports
The managing entity will submit quarterly utilization management reports to
the department. These reports will include utilization activity relative to
utilization goals, corrective actions, and a monthly report of the substance
abuse/mental health waiting list for residential treatment.
(c) Oversee Application of Utilization Management Criteria
The utilization management criteria for substance abuse is the ASAM PPC-
2R Florida Supplement, American Society of Addiction Medicine, Patient
Placement Criteria for the Treatment of Substance Related Disorders, second
edition - revised, July 1, 2001, or the latest revised edition thereof. The State
may specify an alternate assessment tool that may replace the current tool.
Consumer placement criteria specific to mental health services will be
developed by the managing entity and approved by the Southern Region
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SAMH Program Office. Standardized tools and assessments approved by
the department must be used to determine placement and level of care. The
managing entity will ensure that subcontractors use the GAIN, when
appropriate, as the behavioral health assessment and placement tool for ages
12 and up in the Southern Region, or as otherwise specified in the approved
annual action plan.
(d) Develop Service Utilization Goals as Part of the Managing Entity's
Approved Annual Action Plan and Monitor Performance
The managing entity will develop utilization projections to be incorporated in
the Utilization Management Section of the Approved Annual Action Plan.
These projections will be developed for program service area and include the
number of persons to be served, average length of stay, and the application
of dollars from the funding source managed by the department. The
managing entity will generate and analyze quarterly utilization reports that
compare actual utilization of services by program service area in relation to
these goals by subcontractor and for the region. The managing entity will
work with subcontractors to address and resolve service delivery practices
that do not conform to client placement criteria and utilization targets.
(e) Review Compliance with Utilization Management Criteria
As part of the quality improvement program, the managing entity will provide
or coordinate reviews of service compliance with criteria and practice
guidelines, such as retrospective reviews to ensure the level of placement of
clients is appropriate. (See the Quality Improvement section.) The managing
entity will take corrective action to resolve situations in which the
subcontracted provider is not following the guidelines or working to help the
system meet its utilization goals.
(f) Manage Waiting List and Interim Services
The managing entity shall conduct oversight, reporting and management of
the behavioral health plan for individuals served. In the event that waiting lists
do develop, the managing entity will develop and implement procedures for
managing the substance abuse and mental health waiting list for all
applicable levels of care including provision of interim services.
(g) Authorize Services
The managing entity shall conduct authorization and reauthorizations for
applicable levels of care as described in the approved Annual Action Plan in
order to ensure timely access to behavioral health services and eliminate the
wait lists. The authorization processes will include:
(i) Timeliness standards for authorization review must adhere to
timelines standards referenced in section 13.1.a.(1) (a) for the
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services provided and departmental, statutory, and judicial
regulations or requirements.
(ii) Processes for making the criteria on which decisions are made
available to practitioners, including any standardized tools and
assessments for use in determining placement and/or level of care.
(iii) Provisions for providing timely appeals, or second opinions, when a
request for authorization for a particular service is denied. (An
appeal differs from a grievance in that grievances are used when a
recipient or member of the covered population believes that he or
she has been treated improperly, whereas an appeal is a request to
review a judgment.) The second opinion shall be obtained
according to the timeliness standards for the service in question.
(h) Manage Resources and Recommend Reallocations of Funds, Provide
Cost Allocation Plan and Submit Annually
The managing entity shall manage resources by funding source, cost center,
and network provider. Within 30 days of contract execution, and annually by
July 30th of each subsequent fiscal year, the managing entity shall submit a
funding allocation plan for department approval. Any subsequent changes to
the approved allocation plan must be submitted to the department for approval
prior to implementation. The managing entity will recommend reallocation of
funds during the contract year as a result of patterns of underutilization of
funds, high demand that reflects the needs and preferences of consumers and
the department targets and plans.
(4) Develop, Maintain, and Improve Care Coordination and Integrated Care
Systems
(a) Develop Initial Service Agreements
The managing entity shall develop and/or maintain written cooperative
agreements with the judicial system and the criminal justice system which
define strategies and alternatives for diverting persons from the criminal justice
system and address the provision of appropriate services to persons with
substance abuse, mental health and/or co-occurring disorders who are
involved with the criminal justice system, as specified in the approved annual
action plan. These agreements must also address the provision of appropriate
services to persons who have behavioral health problems and leave the
criminal justice system. The managing entity shall submit a copy of the
agreements to the department's contract manager.
The managing entity shall execute a department-approved working agreement
with the department's contracted Community Based Care (CBC) providers in
support of the Southern Region's SAMH Program Office's working agreement
with the CBC. The intent of the working agreement is to establish a formal
linkage of partnerships with a shared vision for improving outcomes for
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families involved in the child welfare system by providing integrated community
support and services. The working agreement shall be submitted to the
department's contract manager, as specified in the approved annual action
plan.
(b) Develop a Plan for Care Coordination
The managing entity will develop written cooperative agreements with other
external stakeholders as described in the approved Annual Action Plan.
(1) The managing entity will oversee the regional SOAR Initiative by
ensuring that providers with co-occurring clients participate in the
SOAR Initiative. The managing entity staff should be trained in
SOAR and assist the department in training needs including
technical assistance and data collection.
(5) Develop, Maintain, and Improve Processes Advocating for Consumer
Rights and Network Access
(a) Establish Procedures
The managing entity shall establish and maintain a consumer rights and
grievance procedure which applicants for, and recipients of, contracted
services may use to present grievances to the managing entity, if their
grievances were not resolved at the subcontractors level and to achieve
resolution. The managing entity shall submit a copy of their rights and
grievance procedure to the department's contract manager for review and
approval within thirty (30) days of contract execution.
(b) Develop and Disseminate Consumer Manual
The managing entity shall develop and maintain a format for subcontractor
service recipients which includes information about access procedures,
recipient rights and responsibilities (including grievance and appeal
procedures). This information will be placed in a manual available for use by
the consumers within each subcontractor location. In addition, the managing
entity shall maintain updated information of each subcontractor on their
website. The managing entity shall submit a copy to the department's contract
manager for review and approval as specified in the approved annual action
plan.
(c) Assist Consumers in Choosing Network Providers
At a minimum, the managing entity will assist consumers in choosing Network
Providers by providing 24 hour/7 days a week access as specified in the
approved annual action plan for individuals who need assistance in accessing
behavioral health services.
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(d) Work and Social Opportunities
A Peer Services Coordinator will be employed to develop work and social
opportunities for consumers and make recommendations to the managing
entity and subcontractors for a consumer-driven system.
(6) Assist Stakeholder Involvement in Planning, Evaluation, and Service
Delivery
(a) Participate in Planning
The managing entity will engage local stakeholders, per section 394.9082
F.S., in its support activities for the department's local plans and in the
development of its Annual Action Plan (see section 13.1.a(9)).
(b) Configure Network Administration Through a Governing Board
The Managing Entity Governing Board shall be responsible for the following:
(i) serving as a bridge between the managing entity, local stakeholders,
(including consumers), and the community;
(ii) establishing and monitoring all managing entity subcommittees and
advisory groups involved in the services provided through the
managing entity for this contract;
(iii) assessing the adequacy of the network and deciding network
composition;
(iv) deciding the content of the Annual Action Plan;
(v) annually approving the standard contract between the managing
entity and network providers; and
(vi) approving and distributing board policies and procedures and
providing copy of such to the department's contract manager.
(c) The Managing Entity Governing Board shall meet at least quarterly and
more frequently if required. Its composition shall be no less than 25 and no
more than 35 Board Members. The Board Members shall be minimally
comprised of the following members:
2 Consumers
2 Family Members of Consumers
8 Substance Abuse and Mental Health Service Providers
1 Local Government Representative (Non-State agency)
1 Judge or Senior Court Official
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1 Elected City, County or State Official
1 Faith-based Leader
1 Local NAMI or other Advocacy Group Director
1 Behavioral Health Community Leader
1 Youth Representative
1 Public Health Representative
(7) Develop, Maintain, and/or Improve Quality Improvement processes
Quality Improvement (QI) reviews address reviews of network provider compliance
with clinical and programmatic requirements. Continuous Quality Improvement
(CQI) activities address outcomes management and systematic activities using data
to improve services. The goal is to improve the accountability for a local system of
behavioral health care services to meet performance outcomes and standards
through the use of reliable and timely data.
(a) Develop Procedures for Quality Management
The managing entity shall develop and implement the Quality Improvement
Procedures. The procedures will describe how the managing entity ensures
that the network meets service and administrative requirements and uses data
to improve services. The elements of the Quality Management Procedures
are specified in the approved Annual Action Plan. The managing entity shall
submit a copy of the Quality Management Procedures, a copy of all quality
assurance reviews, a copy of all monitoring reports within 30 days of
completion, a copy of all corrective action plans, and a quarterly quality
management report to the department's contract managers.
(8) Provide Training and Technical Assistance
The managing entity shall develop and implement a training program for its staff
and the subcontractor staff. The training shall assure that staff receives externally
mandated and internal training. , The managing entity may coordinate training or
directly provide training to subcontractor staff. In addition, the managing entity will
encourage cross-organizational training and assistance to help non-accredited
providers become accredited. The managing entity shall submit a quarterly report
on the training received by the subcontractors and managing entity staff. The
managing entity shall submit an annual training plan (see approved Action Plan for
specifics).
(9) Develop, Maintain, and Improve Planning Support and Plan Development
The local department plans and the managing entity Annual Action plan are the
vehicles for identifying the services and improvements that the managing entity will
develop and provide on a year-to-year basis.
(a) Provide Support for Local Department Planning
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The managing entity will support the planning efforts of the department and
develop an Annual Action plan, subject to the approval of the department. The
department plans supported by the managing entity are the Annual Regional
Plan and the strategic plan developed every three years. The managing entity
will support the department's local plan by providing:
(i) A summary of the network's performance in relation to the previous
year's Annual Action Plan;
(ii) Demographic, population and prevalence data as specified by the
Region. These should include demographic comparisons among the
entire population of the Region, the population being served by the
network, and the persons providing direct treatment services;
(iii) Other summaries of reports already compiled by the managing entity
as part of its reporting requirements, such as performance
management reports; grievance, appeals, and other complaint
information; and the results of satisfaction surveys;
(iv) Ad hoc utilization reports identified by the planning participants;
(v) The perspectives of consumers, advocates, and other stakeholders
on a county-by county basis;
(vi) The schedule and formats for these reports will be identified in the
approved Annual Action Plan.
(b) Maintain Regular Communication with the Department
The managing entity representative will meet at least quarterly with the
Southern Region SAMH program supervisor to discuss the status of the
network's operations. This meeting can be in person or by phone.
(c) Develop a Contingency Transition Plan
The managing entity shall, in coordination with the department, develop a
Contingency Transition Plan in the event of termination or non-renewal of this
contract. The Contingency Transition Plan shall be submitted to the contract
manager in accordance with the approved annual action plan and is
incorporated herein by reference.
(10) Develop, Maintain and Improve Reporting
The managing entity shall submit reports included in Exhibit G, Required Reports.
In addition, the managing entity will provide the department ad hoc reports at its
request because the managing entity is the department's primary source for
network reporting. In all cases, the delivery of reports, ad hoc or scheduled, shall
not be construed to mean acceptance of those reports. Acceptance, in writing, of
required reports shall constitute a separate act and shall be approved by the
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department's contract manager. The department reserves the right to reject reports
as incomplete, inadequate or unacceptable.
(11) The managing entity will ensure that subcontractors have updated
emergency/disaster plans annually within 30 days of the beginning of hurricane
season, and they are activated upon notification of disasters from the department.
The managing entity will conduct post disaster assessments of damage incurred by
providers and submit to the department.
(12) The managing entity provider shall ensure that prevention services
subcontractor contained in the Performance Based Prevention System. The "final"
PPT shall be printed from PBPS and sent to the managing entity's contract
manager for approval within 30 days of contract execution. The managing entity
shall review and approve the Prevention Program Tool (PPT).
(13) The managing entity shall ensure that Prevention Program Coordinators and
any other personnel responsible for entering data into the Prevention data system,
including subcontractors who upload data from their own system, must register and
complete training on use of the PPT at least annually.
(14) The managing entity shall ensure that Substance Abuse Treatment
subcontractors contracted for HIV Early Intervention Services will designate a
representative to participate in the local Department of Health HIV/AIDS planning
body's meetings. The managing entity shall ensure that subcontractors participate
in a minimum of 50% of the meetings involving community service partners.
(15) The managing entity shall ensure that subcontractors collaborate with the local
community substance abuse coalitions (where available) to help develop and
support capacity to address community substance abuse needs. Activities shall be
specified in the Prevention Activities Exhibit, which is incorporated herein by
reference, and as specified in the approved annual action plan.
(16) Based on the most recent local department approved comprehensive
community action plan, the managing entity agrees to ensure that its
subcontractors, administer and deliver appropriate evidence-based programs or
strategies as specified in the Consolidated Program Description required by Rule
65E-14.021, F.A.C., and is on file in the department contract manager's file and
incorporated herein by reference.
(17) The provider shall comply, and ensure that its subcontractors comply with
Children and Families Operating Procedure 215-8, OVERSIGHT OF HUMAN
SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD DESIGNATION.
The policy and guidance can be found at:
http://www.dcf.state.fl.us/news/humanresearchpolicy.shtm1. Approval from the
department is mandatory for all research conducted by any department employee,
contracted organization or individual, or any public or private vender, even if the
aforementioned has their own Institutional Review Board which has granted
approval.
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(18) Client Satisfaction Survey
The managing entity shall ensure all network providers conduct client satisfaction
surveys pursuant to CFP 155-2.
(19) Client Files
Upon contract execution, the managing entity will accept and maintain all current
and subsequent SAMH client files.
(20) The managing entity shall ensure that all subcontractors that provide SAMH
Treatment Services execute a Memorandum of Understanding (MOU) with the
appropriate Federally Qualified Health Center as listed in the Annual Action Plan.
The MOU provides for integration of primary care services to the medically
underserved.
(21) The managing entity will demonstrate and encourage efforts from its
subcontractors to initiate and support local county implementation of the Medicaid
Substance Abuse Local Match Program in order to expand community service
capacity through draw down of Federal funding.
(22) TANF Guidelines
The managing entity agrees to comply, and require its subcontractors to comply
with the provisions of the TANF Guidelines, which is incorporated herein by
reference, for any TANF funds provided under this contract.
(23) Family Intervention Specialist
The provider agrees to comply, and require its subcontractors to comply, with the
provisions of the Substance Abuse Family Intervention Specialist Services,
which is incorporated herein by reference, if the services of Family Intervention
Specialists are being provided under this contract.
(24) Clinical Supervision for Evidence Based Practices
The provider agrees to comply, and require its subcontractors to comply with the
provisions of Clinical Supervision for Evidence Based Practices, which is
incorporated herein by reference, if these services are being provided by the
managing entity or its subcontractors.
(25) Prevention Services Invitation to Negotiate (ITN)
As existing prevention contracts end, or as otherwise specified in the approved
annual action plan, the managing entity shall use the department's Evidence-Based
Practices Procurement for the Prevention of Underage Drinking and Other Alcohol-
Related Problems ITN template, which is incorporated herein by reference, for
contracting SAPT Block Grant funding for prevention services.
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(26) Forensic Service Program
The provider agrees to comply, and require that its subcontractors comply with the
provisions of Forensic Mental Health Specialist Services, which is incorporated
herein by reference.
The managing entity will be responsible for ensuring the provision of mental health,
substance abuse and ancillary services to individuals charged with felony offenses
and have been committed or may be at risk of commitment to the Department of
Children and Families, pursuant to chapter 916, F. S. The managing entity will
ensure the development of a comprehensive forensic program that meets all
requirements of chapter 916, F.S., Forensic Client Services Act, the Forensic
Mental Health Services Exhibit and established forensic performance measures.
The managing entity will ensure the development and implementation of an
automated system to track the activities of the program and to generate reports
pertinent to the program. Additionally, the forensic program will contain the following
components:
a. Diversion- The managing entity will be responsible for the identification of
individuals charge with felonies in the Miami-Dade and Monroe County Jails
who are at risk of commitment to the Department of Children and Families, but
who may be diverted to the community with appropriate services and
monitoring.
(1) CFOP 155-38, entitled "Procedures for Post Commitment
Diversion" establishes eligibility criteria to be used for both pre-commitment
and post commitment diversion.
(2) Referrals sources for diversion include the Offices of the Mental
Health Administrator, Public Defender, State Attorney, Corrections Health
Services and Prison Health Services the judiciary, and the Jail Diversion
Program. The managing entity or its subcontractors may establish through
cooperative agreement with these entities, an alternative source or
methodology for obtaining referrals and/or identifying individuals who meet
criteria for diversion.
(3) The managing entity will ensure that all referrals for diversion are
screened to ensure eligibility and suitability for diversion to a community
program. The screening will include review of all documentation, including
arrest reports, criminal histories, court ordered evaluations and court
orders.
(4) The managing entity will ensure that appropriate referrals for
services in the community are initiated and dispositions are received in
writing.
(5) The managing entity will ensure the development and submission
of an appropriate plan for conditional release to the committing court. The
plan will include mental health treatment, competency restoration training,
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residential care or housing with supervision, medical and auxiliary services
if appropriate, case management and monitoring.
(6) The managing entity will ensure attendance at court hearings,
obtain conditional release order s and ensure individuals are monitored in
the community in accordance with the terms of the conditional release
order.
b. Discharge Planning — The managing entity will be responsible for
ensuring the active participation of forensic specialists in discharge planning
activities for forensic clients at state treatment facilities.
(1) The managing entity will ensure the forensic specialists conduct
quarterly face- to- face meetings with forensic clients in both civil and
forensic state treatment facilities and provide written assessments that
include mental status, barriers to discharge, and discharge plans.
(2) The managing entity will ensure that forensic specialists participate
in treatment team, and discharge planning meetings for forensic clients in
state treatment facilities.
(3) The managing entity will ensure the review reports to court
generated by the state treatment facilities in order to determine action
necessary to comply with treatment team recommendations and/or
resulting court orders.
(4) The managing entity will ensure the development and submission
of conditional release plans, discharge plans to state treatment facilities
and to the committing court. The content of the plans is described above
in the Forensic Mental Health Specialist Services exhibit which is
incorporated herein by reference.
(5) The managing entity will ensure attendance of forensic specialists
court hearings in the cases of individuals discharged from state treatment
facilities and ensure effective linkage to the new mental health service
provider.
c. Conditional Release Monitoring —The managing entity will ensure that
individuals on conditional release order in Dade and Monroe Counties,
including individuals transferred into the counties from other circuits are
monitored.
(1) The managing entity will ensure that individuals on conditional
release order are monitored in accordance with the requirements of Rule
65E-15. F.A.C., Continuity of Care Case Management and the court order
to ensure compliance with the order and department rules.
(2) The managing entity will ensure the committing court is immediately
notified by phone and in writing of any deviations from the conditional
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release order. The managing entity will ensure the Circuit Forensic
Coordinator is copied on written correspondence to the court.
(3) The managing entity will ensure the review of required monthly
monitoring reports in order to intervene in problematic situations, to provide
alternative treatment modalities when necessary, and to identify trends and
issues that illustrate opportunities for improvement in service delivery. The
managing entity will bring the aforementioned situations, trends and issues
to the immediate attention of the Circuit Forensic Coordinator.
(4) The managing entity will ensure the distribution of copies of
conditional release orders and modifications to the agency providing
mental health and substance abuse services to the individual and to the
SAMH Regional and Headquarters Office in Tallahassee.
d. Prison Aftercare Services -The managing entity will ensure the provision
of aftercare services for inmates returning to Dade and Monroe Counties
following end of sentence (EOS), in accordance with the Interagency
Agreement between The Florida Department of Corrections (Office of Health
Services) and The Florida Department of Children and Families (Mental Health
Program Office).
(1) The managing entity will ensure the development and
implementation of a procedure for the receipt and review of referrals for
services from prisons throughout the state and/ or from SAMH.
(2) The managing entity will ensure that appointments are scheduled
for the appropriate levels of services required by the inmate, including
hospitalization and provide notification of appointment and /or
arrangements for hospitalization or stabilization to the referring prison
facility.
(3) The managing entity will ensure the provision of follow-up services
for a period of at least 60 days to ensure the individual keeps the
scheduled appointments and that they do not run out of prescribed
medication.
e. Utilization Management - The managing entity will be responsible for
managing the utilization of residential treatment beds funded by community
forensic dollars in Circuit 11 and the statewide community forensic beds
located in Circuits 11 & 17. This includes a short -term residential treatment
facility and residential level 2 beds. The managing entity will be responsible
for managing the appropriate utilization of community forensic residential
treatment beds.
f. Administrative Functions- The managing entity will ensure that
adequate administrative support staff is assigned to the forensic program. In
addition, the managing entity and/or it's contracted providers will:
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(1) Actively participate in all related workshops and training, meetings,
performance improvement teams, and other activities designed to increase
the knowledge and skill levels of staff assigned to the forensic program.
(2) Ensure that applicable staff obtains certification of attendance from the
Florida Forensic Examiner Training within one year of employment.
(3) Conduct biweekly case staffing of individuals committed to DCF,
pending discharge from a state treatment facility, currently on conditional
release or pending release from state prison.
(4) Timely request technical assistance from the Circuit Forensic
Coordinator on issues related to service delivery, interactions with state
treatment facilities and the circuit court.
(27) Comprehensive Community Service Teams Case Management
Comprehensive Community Service Teams (CCST) Cost Centers, must continue
to provide Adult Mental Health Case Management Services as defined by the
Continuity of Care Guidelines for Geo Care, Inc./South Florida State Hospital (on
file at the Southern Region SAMH Program Office). Additionally, CCST Cost
Centers must provide appropriate Adult Mental Health services to CCST team
consumers with the availability to increase or decrease intensity and frequency of
similar services, as needed.
CCST services must be delivered by staff working in a multidisciplinary team that
includes Peer Specialists who are consumers of mental health services. See the
CCST cost center model cost description, incorporated herein by reference.
Children's Mental Health Comprehensive Community Service Teams (Exhibit
H), together with the Incidental Cost Center, will be the vehicle for provision of
services to children and families under the Miami Dade Wraparound Cooperative
Agreement#1 U79SM059055-01.
(28) Florida Assertive Community Team (FACT)
The managing entity will provide oversight monitoring and service validation for
FACT Team Providers, as per the state's existing allocations when this contract is
executed. The managing entity will ensure that the FACT teams provide intensive,
assertive community-based treatment that includes rehabilitation and support
services for persons with symptoms of severe and persistent mental illnesses. The
managing entity will ensure that FACT teams adhere to the fidelity of the program
as described in Attachment I PSMA 1 HC08 FACT Program document,
incorporated herein by reference, and the NAMI Published Program Standards for
ACT Teams. The managing entity FACT Liaison must be a qualified mental health
professional with experience in the mental health field.
a. The managing entity will monitor FACT Enrollment, Referrals, and
Membership as follows:
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1) Maintaining a Referral Tracker
2) Reviewing referrals for completeness & eligibility criteria within 48 hours.
3) Contacting the referral source and requesting additional information if
needed for determination of eligibility within 24 hours
4) Ensuring FACT Teams conduct screening (face-to-face) within 72 hours
of referral receipt
5) Making referral approvals, reviewing disposition outcomes, and/or
providing alternative referral sources.
6) Approving FACT Team discharges and oversight of discharge planning
7) Approving and coordinating enrollee transfers within FACT Teams
8) Ensuring attendance of the FACT Teams to monthly Treatment Team
Meetings and Discharge Planning Meetings at the South Florida State
Hospital as applicable.
9) Ensuring that FACT teams utilize the SOAR (SSI/SSDI Outreach Access
and Recovery) application process for all eligible enrollees.
b. The managing entity will provide oversight monitoring of FACT
Supports and Day-to-Day Operations as follows:
1) Providing technical assistance and consultation on-site at least bi-
monthly for each provider
2) Approving request for the use of flexible funding.
3) Approving any changes in FACT Team services, location, and business
hours.
4) Participating in the Quarterly Advisory Board Meetings
5) Maintaining communication with local AHCA representatives for the
administration of managed care enrolled individuals
6) Advocating for FACT enrollees with other public entities
C. The managing entity will monitor required FACT Reports and
Utilization as follows:
1) Requesting a Corrective Action Plan (CAP) to ensure compliance and
requesting approval for a CAP from the Southern Region SAMH Program
Office:
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2) Overseeing FACT Team staffing levels
(a) Reviewing the Monthly Vacant Position Report and maintaining a
Monthly Vacant Position Report tracker
(b) Ensuring that FACT Teams are fully and appropriately staffed as
described in the Attachment I PSMA 1 HCO8 FACT Program
document, which is incorporated herein by reference. The managing
entity may not authorize any staff substitutions without obtaining prior
written approval from the Southern Region SAMH Program Office.
(c) Ensuring prompt communication if FACT Team provider fails to
maintain appropriate staffing level for thirty (30) consecutive calendar
days
3) Monitoring utilization of Enhancement Funds
(a) Reviewing the Quarterly FACT Enhancement Reconciliation Report
and maintaining a FACT Enhancement Reconciliation Report Tracker
(b) Sending copies to Southern Region SAMH Program Office and
Central Program Office of Quarterly FACT Enhancement
Reconciliation Report and Tracker
4) Monitoring the FACT Team Enrollment Report
(a) Reviewing the Monthly Enrollment Report and maintaining a
Monthly Report Tracker
(b)Verifying Quarterly FACT Monthly Report for accuracy, track and
evaluate trends and provide constructive feedback to FACT Teams
5) Ensuring accuracy of the FACT Ad Hoc Report
(a) Reviewing the FACT Ad Hoc Report and maintaining an Ad Hoc
Report Tracker
(b) Ensuring that FACT Teams submit the Ad Hoc Report to
Tallahassee Mental Health Program Office
(c) Sending copies of the Quarterly FACT Ad Hoc Report to Southern
Region SAMH Program Office
6) Reviewing FACT Managed Care enrolled individuals
(a) Reviewing the FACT AHCA Report and maintaining an AHCA
Report Tracker
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(b) Sending copies of FACT AHCA Report to the local AHCA
Managed Care Representative
7) Ensuring that FACT Team Performance Measures are met
(a) Reviewing the Monthly Performance Measure Data and monitoring
for compliance of outcome measures
(b) Presenting on Performance Measures during the Quarterly
Performance Measure Review Meetings to the Southern Region
(c) Sending copies of Monthly Performance Measures Report to
Southern Region SAMH Program Office
8) Reviewing FACT Team Incident Reports
(a) Maintaining an Incident Report Tracker
(b) Identifying and addressing significant trends revealed by incident
reports
(c)Sending copies of significant incidents and interventions as needed
to Southern Region SAMH Program Office
(29) Projects for Assistance in Transition from Homelessness (PATH)
The managing entity will provide oversight monitoring and service validation for the
PATH network providers who have funds allocated (see Funding Detail) for support
services for individuals who have a serious mental illness and/or substance abuse
and are homeless or at imminent risk of becoming homeless as per the state's
existing allocation when this contract is executed.
a. The managing entity will manage PATH services and ensure
dissemination of deliverables as set forth and described in each approved and
signed Local Intended Use Application.
b. Eligible PATH local matching funds must be expended in the provision of
PATH eligible services to PATH eligible persons. The expenditures must match
the types of services outlined in the Local Intended Use Plan. The formula to be
followed is cited in Section 524 of the Public Health Services Act, as amended by
Public Law 101-645.
C. The managing entity will manage the PATH Grant as follows:
1) Maintaining a Quarterly Report Tracker
2) Verifying Quarterly Reports for accuracy and utilization of funds and
clients served.
3) Sending the Southern Region SAMH Program Office copies of the Tracker
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and Quarterly Reports.
4) Overseeing the Annual reapplication process for the PATH Grant
5) Compiling Annual report information and sending a final draft to the
Southern Region SAMH Program Office for approval.
6) Ensuring providers submit final Annual report to Tallahassee.
(30) Contingency Funds for Adult Mental Health
The managing entity will provide oversight monitoring to network providers to
ensure utilization of allocated Contingency Funds for housing, medication and
other emergency expenses for indigent consumers as per the state's existing
allocations when this contract is executed.
a. The managing entity will oversee that providers itemize contingency funds
expenditures by consumer, including expense description, time period and
dollar amount.
b. The managing entity will manage Contingency Funds as follows:
1) Maintaining a Quarterly Report Tracker
2) Verifying Quarterly Reports (separate Forensic/Civil Reports) for
accuracy and utilization of funds.
3) Monitoring providers to ensure utilization & prevent lapsed funds
4) Sending copies of the Tracker and Quarterly Report to the Southern
Region SAMH Program Office and Contract Manager.
(31) Children's Mental Health Services, including services for Severely
Emotionally Disturbed Children, Emotionally Disturbed Children and their
Families
The key strategic objectives and strategies that support the department's mission
and direct the provision of services to Florida's citizens are detailed in the
Substance Abuse and Mental Health Services Plan 2010-2013, which is
incorporated herein by reference. They represent the primary focus of the
Substance Abuse and Mental Health programs, and it is expected that the
managing entity will ensure adherence to them, including but not limited to the
following:
a. Ensure that families and youth are full partners in the development and
implementation of individual recovery plans and have a prominent voice in
designing supports and services.
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b. Prioritize services and supports for children who are involved with the child
welfare and juvenile justice systems. Within these priority groups, children birth
to five years of age, youth transitioning to adulthood and children at risk of
residential treatment are the focus of specific activities and initiatives. System
transformation is the driving force for current and future activities, with an
emphasis on evidence based practices that are culturally competent, focused
on prevention, early identification and intervention, and family-centered.
c. Ensure that services and supports for children, youth, and families are
sensitive to the impact of trauma, and are designed to address treatment
issues and minimize system elements that might produce further trauma.
d. Address the critical need for better information, planning, and assistance
for eligible children transitioning into the adult mental health system.
e. Develop coordinated systems of care for children that provide services
and supports that promote recovery and resiliency by being:
1) Community-based
2) Culturally competent
3) Strength-based
4) Evidenced-based practices for children and adolescents - including
Multisystemic Therapy for children and youth with or at risk of juvenile
justice involvement, Therapeutic Foster Care, Family Support and
Education, Cognitive Behavioral Therapy for traumatic stress, Dyadic
Therapy for infants and toddlers, and the Wraparound Approach.
5) Individualized, child focused, and family directed.
6) Inclusive of early intervention with the child and family.
7) Coordinated across agencies and time lines
f. The managing entity will agree to ensure that its subcontractors provide a
full continuum of services to address the needs of Severely Emotionally
Disturbed Children, Emotionally Disturbed Children and their Families. These
services must include but not be limited to:
1) Dyadic Therapy for children under 5,
2) Behavior Analysis services for children with behavior problems,
3) Life skills and Wellness Recovery Action Plan services to children
transitioning to the adult system,
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(32) Children's Mental Health- The Miami Dade Wraparound Cooperative
Agreement#1 U79SM059055-01
The Miami Dade Wraparound Cooperative Agreement #1 U79SM059055-01 while
espousing many of the same principles as Children's' Mental Health Services will
be a separate responsibility for the managing entity. SAMHSA grant
#1U79SM059055-01 was awarded to the Department of Children and Families,
Substance Abuse and Mental Health on September 9, 2010. The purpose of the
grant (Miami-Dade Wraparound Project) is to transform the existing Children's
Mental Health system of care. The "Miami-Dade Wraparound Project" (MDWP) is a
collaborative effort to enhance, expand and strengthen the existing community-
based family and youth mental health services in Miami-Dade County, in order to
better serve children who have serious emotional disturbances (SED) and their
families or caretakers in Miami Dade County, Florida. The Miami Dade
Wraparound Project (MDWP) will enable youth with multiple and changing needs
to remain in the least restrictive settings in their community, in school, out of the
juvenile justice/legal system and attain and maintain a physical-mental-emotional-
spiritual recovery. The target population of this project is "SED adolescents, ages
12 to 17, who also have a co-occurring substance abuse diagnosis". The Project
intends to provide culturally grounded, linguistically competent services to targeted
youth residing within a unique racial/ethnic and culturally diverse, Miami Dade
County, populated by a Hispanic majority.
The MDWP will transform the existing system by offering a comprehensive range
of integrated treatment services, made possible by a cross county, cross systems
interagency collaboration. "System of care" values (i.e. ChildNouth-centered and
family focused, community-based, culturally, and linguistically competent) are
implemented using, a wraparound process, and further guided by a wellness
maintenance model adapted for youth (e.g. Wellness Recovery Action Plan). This
approach transforms the children's mental health system into a recovery-oriented
mental health and co-occurring disorder system of care for children. The Project is
committed to adhering to the values and guiding principles that support and
encourage Family-Driven, youth guided and culturally and linguistically competent
care.
a. The goal of the Project is to provide youths and families with the services
and supports they may need in the following "life domain" areas:
1) basic needs (e.g. housing, transportation, food)
2) family environment (e.g. family counseling, parenting skills, daily living
skills, respite)
3) social environment (peer relations, psychosocial skills; recreation);
4) school/vocational (e.g. tutoring and job training, functional skills)
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5) mental health/co-occurring substance abuse treatment (counseling,
medication compliance, rehabilitation; legal and safety (e.g. legal counsel,
crisis management);
6) System level (e.g. advocacy, support, utilization of services).
b. With respect to services delivery, the following basic service components
will be implemented: (1) Enrollment and strength-based Needs Assessment;
(2) Youth Clinical Diagnostic Evaluation/Assessment; (3) Immediate Crisis
Stabilization; (4) Individualized Wraparound Team formation, (5) Service/Care
Plan development; (6) Service/Care Plan Implementation (using community-
based treatment providers; (7) Crisis and Safety planning, (ongoing); (8)
Tracking, Monitoring and Adapting Service/Care Plan, and (9) Transition
Services and support.
c. SAMHSA Grant #1 U79SM059055-01 will be transferred to the Managing
Entity. The Managing Entity will develop the infrastructure necessary to
support the transformation effort, implement the service components as
outlined in the grant #1 U79SM059055-01 narrative, and negotiated by the
Substance Abuse and Mental Health program office, as specified in the
approved annual action plan. The managing entity will manage all aspects of
the Children's Mental Health system of care under the direction of the
Substance Abuse and Mental Health program office.
(33) The Children's Crisis Response Team (CCRT)
a. The Children's Crisis Response Team (CCRT) is a crisis mobile team that
is attached to the Children's Crisis Stabilization Unit. They are led by a
psychologist, have a behavior analyst, individual therapist, family therapist
and a case manager. One on ones and other wraparound services are
provided as needed. When The Southern Region is referred an indigent
child for residential treatment we send out the team to do an assessment and
to decide if the child can be maintained in the community. If the answer is
yes, they provide an intense array of services until the family is more stable.
The Children's Crisis Response Team may at times provide non-Medicaid
eligible services to Medicaid recipients.
b. The managing entity will oversee the Children's Crisis Response Team.
The goals of the CCRT are:
1) To respond to children and their families in the community who are
experiencing crisis because of their mental health issues.
2) To ensure that indigent children receive services in the least
restrictive level possible to meet their needs.
3) That residential treatment for indigent children remains with the
allowed Purchased Residential Treatment Services (PRTS) budget
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(34) Juvenile Incompetent to Proceed Program
The managing entity will manage the Juvenile Incompetent of Proceed Program as
per section 985.223, F.S. and as per the Department of Children and Families
operating procedure. In addition, the managing entity will insure that all children
involved with the JITP program are linked with the appropriate mental health
services and reduce the time to access treatment services.
(35) Residential Level 1 Services
The managing entity will insure that Residential Level 1 is available to children in
the community. Management of this resource is a complex issue. The managing
entity will establish a comprehensive assessment process to determine when
children are most appropriate served within residential facilities or as is often the
case in their home. The managing entity will establish a system of intensive in-
home services for the most severely disturbed children and families as an
alternative to residential.
(36) KidCare Insurance Program
a. The Florida KidCare Program was created by the 1998 Florida Legislature
in response to State Children's Health Insurance Program (SCRIP) legislation.
Florida KidCare is the state's children's health insurance program for uninsured
children under age 19. It includes four different parts, or programs: MediKids,
Healthy Kids, Children's Medical Services and Medicaid. Florida KidCare
covers primary health and mental health care.
b. It is essential in order to maximize the use of Substance Abuse and Mental
Health funding that as many eligible children as possible be enrolled in
KidCare. The Southern Region has many children eligible for, but not
receiving, KidCare services. This lack of enrollment often leads to services
being funded by Substance Abuse and Mental Health. The State is in support
of a foundation to be established to pay the family's monthly fee, which has
been a barrier.
The Managing Entity's responsibilities include:
1) Ensuring that all children who apply for Substance Abuse and Mental
Health funded services are screened for KidCare within a month of initial
assessment
2) Putting a process in place to facilitate the application procedure for
families and provide all needed assistance
3) Addressing barriers to signing up and to family involvement. Provide
timely responses to families
c. BNET is a Kid Care partner developed to provide mental health and
substance abuse services to children between 5 and 18 years old who require
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services beyond the scope of Kid Care.
The Managing Entity's BNET responsibilities include:
1) Managing the contract with the current BNET provider
2) Ensuring that the available slots are used for children with the highest
need and medical necessity
3) Addressing barriers to signing up and to family involvement. Provide
timely responses to families
(37) Functional Family Therapy (FFT) is a highly structured, short-term family
intervention for youths with multicultural needs and effective delinquency
prevention for siblings of offenders. It has been developed for use with highly
dysfunctional families at risk of serious problems, including delinquency and
family violence. FFT is designed to target children between the ages of 11 and
17. The goals of FFT are to engage and motivate the youth and their families by
decreasing negative interactions, and thus breaking the patterns that attribute to
negative consequence for the youth and the rest of the family. Each family will
develop a specific behavior change plan to reduce and eliminate problem
behaviors and negative family relational patterns. For the final goal, the family
will generalize changes acquired in therapy across problem situations, and learn
to successfully utilize community resources.
The managing Entity will create and implement a utilization management
process to manage this valuable resource in the children's mental health system.
b. Task Limits
Within the scope of this contract, the managing entity shall perform only those tasks
and services set out above in Section 13.1.a., and shall ensure that the network
providers do the same as applicable. Services shall only be provided in the Southern
Region (Miami-Dade and Monroe Counties), with the exception of clients residing in
state hospitals, or Short-Term Residential Treatment programs that are Southern
Region clients, or by exception with approval by the department.
The managing entity agrees to abide by the Consolidated Program Description, CFP
155-2 and Rule 65E-14, F.A.C., and is not authorized by the department to perform
any tasks related to the project other than those described in Section 13.1.a. without the
express written consent of the department. The managing entity may unbundle
Medical Services from the Substance Abuse Residential Levels II, III, and IV cost
centers for clients with co-occurring disorders, unbundle Psychological Evaluations
from the Children's Mental Health Residential Levels I and II, and unbundle
Psychological Evaluations from the Children's Substance Abuse Residential Levels II,
111, and IV cost centers. The managing entity shall ensure that services are performed
in accordance with applicable rules, statutes, and licensing standards.
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2. Staffing Requirements
a. Staffing Levels
(1) The managing entity shall require that all network providers maintain staffing
levels in compliance with applicable rules, statutes and licensing standards. See
Exhibit F, Minimum Service Requirements.
(2) The managing entity shall provide oversight so that the subcontractors engage in
recruitment to maintain as much as possible staff with the ethnic and racial
composition of the clients served.
b. Professional Qualifications
(1) The following positions/functional areas listed below shall require the minimum
qualifications:
(a) Chief Executive Officer/President/Executive Director
Management or supervisory experience providing services to persons with
Behavioral Health issues, including at least ten years in a management
position. Masters Degree in Behavioral Health field or business (four years
experience in addition to any other experience required may be substituted
for a Masters Degree providing the individual has a Bachelors Degree).
Must have a demonstrated working knowledge of contractual and
government regulations, Behavioral Health treatment, fiscal management,
Quality Assurance, data management and development, and Community
Organization. Experience in the management of a nonprofit organization is
preferred.
(b) Deputy Director and Chief Financial Officer
Masters Degree in Behavioral Health field or business. Eight years of
experience in a Senior Management position of which five years must be in
the Behavioral Health field. Must have a demonstrated working knowledge
of contractual and government regulations, Behavioral Health treatment,
fiscal management, Quality Assurance, data management and
development, and Community Organization. Experience in the
management of a nonprofit organization is preferred.
(c) Medical Director
The Medical Director will possess a valid Florida license to practice
medicine in the State of Florida and a certification by the American Board of
Psychiatry and five to seven years of experience in providing services to
persons with psychiatric disabilities. The Medical Director shall be involved
in the development and approval of clinical-medical policies and
procedures, including those for service authorization and the review of the
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provision of medical services. The Medical Director shall also be involved in
quality management. This position can be part-time.
(d) Peer Services Coordinator
The Peer Services Coordinator must be a Behavioral Health Services
consumer who is in recovery and is either a certified Peer Specialist or
working towards a certification.
(e) Chief Clinical Officer
Masters Degree in a Behavioral Health discipline with a current Florida
license allowing the individual to provide services in a Behavioral Health
service discipline. A minimum of six years experience in providing or
managing the delivery of Behavioral Health services of which three or more
years must be at a supervisory level. Must have a demonstrated working
knowledge of Behavioral Health, community resources, funding sources,
statistical reporting, best practices, recovery and resiliency concepts, quality
improvement, and statistical report preparation. Must be able to define
problems, collect data, establish facts and draw valid conclusions. Must be
able to write policies and procedures and develop and implement treatment
services and prevention protocols. Must be able to manage and prepare
reports on multiple grants and contracts.
(f) Director of Finance
The Director of Finance must have demonstrated knowledge and
experience in generally accepted accounting principles, auditing standards,
financial evaluations, and funds management. A Bachelors Degree or its
equivalent from an accredited institution with a focus on business, finance,
economics or related field is required. Must be able to interpret and analyze
audits and other financial reports, prepare electronic spreadsheets, and
interpret and present financial data in an understandable format. Five years
experience in fund accounting and grants management required.
(g) Director of Behavioral Health Services
Masters Degree in a Behavioral Health discipline with a minimum of five
years experience in providing or managing the delivery of Behavioral Health
services of which three or more years must be at a supervisory level. Must
have a demonstrated working knowledge of community resources, best
practices, resiliency and recovery concepts, CCISC model and utilization
management processes. Supports the Chief Clinical Officer in managing
complex systems of care.
(2) The managing entity shall require that all subcontractors comply with applicable
rules, statutes, requirements, and standards with regard to professional
qualifications. See Exhibit F, Minimum Service Requirements.
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(3) The managing entity shall require that all network providers provide Level II
background screening for mental health personnel and all owners, directors, and
chief financial officers of service providers in accordance with chapter 435 and
section 408.809, F.S., and, as specified in section 394.4572(1)(a)-(c), F.S. "Mental
Health personnel" includes all program directors, professional clinicians, staff
members, and volunteers working in public or private mental health and substance
abuse programs and facilities who have direct contact with or who are providing
direct services to consumers of mental health services. It is the expectation of the
department to support the SAMH Transformation Initiative by employing Peer
Specialists and in turn following regional procedures.
(4) The managing entity shall require that all subcontractors comply with Level II
employment screening for substance abuse personnel as specified in section
397A51, F.S.
(5) The managing entity shall require all managing entity staff receive a Level II
employment screening set forth in section 435.04, F.S. regardless of whether staff
have direct contact with individuals served.
c. Staffing Changes
The managing entity shall staff the project with key personnel identified in 13.2.b.(1)
who are considered by the department to be essential to this project. Prior to
substituting any of the proposed individuals the managing entity shall notify and
obtain written approval from the department for the proposed substitution. Written
justification should include documentation of the circumstances requiring the
changes and a list of the proposed substitutions in sufficient detail to permit
evaluation of the impact on the project. The department, at its discretion, may agree
to accept personnel of equal or superior qualifications in the event that
circumstances necessitate the replacement of previously assigned personnel. Any
such substitution shall be made only after consultation with department staff.
The managing entity shall notify the department's contract manager, in writing within
(10) calendar days of staffing changes regarding the positions of Chief Executive
Officer, Deputy Director/Chief Financial Officer, Medical Director, Chief Clinical
Officer, and Director of Finance pursuant to Rule 65E-14.021(8)(d)1.d.(I)(iii), F.R.C.
for the managing entity and for all of the network providers. Additionally, the
managing entity will notify the contract manager in writing of changes in the
executive director or any senior management position of the managing entity.
The managing entity shall submit for approval a table of organization (TO), that will
reflect all necessary staff to operate this contract prior to implementation.
d. Subcontractors
(1) Section 394.9082, F.S. provides the department with the authority to contract
with a managing entity for the provision or management of behavioral health
services. By design and intent, the managing entity is to subcontract with network
providers to provide community-based services for adults and children with
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substance @bUSe, mental health disorders @Od/O[ CO-OCCu[hDg disorders, as
authorized in section 394.74. F.S.. subject to the p[OviSiOOS of Section 1.1.1-3 of the
standard contract.
(2) In aCCORj@DCe with Section |.| of the StGOd@nj CODt[@Ct, the nO@D@giDg entity may,
only with the prior written consent of the dep@rtmeDt, enter into written SUhCODtraCt(S)
with the Gpp[Ov@| of the Southern Region SAKAH P[Og[ann Supervisor o[ designee.
In order to comply with this requirement, o request for approval must be submitted to
the contract D7@D@ge[ 14 days prior to CODtn@Ct negotiation which includes the D@rOe
of the proposed SUbCODt[@CtO[ and @ notarized affidavit Of @Ssu[@OCe that the
conditions listed in section 13.2.05\ do not exist.
<3\ The managing entity may SUboOOtr@Ct the mnoD@genneDt and oversight of the
network providers which lead to COSt efficiencies with the written approval of the
department.
(4) The managing entity shall offer all existing department and South Florida
Behavioral Health NebmO[k. Inc. providers SubCOnt[@CtS through, at @ rOininnUrO, the
end of State FiSC@\ Ye@[ 2011-2012.
/5> The managing entity Sh@|| not subcontract for substance abuse/mental health
services with any person or entity which:
(a) is barred, SuSpeOded. or otherwise prohibited from doing business with any
gOVe[OnneOt eOtih/. or has been barred, SuSpeOded. or otherwise prohibited
from doing business with any government entity within the last 5 years;
(b) is under investigation Or indictment for S[inniD@| CODduCt. or has been convicted
of any crime which VVOu|d adversely reflect OO their ability to provide Sen/iCeS.
or which adversely reflects their ability to properly handle public funds;
(c) is currently involved, or has been involved within the last 5years, with any
|itigoUOO. Peg@[d\eSS of whether as @ plaintiff V[ defeDdoOt. which might pose @
COOf|iCt of interest to the department, the state or its subdivisions, Or @ federal
entity providing funds to the department;
(d) had g COOt[@Ct terminated by the department for failure to satisfactorily perform
Q[for cause; or,
(e) failed to implement @ corrective oCtiOO p|@O approved to the satisfaction of the
managing eDtih«, the department, and other governmental eDtitieS, after having
received due notice.
/6\ NO SubCOOt[@Ct which the managing entity enters into with respect to
performance under the CODt[@Ct Sh@|| in any way relieve the nn@O@giOg entity of any
responsibility for perf}[Ol@DCe of its duties. All p@VnneDtS to subcontractors Sh@|| be
made by the nnoDogiOg entity. NO reimbursement Of payment made to 8
subcontracted DebmO[k provider will be processed by the department unless there is
prior written approval from the department for said subcontract.
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(7) All SubCODtr@CtS with OebNO[k providers Sh@U adopt the applicable terms of the
provider's contract with the department. The nn@D@giDg entity shall include in all
subcontract agreements @ detailed scope of work; clear and specific deliverables;
and perfO[nn@OCe standards. Each of the SUbcUOtroCtO[s will be required to fo||OVV the
managing entity's Policies and Procedures and Contract.
/8\ UD|eSS []CF agrees tOoDalternative payment method @Sauthorized in section
394�9082, F.S., and prior to entering into any SubCODt[a(t. or an amendment which
modifies the p[ev\OuS|V negotiated unit cost rate or adds additional cost centers, the
managing entity shall conduct a cost analysis for said subcontract, in accordance with
F|U|e 65E-14.021. A COSt @Oa|ySiS is the review of the proposed COSt elements to
determine if they are OeCeSSory. o|lOVxGh\e. appropriate and reasonable.
Subcontractors will be required tO comply with Rule 65E-14.O21. Unit Cost Method Df
Payment, including but not limited to, COSt CeDhe[S, unit nneoSU[eD7eDtS, deSc[iptiODS,
program o[e@S, data elenneDtS, nno%irDUnn unit COSt [@teS. RaqUiRad fiscal reports,
p[Og[aDl description, setting unit COSt [otes, payment for services including @|\OVV@b|e
and unallowable units and requests for payments,
(9) The managing entity Gh@|| COOdUCt COrDpeUUve procurements for new
discretionary funds that they SubCODt[8Ct in excess Of $3OO.00O in accordance with
established procurement operating procedures.
3. Service Location and Equipment
a' Service Delivery Location
(1) Sen/|CeS shall be delivered at the |OcodODS provided in the Consolidated P[Og[@nn
Description developed pursuant tORule 65E-14.021/8\/d\1d./111\. F.A.C.
(2) The nO@D@giOg eDbh/ must nn@iOtoiD an administrative office in the Southern
F(eQiOO and @ nnoO@giDg presence in each circuit if appropriate given geographic and
population factors.
b' Service Times
(1) A continuum of services shall be provided during the days and times as specified
iD the consolidated program description OO file iO the department contract manager's
office and incorporated by reference.
(2) The nn@D@g|ng entity shall notify the department's contract manager, in writing,
within /10\ C@|eDd@[ days of any changes in days and times where services are
being provided pursuant tORule 65E-14.021(8)(d)5.. F.A.C.
c' Changes In Location
The managing entity UpOO DOUfiC@tiOD, shall in tu[O. notify the department's COnt[@Ct
manager, in writing, @ OliDinnUDl of ten /10\ calendar days prior to making changes
which will affect the department's ability tO contact the managing entity by telephone O[
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facsimile transmission or as set out in Rule 65E-14.021(8)(d)d(ill), F.A.C. The
managing entity shall be available and will be responsible for providing an immediate
response 24 hours a day, seven days a week.
d. Equipment
Any nonexpendable property purchased with departmental funds under this contract
either by managing entity or network providers must comply with Tangible Property
Requirements (Exhibit 1) and department operating Policies and Procedures as
outlined in CFOP 40-5, 50-9, CFOP 80-2, Rule 65E-14, F.A.C., which are incorporated
herein by reference.
4. Deliverables
a. Services
The managing entity will provide administration, management and oversight to the
network of providers to ensure the delivery of client services in accordance with the
Consolidated Program Description on file with the department. The funding allocated
for this administration is listed in the Funding Detail (Exhibit A).
An administrative unit of service is defined as one month of costs associated with the
administration, management, and oversight of the provider network by the managing
entity in accordance with this contract. The unit rate for this service is specified in
Section C, Method of Payment.
b. Records And Documentation
To the extent that information is utilized in the performance of this contract or generated
as a result of it, and to the extent that information meets the definition of"public records"
as defined in section 119.011, F.S., said information is hereby declared to be and is
hereby recognized by the parties to be a public record and absent a provision of law or
administrative rule or regulation requiring otherwise, shall be made available for
inspection and copying by any interested person upon request as provided in section
1119,01(2)ft F.S., or otherwise. It is expressly understood that the managing entity's
refusal to comply with chapter 119, F.S., shall constitute an immediate breach of the
contract, which entities the department to unilaterally cancel the contract agreement.
The managing entity will be required to promptly notify the department of any requests
made for public records.
Unless a greater retention period is required by state or federal law, all documents
pertaining to the contract shall be retained by the managing entity for a period of six (6)
years after the termination of the resulting contract or longer as may be required by any
renewal or extension of the contract. During the records retention period, the managing
entity agrees to furnish, when requested to do so, all documents required to be retained.
The managing entity shall maintain such records in whatever reasonable format is
required by the department at the time, at the managing entity's expense. Data files will
be provided in a format readable by the department.
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The managing entity agrees to nnoiDtGiO the COOfideDb@|it« of all records required by |aVV
or administrative rule to be protected from disclosure. The managing entity further
agrees to hold the department harmless from any claim or damage including reasonable
attorney's fees and costs or from any fine or penalty imposed as a result of an improper
disclosure by the nn@D@giDg entity of confidential records whether public reCOR]S or not
and promises tO defend the department against the same at its expense.
/1\ The nnoO@giDg entity shall require that all DehmO[h providers will protect,
confidential records from disclosure and protect client confidentiality in @SCOrd@OCe
with subsections 397.501(7), 394.455(3), sections 3944615. 414.295. F.S. and
also the Health Insurance Portability and Accountability Act (HIPAA), and any other
applicable State. and Federal laws, rules, and regulations.
(2) The rO@O@0iOg eDtihv, through the OehNO[k providers, is responsible for
maintaining dOCunneDt@tiOO of all tasks and deliverables and shall nn@iDt@iO FeCO[dS
documenting the total number of clients and names (or unique identifiers) of clients
to VVhOnn services were provided and the date(s) that the services were provided so
that @D audit trail documenting service provisions can bemaintained.
(D) It is preferred that all CO[FeSpOOdeDCe. FepO[tS. records and dOCunneDt@tiOO may
be provided to the department's CODt[@Ct [D@D@ge[ 8|eCt[OOiC@|k/, if this is not
feaaib|e, or is not received by the department's contract nnanaQer, then hard copies
must be mailed to the department's CODtr@Ct nnoO@ge[ to be received by the
appropriate due dates.
<4\ The nn@O@giDg entity shall COnnp\y with activities related to iOfO[nn@tiOO systems
in :Ornp|iaDCe with the department's CFP 155-2. which is iDCo[DO[@ted herein by
reference and is maintained OD the dep@[tnneOt'SxvebSite.
c. Reports
Where this COOt[@Ct requires the delivery Of reports to the department, mere receipt by
the department shall not be construed to mean or imply acceptance of those reports. It
is specifically intended by the parties that @CCept@DCe Of required reports Sh@U require @
separate act in writing. The department reserves the right to reject reports as
incomplete, iDGdeqVate. or unacceptable @CCO[diDg to the parameters Set forth in the
[esV|bDg COOtraCL The department, at its option, may @|\OVV additional time within which
the managing eDbh/ may remedy the obieCUOOS noted by the department or the
department may, after having given the nn@D@g|Og eObb/ @ [e@sOOob|e OppOdUD(h/ to
comply with the report Fequi[enneOtS, declare this agreement to be in default.
(1) The managing entity shall submit to the department fiDoOCi@| and p[O0[omnrD@tiC
reports specified in 13.1.o.(10) above and Exhibit G, Required Reports by the
dates specified.
(2) The Ol@D@giOg entity shall nnOOitO[ and ensure that network providers submit
treatment data. as Set out in subsection 394.74/3\ (e). F.S. and Rule 65E-14.022.
F.A.C. Data Sh@U be submitted e|eCt[ODiCa||y to the department by the nn@D@giOg
entity by the 15 mOf each [DnOth as Specified in [}ep2[trDeOt Of Children and
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Families' Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and
Data (CFP 155-2). The managing entity shall also monitor and ensure that:
(i) Ensure that the data submitted clearly documents all client admissions
and discharges which occurred under this contract;
(ii) Ensure that all data submitted to the Substance Abuse and Mental Health
Information System (SAMHIS) is consistent with the data maintained in
the provider's clients' files;
(iii) Review the department's File Upload History screen in SAMHIS to
determine the number of records accepted, updated and rejected. Based
on this review, the provider shall download any associated error files to
determine which provider records were rejected and to make sure that the
rejected records are corrected and resubmitted in the SAMHIS;
(iv) Resubmit corrected records no later than the next monthly submission
deadline. The failure to submit any data set or the provider's total monthly
submission per data set, which results in a rejection rate of 10% or higher
of the number of monthly records submitted will require the provider to
submit a corrective action plan describing how and when the missing data
will be submitted or how and when the rejected records will be corrected
and resubmitted; and
(v) In accordance with the provisions of section 402.73(7), F. S., and Rule 65-
29.001, F.A.C., corrective action plans may be required for non-
compliance, nonperformance, or unacceptable performance under this
contract. Penalties may be imposed for failures to implement or to make
acceptable progress on such corrective action plans.
(3) Upon request, the managing entity shall submit to the department information
regarding the amount and number of services paid for by the Community Mental
Health Services Block Grant and/or the Substance Abuse Prevention and
Treatment Block Grant.
(4) The managing entity shall submit audit reports for the managing entity and its
subcontracted network providers. The managing entity shall ensure that all audit
reports will include the standard schedules that are outlined in Rule 65E-14.003,
F.A.C. The managing entity shall submit to the department's contract manager
copies of their and all subcontractors' financial and compliance audit reports.
(5) The managing entity shall provide oversight so that all network providers comply
with section I.D. (Audits, Inspections, Investigations, Records and Retention) of the
Standard Contract and with Financial and Compliance Audit attachment.
(6) The managing entity must ensure that all children's mental health providers
complete a typed quarterly progress report that is filed in the medical record. The
provider is required to provide Children and Families or Community Based Care
workers, immediately upon request, with the most recent quarterly written report
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detailing the progress, current status and therapeutic needs of the named child.
5. Performance Specifications
a. Performance Measures
(1) The managing entity shall meet the performance standards and required
outcomes as specified in Exhibit D, Substance Abuse and Mental Health
Required Performance Outcomes/Outputs and Indirect Prevention
Performance Measures, which is incorporated herein by reference, or by obtaining
a waiver from SAMH or implementing a corrective action plan as approved by
SAMH to ensure that its subcontracted network providers meet these performance
standards and required outcomes.
(2) The managing entity agrees that the Substance Abuse and Mental Health
Information System (SAMHIS) Data System will be the source for all data used to
determine compliance with performance standards and outcomes in Exhibit D,
Substance Abuse and Mental Health Required Performance
Outcomes/Outputs Indirect Prevention Performance Measures, which is
incorporated herein by reference. The managing entity shall provide oversight to
ensure that all network providers submit all service related data for clients funded,
in whole or in part, by SAMH funds and local match.
(3) The managing entity shall ensure that all subcontractors providing prevention
services submit prevention data to the Performance Based Prevention System
(PBPS) which is maintained by KIT Solutions.
(4) The managing entity agrees that the Performance Based Prevention System will
be the source for all data used to determine compliance with substance abuse
prevention related performance standards and outcomes in Exhibit D, Substance
Abuse and Mental Health Required Performance Outcomes/Outputs Indirect
Prevention Performance Measures, which is incorporated herein by reference.
The managing entity shall submit all service related data for clients funded, in whole
or in part, by SAMH funds.
(5) The managing entity shall monitor and ensure that Prevention Program
Coordinator at applicable subcontractor agencies and any other personnel
responsible for directly entering data into the Prevention data system must register
for data entry training on PBPS and complete online or face-to-face training within
30 days of hire, and annually thereafter. Subcontractors must maintain the
certificate of attendance for all participants for all trainings. This does not apply to
providers who have their own data system and upload data to PBPS.
b. Performance Measurement Terms
CFP 155-2 provides the definitions of the data elements used for various performance
measures which are quantitative indicators, outcomes, and outputs used by the
department to objectively measure a provider's performance, and contains policies and
procedures for submitting the required data into the department's data system.
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c. Performance Evaluation Methodology
(1) The managing entity shall require that the network providers collect information
and submit performance data and individual client outcomes, to the department
data system in compliance with CFP 155-2 requirements. The specific
methodologies for each performance measure may be found at the following
website:
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(2)The managing entity agrees that its performance under this contract must meet
the standards set forth above and will be bound by the conditions set forth in this
contract. If the managing entity fails to meet these standards, the department, at its
exclusive option, may allow a reasonable period, not to exceed 6 months, for the
managing entity to correct performance deficiencies. If performance deficiencies
are not resolved to the satisfaction of the department within the prescribed time,
and if no extenuating circumstances can be documented by the managing entity to
the department's satisfaction, the department must terminate the resulting contract.
The department has the sole authority to determine whether there are extenuating
or mitigating circumstances.
(3) The department's contract manager will monitor the standards and outcomes
specified in Exhibit D, Substance Abuse and Mental Health Required
Performance Outcomes/Outputs and Indirect Prevention Performance
Measures (incorporated herein by reference), during the contract period, to
determine if the managing entity is achieving the levels that are specified.
6. Managing Entity (ME) Responsibilities
a. Managing Entity Unique Activities
The managing entity is responsible for the satisfactory performance of the tasks
referenced in Section B.I.a. of this contract. By executing this contract, the managing
entity recognizes its responsibility for the tasks, activities, and deliverables described
herein and warrants that it has fully informed itself of all relevant factors affecting the
accomplishment of the tasks, activities and deliverables and agrees to be fully
accountable for the performance thereof whether performed by the managing entity or
its subcontractors.
In addition, the managing entity shall:
(1) Provide performance information or reports other than those required by this
agreement at the request of the Southern Region's SAMH Program Supervisor, or
their designee. For requests that are complex and difficult to address, the
managing entity and the department will develop and implement a mutually viable
work plan.
(2) Cooperate with the department when investigations are conducted regarding a
regulatory complaint of the managing entity subcontractors.
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(3) Provide oversight so that clients receive assistance in making an informed
choice of network provider services that are appropriate for their condition and are
of high quality.
(4) Upon request, assist network providers with development and implementation of
client admission, continued stay, discharge criteria specific to each level of care,
diagnosis, presenting problems, and the establishment of review dates.
(5) Make available and communicate all plans, policies, procedures, and manuals
to the managing entity staff, network provider staff, and to clients/ stakeholders if
applicable. The managing entity shall use the department's operating procedures
for all agency procedures that have not been previously approved by the
department for implementation. While strict interpretation of the department's
procedures may not be translatable to the managing entity's organizational or
operating structure, the intent of the procedure or process should be adhered to. If
there are procedural issues that result in ambiguity, the parties shall meet to resolve
the issue. The managing entity shall have their operating procedures submitted for
review and approval not later than March 31, 2011, or as otherwise specified in the
approved annual action plan.
(6) Maximize all potential sources of revenue to increase services, and institute
efficiencies that will consolidate infrastructure and management functions in order
to maximize funding, as specified in the approved annual action plan.
(7)Have a data system in place that adequately supports the collection, tracking,
and analysis of data necessary to perform utilization management activities,
reviews of clinical/administrative performance related to levels of care, clinical
outcomes, and adherence to clinical/administrative standards.
(8) Make available to the department all subcontractor reports and corrective action
plans, pertaining to outside licensure, accreditation, or other funding entities.
(9) Integrate current and/or new state/federal requirements and policy initiatives into
its operations upon provision by the department of the same.
(10) Assist the department in developing legislative budget requests based upon
identified needs of the community.
(11) Maintain policies and procedures and documents that permit the reconciling of
the invoices submitted to the department. The invoices shall reconcile with the
amount of funding and services specified in this contract as well as the agency's
audit report and client information system.
(12) Make individual subcontract files available to the department, State auditors,
and Federal auditors upon request.
(13) Make available source documentation of units billed by sub-contracted
network providers upon request from the department's contract manager.
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(14) Client Trust Funds (CTF)
/a\ If the OebND[k providers are the representative payee of C|ieDtS. the
managing entity shall provide oversight so that network providers comply with
the applicable federal |@xvS regarding the establishment and management of
individual client trust accounts (2UCFR416 and 31CFR 240).
(b) The managing entity shall provide oversight S0 that the network providers'
assuming responsibility for administration of the personal property and funds
of clients Sh@|| follow the department's Accounting Procedures K8@OUa| /\FzM
\/D|U[Oe 7, Chapter 8' incorporated herein by reference (7/\PM6). The
department pe[S0DDe| or their designees, upon reqUeSt, may review all
[eCDnd8 relating to this section. Any ShD[t@0eS of client funds that are
attributable to the network providers Sh@|| be Fep@id, plus applicable interest,
within one week of the determination.
(c)The managing entity Sh@|| provide oversight SD that, the SUbDDOtn3Ctors
maintain all reconciliation records on-site for revieVV. not withstanding 7 APK8
8 Section 15.
(15) Provide management and oversight SO that all network providers that receive
federal block grant funds from the Substance Abuse Prevention and Treatment or
COOlD1un\h/ Mental Health Block Grants Sh@|| comply with Subparts | and || of p@d
B of Title )(|X of the Public Health Service ACt, SeCtiDOS 42 U.S.C. 300X-21 et Seq.
(as approved SepteOlbe[ 22. 2000\ and the Health and Human Services /HHS\
Block Grant regulations (45CFR Part S0).
(a) If funding is received from the Substance Abuse Prevention and
Treatment Block GD@Ot, the On@OagiO0 entity Sh@|| comply and take the steps
necessary such that all network providers comply with the data SUbO1iSSiDn
requirements outlined in CFP 155-2 and within the funding restrictions
outlined in ^SAMH (}CA'S@Od Funding Restrictions" incorporated herein by
reference.
/b\ The [n@O@0iD0 entity Sh@|| make available through its SUbCOOtnGCtDnS.
either directly or by arrangement with others, tuberculosis services to include
counseling, testing and referral for evaluation and treatment.
/c\ Funds under this grant may be used to support substance abuse
treatment services for individuals with @ co-occurring mental disorder as long
@S the funds allocated are used to support substance abuse prevention and
treatment services and mental health treatment and supports CaO be tracked
tD the specific substance abuse Dr mental health activity @S listed inthe State
Funding by Program and Activity, which is incorporated herein by
reference.
(d) If funding is received from the Substance /\bUSe Prevention and
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Treatment Block Grant, the managing entity shall ensure that all network
providers are required to participate in the State's Peer Review process if
applicable to assess the quality, appropriateness, and efficacy of treatment
services provided to individuals under this contract pursuant to 45 CFR
96.136.
(16) Maintain data, pursuant to section 402.73, F.S., on performance standards
specified in Exhibit D, Substance Abuse and Mental Health Required
Performance Outcomes/Outputs and Indirect Prevention Performance
Measures (incorporated herein by reference), for the types of services provided
under this contract and shall submit such data to the department upon request. All
data submission requirements can be found in CFP 155-2.
(17) Require that all network providers comply with Exhibit E, Missing Children,
which is incorporated herein by reference and available from the contract manager,
if the provider is providing these services.
(18) Maintain any collaborative agreements between the department and other
governmental/non-governmental agencies as mutually agreed upon by the
department.
(19) Prevention Partnership Grants
The managing entity shall be responsible for the contracting and oversight of the
Prevention Partnership grants, incorporated herein by reference, and shall ensure
compliance with the language and provisions of the awarded grants.
(20) Indigent Drug Program
The managing entity will provide oversight monitoring and service validation for the
IDP network providers to ensure that all funds allocated (see Funding Detail) are
utilized for purchasing psychotropic medications or medications accessed through
the "Line of Credit" from the Indigent Drug Program (IDP), as per state's existing
allocations when this contract is executed:
(a) The managing entity will monitor subcontractors so that they utilize IDP
funds for individuals who meet any of the following criteria:
1) Have an annual income that is at or below 150% of the Federal
Poverty Income Guidelines, as published annually in the Federal
Register.
2) Have no liable third-party insurance or other source of psychotropic
medications available, nor is the individual a participant in a program
where psychotropic medications are paid for by any other funding
source.
3) If the individual has third party insurance for psychotropic medications
but has temporarily been denied benefits for these medications, they
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may receive IDP medications until such time as eligibility has been
reestablished.
(b) The managing entity will manage the IDP allotment as follows:
1) Disseminating IDP Year-To-Date (YTD) Activity Reports to all
providers as received from Florida State Hospital.
2) Monitoring providers to ensure utilization & prevent lapsed funds.
b. Coordination with other Providers/Entities
(1) The provider agrees to coordinate services with other providers and state
entities rendering services to children, adults, and families as the need is identified
by either the department or the provider or as defined in the approved annual action
plan.
(2) The failure of other providers or entities does not relieve the provider of any
accountability for tasks or services that the provider is obligated to perform pursuant
to this contract.
(3) The managing entity will ensure through its subcontractors that crisis mental
health services are available to Protective Investigators to support the principle of
keeping children in the home whenever possible.
c. Minimum Service Requirements
See Exhibit F, Minimum Service Requirements.
7. Department Responsibilities
a. Department Obligations
(1) The department will provide information related to any part of this contract's
budget, training events, and changes in applicable state and federal laws,
regulations, administrative rules, operating procedures, or department policies,
including those references listed in Exhibit F, Minimum Service Requirements to
designated managing entity personnel in a timely manner.
(2) The department will provide technical assistance and support to the managing
entity and the network providers to ensure the continued integration of services and
support for clients. The department will provide technical assistance and support to
the managing entity for the maintenance and reporting of data on the performance
standards that are specified in Exhibit D, Substance Abuse and Mental Health
Required Performance Outcomes/Outputs and Indirect Prevention
Performance Measures (incorporated herein by reference).
(3) The department will participate in developing the Contingency Transition Plan,
which is incorporated herein by reference.
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i4\ If the rDan@0iO0 entity is under corrective action pl@O, the department will
conduct monthly oversight activities to ensure compliance with the plan.
(5) The department will participate in the collaborative development and
implementation of the working agreement with the CD00OUnib/ Based Care and
substance abuse and mental health providers to ensure the inte0[@bDO of services
and support within the CoO101UDit«. The department will support the development
and \[Dp|eOleOt@tiDO of the VVDd(iO0 agreement by providing an eX@Olp|e of a policy
vvOrh\Og @greeOleOt. system of care iDfDrOl@tiDO, data reporting requirements and
technical assistance.
(6) The department will review the managing entity's proposed policies, procedures,
and plans required to be submitted by the managing eOt\b/ and will respond in
writing with C0[n[OeOtS, or will approve within 30 working d@VS from the day of
receipt. (]OCe reviewed by the department, the rn@D@0iOg entity's policies and
procedures may be amended without further departmental review, provided that
they conform to state and federal |aVVS. the state Administrative Code' and federal
regulations.
/7\ At @ D1iniD1UOl. the Southern Re0iDD'S SAK8H PnDgn@Ol Supervisor will meet
quarterly with the managing entity to obtain @ briefing on the networh'e operations.
The meeting can be in person or by the phone.
(8) The department will request SUppD[[iO0 dDCUrDeOt@tiOO and review source
doCU[neDt@UDO of units billed to the department.
/9\ The department will make @V@i|@b|e to the OlaO@0iOg entity any inter or intra-
departmental collaborative agreements and/or any other collaborative agreements
between the department and other govern mental/no O-goverOmental agencies.
b. Department Determinations
The managing entity agrees that Sen/iCeS other than those Set out in this contract will be
provided only upon receipt of @ written authorization from the department's CDntn@Ct
manager OraD authorized department staff member. The department has final authority
to make any and all determinations that affect the he@|Ul safety and well being of the
citizens of the State of Florida.
c' Monitoring Requirements
(1) The department will monitor the rn@n@giO0 entity in @CC0nd@OCe with section
394.741. F.S. and CFOP 75-8. [|DOb@Ct Monitoring Operating Procedures and be
obtained from the contract Ol@n@0er' and is incorporated herein by reference. The
managing entity shall comply with any coordination or documentation required by
the department's ev@|U@t0r(S) to SUCCeSSfU||V evaluate the pnD0r@OlS. and Sh@||
provide complete @CCeSS to all budget and financial information related to services
provided under this contract, neg@nd|eSS of the source of funds.
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(2) The department will monitor the managing entity on its performance of all tasks
and special provisions of the contract.
(3) The department will provide a written report to the provider within 30 days of the
monitoring. If the report indicates corrective action is necessary, the provider shall
have 30 days from receipt of the monitoring report to respond in writing to the
request. Except in the case of threat to life or safety of clients, in which case the
corrective action will be immediate.
C. Method of Payment
1 Payment Clauses
a. This is an advance cost reimbursement and fixed price, fixed payment contract,
comprised of Federal sources and a grant of State funds. The Funding Detail is the
document that identifies the amount of Federal and Grant resources. The department
will ensure that any applicable appropriated funding for direct substance abuse and
mental health services is contracted with the managing entity. Any increases will be
documented through a contract amendment, resulting in a current fiscal year funding
and corresponding services increase. Such increases in services must be supported by
additional deliverables as outlined in the amendment. At the beginning of each fiscal
year, the Funding Detail will be amended into this contract, and the total contract
amount will be adjusted accordingly. The department shall pay the Managing Entity for
the delivery of services provided in accordance with the terms of this contract for a total
dollar amount not to exceed $362,976,259.00 subject to the availability of funds. A
summary of the Funding Detail is attached as follows:
Exhibit A- 1 Fiscal Year 10-11 $54,851,259.00
Exhibit A- 2 Fiscal Year 11-12 $TBD
Exhibit A- 3 Fiscal Year 12-13 $ TBD
Exhibit A- 4 Fiscal Year 13-14 $ TBD
Exhibit A- 5 Fiscal Year 14-15 $ TBD
Exhibit A- 6 Fiscal Year 15-16 $ TBD
(1) Network Provider Service Expenses — Cost Reimbursement
(a) The department shall reimburse the payment of the delivery of service units
provided by approved network providers that are provided in accordance with
the terms and conditions of this contract, not to exceed the following, based on
the Funding Detail, subject to the availability of funds.
Fiscal Year Subcontracted Services Total Amount
2010-2011 $51,703,875.00
2011-2012 $ TBD
2012-2013 $ TBD
2013-2014 $ TBD
2014-2015 J $ TBD
2015-2016 J $ TBD
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(b) The department will make payment to the managing entity, on a cost
reimbursement basis, for the delivery of behavioral health services. Payments
to the managing entity shall be made based upon the actual payments made to
approved network providers and invoices will require submission of the
approved subcontractors' paid invoices. No reimbursement will be made by the
department for payments made by the Managing Entity to subcontractors not
previously approved by the department.
(2) Administrative Expenses— Fixed Price, Fixed Payment
The department shall make a fixed monthly payment to the managing entity for the
administration, management, and oversight of the Behavioral Health System of
Care, not to exceed the following, subject to the availability of funds:
Service Unit Fixed Fee # of Units Total Amount
One Month of Administration,
Management and Oversight $ 287,828.00 9 $ 2,590,452.00
(10/01/10-06/30/11)
One Month of Administration,
Management and Oversight $ TBD 12 $ TBD
(07/01/11-06/30/12)
One Month of Administration,
Management and Oversight $ TBD 12 $ TBD
(07/01/12-06/30/13)
One Month of Administration,
Management and Oversight $ TBD 12 $ TBD
(07/01/13-06/30/14)
One Month of Administration,
Management and Oversight $ TBD 12 $ TBD
(07/01/14-06/30/15)
One Month of Administration,
Management and Oversight $ TBD 3 $ TBD
(07101/15-09/30/15)
(a) The department will make payment to the managing entity for the
administration, management, and oversight of the Behavioral Health System of
Care (to include the administration of special projects as identified in the
approved annual action plan) based on a fixed price, fixed payment method of
payment. A fee equal to one twelfth of the annual administrative expenses will
be paid monthly. The monthly payment for administrative expenses is based
on the final negotiated approved Line Item Operating Budget (Exhibit B) and
Budget Narrative, incorporated herein by reference.
The department during a given fiscal year may require the managing entity to
prepare and negotiate a revised line item operating budget and scope of work
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for the allowable administrative expenses charged to the department based on
decreases and increases of the approved Line Item Operating Budget
(Exhibit B).
(b) The managing entity will submit monthly expenditure reports for
department review, no later than 30 days after the end of the month for which
payment is being requested. The expenditure reports must reconcile actual
administrative expenditures incurred by the managing entity versus payments
for administrative expenses disbursed to the managing entity by the
department. The managing entity will submit a final expenditure report within
30 days of the end of the fiscal year for department review to determine if there
are any unspent funds/overpayments that need to be returned and/or
reallocated to the department. Any unearned administrative funds identified in
the reconciliations will be considered overpayments and will be recouped by the
department. Repayment, if applicable, should be made immediately per
section 1.J. of the Standard Contract.
(c) The managing entity will have a total of 10% flexibility within the approved
Line Item Operating Budget (Exhibit B) for allowable administrative
expenses. Any budget revision that is required beyond the 10% flexibility must
be submitted to the department and approved by the designated representative
prior to its implementation. Any line item funding allocated under Special
Projects in the Line Item Operating Budget will have no flexibility. Any budget
revision shall be submitted to the contract manager and maintained in the
contract manger's file.
(d) Payment may be authorized only for allowable monthly expenditures,
which are in accordance with the approved Line Item Operating Budget
(Exhibit B).
b. Renewal Clause - This is a multiple year contract for five (5) years. This contract
may be renewed for a term of up to five (5) years. Such renewal shall be made by
mutual agreement and shall be contingent upon satisfactory performance evaluations
as determined by the department and shall be subject to the availability of funds. Any
renewal shall be in writing and shall be subject to the same terms and conditions as set
forth in the initial contract, including amendments.
c. The managing entity shall provide local match on its own or through its network
providers, according to Rule 65E-14.005, F.A.C., up to the amount specified in Exhibit
A, Funding Detail.
d. If the managing entity intends to close or suspend the provision of subcontracted
services funded by this contract, the managing entity agrees to notify the department in
writing at least sixty (60) calendar days prior to their intent to close, suspend or end
service(s).
2. MyFloridaMarketPlace Transaction Fee
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This contract is exempt from the MyFloridaMarketPlace Transaction Fee in accordance
with Rule 60A-1 M2(1) (d), F.A.C.
3. Advance Payment
a. The managing entity may request an advance for the first and second month of each
fiscal year, based on anticipated cash needs, subject to approval by the Department of
Financial Services.
b. In accordance with subsection 216.181(16)(b), F.S., any interest earned on advanced
funds shall be returned to the department. The managing entity must submit back up
documentation from the financial entity where interests were accrued supporting the
Annual Percentage Rate and actual interest earned for each month.
c. The initial invoices for advances will not require the submission of supporting
documentation at the time of the request for the advance, but supporting documentation
will be required for all invoices submitted after actual costs have been incurred.
d. After the initial advance period, the managing entity agrees to request payment
based on actual payments made to the subcontractors beginning with the first month
that was advanced in accordance with the scheduled in Section f. below.
e. Any funds that were advanced to the managing entity for administrative expenses
and/or subcontracted services that were not accounted for and recouped through the
final fiscal year end reconciliation of actual expenditures shall be returned to the
department at the end of each state fiscal year with the submission of the final invoice
for the fiscal year.
f. Scheduling the Advance Payment: The following is an example of how to schedule
the submission of advance and reimbursement requests:
For Fiscal Year 2010-2011:
Month Type of Request Based On: Date of Submission
October Advance Anticipated Cash Needs October 1 s"
November Advance Anticipated Cash Needs October 1 sF-
December Reimbursement October Actual Expenditures November 30th
Janus Reimbursement November Actual Expenditures December 30
February Reimbursement December Actual Expenditures January 30'
March Reimbursement January Actual Expenditures February 30th
April Reimbursement February Actual Expenditures March 30th
May Reimbursement March Actual Expenditures April 301h
June Reimbursement April Actual Expenditures May 30
Reconciliation Recoupment May Actual Expenditures June 30th
Reconciliation Recoupment June Actual Expenditures July 30th
Final FY Invoice Reconciliation—Final Year to date Actual Expenditures July 30th
Expenditure Report as of June 30"'
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For Fiscal Year 2011-2015
Month --Type of Request Based On: Date of Submission
July Advance Anticipated Cash Needs JUIV 15
Au ust Advance Anticipated Cash Needs July 1st
September Reimbursement July Actual Expenditures August 30
October Reimbursement August Actual Expenditures Se tember 30th
November Reimbursement September Actual Expenditures October 30`
December Reimbursement October Actual Expenditures November 30th
January Reimbursement November Actual Expenditures December 30
th
February Reimbursement December Actual Expenditures January 30`
March Reimbursement January Actual Expenditures February 30th
April Reimbursement February Actual Expenditures March 30th
May— Reimbursement March Actual Expenditures Aril 30
June Reimbursement Aril Actual Expenditures May 30
Reconciliation Recou ment May Actual Expenditures June 30th
Reconciliation Recou ment June Actual Expenditures Juff
Final Invoice Reconciliation — Final Year to date Actual Expenditure Ju
Expenditure Report as of June 30th
Fiscal Year 2015-2016
Month Type of Request Based On: Date of Submission
Jul Advance Anticipated Cash Needs Jul 1"
August Advance Anticipated Cash Needs Jul 1 St
September Reimbursement July Actual Expenditures Au ust 30
Reconciliation Recou ment August Actual Expenditures Se tember 30th
Final Invoice Reconciliation — Final Year to Date Actual Expenditure October 30
th
Expenditure Re ort as of September 30th
4. Reconciliation of Advanced Funds
a. Monthly expenditure reports for the month which reimbursement is being requested
shall be submitted by the managing entity along with their request for reimbursement in
accordance with the above schedule.
b. Durin the first year of this contract, a reconciliation report will be required after the
6th and 8t month. During the remaining years of this contract, a reconciliation report will
be required monthly.
c. All of the interest earned on advanced funds shall be returned to the department on
a monthly basis, either through the submission of a monthly check or an adjustment to
the monthly invoice.
d. The department reserves the right to request reimbursement for advances issued to
the provider that exceed actual provider expenditures that cannot be reasonably
justified through these expenditure reconciliation reports.
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e. Advanced funds shall be reconciled during the final two months of each fiscal year,
either through the submission of a check or an adjustment to the invoice.
5. Additional Release of Funds
At its sole discretion the department may approve the release, of more than the
monthly-prorated amount when the managing entity submits a written request justifying
the release of additional funds, if funds are available and the services have been
provided.
6. Medicaid Billing
a. Medicaid earnings cannot be used as local match. In the absence of the
Medicaid Electronic Verification report, the managing entity will rely on the
subcontractors billing information.
1b. Subject to the availability of the Medicaid Electronic Verification, the managing
entity shall require that the Medicaid enrolled network providers will not bill the
department for Medicaid billable services provided to Medicaid eligible recipients. FACT
services for Medicaid clients can be billed to the department.
C. However, when services are covered under the Florida Medicaid program for
Medicaid recipients and the recipient does not have other third party coverage, the
department shall not be considered a liable third party for Mental Health and Substance
Abuse Program payments funded through the department. Services shall then be billed
to Medicaid and not the department;
d. The managing entity shall monitor that authorized subcontractor services only be
billed to the department if services are provided to non-Medicaid recipients, and/or for
non-Medicaid covered services, and no other non-Medicaid first or third party payors
are available;
e. The managing entity shall monitor to ensure that in no event subcontractor's bill
the Medicaid program for services or expenses for Medicaid recipients for which the
subcontractor has already been paid by any other liable third party payor;
f. The managing entity shall monitor Network Provider subcontractors to ensure
that Medicaid earnings separate from all other fees;
g. The managing entity shall monitor Network Provider subcontractors to ensure
that Medicaid payments are accounted for in compliance with federal regulations;
h. In no event shall both Medicaid and the department be billed for the same
service;
L The managing entity shall monitor to ensure that subcontractor operating a
facility licensed as a crisis stabilization unit, detoxification facility, short-term residential
treatment facility, residential treatment facility Levels 1 or 2, or therapeutic group home
that is greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee-
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For-Service programs for any services for recipients while in these facilities;
j. The managing entity shall monitor to ensure that subcontractors operating a
children's residential treatment center of greater than 16 beds is not permitted to bill or
knowingly access Medicaid Fee-For-Service programs for any services for recipients in
these facilities except as permitted under the Medicaid State Inpatient Psychiatric
Program Waiver;
k. The managing entity shall monitor that subcontractors assist clients who need
assistance and who may be eligible for Medicaid to make application including
assistance with medical documentation required in the disability determination process;
and
1. The managing entity shall monitor to ensure that subcontractors agree to assist
Medicaid recipients covered by a Medicaid capitated entity who need and request
assistance to obtain covered mental health services that the treating provider considers
to be medically necessary. This assistance shall include assisting clients in appealing a
denial of services.
7. Billing for Non-Medicaid Recipient and/or Medicaid Covered Children Mental
Health Services
The managing entity will insure that all providers agree that prior to billing the department
for non-Medicaid recipient or for non-Medicaid covered services; the provider will seek
payment from all other first or third party-payor. In no event shall the provider bill the
department for services already paid by any other liable first or third party payor.
8. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental
Health Plans, or Provider Services Networks.
Unless waived in Section D (Special Provisions) of this contract, the managing entity
agrees that payments from a health maintenance organization, prepaid mental health plan,
or provider services network will be considered to be "third party payer" contractual fees as
defined in Rule 65E-14.001(2)(z), F.A.C. Services which are covered by the subcapitated
contracts and provided to persons covered by these contracts must not be billed to the
department.
9. Temporary Assistance to Needy Families (TANF) Billing
The managing entity shall fulfill its obligations under applicable parts of Part A or Title IV of
the Social Security Act and ensure that TANF funds shall be expended for TANF
participants as outlined in the Temporary Assistance to Needy Families (TANF)
Guidelines. Subcontractors' contracts shall specify the unit cost rate for each cost center
contracted for TANF funding. TANF Guidelines can be obtained from the contract manager,
or can be found at the following web site:
http:/,/www.dcf,state.fi.Lls/mentalhealth/contract/index.shtmi
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10. TANF SAMH Incidental Expenditures for Housing Assistance
The managing entity shall comply with the provision of TANF SAMH Incidental
Expenditures for Housing Assistance, which is incorporated herein by reference.
11. Invoice Requirements
a. The reimbursement for the administrative costs incurred in the administration,
management and oversight for behavioral health services and the reimbursement for
costs incurred in the delivery of service units or other agreed upon methods of
payments provided by subcontracted network providers shall be invoiced separately by
the managing entity using the following invoice formats or other agreed upon formats:
See Exhibit C-1, Managing Entity Administrative Services Monthly Request for
Payment/Advance and Exhibit C-2, Network Provider Services Cost Reimbursement
Report of Expenditures and Request for Payment/Advance.
1b. Subcontracted Network Providers
(1) The rates negotiated with any subcontracted network provider may not exceed
the model rate as specified in Rule 65E-14, F.A.C. Any exception to this must be
approved in advance in writing by the department.
(2) Subcontractors will be required to comply with Rule 65E-14.021, Unit Cost
Method of Payment, including but not limited to, cost centers, unit measurements,
descriptions, program areas, data elements, maximum unit cost rates, required fiscal
reports, program description, setting unit cost rates, payment for services including
allowable and unallowable units and requests for payments. If agreed upon with the
department, other payment methods may be permitted.
c. The managing entity's final invoice of each fiscal year must reconcile actual
expenditures during the fiscal year with the amount paid by the department. The
managing entity shall submit its fiscal year final invoice and expense report to the
department within thirty (30) days after the end of each state fiscal year in the contract
period.
d. If no services are due to be invoiced from the preceding month, the managing entity
shall submit a written document to the department indicating this information within thirty
(30) days following the end of the month
e. Invoices shall be submitted in detail sufficient for a proper pre-audit and post-audit.
f. Supporting Documentation Requirements
The managing entity shall submit the following documentation in support of their
invoices.
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(1) Administrative Services
To support the administrative services unit of service (Exhibit C-1), the managing
entity will submit a properly completed invoice along with an expense reports as
required in section C.1.a. and a report of any interest earned on advanced funds.
(2) Subcontracted Network Provider Service Delivery
(a) To support subcontracted network providers line item invoices (Exhibit C-2),
the managing entity shall submit to the contract manager a copy of the properly
completed invoice submitted for payment by each subcontracted network
provider and a copy of the managing entity's proof of payment (copy of
subcontractors' paid invoice) to each subcontracted network provider for the
month for which reimbursement is requested.
(b) The amount paid under this contract cannot exceed the total amount of
funding as specified in the Funding Detail. The Southern Region SAMH
Program Office allocates the funding for this line item.
(c) The managing entity is responsible for verifying the accuracy of each
subcontracted network provider's invoice.
(d) The managing entity shall ensure that all services provided by its
subcontracted network providers are entered into the SAIVIHIS or other data
system designated by the department.
12. The managing entity shall complete and submit to the department a Utilization/Lapse
Report as per the approved annual action plan.
13. A separate detailed annualized line item budget with corresponding narrative for the
operational costs for the administration and oversight must be submitted at least sixty
(60) days before the beginning of each fiscal year during the proposed contract and
renewal period.
D. Special Provisions
(1) Option for Increased Services
The managing entity acknowledges and agrees that the contract may be amended to
include additional, negotiated, services as deemed necessary by the department.
Additional services can only be increased if the managing entity demonstrates competence.
(2) Dispute Resolution
a. The parties agree to cooperate in resolving any differences in interpreting the
contract. Within five (5) working days of the execution of this contract, each party shall
designate one person to act as the its representative for dispute resolution purposes,
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and shall notify the other party of the person's name and business address and
telephone number. Within five (5) working days from delivery to the designated
representative of the other party of a written request for dispute resolution, the
representatives will conduct a face to face meeting to resolve the disagreement
amicably. If the representatives are unable to reach a mutually satisfactory resolution,
either representative may request referral of the issue to the Executive Director and the
Program Supervisor of the respective parties. Upon referral to this second step, the
Executive Director and the Program Supervisor shall confer in an attempt to resolve the
issue.
b. If the Program Supervisor and Executive Director are unable to resolve the issue
within ten (10) days, the parties' appointed representatives shall meet within ten (10)
working days and select a third representative. These three representatives shall meet
within ten (10) working days to seek resolution of the dispute. If the representatives'
good faith efforts to resolve the dispute fail, the representatives shall make written
recommendations to the Assistant Secretary, or designee, who will work with both
parties to resolve the dispute. The parties reserve all their rights and remedies under
Florida law. Venue for any court action will be in Leon County, Florida.
(3) Termination
Paragraph 111. C.1. of the Standard Contract is deleted in its entirety, and the following
language is inserted in lieu thereof:
"This contract may be terminated by either party without cause upon no less than ninety
(90) calendar days notice in writing to the other party unless a sooner time is mutually
agreed upon in writing. Said notice shall be delivered by US Postal Service or any
expedited delivery service that provides verification of delivery or by hand delivery to the
contract manager or the representative of the provider responsible for administration of
the program. If either party terminates this contract without cause, that party shall
coordinate a transition plan, as described in the "Contingency Transition Plan", which
is incorporated herein by reference, with the other party within 30 calendar days of
making such notification. This provision shall not limit the department's ability to
terminate this contract for cause according to other provisions herein.
(4) Sliding Fee Scale
The managing entity shall require the network providers to comply with the provisions of
Rule 65E-14.018, F.A.C. A copy of the subcontractors sliding fee scales that reflects the
uniform schedule of discounts referenced in Rule 65E-14.018(4), F.A.C. shall be furnished
by the managing entity to the department's contract manager within thirty (30) days of
contract execution. The managing entity shall submit to the contract manager, within thirty
(30) days of the execution of this contract, a validation that all sliding fee scales have been
received from all network providers and reviewed by the managing entity for compliance.
(5) Transportation Disadvantaged
The managing entity agrees to comply with and provide oversight so that all network
providers will comply with the provisions of chapter 427, F.S., Part 1, Transportation
Services, and chapter 41-2, F.A.C., Commission for the Transportation Disadvantaged, if
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public funds provided under this contract will be used to transport consumers. The
managing entity agrees to comply with and provide oversight so that all network providers
will comply with the provisions of (CFOP 40-50) if public funds provided under this contract
will be used to purchase vehicles, which will be used to transport consumers.
(6) Agreements with Health Maintenance Organizations/Managed Care Organizations
a. The managing entity shall notify the department's contract manager, in writing, prior
to entering into a contract for the provision of substance abuse and mental health
services with a health maintenance organization or other managed care organization
that is capitated by Medicaid to provide substance abuse and mental health services or
an agent of any such health maintenance organization or other managed care
organization.
b. Copies of the contract shall be furnished to the department's contract manager within
thirty (30) days of execution.
(7) Medicaid Enrollment
Those providers with substance abuse and mental health contracts in excess of $500,000
annually and rendering substance abuse services shall enroll as a Medicaid provider. This
process shall be initiated within 90 days of contract execution. A waiver of this requirement
may be granted, in writing, by the Director of Substance Abuse.
(8) National Provider Identifier
a. All health care providers are eligible to be assigned a Health Insurance Portability
and Accountability Act National Provider Identifiers (NPIs); however, health care
providers who are covered entities (which include all State-Contracted Community
SAMH providers and State Treatment Facilities) must obtain and use NPIs.
b. An application for an NPI may be submitted online at:
.do?forward=stafic.nPistart.
c. Additional information can be obtained from one of the following websites:
(1) The Florida Medicaid Health Insurance Portability and Accountability Act web
site: http://www.fdhc.state.fl.us/Medicaid/hipaa/NPI/npi.shtml
(2) The National Plan and Provider Enumeration System (NPPES) located at:
litt2s,//t?_pp es.cmlhhs.qov/NPPES/Welcome,do,
(3) The CMS NPI web page located at:
iLtIE,.//Www.ci-ns.hh§,goy/NationalProvjdentStarld/.
(9) Ethical Conduct
The managing entity understands that performance under this contract involves the
expenditure of public funds from both the state and federal governments, and that the
acceptance of such funds obligates the provider to perform its services in accordance with
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the very highest standards of ethical conduct. No employee, director, officer, agent of the
provider or network provider shall engage in any business, financial or legal relationships
that undermine the public trust, whether the conduct is unethical, or lends itself to the
appearance of ethical impropriety. Provider's and network providers' directors, officers or
employees shall not participate in any matter that would inure to their special gain, and
shall recuse themselves accordingly. Public funds may not be used for purposes of
lobbying, or for political contributions, or for any expense related to such activities, pursuant
to Section I. R.of the Standard Contract of this contract. The provider understands that the
department is a public agency which is mandated to conduct business in the sunshine,
pursuant to section 286.011, F.S., and chapter 119, Florida Law, and that all issues relating
to the business of the department and the provider are public record and subject to full
disclosure. The provider understands that attempting to exercise undue influence on the
department and its employees to allow deviation or variance from the terms of this contract
other than a negotiated, publicly disclosed amendment, is prohibited by the State of Florida,
pursuant to Section 111. C. of the Standard Contract and section 286.011, F.S. The
provider's conduct is subject to all state and federal laws governing the conduct of entities
engaged in the business of providing services to government.
(10) Mandatory Reporting Requirements
a. The provider and any subcontractor must comply with and inform its employees of
the following mandatory reporting requirements. Each employee of the provider, and of
any subcontractor, providing services in connection with this contract who has any
knowledge of a reportable incident shall report such incident as follows:
(1) Reportable incidents that may involve an immediate or impending impact on the
health or safety of a client shall be immediately reported to the contract manager;
and
(2) Other reportable incidents shall be reported to the department's Office of
Inspector General by completing a Notification/Investigation Request (form CF 1934)
and emailing the request to the Office of Inspector General at
ig_complaints@dcf.state.fl.us. The provider and subcontractor may also mail the
completed form to the Office of Inspector General, 1317 Winewood Boulevard,
Building 5, 2nd Floor, Tallahassee, Florida, 32399-0700; or via fax at (850) 488-
1428.
b. A reportable incident is defined in CFOP 180-4, which can be obtained from the
contract manager.
(11)Liability Insurance Coverage
The managing entity shall notify the department's Contract Manager within 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.
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(12) Informed Consent for Follow-Up Surveys
The provider agrees to comply, and require its subcontractors to comply with the
provisions of the Informed Consent for Follow-up Survey Guidelines, which is
incorporated herein by reference, when drafting consent forms for post treatment follow-
up surveys.
(13) Contracting with a Managing Entity
(a) The managing entity shall allow the department to retain the right to perform the
service or activity, directly or with another contractor, if service levels are not being
achieved.
(b) The managing entity shall identify a clear and specific transition plan that will be
implemented in order to complete all required activities needed to transfer the services
or activity from the department to the provider and operate the service or activity
successfully.
(c) The managing entity shall interview and consider for employment with the
provider each state employee (displaced as a result of this outsourcing) who is
interested in such employment.
(d) The managing entity shall meet all requirements for retaining records and
transfer to the department, at no cost, all public records in possession of the provider
upon termination of the contract and destroy any duplicate public records that are
exempt or confidential and exempt. All records stored electronically must be provided
to the department in a format that is compatible with the information technology
systems of the department.
(e) The managing entity shall, if applicable, allow the department to purchase from
the provider, at its depreciated value, assets used by the provider in the performance
of the contract. If assets have not depreciated, the department shall retain the right to
negotiate to purchase at an agreed-upon cost.
(14) Information Technology Resources
All department contract providers must receive written approval from the department
prior to purchasing any Information Technology Resource (ITR) with contract funds.
The provider agrees to secure prior written approval by means of an Information
Resources Request (IRR) Form before the purchase of any ITR. The Contract Manager
is responsible for serving as the liaison between the provider and the department during
the completion of the IRR in accordance with Children and Families Operating
Procedure (CFOP) 50-9, Policy on Information Resource Requests. The provider will
not be reimbursed for any ITR purchases made prior to obtaining the department's
written approval.
(15) Emergency Disaster Response Grant
The managing entity will coordinate and implement any disaster/emergency grants
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awarded to the Southern Region.
(16) Documents incorporated by reference in this contract are available in the
department's contract manager's file.
E. List of Exhibits
1. Exhibit A-1 —A-6, Funding Detail
2. Exhibit B-1 — B-6, Line Item Operating Budget
3. Exhibit C-1 Managing Entity Administrative Services Monthly Request for
Payment/Advance
4. Exhibit C-2, Network Provider Services Cost Reimbursement Report of
Expenditures and Request for Payment/Advance
5. Exhibit D, Substance Abuse and Mental Health Required Performance
Outcomes/Outputs
6. Exhibit E, Missing Children
7. Exhibit F, Minimum Service Requirements
8. Exhibit G, Required Reports
9. Exhibit H, Children's Mental Health Comprehensive Community Service Team
10. Exhibit 1, Tangible Property Requirements
South Florida Behavioral Health Network, Inc. 87 KH225
10101P2010 Exhibit A-1 Performance Contract
SAMH Soon—Program
MENTAL HEALTH
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R Ia a g l Or-Manatee 8
SP503 i CR/Manatee Glens Child Baker Act 9P532 r
GR Fanuly Emergency Treatment-Pinellas SP525 ° GR/CS Id District
08 nsiva Behavioral Services SP542 j
p _.._._
LJ District OS SP542
GR'Apalachee CSU-Leon SP549 I GR/Marion-Citrus MH-Children CSU SP550 t
OR/Family Emergency Treatment-Sarasota SP553 General Revenue SP5EB
GR/Lifestrearn(.SU-I.ake,Sumter SP559 FGTF=Pule NB Wp027 $10 tT29
....__._...,_..__ .-.._.n..., -,-....W.�. ............_...
GR,Ruth Cooper CSU-Lee SP560
M........._ ,_ ..__...__
GR'Sen role County CSU SP561
.._......._. ..__..-... ...
'ISTF�Orange County Receiving,Center SP572 I `
GR/APALACHEE SHRT-TERM RESID FAC SPAC9 --�---� ..........
G/A-BAKER ACT SERVICES (100611) WA-CHILDREN'S BAKER ACT (104257)
General Revenue 19MF4 $6058860 General Revenue 19ME1 r $1,1tt1913
........... .......�
'I S I F Adult Ymerg Biker Act$eivices-Hernando,Pasco SP592 iI General Revenue SP581
Emergency St abiIizatinn Total= $1,530,704
Cif A-OITl-PA'Fll"N"T RAKER ACT SERVICES PILOT (100612)
General Revenue 19ME4
Emergency Stabilization Total= 57,548511 w.
502018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY
G/A-AIM CICOMM.MENTALHEALT11 (100610) _ G/A-CHILDREN'S MENTAL HEALTH (100435)
A DAMI-{From Fund* 19018 - $82E 598 ADAMFI Trust Fund* 19C13 $728 063
AUAMHTr List hlmdlFACT 19019 $241362 General Revenue 19M13 $t,484883 I
(jenerai RevenuensrF 191,1118 $8823458 GR/TSTF 32NO3 e
_ -1
General Revenue,/FGTF 9QPSR - - i FGTF-TitleXXI 89Q13 t $1191233
GR/AGAPE FAM MINISTRY AFMMD $600000 GR/R"CC Non-Medicaid Eligible 9PRNM t........... $2t 750
W FIT I TANT 39A18 $1 540 806 GR/Henderson MH Center-Broward SP506 s t
FGJF ADAMH GR/Cotnm Forensic Reds-Adult Svc CFBAS $2 365 890 ADAMH TF/Infant&Young Special Project SP53.3
FGTF PATH GX018 $396 695 Federal Grants FT GMDW I $S00 01H1 r
-„- ;
(RTSPF/FG17,-F:ACTAdmin F1'A19 $2008626
GRJFAC'ISvcs FI'S19 1 $572,400
OAVII}"/FGTF Cum MIT Srvs Contract-NEFSH MHS18 G/A-PURCILASED RESIDENTIAL
G R LPPML $750000 TREATMENT SERVICES (102780)
N R C oun Coaagcs in the[lines
SP502 GR/RTC Non Medicad Eligible 9PRNM $270 214
_
GR 1`,51'F/Wayne Densch Center-Orange SP504 GR/Purch Res Treatment-Medicaid Svcs 9PRTS r
GRCharlotte Comitq CMH Center SP505
GR Short-Terra Residential Treat-HIIlsborough SP511
Ue.nerl Revenue.t")TFIDouq Gardena CM Cm SP51 $236 2F0 G/A-PURCH A.SE/THERA SVCS CHILD (lo0800)
GR Nfian -Dade Homeless Trust SP513 $135,000 General Revenue 19MCB --'
GRrCannhus Lki"c Canter-Dade SP551 $187 500_
GR FACT"ream-Bay,Gulf SP552
..-,. ... .......
ORAlmnu Behavioral Hlth Or-Uninsured Dade SP555 $187,500
GICThe Village-Campaneros En Recup-Dade SP558 $225,000
CAMILLUS BEHAVIOR HLTH TRT CTR SP5C B
FAM EMERG TRMT CTR 19 CIRCUIT SP5FE � �
.JUV CC-OCCUR ADDTNS Dade/Broward/Monroe SPJC9
GRfNEW HORIZONS CENTER $PN1I9
G AA iNDIGEN1 PSYCH MEDICATION PROGRAM (101350)
G"ened Revenue 19M18 $85,495 =
G!A-BAKER ACT SFRVIC:ES (100611)
General Revenue 19M18
Recovery&Resiliency"Total= $19,182,580 Recovery&Resiliency Total= $4,20t,143
TOTAL ADULT COMM.MEI= $26,731,091 TOTAL CHILDREN'S MENTAL HEALTH= $5,731,847
"Community Mental Health Block Grant
Rev.10101/2010 Contract No.KH225
South Flonda Behavioral Health Network,Inc. 88
1 0101/201 0 Exhibit A-1 Peftmnhrua,C-aniet
SAMH S—c..P,ugnun
SUBSTANCE ABUSE
FUNDING DETAIL
Provider Name South Florida Behavioral t icalth Network,Inc Contract 4[hJH225 Re rsimr
Budget Entity 60910603-Aduh Substance Abuse OCA AMOUNT Budget Entity 60910602-Children's Substance Abuse OCA AMOUNT
603005-DETOXIFICA1[ON 602001-DETONIFICATiOYARF
OiA-CONINI St J BSTANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS (100420)
SAPFBO $� SAPTBG 6 270G5 270 il
GIC'Folbacco Settlement First Fund 27ME5 1 16 GR/Tobacco Settlement Frust Fund 27NIF1 $313,0iii
�
it G "Adull Deto, ADDEX GR,,Child Detox CHDFX�__
Detoxification Total= $576,272 Detoxification Total= S67fi_
603006-PREVENTION SERVICES 602002-PREVENTION SERVICES
GIA-COMM SI JISJANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS(100420)
General Revenue 27ME6 Prevention Services-SIG/ADAMITIT 271`02
ADANlHFrusj Fund Prevention Services 27PR6 ... �1_1�,096J General Revenue 27-ME2
ADAMH'frust Fund-Prevention Services 27PR2 1 384
i Prevention Partnership Services 27PR3
6R/Chdd Prevention Svcs CHPRV $843,1711510
General Revenue SP613
GR/Stewart,Marchmaiil'rmt,Ctr-DI2 SP643
Prevention Services Total $196,096 Prevention Services Total
603007-TREATMENT&AFTERCARE 602003-TREATMENT&AFTERCARE
G,A-COMM SUBSTANCE ABUSE SVCS (1()0618) G/A-CHILD/ADOL SUBSTANCE ABUSE SVCS(100420)
J SAP BG 270G7 F` SAPTBG 27063
ADAMHTF Achannistranw Expendriures 27AD7 1 $30,892
I ADANH I Trust Fund Administrative Expenditures 27AD3 i ...... .......——----------- ' 27CH -,ADAMHTF lntrzivenous Ding Usage 27HIV $902 608 I ADAMH'Fiust Fund V t
GR/,rsrF,o&mFF 27 i�_'
ME7 S1,658,936'1 GRfFSTF/O&MTF/CASATF 27ME3 753,161
Af)A.\tli'T'F Services to Women 27WOM $1 54 7J)'S \vTFF TANF 391ci S128 03 4
39FC0 $w 514 OFYT�&Allen,—-child WTTF TAN F CH-FRT $311
I rust Fund ADTRr $I 67,445 ADANIFITrust Fund HIV 27CHV 556�
SSBGTFCinmlos Life Center-Dade BS631 iI ADANUiTrust Fund-Roots n'Wings St 602
General Revenue DPG08 $13 765 1 OR,'Adol Tx Dually Diagnosed Girls-Di I SP606 p $375,000
FEDERAL GRANTS TRUST FUND SB004 GR/The Compass Program SP608 750
Cur D12 SP614 GR/ADANIFFIT-The starting Place S11610
ADANIHIT-New llonrons Dual Dia 5 ADAINUrTF-Adolescent Res SA Ix Facility SP611
noosts SP6 6719�_�
ADAMITIT-Achficuon Frunt Services SP616 OR/Pionect Warm-D12 SP644
ADAMH FF-New Beginnings Prog Renewal SP6:7 GRAnImenix House-R23 SP645
Sp(, 8 $135,000 i GR/1ST STEP/MOTHERS/INFANT SP646
ADAMHTF-Rivcr Re rot Services,Inc .........
SP619 GR/Drug Abuse Comprehensive Cord Ofe SP647 1
ADANIHFF%Passa ge Way Aftercare Project SP022 i GR/Here's Help SP692 $150,000
ADAMIFFF-Firierg Wahl isi Reduc Project SP623
ADANIFIFF-Project Warm SP624
GR/AGAPE AGAPE $187,500 j
GR,Rjver Region Wonnen's SA SP651
GWOrcles of Care-Brevard SP652
GRXenter for Drug Free tog SP669
GR/Cenha For Drug Free Li,i ng-Brevat d S11670
Treatment&Aftercare Total= $_lO�960 917 Treatment&Aftercare Total
TOTAL CHILD/ADOL SUB.ABUSE= $7,507,652
TOTAL ADULT SUB.ABUSE= 511,733,285
GRAND TOTAL ALI,PROGRAMS=
MATCH CALCULATIONS APPLICABLE To CONTRACT
FUNDS NOT REQUIRING VUVICH
Jlculsotiai onaliz a no n Protects rr $12,602,6I5 i TOTAL FUNDS REQUIRING MATH C S21,.,44,051
,Children"e Mental Health Base Fun a S3,859,720
Grant Allocation $069,397 LOCAL MATCH REQUIRED $7 181350
_4
J)iuc Abu e Service, $9,620 461) ADDITIONAL LOCAL MATCH
GRAND TOTAL LOCAL MA I-CH S7 181,3",
TOTAL FUNDS NOT RT QUI RING MATCH S30,159,925
E,Pdi1must 1.suflM.—,Abuse.Prevention and'irr-on-1 81-k Gt,Ihiibk
Suthn.nre Ah.s,Po,fio,r and fre.h.-t 111-k Grunt-footahng Agr—io-RESTRICTIONS APPLY
R10/01/2010
South Fl-da Sehav oral Ho,nth Network,Inc 89 Contract No.KH225
10/01/2010 Exhibit A-2 Performance Contract
SAMH Services Program
MENTAL HEALTH
FUNDING DETAIL
Provider Ninoe !Su'oah Flonda B c Contract 4 �kk-;25 Revision 4 W
cia�uual Health Network,In
..........----............
Budget Entity 60910502-Adult Mental Health OCA AMOUNT Budget Entity 60910503-Childrea's Mental Health OCA AMOUNT
502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION
G/A-ADULr('0%INI MENFALHEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435)
ADANIH Ti ust Fund* 19004 ADAMI-ITrust Fund* 190C1
----—------—------------....... ........... -----------------
Gieneral Rc,cuuc,TsrF 19IME4 General Revenue 19VIEI
ADAMfTFF/Consurrer Self-Directed Care Pilot SP501 FG'IT-'Title XXI tIuQol
(4R11'anidy Enierge-v Treatment Ctr-Manatee SPS03 GRYMariatee Glens Child Baker Act SP532
...........—
GR C ocsper CStj SP516 GR/Cluld Comprehensive Behavioral Services SP540 I
61CFarnily Fiiiergeticy'l'teattiient-Pitiellas SP525 i GWCSU District 08 SP542
GR/Apalaclrec CS(T-Leon SP549 luldien CSIJ SP550 GR/Manon Citrus Milt-C
GR/Fauuly SP553 General Revenue SP5EB
GR�I.ifcstream(SI 1-Lake,Sumter SP559 FGTF-rule IVB W0027
GR/Ruth Cooper CSU-t.ce SP560
GR/Sc to C—niv Cstli SP561
---------------
TSTF Orange County Rece—m,Center SP572
GR/APALACHEE SHRT-TERM RESID FAC SPAC9
G/A-BAKER ACI'SFRVICES (100611) G/A-CHILDRFN'S BAKER ACT (104257)
Genoa)Revenue 19NIE4 General Revenue 19NIEI
TSTFAdult Etneig Baker Act Services-Hernando,Pasco SP592 I General Revenue SP581
Emergency Stabilization Total= $o
6,A-0UTPATIENT BAKER ACT SERVICES PiLo'r (100612)
General Revenue I9ME4
Emergency Stabilization Total
5102018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY
GA-ADULFCONI'M MENTALHEALI'll (100610) G/A-CHILDREN'S MENTAL HEALTH (1100435)
ADANIII Trust fund* 19018 ADAMH Trust Fund* IQC13
ADAMII trust FundIFACl' 19019 General Revenue lwm I�3
General Revenuol'STIF 19NI 18 GICTSTF 32NO3
...................................-------
. ......................
Genetal Re,enue/F(TIT 9QPSR FGTF-Title XXI 891)13
GR/AGAPE FAM M 39AI8 NISTRY AFMMD GR,!RTC Non-Medicaul Eligible 9PRNM r
WTTF FANF
GICIlenderson Vill Centei-Browaid SP506
ADAMH TF/Influn&Young Special Project SP533 FG]F ADAMIVGR.Corum Forensic Beds-Adult Svc CFBAS
...........
FGlFPATH GX018 General Revenue SP5MA
OIC I'SITTGTF-FACT Admin FTA19
6 R/FACT Svcs FTSI9
............
0&N,I'FFFGrFCom MI4S;,sConuact-NEFSIJ NIIIS18 G/A-PURCHASED RESIDENT IAL
F6 IT, MITrn 'TREATMENT SERVICES (102780)
GR/Couit Cottages in the Pines g SP502 GR/RTC Non-Memead Eligible 1)PRNM
GR,'TSTF Wayne Densch Conter-Orange SP504 GR/Purch Res fieatment-Medicaid Svcs 9PR'I S
...........................
GR.iCho,1,,ttc Conivy CMI I Cont, SP505
GRyShort-Tenn Residenti,,it'lieat-iiiiisborougli SP511
Ocned Revenue/TSIFDong Gardens CNIII('it SP512 G/A-PURCIIASEJI IERA SVCS CHILD (10080o)
GRAliano-Dade Hinneless fiust SP513 General Revenue 19kl('B i
............
GIUCanullus Life Center-Dade SP551
ORIFACT Tema-Bay,Ouff S11552
GRI/Nharni Behavioral I Ilth Cu-T,'ninsured Dade SP555
OR/The Village-Campaneros Err Recup-Dade SP558
.............
CAMILLUS BEHAVIOR HILTH TRT CTR SP5CB
FAM EMERG TRMT CTR 19 CIRCUIT SP5FE
JUV CO-OCCUR ADDTNS DadelBroward/Monroe SPJC9
.. ......
GRINEW HORIZON'S CENTER SPNI19 ....
G/A-IND16FN I'PSYCH MEDICATION PROGRAM (101.350)
Goner I Revenue 19MIS
...........
G/A-BAKERACT',,ERVI('EiS (100611)
General Revenue 19M18
Recovery&Resiliency Total= $0 Recovery&Resiliency'll'otal= $0
TOTAL ADULT COMM.MH= $0 TOTAL CHILDREN'S MENTAL HEALTH= $0
Community Mental Health Block Grant
Rev,10/01/2010 Contract No.KH225
South Florida Behavioral Health Network,Inc. 90
10/01/2010 Exhibit A-2 Performance Contract
SAMH Services Program
SUBSTANCE ABUSE
FUNDING DETAIL
Pro%liter Name South Honda Behavioral Health Network,Inc. Contract A ............
�)SLtL2 Revision# 111--l-1-111— IFY 2011-12(12 Mon)
Budget Entity 60910603-Adult Substance Abuse OCA AMOUNT Budget Entity 60910602-Children's Substance OCA AMOUNT
603005-DETOXIFICATION 602001-DETOXI FICATION/ARF
G,'z\-('O%IM SUBSTANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSESV( (100420)
SAPTBG 270G5 SAPTBG 2706 1
GR/Tobacco SetflementTrust Fluid
27VIE5 GRI Tobacco Settlement Trust Fund 27MEI
GRYAdult Delos ADDEX i GR/Child Detox
CHDE X
Detoxification Total $0 Detoxification Total (7)
603006-PREVEN FION SERVICES 602002-PREVENTION SERVICES
G,'A-('O%I'i,l SUBSJANCE ABUSE SVCS (100618) TTA-Cl III.D/AD0L SUBSTANCE ABUSE SVCS(100420)
General Revenue 27ME6 Prevention Services-SIG/ADAMIiTF 271`02
ADANIFITrust Frind Prevention Services 27PR6
General Revenue 27ME2
-------...................
ADANIFITrust Fmid-Prevention Services 27PR2
Prevention Partnership Services *** _4
27PR3
(JR/Child Prevention Svcs. CfIPRV I i
General Revenue SP013
G R/Stewart Marclirrian Irmt.Ctr.-D 12 SP043
Prevention Services Total= $o Prevention Services'Fotal
603007-TREATMENT&AFTERCARE 602003-TREATMENT&AFTERCARE
G.,A-(1`0TvIM SUBS FANCE ABUISE SVCS (100618) G/A-CIJII,D/AD0L SUBSTANCE ABUSE SVCS(100,120)
SAPTBG 270G7
SAPTBG 270G3
..............................
ADAMI ITF Administratik c Expenditutes 27AD7 F ADANIH Trust Fund Administrative Expenditu 27AD3
ADANI]TTFIntravenous Drug Usage 27HIV -------------- ADAMIJ Trust Fund 27CFIV
OW FSTF 0&1011' 27ME7 (;R/f'S'FF,'O&M'FF/CASATF 27MF3
...........
ADANII IT F Services to Women 27WOM i w r'IT TAN F 39TCJ
...... ................ --------
W FIT FANT 39TCO GR/"I'x&Aftercare-child ('fi rRT
I rust Ford AD CRT ADAMFITrust Fund HIV 27CfIV I
—----------
SSBGFF Camillus Life Center-Dade BS631 ADAMIT Trust Fund Roots n"Wings SP602
General Revenue DPG08 i GR/Adol.Ts.Dually Diagnosed Girls-D I I Spoof,
FEDERAL GRANTS TRUST FUND S13004 GR,'I'lic Compass Piogratin S11608 I
.......
ADAMIFIF-Steward vlarchman Ctr,D12
.. ...
SP614 GR/ADAM[I]'F-'I-he starting Place S11610
ADAMH IT New Horizons Dual Diagnosis SP615 ADANIFITT-Adolescent Res.SA'I'x Facility S 6 1 .........
AL),VNIII IT-Addictron Firtirt Sen ices S 1616 GR/Project Wann-D12 S P644
ADAMILIT-New Bepinnings Plug Renewal SP617 GR/Phocnix House-R23 SP645 ....... ..
ADANI I LFF-C oco it Lit Gyrov e-Behav I I th C tr S 618 .. ................. GPJlST STEP/MOTHERS/INFANT SP646
ADX\,IH IT-River Recions Senrces,Inc. S 619 GR/Drug Abuse Comprehensive Cord Ole, SP647
..............
ADANIFLIT-Passage WayAtIercare Project S 622 OPERATION&MAINTIF SP648
ADANIM'F-Einerg.'Nart f,i,,t RedLIC,Ir0JCCt S)623 ...........
ADAWITF-Rro ect Warm
'I S624
ADANUITF-Elderly Compliance SA&MH S)625
GWRi\er Region Women's SA S i('5 I ...........
GRXimies of(',ic-Buc,aird SP652
...............—-----
GRI(Ceriter Im Drug Free Living SP669
(JR/Center I'm Dnig Free Living-Brevaid SP670
Treatinent&Aftercare Total= $0 Treatment&Aftercare Total= $0
TOTAL CIIILD/ADOL SUB.ABUSE= $0
TOTAL ADULT SUB.ABUSE= $0
ESTIMATED GRAND TOTAL ALL PROGRAMS $72,500,000
tvIA I'CH CALCULATIONS APPLICABLE,TO CONTRACT
................. FTj'N.D_S_N0T RE [RING MATCH:
...........
............... 544,600,000 TOTAL FUNDS REQUIRING MATCH $27,900,000
......................................... --—-...... ..................... ................
............. .............. LOCALNIATCHREQUIRFID �11,100
ADE)i rIONAL LOCAL,NIA I('It
GRAND TOTAL LOCAL MATCH S9,300,0()()
FOLAL FUNDS N'6'F'REQUIRING' "", ' M_"-AT CH $44,600,000
E.P-diture cmwl be Substance Abuse Fri,ccoticar and Treatment Block Grant eligible
Substance Abuse Prevention and ri-cattacat Block Grant-Funding Agreement-RESTRICTIONS APPLY
Rev.1010112010
South Ronda Behavioral Health Network,Inc 91 Contract No.KH225
10101/2010 Exhibit A-3 Performance Contract
SAMH Services Program
MENTAI,HEALTH
FUNDING DETAIL.
Provider Name tiou b Flouda Behavioral health Nc.t vc rk Inc, ! C'ontract# KI I225 I Revision rr - PY Zt712-2013(I2 ydW
Budget Entity 60910502-Adult Mental Health OC:A AMOUNT Budget Entity 60910503-Children's Mental Health OCA AMOUNT
502004-EMERC,ENCI'S'rABI,IZATION 503001-EMERGENCY STABILIZATION
G1 N NDULr C CAINI.MENTAL HEALTH (Io0610) G/A-CHILDREN'S MENTAL,HEALTH (100435)
ADAMH Trust E uno* 19004 ADAMH Trust Fund* 190CI ?
�...___.. ..........._..
Geucral RevrnuelTS'TF 19MF4 General Revenue I9MEI k
...... ..: ....._ .. a
ADAMffl FICon,arner Self-Directed Care Pilot SP501 FGTF-"Title XXt 89Q01 ? i
frR I amtly Etuc.rs:cnay Treatment C`fr-Manatee SPSp3 ( GR/Marwaee Glens Child Baker Act $I'S32
GRCooper CSU SP516 GR/Child Comprehensive Behavioral Services SP54)GICFanoly I
C�RrA tiacl ee.Ir41�r�V Treatment-Pinellas SP525 GRICSU District 08 SP542 a
CSU-Leon SP549 - = GILMarion-Citrus MH-Children CSU 4PSSo j
p` _-., ...... _..I -
C R Fatrvty Emergency`1Ye.atmenf-Sarasota SP553 General Revenue SPSEB -,
...-..- ...,_.�.. a
GRI Efestrea fm 9I,-Lalce,Sumter SP553 FGTF=Pule[VB W0027 t
OR Ruin Cooper CSU-Lee SP560
GRSeminole C ourrty CSU SP501
'I S 1'F1}range County Rcceiving('enter SP572 _
GRIAPA(ACHEE SHRT-TERM RESID FAC SPAC9
G,A-BAKI3t2 ACT SER V IC ES (10061 1) G/A-CHILDREN'S BAKER ACT (104257)
19ML4 General Revenue I9MEI
General Revenue
"I'STF,Adult€.rnerg Balser Act Services-Llernando,Pasco SP592 General Revenue SP58( ;
-.-__ ..._..__.__ Emergency Stabilization Total
Cn A 0UTPAE IF,N r RAKER ACT SERVICES PILOT 1100612)
General Revenue 19ME4
Emergency Stabilization'rotal=
502018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY
WA ADUL T CONIM N4EN TAL HEALTH (100610) „ G/A-CHILDREN'S MENTAL.HEALTH (100435) _
A DAN1 H Trust Fu,W 19018 ADAMH"trust Fund* 19C I3
,. .
ADAMH"T'nust FunNFACT 19019 _ General Revenue !9M13
General Reve.mie/I-STF 19M18 6R/TS'TF 32NO3 'r
General RevenuelFG7"F 9QPSR FGTF-Talo XXI 89Q t3 t
_....�.,.�._. -.....-.,._-f
GRfAGAPE FAM MINISTRY AFMMD GR(RTC Nun-Medicaid Eligible 9PRNM 7
W1-I'FTANF
39A18 GR/Honderson NIT Center-Broward SI''S66 ? r
II(Illt I''1'I'F1 H OR/C'amtn Parensic Beds-Adult Svc, CFBAS(iXOI B $0 i (Decal Revenue pant&Yomrg Special Project SPS 3 i
_., -
SPSMA i
C R I S'rFiFC t F-FACT Adrian FTA 19
GR FACT Svcs T''rS I ..._..._ _-....__.....-_7
0f.M1 F/FGTF t`am MH Srvs Conti act-NEFSH MHS18 G/A-PURCHASED RFSIDENTIAl,
_t
FGTF MH'1 I I TREATMENT SERVICES (102780)
s -
r ..crurt Cottages to the Pines $PSOa GR/RTC Non-Medicad Eligible 9PRNM E
r. _. .....
.-.r
6R hSTF(W avne Dniseh Center-Orange SP504 GR/Punch Res Treanment Medicaid Svcs 9PR`rS 7
GR t'Prarlottt(bnnty CM}7 Center SP505 i
s-._.._.._.,,._.............�....v.._..e
GR/Short-l'eirn Residential Treat-Hillsborough SP511
Generl Revenue ES"rF/Doug Gardens CMH Co- SP51 G/A-PURCHASEJFHERA SVCS CFIII.,D (i00$GO)
GR/Iv iarni-Dade Homeless Trust S1151 1 General Revenue 19MC3 £----�-�
GRrCamillus Life Center-Dade SP551 -� - - �-- --
G R FACT'rwm-Bay,Gulf SP552 .
_.. .......
OR Miatni Behavioral filth Ctr-Uninsured Dade SP555
GWThe Village-Canrpanems En Recup-Dade SP558
CAMILLUS BEHAVIOR HLTH TRT CTR Sm,B i
FAM EMERG TRMT CTR 19 CIRCUIT SPSFF
JUV CO-OCCUR ADDTNS Dade/Broward/Monroe SPJC 9
GRINEW HORIZON'S CENTER SPNI19
G A-INDIGEN r PSYC II MEDICATION PROGRAM (101350)
Genet l Revenue 19M18 ..._... ... .�.
GIA-BAKER ACT SERVICES (100611)
Genctal Revenue 19M18 ...._.. ._...... ._.,
Recovery&Resiliency final= $0 Recovery&Resiliency'1'otal= $0
TOTAL ADULT COMM.MH= $0 TOTAL C11111-DREN'S MENTAL LIEALTH= $0
Community Nlental Health Block Grant
Rev.10/0112010 Contract No.KH225
South Florida Behavioral Health Network,Inc. 92
10/0112010 Exhibit A-3 Performance Contract
SAMH Services Program
SUBSTANCE ABUSE
FUNDING DETAIL
conta act 4 oi at I leall Network,Inc. 4on)
Provider Name ISouthtloridaBelimi Revision 4
Budget Entity 60910603-Adult Substance Abuse OCA AMOUNT Budget Entity 60910602-Children's Substance OCA AMOUNT
603005-DETOXIFICATION 602001-DETOXIFICATION/ARIF
G!12F
- ONIM SUBSTANCE ABUSE SVCS (100618) G/A-CI IILD/ADOL SUBsrANCE ABUSE SV((100420)
SA11FBG 270G I 05( i Rkacco Settlement Fritst Fund 27ME5 GRJobacco SettlementTrust Fund 27MEI
GR/Cluld Detox CH DE I
OR/Adult Delox ADDEX
Detoxification Total= $0 Detoxification Total $0
603006-PREVENTION SERVICES 602002-PREVENTION SERVICES
GIN-CONIM SUBS LANCE AW SE SVCS (100618) 6/A-CFllL,D/ADOL SUBSTANCE ABUSF,SVCS(100420),
General Revenue 27ME6 Prevention Services-SIG/ADAMUTF 27102 1
................ ............
ADAMI I Trust Fund Prevention Set-vices 27PR6 General Revenue 2 7M E12
ADANIHI'nistFtijid-FreNejitiotiServices 27TR2
Prevention Partnership Services 27PR3
GR/Cluld Prevention Svcs. CIIPRV
General Revenue sp613
GR/Stewart MarchmanTran,Cti,-D 12 SP643
Prevention Services Total Prevention Services Total= so
603007-TREATMENT'&AFTERCARE 602003-TREATMENT&AFTERCARE
G/A-CONAI SI:BSFANCF ABt7SF SVCS (100618) G/A-CLlILD/ADCL SUBSTANCE ABUSE SVCS(100420)____
SAP`FBG 270G7 j SAI1FBG 270GI
ADANIFFIT Administrative Expenditures 27AD7 7 ADAkIFITrust Fund Administrative Ex rending 27AD3
. ...........
ADAMLITF Intravenous Drug Usage 27HIV ADAMI I Ti ust Fund 2701V
TF/O&MTF/CASATF 27%IE3
GRi I S LF,O&M IT 27ME7 GRJS
AD
AMFFFF Services to Women 27WONI WTTF TANF 39T
I RF
C 1
WTTF TANF
39TCO GR/Tx&Aftercare-child CII
Trust Fund ADTRT ADAMFITnist Fund IIIV 27CFIV I
SSBGTF/Canallus Life('enter-Dade BS611 .........
ADAMIJ'Frust Fund-Roots nWings S 601
................
Ocneral Revenue DPG08 GR/Adol.Us Finally Diagnosed Girls-D I I S 606 1
..............
FEDERAL GRANTS TRUST FUND GRMie Compass Pro&rarn S160
SB004 8
AD MI FIT-Steward Nlarchnian Ctr.D12 SP6 4 GR/ADAMLITF-The starting Place S1610 'I
ADAMLITE-New Horizons Dual Diagnosis S11615 ADAMITTF-Adolescent Res,SAT's Facility SP611
ADAMIFIT-Addiction Trtna Services SP6 1 6 GR/Pio.cot Wai in-D 12 SP644
ADAMITIT'-New Beginnings Prog Renewal SP6 7 GR/PhOi IIOLse-R23 SP645
ADAMLITL-Cocoma 0 rove-Behav Ill SZ8 GR/1 ST STEP/MOTHERS/INFANT Sl:6'4'6
ADXMIL fF-Ri\er Regions Services,Inc. Sp619 I GR/Drug Abuse Coniprehensn SI
e Cord Ole. 647
ADAMFLIT-P ass age Way Aftercare Project S 622 OPERATION&MAIN IT SP648
ADANIFITF-Emerg.Wait List Reduc,Project S 623
ADA1vIFLT F-Project Wann S P624
ADAN I I FFF-F.Iderly Compliance SA&VIF1 S 675
(iRjRiver Region Women SA SP651
GR,Circles ofCare-Brevard S11652
GR/Center for Drug Free Living SP669
GR/Center for Drug Free Living-Brevard SP670
Treatment&Aftercare Total= SO 'Treatment&Aftercare'Total= SO
TOTAL CIJILD/ADOL SUB.ABUSE= Sit
TOTAL ADULT SUB.ABUSE= SO
ESTIMATED GRAND TOTAL ALL PROGRAMS= $72,500,000
MATCH CALCULATIONS APPLICABLE TO CONTRACT
FUNDS NOT REQUIRJ:Nq�M� ...............
Dcuisliortionalization Pro
Jects 44L600,000 i TOTAL FUNDS REQUIRING MATCH S27,900,000
Cldildren"c Mental health Base Fur
.............
otp-t,Block..-...6...,.t.a.-nt Alio,c,a'n.on LOCAL MATCH $9,300,000
.
ADDITIONAL LOCAL MATCH L
777
................ GRAND TOTAL LC MATC
H TCH S9,300,006'
TOTAL FUNDS NOT REQUIRING MATCH S44,600,000
Expenditure must be Stil Abuse Prevention and Treatment Block Grant eligible
Substance Abuse Pri,ifirri andT.e.h.e.1 131-1,Grant-Funding Agreement-RESTRICTIONS APPLY
Rev 1010112010
South Florida Behavioral Health Network,Inc 93 Contract No.KH225
1 0101/2 01 0 Exhibit A-4 Performance Contract
SAMH Services Program
MENTAL HEALTH
FUNDING DETAIL
Pin ides Narac ,South F'londa Beh rvux rl If alth Nctumk lnc Contract# ;KH225 ., -,. Revision k ;_�., „-,--„�„-, FY 2Q13-2G14(12 Moa
Budget Entity 60910502-Adult Mental Health OCA AMOUNT Budget Entity 60910503-Children's Mental Health OCA .AMOUNT
502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION
Gr A-ADI ILX COMM_MENTAL HEALTH (100610) G/A-CHILDREN'S MEN-rAL,HEALTH (100435)
ADAN4H Trust Fund* 19004 ADAMH Trust Fund* 190C1
General Revenue/'TSTF 19ME4 General Revenue 19ME! I
ADAMHTFlConsnmer Self-Directed Care Pilot SP501 ? FGCF-Title XXI 89f�01 3 i
y __ _
GR'Famd E.merge.ey'treatment Ctr-Manatee SPS03 GRlManatee Glens Child Baker Act SPS32
GRrCar7per CSL! SP516 GR/Chdd Comprehensive Behavioral Services S11540
f IZ I"amity Finer yertev'FYattnrent-Pi tad las SP525 GRCSU District 08 SP542 ,
i
GR/Apalachee,CSU-Leon SP549 GR/Marion-Citrus MI-(,Yiildren f.'SU SA550
GRrFamily F.tncrgency TreatmentSarzsota SP553 t - General Revenue SPSEB 1
._._., .. ...,,....r
Ci R/Lifestream CSU-Lake,Sumter SP559 FG,I-F=Title IVB WO027 r
t
....______.___.e_........ ..._......�. __.....,..
GW uth C'oopei CSU-Lae SP560
GR/Scounole County CSU SP561 _. ._ ..
7 STT/Onmc,e County Receiving Center SP572 .. .q
GR/APALACHEE SHRT-TERM RESID PAC SPAC9 �
G A BAKER ACT SERVICES (100611) G/A-CHILDRENrS BAKER ACC (I04257)
General Revenue 19ME4 General Revenue 14,ME1
........_ .............. ......
`CSi'F/Adult[mctg Baker Act Services-Hernando,Pasco SP592 General Revenue SP581
�- - _- Emergency Stabilization Total= --$0
G/A-OUTPATIENT BAKER ACT SERVICES PILOT (100612)
General Reveonue 19ME4
Emergency Stabilization Total
502018-RECOVERY&:RESILIENCY 503013-RECOVERY&RESILIENCY
G A-ADULT(OMM-MENTAL HEALTH (100610) G/A-CHILDREN'S MENTAL HEALS-1 (100435)
ADAMH Trust Fund* 19018 - ADAMH Trust Fund* 19C I o
_._.. _... ..._.-t t-. ....__ .. . .m.)
A L)A\QH Trust 1 unf�FACT 190I9 General Revenue 191vt 13 -j
General Revenue tSfF 19M18 GRTSTF 32NO3
..,..,.
General Revcuuc.'LGTF 9QPSR ItG'iR Title XXI 89QI1 i
GR/AGAPE FAM MINISTRY AFMMD GR/R"CC Non-Medicaid Eligible 9PRNM i
W"1TE'`fANF 39A18 GR/Henderson MH Center-Broward SP506 r
F(I I'ADAN11 WR/Comm Forensic Beds-Adult Svc CFB AS 80 r1DAMH TF/Infant ck.Young Special Project SP53i
_....,.. ... .., .m._ M-�..............y
FGIF PATH GX018 General Revenue SPSMA t
...,.. -...q-._.....----A _...m.-._
(R1STF,F TF-FACTAdmin FTA1)
(R FACT Svcs FTS19
O&WIF'/FGTI^Corn Mil Srvs Contract-NEFSH MHS18 G/A-PURCHASED RESIDENTIAL
FGTF MH'I CI TREATMENT SERVICES (102780)
�RRf �Fet Cottages in the Tinos SP502 = __ GR/RTC Non-Mechead Eligible 9PRNM
r yne L7ensch Center-Orange SP504 GR/Purch Res Treatment-Medicaid Svcs 9PRTS
G R(Charkotte County CM}i Center SP505
OR/Short-Term Residential"Freat-Hillsborough SP511
Genert Revenue l'S'1"Fit7uug Gardens C:MH Ctr SP51' G/A-PURCHASE/THERA SVCS CHILD (100800)
GRMiami-Davic Ftomelesa`trust SP513 4 General Revenue I9MCB 1
F_...-.. .....-.v.-..,.-..2 _.�.,.w.... _.-,...._-<
GR,Camillus Life Center-Dade SP551
URiFAC-f Teann-Bay,Gulf SP552 ..� ._
......._,
GRMiami Behavioral Hlth Ctr-Uninsured Dade SP555
GR/l-he Village-Carnpaneros En Recup-Dade SP558
CAMILLUS BEHAVIOR HLTH TRT CTR SPSCB
FAM EMERG TRMT CTR 19 CIRCUIT SPSFE ---.
JUV CO-OCCUR ADDTNS Dade/Broward/Monroe SPJC9
GR/NEW HORIZON'S CENTER SPNH9 _
G A-1NDb3F'N I PSYCFL MEDICATION PROGRAM (101350)
(iencrl Revemte 19M18 -- -
GA-BAKER ACC SE'.RVICES (100611)
General Revenue 19M18
Recovery&Resiliency'Total $0 Recovery&Resiliency Total= $0
TOTAL ADULT COMM.MEL $0 'TOTAL CHILDREN'S MENTAL HEALTH= SO
"Community Mental Health Block Grant
Rev.10/0112010 Contract No.KH225
South Florida Behavioral Health Network,Inc. 94
10/01/2010 Exhibit A-4 Performance contract
SAMH Services Program
SUBSTANCE ABUSE
FUNDING DETAIL
P,o,.dcrNamc Seudr hlotida Behavioral Health Network,Inc. Contract 4 KH225 t Revision 4 F Y 2013-14(12 Mon)
Budget Entity 60910603-Adult Substance Abuse OCA AMOUNT Budget Entity 609106112-Children's Substance OCA AMOUNT
603005-DETOXIFICATION 602001-DETOXIFICATION/ARF
G/A-COMM SUBS LANCE ABUSE SVCS (100618) G/A-CHILD/ADOI,SUBSTANCE ABUSE SV((100420)
...................................I ..... ...
SAIII BG 270(35 SAPTBG 270GI
GR/Tobacco Settlement`Trust Fund 27NIE5 & GR/Tobacco Settlement Trust Fund 27ME
GR'Adtilt Detox ADDEX GR/Child Detox CIIDE
Detcocificanion'Total Detoxification Total- $0
603006-PREVENTION SERVICES 602002-PREVENTION SERVICES
G/A-CONINI SUBSTANCE ABUSE.SVCS (100618) ................................... G/A-CIIILD/ADOL SUBSTANCE ABUSE SVCS(100420
General Revenue 27MF6 i� Prevention Senices-Sl(',/AI)Alvlli,rF 271-02
........... ............
ADAMII Trust Fund Prevention Services 27PR6 General Revenue 27ME2
ADAM1ITnistf�tijid-PreveiitionServices **1 27PR2
Prevention Partnership Services 27PR3
GR/Child Prevention Svcs. ('11PRV
General Revenue S11613
GR'Stewart Marchman Trait.Co.-1)12 SP643
Prevention Services Total= $0 Prevention Services Total .................11 so
603007-TREATMENT&AFTERCARE 602003-TREATMENT&AFTERCARE
GI/A-C OMM SUBSTANCE ABI,!SF1'SVCS (100618) G/A-CFIILD/ADOL SUBSTANCE ABUSE SVCS(10042
SAPTBG 270G3
SAIYFBG 270G7
ADANIfFIT Adnonistrafive F'.xpendinires 27AD7 ADANIH Trust Fund Administrative Fxpendini 27AD3
ADAMI IJ F Inhaienotis Drug Usage
27HIV ADAMTITrust Fund 27CHV
GR/TS IT O&M IT 27ME7 GR/JSTF/O&MTF/CASA I F 27ME3
ADAMI H F Services to Women 27WOV1 1 WJTFTANF 39TCI
WTTF TANF 39TC0 GR/Tx&Aftercare-child CITERT
`Trust Fund ADTRT —----------
ADAMI I Trust Ford HIV 27CFIV
SSF16 I E -Dade Camillus Lite Center BS631 - ---------------------- ADAMH Trust Fund-Roots ii SP602
Gencial}rev;nor GR/Adol.Tx Dually Diagnosed Girls-DI I SP606
............
FEDERAL GRANTS TRUST FUND S'13004 GR/,rhcCoinpass Program SP608 i
I 1?6�4 NI
ADAVIFFIT-Steward Marchnian Ctr.D12 S GR/ADAFITF-The starting place SP6 10
ADMvii iTU-New Horizons Dual Diagnosis SP6 5
ADANUFTF-Adolescent Res.SA Tx Facility SP611
ADA.NM rUAddiotion Frihin Services S 616 GR/Prqject Warrn-D 12 SP044
ADAMII FF-New Beginnings Prig Renewal S)617 -------------------
....... GR/Phoenix House-R23 SP645
ADAMH I-F-Coconut Grove-13chav I Ith Ctr SP618 GR/1ST STEP/MOTHERS/INFANT SP646
...............
ADA,MIJTIRner Regions Services,Inc. SP619 GR/DrugAbuse Comprehensive Cold Ofc. SP647 i
ADA-MI-FIT-Passatize Way Aftercare Project SP622 3
OPERATION&MAINTF SP648
AI)AMFITF-Fircerg,Wait List RedUC.project Sli
ADAMITTF-ProJect Warm SP624
ADAMH FF-Elderly Compliance SA&VI]I SP625
GR/Rn er Repon Women's SA SP651 ----------------------
GRA'ircless ofCare-Brevard SP6.52 ..........
GR(otter for Drug Free Living SP669
GR/Cerder for Drug Free Living-Brevard SP670
`Treatment&Aftercare'Total= $0 Treatment&Aftercare Total= $0
'TOTAL CtIlUD/AD0U St III.ABUSE= $0
TOTAL,ADULT SUB.ABUSE= $o
ESTIMATED GRAND TOTAL ALL PROGRAMS= $72,500,000
MATCH CALCULATIONS APPLICABLE TO CONTRACT
J.)cinsfitutiona rzation Piolects,, ............. ......................
§44,600 000 JOIAL IUNDS REQUIRINGNIArCH $27,900,000
...........
citildierCe Mental Health Base Fraiding
btl .................
I E s d,irp't Black' r-di ii:"A'I loc at i on
LOCAL MATCH REQ1]RED $9,300,000
AL
Drug Abuse Services ADDITION LOCAL NIA' YCII
GRAND TOTAL,LOCAL MATCH- S9,300,0oo
............ ............. .......... .... .......
TO'l Al,FUNDS NOT REQUIRING MATCH $44,600....,000
Expenditure joust he Substance Abuse Prevention and Treatment Blo&Grant eligible
Sulotanct,At,—Pireccatio.cad"treatment Block Grant-Funding Agreement-RESTRICTIONS APPLY
Rev,10/01/2010
South Florida Behavioral Health Network,Inc 95 Contract No.KH225
10/01/2010 Exhibit A-5 Peurina-re Contract
SAMH Services Program
MENTAL HEALTH
FUNDING DETAIL
Pro,dci Name S,0i.th Florida Behavioral He rlth Network Inc, Contract 9 K11225 Revision 4
FY 2014-2015(1'V_Budget Entity 60910502-Adult Mental Health OCA AMOUNT Budget Entity 60910503-Children's Mental Health OCA AMOUNT
502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION
G,A-ADULFC01,110 MENTAL HEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435)
ADAMI I Frust Fund* 10004 ADAM14 Trust Fund* 190C]
.........
L
0eneral Rc,enuc,isu 19ME4 i General Revenue 19MEI
ADANIFIFF Cons
urner Self
-DueQtcd Care Pilot SP501 ............1 FGTF-Title XXI SgQo I
-Manatee SP503 GR/Manatec Glens Cluld Baker Act SP5,12
(IR,Tarrifly ErnergencyTreatruent Ctr
OR/Coopet CSU SP516 OR/Cluld Comprehensive Behavioral Services SP540
GR/Fanaly Eiiiuigency']-i,eattiietit-Pinellas SP525 GR/CS[J District 08 SP542
1....................
OR/Apalachee CSI 1-1-con SP549 GR/Marion-Citrus MH-Children CSU SP550
GR rndy Emergency Treatment-Sarasota SP553 ----------
Fa General Revenue SP5EB
GRIL,ficstrearr,CSI-1-Lake,Srante,
SP559 Fut-F-Tale IVB W0027
GR,Ruth Cooper CSU-Lee SP560
GiR,Senariole County CSU
SP561
T.S'H`!0Tange Count Receiving Center SP572
GR/APALACHEE S-iRT-TERM RESID FAC SPACQ
G A-BIKER ACI SERVICES (100611) G/A-CHILDREN'S BAKER ACT (104 257)
Giermal Revenue I9MF4 i General Revenue 19%1EI
I SI FlAdult Errierg Baker Oct Service-Hernando,Pasco SP592 General Revenue SP581
...........
Emergency Stabilization Total $o
G/A-0U ITA 11EN"I BAKE R AC f SERVICES PILOT (100612)
General Revenue 19ME4
Emergency Stabilization Total
50201FRECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY
G A-ADUIT COMM.MENFLALHEALTH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435)
ADANII 11 mar Fund- 19018 ADAMH Trust Fund* 19CI3
ADAMH Dust FLa,dTACf 19019 (jencral Revenue 19M13
..........
General Re- i,c'l S FF 19M 18 1 GRff'STF 32NO3
Ge Rcvem,e?FGTF 9QPSR FGIT-Title XXI 891)13
GR/AGAPE FAM MINISTRY F_
AFMMD G RjRTC Non-Medicaid Eligible 9PRN`A
WITI, FANF 39AI8 GR/Henderson MH Center-Bioward SP506
----------
1`61 F/ADANIILGR,Corurn Forensic Beds-Adult Svc CFBAS $0 ADAMI I TF/Infant&Young Special Protect
i SP533
..........
FG1 F PA I'll GX018
General Revenue SP5MA
(IRASIFTGIT-I�ACTAdrraa FFA 11)
GICFACTSvcs, FTS19 I
0&N1TF,,FGj'b Corjj MH Sivs Contract-NEFSH MHS18 GiA-PURCHASED RESIDENTIAL
FG IT MHTTI TREATMENT SERVICES (102780)
GR Courf Cottages in the Pines
SP502 GR'RTC Non-Medicad Eligible 1)PRN1,I
OWTS1 I"Wayric Densch Center-Orange SP504 /
.
GRPurch Res Treatment Svcs 9PRLS 1
.........
GRXharlotte County CMH Center SP505
GR/Short-Tenn Residential Treat-Hillsborough SP51 I
Owned Revenue,,FSTF,Doug Gardens CMH Ctr SP5 12 G/A-PI JRCHASETHERA SVCS CHILD (Iorrioo)
(;R Nfi.rrn-Dade Horacress Tnrst SP5 13 General Revenue 19MCB
GR'Calaillus Life Center-DadeSP551 ...............
6RFACT'Leani-Bay,Gulf
SP552
OR,,Miaim Belba,jocal Hith Ctr-Uninsured Dade SP555
OR,Thc VihagQ-Carnpaneros Fit Recup-Dade SP558
CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB
FAM EMERG TRMT GTR 19 CIRCUIT SP5FE
JUV CO-OCCUR ADDTNS Dade/Broward/Mooroa SPJC9
.............
GR/NEW HORIZONS CENTER SPNH9
WA-INDIG&N LPSYCII MEDICATION PROGRAM (101350)
Gene,I Re,emw I9NI18
G A-BAKER ACT SERVICES (100611)
General Revenue I QM 18
........... ...........
Recovery&Resiliency Total= $0 Recovery&Resiliency Total= $o
TOTAL ADULT COMM.MH= $0 TOTAL(THILDREN'S MENTAL lIEALTI1= $o
Community Mental Health Block Grant
Rev,10/0112010 Contract No.KH225
South Florida Behavioral Health Network,Inc. 96
10/QV2010 Exhibit A-5 Performance Contract
SAMH Services Program
SUBSTANCE ABUSE
FUNDING DETAIL
Provider Name I South Florida Behavioral Health Network,Inc. Contract$i 1KH225 Revision Ij
I I I FY 2014-15(ITvI,,T)
Budget Entity 60910603-Adult Substance Abuse OCA AMOUNT Budget Entity 60910602-Children's Substance OCA AMOUNT
603005-DE FOXIFICATION 602001-DETOXIFICA'FION/ARF
(31;A-COMM SUBSTANCE ABUSE_SVCS (100618) G/A-CF1ILD/AD0L SUBSTANCE ABUSE SV((100420)
SAPTEK1 270(3.5 SAp'rBG 2 70C3 I,
GJR/Lob acco Settlement Trust Fund 27ME5 GR/Tobacco Settlement Trust Fund 27ME I
GR.�Adult Detox ADDER GRiClaild Detox CI IDIX
Detoxification Total 'SO Detoxification Total= so
603006-PREVENTION SERVICES 602002-PREVENTION SERVICES
G/A-COMNI SUBSTANCE ABLISE SVCS (100618) ........................................ G/A-CIIILD/AD0L SUBSTANCE Alot'1SI-SVCS(100420)''_
General Rev urine 27VIF6 Prevention Services-S Ki/ADAM HTF ... 271`02
ADANILICrust Fund llic\ention Services
27PR6 General Revenue 27NIE2
ADAMI I Trust Fund-Prevention Services 27PR2
Prevention Partnership Services 27PRI
GRI/Child Prevention Svcs. CI IPRv,'
..........
General Revenue S1,61
GR/Stewart Marchriatin Lrtnt Ctr.-D12 SP643
Prevention Services Total= so Prevention Services Total
603007-TREATMENT'&AFTERCARE 602003-TREATMENT&AFTERCARE
6/A-COMM So'BSTANCE AIR'SE SVCS (100618) G/A-CHILD/ADOL SUBs,rANCFA13USE SVCS(100420.)
SAIITBG 270G7 SAFTFIG 270G3
ADAN11 I I F Adrnimstrativc I'Apenditures 27AD7 1 ADAMFITnist Fund Atintinistratne Expenditu 27AD3
AD AM 111 F hat m cam is Drug I'sage 27111V ADAMIT Trust Fund
27CHV
G,R/TSTV0&XlTF 27ME7 GRfLSTF/0&VrrF/CASATF 27ME3
................................
ADANIH_fF Services to Women 27WOM w,r,I'F TANF 39TCI
W FTF FAN F 39TC0 GR/"Ix&Aftercare-child CIITRT
Trio Fund AD FRT t ADAMH mist Fund I[IV 27CLIV
ADAMIJTnrst Find-Roots n'Wings SP602
SS116T]"Canallus Life('enter-Dade BS631
General Revenue DPG08 —-----------------
GR/Adol.Tx Dually Diagnosed Girls, D 11 S11606
FEDERAL GRANTS TRUST FUND S13004 GR_/The Compass Prograrn SP608
D12 SPO 14 (;R/ADANIRTF-Tbe starting Place SP610 1
...........................
ADANIH IT-New Horizons Dual Diagnosis SP615 ADANIFITF-Adolescent Res,SA Tx Facility SP611
ADANIFTIT-Addiction tuna Services SP616 GR/Pio cet Waun-D12 S11644
ADAMIFFF-New Beginnings Prog Renewal S'116 17 GR/Phoenix House-R23 SP645
ADANII FIT-Coconut Orove-Behav I Ith Chr SP618 GR/IST STEP/MOTHERS/INFANT S P646
AD ..................No I IT F-Ri t er Regions Services,Inc,. S11619 GR/DrugAblese Comprehensive Cord 0 fe. SP047
ADAMII IT-Passage Way Aftercare Protect SP622 OPFRAT -IT ION&MAIN SP648
ADAMI ITF-Einerg,Wait List Reduc.Project SP623
ADA. MIL FF-Pro.ject Wax in S1621
ADAMI I IF-Elderly Compliance SA&MI I S P6,
GR/Rivet Repon Women's SA SP651
GR)Circles of Cate-Bre\ard S11652
GR/Center for DrUtI,Nee Living SP669
GR1Ccntei for Drug Fiec Living-Bievard SP070
'Treatment&Aftercare Total= $o Treatment&Aftercare"rota)= So
TOTAL CllUt,D/ADO1,SUB.ABUSE= so
TOTAL ADULT SUB.ABUSE= $o
ESTIMATED GRAND TOTAL ALL PROGRAMS- $72,500,000
MATCH CALCUI A I IONS APPLICABLE TO CONTRACT
_S.N01 REQUIRING MATCH:
........... .... ......................
Quistitutionalization Pro or
Protects S44,600,000 TOTAL $27,900,000
................
Childvcncen Mental Ilc�I It Fort F di
1111 1-11111-111-.............I'll 1111111o,11111111,��_im-1111 s.
-------------
Nfl I 1,3empt Block Giant Allocation
.......... LOCAL mxrcii RFQUIRED= $9,300,000
...... Abuse Sc tc t ................- AUDI FIONAL LOCAL MAJ CI I
GRAND TOTAL LOCAL'NIA FCI 1 $9,300,000
................-------- MATCH
'Tor FAL FIJNDS NOT REQUIRING MATCH $44,600,000
Evpc.c1itv,.t 1.Substance Abuse Prevention and Trcauncia Block Grant eligible
Substance Abase Prevention and Treatment Block Funding Ag,"croart-RESTRICTIONS APPLY
Rev 10/0 1 f201 0
South Fionda Behavioral Health Network,Inc 97 Contract No.KH225
10R01/2010 Exhibit A-6 Performance Contract
SAMH Services Prndram
MENTAL HEALTH
FUNDING DETAIL
Provider)dame .South Fk ndr Behavior al health Nei taotk [tic Contract l, K112 s Revision# = Ty 2015-2016(3 Mos)
Budget Entity 60910502-Adult Mental health OCA AMOUNT Budget Entity 60910503-Children's Mental health OCA AMOUNT
502004-EMERGENCY STABILIZATION 503001-EMERGENCY STABILIZATION
GrA ADULT COAIM MEtiTALHEALFH (100610) G/A-CHILDREN'S MENTAL HEALTH (100435)
ADAMN Trust Fund'" 19004 d ADAMI{Tnasf Fund* 140C1 i £
enur al Revenue IS'TF 19ML4 General Revenue 19ME1 i
__
F c tl Care Pilot S Title XXl 89Q01
GRam1v[inrgeey T unenttr Manatee SPS03 G� tee ..
Glens Child Baker Act SP532
GR,('uo per CSU SP516 GR/Child Comprehensive Behavioral Services SP540
C R Family Erntagencv Treatment-Pinellas SP525 GR/CSU District U8 SP542 I '
-_._- ._......
C R A tala0ee CSU-t.eon SP549 _ _ 3
I � ., GR/MafR')n-Citrus MH-Children CS17 SP550 � t
GR F'armly Eniergency'l'ieutnient-Sarasota SP553 General Revenue BPSEB r i
GR Iticstreau C St'-Fake„Sumter SP559 i EGTE-Title IVB W0027 '
GR Ruth Cooper CSU-Lee SP560
GR'Seminole County CSU S11561
'I STFrOrange Cc,unty Recetcing Center SP572
GR/APAt.ACHEE SHRT-TERM REBID FAC SPAC4
G,A-BAKER.ACT SERVICES (10061 1) - ,....._ G/A-CHILDREN'S BAKER ACT (104257)
Genera[Revenue 19ME4 i General Revenue 19MEF r €
TS'I'FlAdult k.meru Baker Act Services-Hem<'mdq Pasco SP.592 t General Revenue SP581
Emergency Stabilization Total= S0
GA-CTAPATII'NJ 3AKFR ACT SERV ICES PILOT (100612)
General Revenue 19ME4
Emergency Stabilization Total= $0
502018-RECOVERY&RESILIENCY 503013-RECOVERY&RESILIENCY
GVADUL`F'(Y)NIM.MENIALHEALTH (Iooblo) G/A-CHILDREN'SMENTAL HEALTH (100435)
ADAMH Trust Fund* 19018 ADAMH'T'rust Fund* 19C'13
ADAMFI Trust Fund/FACT 19019 ---. -. ....
General Revenue 14M13 '
General Revenue TSTE 19M Is GRITSTF 32NO3
General Revenue F'G'I-F 9QPSR FGTF-TitleXXI 89Q13
GRfAGAPE FAM MINISTRY AFMMD GRi RTC Non-Medicaid Eligible 9PRNM l 1
b4 t I1 T 1N h' 39A18 6WHenderson MIT Center-Broward SP506 1F
A P
1�1�(rII PATH If t;ft;C" - Special Project Si>533
Dram Forensic Beds-Adult Svc CFE3>S $0 � ADAMH Ti-,Infant&Ynwa ,- --, ..w..-
GX018 - General Revenue SPSMA
C R I S]F(FG IT-FACT Adnu n ETA 19
....... .......
C R TACT Svcs FTS 14
O&AITI'/FGFFt.'omMHSrvsContractNEFSH MF{S18 T G/A-PURCHASED RESIDENTIAL
FGTI` MHTTI 'TREATMENT SERVICES
02780)
OR f nwt Cottages in the Pines SP505 +, C,R/It'I'C Non-Medical Eligible 4PRNM '
C R,TSI AVavne Densch Center-Orange SP504 GR/Purch Res Treatment-Medicaid Svcs 9PR`I'S � I
GR Charlotte Ci,ivav CMI I Center SP505
GR/Short-Ferro Residential`Treat-Hillsborough SP511 _�-
Cienei 1 Revenue I'2;xTPNoug Gardens('MN Ctr SP512 G/A-PURCHASEITHERA SVCS CHILD (100500)
_..�..— ___..
GR,VEaoa-Dade Hotnetess crust SP513 General Revenue 19MCB t i
.� ..� _ .....w.,._.-. - --.�.t
GRA'arnitius Life Center-Dade SP551 --
,..u._... ....._................--i
GR`FACF Team-Bay,Gulf SP552
GR,Miami Behavioral Hlth Ca-Uninsured Dade SP555 i
GRfT-he Village-Carnpaneros En Recup-Dade SP558
CAMILLUS BEHAV'OR FILTH TRT CTR SPSCB ,
FAM EMERG TRMT CTR 19 CIRCUIT SPSF E _
JUV CO-OCCUR ADDTNS Dadefaroward/Monroe SPJC9
GRINEW HORIZON'S CENTER SPNN9
G A INDIGENT PSYCH MEDICATION PROGRAM (101350)
Generi Revenue 18M18 -.- .--......_.-
G/A-BAKER 1C'F'SF.RVICES (100611)
General Revenue I4M 18
Recovery&Resiliency Totai= $0 Recovery&Resiliency`Dotal= $0
'TOTAL.ADULT COMM.Mill= $o TOTAL CHILDREN'S MENTAL IJEALTH $0
"Comnumit Mental Health Block Grant
Rev.10t01t2016 Contract No.KH225
South Florida Behavioral Health Network,Inc. 98
I0f0112010 Exhibit A-6 Performance Contract
SAMH Services Program
SUBSTANCE ABUSE
FUNDING DETAIL
Contract 4 Re,ision
Provider Name Behavioral Health Network-Inc.
Budget Entity 60910603-Adult Substance Abuse OCA AMOUNT Budget Entity 60910602-Children's Substance OCA AMOUNT
603005-DETOXIFICATION 602001-DEToxIFICA'IJON/ARF
WA-COMM SUBS LANCE ABUSE SVCS (100618) G/A-CHILD/ADOL SUBSTANCE ABUSE SV((100420)
SAPTEIG 270GI f
S�Apr FBG 270G5
GR/Tobacco Settlement Trust Fund 27ME5 I GVFobacco Settlement Trust Fund 27MEI
GR.,Adult Detox ADEX GR/Child Detox ClIDEX
Detoxificafion'FDotal $0 Detoxification'ratid=
603006-PREVENTION SERVICES 602002-PREVENTION SERVICES
G,A-COMM SUBS FANCE ABUSE SVCS (100618) G/A-Cl JILD/ADOL SUBSTANCE ABUSE SVCS(100420)
General Revenue 27ME6 Prevention Services-S IG/ADAM ITIT 271`02
ADA-MIlTrust Fund Prevention Services 27PR6 General Revenue 27ME2
ADAM LITrust Fund-Prevention Services 27PR2
Prevention Partnership Services 27PR3
GR/Child Prevention Svcs. CIIPRV
General Revenue SP613 j
GR/Stewart MarchmanTirrit.('it.-D12 SP643
Prevention Services Total $0 Prevention Services Total
603007-TREATMENT&AFTERCARE 602003-TREATMENT`&AFTERCARE
GIA-COMM SI,'FISTANCE ABUSE SVCS (100618) G/A-CF1ILD/ADOL SUBSTANCE ABUSE SVCS(100420)
.........—---------------I
SAV1136 27007 E SARTFIG 270G3
ADy\MIl IT Administialke Expenditures 27AD7 ADAMLI Trust Fund Administrative Expenditu 27AD3
ADANIFFIT Intravenous Drug Usage 27111V ADAMIJ Trust Fand 27CIIV
..........
GR/TS IT!O&M IT 27ME7 GR/TSTF/O&MTF)CASATF 27NIE3
\r A% � 6,
itul'Services to Women 27WOM W'I`TF TANF 39TC I
WTTF1 ANF 39T(0 G R/Tx& ldlercare-cluld CITIRT
Trust Fund ADTRT ADAI,411 Trust Fund HIV 27CI-IV
SS13{jr
ITI;Canallus Lite('enter-Dade BS6 I 3, ADAMIi Trust Fund--Roots n'Wings SP602
General Re,car ic
DPGO8 GRJAdol.Tx Dually Diagnosed Girls-DI I SP606
FEDERAL GRANTS TRUST FUND S'B004 .......... GRTITre Compass Program SP608
ADX`0}ITF-Stovard Maichnian Ctr.D12 S11614 GR/ADANIFFIT-Ttie starting Place S 610
ADAM FITF-Adolescent Res.SA Fx Facility SP611
ADAMIT IT-New Horizons Dual Diagnosis SP615
ADAMITIT-Addiction Front Services SP616 G R/Project Warni-D 12 SP644 ------
.................. -------
ADAINIFFIT-New Beginnings Prog Renewal SP617 GR/Phocnix Lloarse-R23 SP645 j
ADANIH IT-Coconut Grave-Behav lith Ctr 8 SP61 GR/lST STEP/MOTHERS/INFANT SP61t6
ADAMHTF-River Regions Services,Inc. S11619 ................. GR/Dru&Abuse Comprehensive Cord Ole. SP647 i.
AIL ADM LF-Passage Way Aftercare Project SP622 OPERATION&MAIN rF SP648
ADAMI I IT-Einerg,Wait List Reduc,Project S11623
i-.............
ADANIFLIT-Project Warm SP624
-
AD AMLIJ F-1,11deily Compliance SA&Mll S::625
GICRaver Region Women's SA S 641
JR,Circles of(are-Fnevard SP652
GR;Center fin Drug Free Living SP669
GR/Ccraer far Drug Fred Living-Brevard SP670
Treatment&Aftercare Total= $0 Treatment&Aftercare Total= $o
TOTAL CIIILD/ADOL SUB.ABUSE= $o
TOTAL ADULT SUB.ABUSE $o
ESTIMATED GRAND TOTAL ALL PROGRAMS $18,125,000
MAIT'Ll CALCULATIONS APPLICABLE TO CONTRA("]'
MATCH:
TOTAL FUNDS REQUIRING MATCH- $6,041,667
einAltutiOnaliZatiOn Pro "12,083,333
..........
'Whildren"e Mental Health Base'Funding
...........-
Grant Allocation
ViLf'Exerniat Blo"ek"
�11 11 . ............................................. LOCAL MAFCIl REQUIRED $2,013,889
J,?rl AIMSCSCI'ViCeS MATCH____4 ADDITIONAL LOCAL NIA -7777=
...................... ............... ............. GRAND TOTAL LOCAL MATCH- 52,013,889
TOTAL FUNDS NOT REOUIRING mxrcti- S 12,083,333
Expenm rare must lC SO,aimi,e Abu.Prevention and firiatunem Iflork Grunt eligible
Su Wmire Atmw Prevfimr ad treatment Block Grant-Funding Agreement-RESTRICTIONS APPLY
Rev 1=112010
South Florida Behavioral Health Network,Inc 99 Contract No.KH225
10/01/2010 SAMH Services Program
EXHIBIT B-1
LINE ITEM OPERATING BUDGET
AGENCY: South Florida Behavioral Health Network, Inc.
CONTRACT#KH225
CONTRACT PERIOD:FROM: 10/01/2010 TO 06/30/2011 DATE PREPARED: 10/01/2010
Special Projects-
Administration, CMH SAMSHA
Management& Wraparound Other Special
Oversight Grant Projects
LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL
I. PERSONNEL SERVICES
(a)SALARIES $1,561,741 $174,289 $ $1,736,030
(b)FRINGE $325,111 $22,170 $ $347,281
TOTAL PERSONNEL= $1,886,852 $196,459 $0 $2,083,311
----------
II.EXPENSES
(a)BUILDING OCCUPANCY $114,000 $ $ $114,000
(b)PROFESSIONAL SERVICES $62,500 $0 $ $62,500
(c)TRAVEL $42,049 $2,540 $ $44,589
(d)EQUIPMENT COSTS $ $ $ $0
(e)FOOD SERVICES $ $ $ $0
(fi MEDICAL AND PHARMACY $ $ $ $0
(g)SUBCONTRACTED SERVICES $ $ $ $0
(h)INSURANCE $15,000 $ $ $15,000
(I)INTEREST $ $ $ $0
(j)OPERATING SUPPLIES& $278,711 $ $278,711
EXPENSES
(k)OTHER $ $ $ $0
(1)DONATED ITEMS $ $ $ $0
TOTAL EXPENSES= $512,260 $2,540 $0 $514,800
Ill.NONEXPENDABLE PROPERTY
(a)EQUIPMENT $39,931 $ $ $39,931
(b)PROPERTY $0 $ $ $0
TOTAL NONEXPENDABLE PROPERTY= $39931 $0 $0 $39,931
IV.COMPUTER HARDWARE,SOFTWARE,
&SERVICES $101,409 $0 $0 $101,409
TOTAL COMPUTER EXPENSES= $101,409 $0 $0 $101,409
V.SPECIAL PROJECTS $0 $407,933 $0 $407,933
GRAND TOTAL= $2,540,452 $606,932 $0 $3,147,384
Rev 10/01/2010
South Florida Behavioral Health Network,Inc, 100 Contract No.KH225
10/01/2010 SAMH Services Program
EXHIBIT B-2
LINE ITEM OPERATING BUDGET
AGENCY: South Florida Behavioral Health Network, Inc.
CONTRACT#KH225
CONTRACT PERIOD:FROM:07/01/2011 TO 06/30/2012 DATE PREPARED: 10/01/2010
Administration, Special Projects-
Management& CMH SAMSHA Other Special
Oversight Wraparound Grant Projects
LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL
I. PERSONNEL SERVICES
(a)SALARIES $ $ $ $
(b)FRINGE $ $ $ $
TOTAL PERSONNEL= $ $ $ $
----------
II. EXPENSES
(a)BUILDING OCCUPANCY $ $ $ $
(b)PROFESSIONAL SERVICES $ $ $ $
(c)TRAVEL $ $ $ $
(d)EQUIPMENT COSTS $ $ $ $
(e)FOOD SERVICES $ $ $ $
(f)MEDICAL AND PHARMACY $ $ $ $
(g)SUBCONTRACTED SERVICES $ $ $ $
(h)INSURANCE $ $ $ $
(I)INTEREST $ $ $ $
OPERATING SUPPLIES& $ $ $ $
EXPENSES
(k)OTHER $ $ $ $
(1)DONATED ITEMS $ $ $ $
TOTAL EXPENSES= $ $ $ $
Ill.NONEXPENDABLE PROPERTY
(a)EQUIPMENT $ $ $ $
(b)PROPERTY $ $ $ $
TOTAL NONEXPENDABLE PROPERTY= $ $ $ $
IV.COMPUTER HARDWARE,SOFTWARE,
&SERVICES $ $ $ $
TOTAL COMPUTER EXPENSES= $ $ $ $
V.SPECIAL PROJECTS $ $ $
GRAND TOTAL= $TBD $TBD $TBD $TBD
Rev, 10/01/2010
South Florida Behavioral Health Network, Inc. 101 Contract No.KH225
10101/2010 SAMH Services Program
EXHIBIT B-3
LINE ITEM OPERATING BUDGET
AGENCY: South Florida Behavioral Health Network, Inc.
CONTRACT#KH225
CONTRACT PERIOD: FROM:07/01/2012 TO 06/30/2013 DATE PREPARED: 10/01/2010
Administration, Special Projects-CMH
Management& SAMSHA Wraparound
Oversight Grant Other Special Projects
LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL
I.PERSONNEL SERVICES
(a)SALARIES $ $ $ $
(b)FRINGE $ $ $ $
TOTAL PERSONNEL= $ $ $ $
IL EXPENSES
(a)BUILDING OCCUPANCY $ $ $ $
(b)PROFESSIONAL SERVICES $ $ $ $
(c)TRAVEL $ $ $ $
(d)EQUIPMENT COSTS $ $ $ $
(e)FOOD SERVICES $ $ $ $
(f MEDICAL AND PHARMACY $ $ $ $
(g)SUBCONTRACTED SERVICES $ $ $ $
(h)INSURANCE $ $ $ $
(i)INTEREST $ $ $ $
OPERATING SUPPLIES& $ $ $ $
EXPENSES
(k)OTHER $ $ $ $
(1)DONATED ITEMS $ $ $ $
TOTAL EXPENSES= $ $ $ $
Ill.NONEXPENDABLE PROPERTY
(a)EQUIPMENT $ $ $ $
(b)PROPERTY $ $ $ $
TOTAL NONEXPENDABLE PROPERTY= $ $ $ $
IV.COMPUTER HARDWARE,
&SERVICES $ $ $ $
TOTAL COMPUTER EXPENSES= $ $ $ $
V.SPECIAL PROJECTS $ $ $
GRAND TOTAL= $TBD $TBD $TBD $TBD
Rev. 10/01/2010
South Florida Behavioral Health Network,Inc. 102 Contract No.KH225
01/2010 SAMH Services Program
EXHIBIT B-4
LINE ITEM OPERATING BUDGET
AGENCY:. South Florida Behavioral Health Network, Inc.
CONTRACT#KH225
CONTRACT PERIOD:FROM:07/01/2013 TO 06/30/2014 DATE PREPARED: 10/01/2010
Special Projects-
Administration, CMH SAMSHA
Management& Wraparound Other Special
Oversight Grant Projects
LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL
I. PERSONNEL SERVICES
(a)SALARIES $ $ $ $
(b)FRINGE $ $ $ $
TOTAL PERSONNEL= $ $ $ $
II.EXPENSES
(a)BUILDING OCCUPANCY $ $ $ $
(b)PROFESSIONAL SERVICES $ $ $ $
(c)TRAVEL $ $ $ $
(d)EQUIPMENT COSTS $ $ $ $
(e)FOOD SERVICES $ $ $ $
(f)MEDICAL AND PHARMACY $ $ $ $
(g)SUBCONTRACTED SERVICES $ $ $ $
(h)INSURANCE $ $ $ $
(i)INTEREST $ $ $ $
(I)OPERATING SUPPLIES& $ $ $ $
EXPENSES
(k)OTHER $ $ $ $
(1)DONATED ITEMS $ $ $ $
TOTAL EXPENSES= $ $ $ $
Ill. NONEXPENDABLE PROPERTY
(a)EQUIPMENT $ $ $ $
(b)PROPERTY $ $ $ $
TOTAL NONEXPENDABLE PROPERTY= $ $ $ $
IV.COMPUTER HARDWARE,
&SERVICES $ $ $ $
TOTAL COMPUTER EXPENSES= $ $ $ $
V.SPECIAL PROJECTS $ $ $ $
GRAND TOTAL= $TBD $TBD $TBD $TBD
Rev. 1 0101/201 0
South Florida Behavioral Health Network, Inc. 103 Contract No.KH225
10/01/2010 SAMH Services Program
EXHIBIT B-5
LINE ITEM OPERATING BUDGET
AGENCY: South Florida Behavioral Health Network,Inc.
CONTRACT#KH225
CONTRACT PERIOD: FROM:07/01/2014 TO 06/30/2015 DATE PREPARED: 10/01/2010
Administration, Special Projects-
Management& CMH SAMSHA Other Special
Oversight Wraparound Grant Projects
LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL
I. PERSONNEL SERVICES
(a)SALARIES $ $ $ $
(b)FRINGE $ $ $ $
TOTAL PERSONNEL= $ $ $ $
II.EXPENSES
(a)BUILDING OCCUPANCY $ $ $ $
(b)PROFESSIONAL SERVICES $ $ $ $
(c)TRAVEL $ $ $ $
(d)EQUIPMENT COSTS $ $ $ $
(e)FOOD SERVICES $ $ $ $
(f)MEDICAL AND PHARMACY $ $ $ $
(g)SUBCONTRACTED SERVICES $ $ $ $
(h)INSURANCE $ $ $ $
(i)INTEREST $ $ $ $
OPERATING SUPPLIES& $ $ $ $
EXPENSES
(k)OTHER $ $ $ $
(1)DONATED ITEMS $ $ $ $
TOTAL EXPENSES= $ $ $ $
111.NONEXPENDABLE PROPERTY
(a)EQUIPMENT $ $ $ $
(b)PROPERTY $ $ $ $
TOTAL NONEXPENDABLE PROPERTY= $ $ $ $
IV.COMPUTER HARDWARE,
&SERVICES $ $ $ $
TOTAL COMPUTER EXPENSES= $ $ $ $
V.SPECIAL PROJECTS $ $ $
GRAND TOTAL= $TBD $TBD $TBD $TBD
Rev. 10/01/2010
South Florida Behavioral Health Network, Inc. 104 Contract No. KH225
10/0112010 SAMH Services Program
EXHIBIT B-6
LINE ITEM OPERATING BUDGET
AGENCY: South Florida Behavioral Health Network, Inc.
CONTRACT#KH225
CONTRACT PERIOD:FROM:07/01/2015 TO 09/30/2015 DATE PREPARED: 10/01/2010
Special Projects-
Administration, CMH SAMSHA
Management& Wraparound Other Special
Oversight Grant Projects
LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL
I.PERSONNEL SERVICES
(a)SALARIES $ $ $ $
(b)FRINGE $ $ $ $
TOTAL PERSONNEL= $ $ $ $
IL EXPENSES
(a)BUILDING OCCUPANCY $ $ $ $
(b)PROFESSIONAL SERVICES $ $ $ $
(c)TRAVEL $ $ $ $
(d)EQUIPMENT COSTS $ $ $ $
(e)FOOD SERVICES $ $ $ $
(f)MEDICAL AND PHARMACY $ $ $ $
(9)SUBCONTRACTED SERVICES $ $ $ $
(h)INSURANCE $ $ $ $
(i)INTEREST $ $ $ $
OPERATING SUPPLIES& $ $ $ $
EXPENSES
(k)OTHER $ $ $ $
(1)DONATED ITEMS $ $ $ $
TOTAL EXPENSES= $ $ $ $
111. NONEXPENDABLE PROPERTY
(a)EQUIPMENT $ $ $ $
(b)PROPERTY $ $ $ $
TOTAL NONEXPENDABLE PROPERTY= $ $ $ $
IV.COMPUTER HARDWARE,
&SERVICES $ $ $ $
TOTAL COMPUTER EXPENSES= $ $ $ $
V.SPECIAL PROJECTS $ $ $
GRAND TOTAL= $TBD $TBD $TBD $TBD
Rev. 10/01/2010
South Florida Behavioral Health Network, Inc, 105 Contract No,KH225
Exhibit C-1 Fixed Price
MANAGING ENTITY ADMINISTRATIVE SERVICES MONTHLY REQUEST FOR PAYMENTIADVANCE
Adminmtvatrve Services
a: AGENCYNAME Soulh Florida Behavioral Health Nietwork Inc b CONFRAUNth KH225 I
C REQUESTACINTH IYEAR OF
Id FEDII 0 9 9 Removurg Months tri Comyirw.j
OVENNOR 10 0f Jiffererl than Fed IDii
Marl$-FIXED PRICEIIFIXED PAYi IiENT I
UNIT OF MEASURE
One (1)Month of AdrnIIntstratron,
er t tat MLE9 2nm_ �
ands Over
OID 50(113 'V)(XI !w(M ilI
PART 2-FUII DISTRIBUTIOR' Oo%E,IF,Gj�
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PART 3 CERT11FICATiON at APPROVAL
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klimtm wapy,I rgrj fy thmt g1p agrj Ij0wjVCiqpsphjC 80vj wVICe OIVOM dMal 11411 been subnWedl to the depatimoms m ax,,xwdame Win the,COMBId
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................
Date GoodalServices Recalwad�
Data Inspected and A pprovod:
Appromd By.
Contract Manager
10/01/2010
South Florida Behavioral Health Netowrk,Inc. 106 KH225
Subcontracted Provider Network Exhibd C-2 Cost Reimbursement
NETWORK PROVIDER SERVICES COST REIMBURSEMENT PERM OF EXPENDITURES AND REQUEST FOR PAYMENT/ADVANCE
Adult Mental Health Services
I.a. AGENCY NAME. South Florida Behavioral Health Network,Inc. b.CONTRACT NO.: KH225
Vic, REQUEST MONTH/YEAR OF:
'd. FEDERAL ID#:
g Remamng Written Contract
e.VENDOR ID(If different than Fed ID):
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ACTIVITY A—t Paid YTD Pamwnts Period) ' '�''�'$"°''^1 "F ! P �h Tu A I �d * n
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PART 3-CERTIFICATION d APPROVAL
h I cart/,the abo-to to accurate and In agreement vtth thm agencys records and mr,the terms of thta agency's contract with the department.
Addmonaily.I certify that all client demographic and sernce event data has been submitted to the department n accordance with the contract.
Signature Title Date
I_ For DCF Contract Manaaer use only:
Date Invoice Received: YTD Advance Balance
Date Goods/Services Received:
Date Inspected and Approved: Total:
Approved By:
Contract Manager
1 OfQt 2010
South Florida Behavlolal Health Network,Inc 107 KH225
Subcontracted Provider Network Exhibit C-2 Cost Reimbursement
----NETWORIK PROVIDER SERVICES COST REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENTOADVANNE
Cluldren Mal lisaiI sitirvoCiss
a A43PE W.Y NANE SOluth Flodidd BehAviorall Heatith work,
b C ON TRAC r KI
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PART I-EARNINGS 01-Il 9,10 41 Wf 11P 9
2;Wih,A a ib
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+
Amount 0 6+0 10 1
Requested(From �1 0 91
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ACTIVITY Amount Paid YTDIPaymients, for Request Period)
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PART 3-CERTIFICATION&APPROVAL
h I certify the above to be accurate and in agreement with this agency's records and with the terms of this agency's contract with the department.
Additionally,[certify that all client demographic and service event data has been submitted to the department in accordance with the contract.
Signature Title Date
i. For DCF Contract Manager use onl
Date Invoice Received: y: WIN A Y to
Date Goods/Services Received:
Date Inspected and Approved: Toll
jApproved By:
Contract Manager
t
10101/2010
South Florida Behavioral Health Network,Inc. 108 KHxxx
Subcontracted Provider Network Exhibit C-2 Cost Reimbursement
NETWORK PROVIDER SERVICES,CO FT REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENTIADVANCE
M04 squWarce Abluse seewcas
a krvf�"PK'Y NO'JAE Somillifft de BettsiviorsiHstaith CIDtIRRAL"I AOD IK 1226
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PART 3-CERTIFICATION&APPROVAL
h I certify the above to be accurate and in agreement with this agencyrs records and with the terms of this agencys contract with the department.
Additionally,I certify that all client demographic and service event data has been submitted to the departmerd In accordance with the contract.
Signature Title Date
For DCF Contract Manaa
Date Invoice Received:
YTD Advance Balance
Date Goods/Services Received:
Date Inspected and Approved: Total
Approved By:
Contract Manager
10/0112010
South Fionda Behavioral Health Network,Inc 109 KH225
Subcontracted Provider Network Exhibit C-2 Cost Reimbursement
NETWORK PROVIDER SERVICES COST REIMBURSEMENT REPORT Of EXPENDITURES AND REQUEST FOR PAYMENTADVANCE
ChibI Siubstaruce Atmitie SeI
a SOI Ftoutda boturviaral Health N~A iric, b WOO NO KAI225
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..........................
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PART 3 CERTIFICATION&APPROVAL
h I certify the above to be accurate and in agreement with this agency's records and with the terms of this agency's contract with the department.
Additionally,t certify that all client demographic and service event data has been submitted to the department in accordance with the contract,
Signature Title Date
I For DCF Contract Manager use only:
Date Invoice Received: YTD Advance Balance
Date Goods/Services Received:
Total:
Date Inspected and Approved:
Approved By:
Contract Manager
South Florida Behavioral Health Network,Inc, 110 KH225
1001/2010 Managing Entity
8AMU Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y0-201/
Provider
Name: South Florida Behavioral Health Network, Inc. Contnaot#: KH225 Date: 10/01/2010 Revioion #:
}. Mental Health Contracted Services
A. Required Performance Output Standards for Each Target Population Minimum
(induding all clients paid for bySAK8H. Medicaid and Local Match) Numbers to
*Please explain io the comment section below ifa target population is indicated in the soctm �nuo|� but there isnu be Served
corresponding outcome standard for that population.
1. Adult Mental Health
a. Adults with Severe and Persistent Mental |||neou (SPN1\) (M0016)/(K8HU16) 21,742
b Adults with Serious and Acute Episodes of Mental Illness (KAU53U1)/(PWH5301) 555
o, Adults with Mental Health Problems(N1053O2)/(yNHS3O2) 1,676
d. Adults with Forensic Involvement(yNU018)/(K8HU18) 274
2. Chi|dren'e Mental Health
a. Children with Serious Emotional Disturbances (SED)(N10O31)/(YWHU31) 10503
b. Children with Emotional Disturbances (ED) (K80032)/(MHO32) 5501
o. Children at-risk of Emotional Disturbances (N1OU33)/(N1HU33) 92
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain m the comment section below n there|san Outcome Standard but there|ano corresponding target Contract
population indicated. Standard
1. Adult Mental Health -Adu|tevxith Severe and Persistent Mental |i|neee
a. Percent of adults with severe and persistent mental illnesses who |iws in stable housing
environment will beat least(N1U742)/N1H742) (Statewide Target—8396) 93%
b, Average annual number ofdays (post admission assessments)worked for pay for adults with
severe and persistent mental illness will beat least(N\0003)/(W1HUU3)—
(Statewide Target—30) 30
2. Adult Mental Health'Adults in Mental Health Crisis, including Adults with Serious
and Acute Episodes of Mental Illness and Adults with Mental Health Problems
a, Percent of adults in mental health crisis who live in stable housing environment will be at least
(W1U744)/K8H744)—(Statewide Target—9O%) 90
3. Adult Mental Heo\th—Aduitmvvith Serious Mental \Uneee (SPY0|, KAH Crisis, Forensic)
a Percent of adults with serious mental illness who are competitively employed will be at least
(yND703)/K8H7U3)—(Statewide Target—15%) 15%
4. Adult Mental Health-Forensic Involvement
m. Percent ofadults in forensic involvement who live in stable housing environment will beat
least(yW0743)/K8H743)—(Statewide Target—7O96) 70%
S. Chi|dren'e Mental Health -Serimueiy Emotionally Disturbed
a. Percent ofchildren with serious emotional disturbance who |iws in stable housing
environment will be at least(K80779)/(yWH779)—(Statewide Target—85%) 95%
b, Percent of children with serious emotional disturbance who improve their level of functioning
will beat least(N10378)/K8H378)—(Statewide Target—G5%) 65Y&
c Percent of school days seriously emotionally disturbed children attended will be at least
(K8OO12)/(N1HU12)—(Statewide Target—8G%) 86%
G. Ch||dren'eK8entei Health -Ennmtimno||y Disturbed
a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778)
—(Statewide Target—S596) 95%
b. Percent of children who improve their level of functioning will be at least(M0377)/(MH377)—
(Statewide Target—64%) 64%
10/0112010 111
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
S8MM Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y0-20Y/
Provider
Name: South Florida Behavioral Health Network, Inc. Contnaot#: KH225 Date: 10/01/2010 Reviuion #:
7. Chi|dron's Mental Health —At-Risk mf Emotional Disturbance
a. Percent of children who live in stable housing environment will be at least (M0780) (MH780)
—(Statewide Target—gO%) 90%
C. Required Internal Measures
1. Data Submission Outcomes for Mental Health
a, Percent ofpersons receiving state-contracted mental health service event records which
have matching mental health initial (purpose 1) admission records in the Substance Abuse
and Mental Health Information System will beat |eaoVSAN1H|S) (N10758)
The standard target for this measure ieet least 95% 9596
U. Substance Abuse Contracted Services
A Required Standards for Each Target Population (including all clients Minimum
paid for by SAKM` Medicaid and Local Match)
*Please explain m the comment section below ife target popu/ouvnivinuicamumtxvsucuvnue|vw'uu��xo,risnn
Numbers to
curmspvnuiugouuvmvstanuamfor mmpopo|euon
be Served
1. Adults with Substance Abuse Problems
a Number of Adults Served (K8UUG3)/(SAUG3) 12,354
2. Children with Substance Abuse Problems
e. Number of Children Served (yNUU52)/(SAU52) 4520
3. Adults At-Risk ofSubstance Abuse Problems-(Non GAA)
a, Number of Adults participating in Prevention Services (N1O785)(SA785) 18087
b, Number of Adults participating in Level 1 Prevention Programs (K80767)/(SA767) 150
o. Number of Adults participating in Level 2 Prevention Prognamo(W1O7G8)/(SA7G8) 10
d. Number ofadults participating in Level 1 Prevention Programs who complete 75 percent of
the prognam'o schedule of activities (PWO7OS)/(SA78Q) 112
e. Number ofadults participating in Level 2 Prevention Programs who complete 75 percent of
the program'a schedule of activities (yNU77O)/(SA77O) 7
4. Children At-Risk of Substance Abuse Problems-(Non GAA)
m. Number ofchildren participating in Prevention Services (yW0762)/(SA762) 14983
b, Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) 9,735
c. Number of children participating in Level 2 Prevention Programu(yNUGQ5)/(SAGSS) 354
d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of
the pnognam'u schedule of activities(K8O7G3)/(SA7S3) 2164
e. Number ofchildren participating in Level 2 Prevention Programs who complete 75 percent of
the prognam'u schedule of activities (K807G4)(SA7G4) 143
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there iwao Outcome Standard but there|nmo corresponding target Contract
population indicated. Standard
1. Adults with Substance Abuse Problems
m. Percent of adults who successfully complete substance abuse treatment services will be at
least(yWU755)/SA755) -(Statewide Target—5O96) Gu%
b� Percent change in clients who are employed from admission to discharge will be at least
(N\0753)/(SA753) (Statewide Target—2O%) 20Y6
o. Percent of adults who live in a stable housing environment at the time of discharge will be at
least (M075G)/SA75G) -(Statewide Target—8O%) 80%
d, Percent change in the number of adults arrested 30 days prior to admission versus 30 days
10/01/2010 112
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
uxMn Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 201[-20YY
Provider
Name: South Florida Behavioral Health Network, Inc. Contneot#: KH226 Date: 10/01/2010 Revision #:
prior to discharge(KA0754/SA754) (Statewide Target—35Y6)
2. Adults At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for Each 50%)
a. Percent ofadults participating in Level 1 Prevention Programs who complete 75 percent of
the prognam'u schedule of activities will beat least([NO771)/(SA771) 60%
b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of
the prognam'o schedule ofactivities will be at least (yN0772)/(SA772) 5096
3. Children with Substance Abuse Problems
a. Percent of children who successfully complete substance abuse treatment services will be at
least (SA725)/yNO725) -(Statewide Target—55Y6)
b, Percent of children who live in o stable housing environment will be at least(N10752)/SA752)
-(Statewide Target—85%) 85%
o, Percent change in the number ofchildren arrested 30 days prior to admission versus 30
days prior tu discharge will beat least(yNU751/SA751) - (Statewide Target—2O%) 20%
4. Children At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for each 50%)
o. Percent of children participating in Level 1 Prevention Programs who complete 75 percent
of the proQnym'a schedule of activities will beat least(K807G5)/(SA765) 50%
b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent
of the progrom'o schedule of activities will beat least(yNU7GG)/(SA7GG)
5. Data Submission for Prevention Program Tool (Baseline—Non GAA)
e, Percent of approved Prevention Descriptions completed within 30 days of contract
execution. (Statewide TerQmt—50%) 5096
C. Required Internal Measures
1. Data Submission Outcomes for Substance Abuse
m. Percent ofpersons receiving state-contracted substance abuse service event records which
have matching substance abuse initial (purpose 1) admission records in the Substance
Abuse and Mental Health Information System will beat|eaut(SAyWH|S) (yN0758)The
standard target for this measure ieet least B5% 95%
}}}' Managing Entity Contracted Services
u. Performance Measures
(11) OO percent of Network Providers surveyed for satisfaction will rate the administrative services of the
provider aa'`Sadofactory'' orhigher.
(2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative oen/ioeo of the provider as
"Sahstsotory'' orhigher.
(3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as
"Ssdiohaotnry" or higher.
/4\ 90 percent of the Network Providers will receive reimbursement for verified services from the provider within
15 days following the_managing entity receipt ofa valid invoice,
(5) TBID percent reduction in the average number of days people are on the residential substance abuse wait
|ist�
10/01/2010 113
South Florida Behavioral Health Network. Inc. KH225
1U01/2O1O
Managing Entity
DAMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 201[-20YY
Provider
Nome: South Florida Behavioral Health Network, Inc. Contraot#: KH225 Date: 10/01/2010 Reviuion#:
(6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list.
(7) TBD percent reduction in the average number of days people are on the adult mental health wait list.
(8) TBD percent reduction in the average number of people waiting on the adult mental health wait list.
(9) TBD percent reduction in the average number of days people are on the children's mental health wait list.
/110\ TBD percent reduction in the average number of people waiting on the children's mental health wait list.
/111\ TBD percent reduction in the average number of days people are on the forensic wait list.
(12) TBD percent reduction in the average number of people waiting on the forensic wait list.
(13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars.
b. Methodology
(1) The numerator is the number of Network Providers indicating ratings of"satisfactory" or higher on the
aedyhacdon survey. The denominator iothe number of Network Providers responding to the satisfaction survey.
The measure is based on attainment of 80 percent or greater level of satisfaction.
(2) The numerator is the number of stakeholders indicating ratings of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure io
based on attainment of8U percent or greater level ofsatisfaction.
(3) The numerator is the number of consumers indicating ratings of"satisfactory" or higher on the satisfaction
auwey. The denominator is the number of consumers responding to the satisfaction survey. The measure io
based on attainment of8O percent or greater level ofsatisfaction.
(4) The numerator is the number of properly prepared invoices received from Network Providers that are paid
within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices
with all required backup data received from the Network Providers for each month. The measure is based on
attaining an average of00 percent or greater rate over a12-monthperiod.
(5) One minus the fraction whose numerator is the average number of days people were on the residential
substance abuse wait list during the past fiscal, and whose denominator is the average number of days people
were on the residential substance abuse wait |\ut during the previous fiscal, the result of this calculation times
1OO provides the percent.
(6) One minus the fraction whose numerator is the average number of people waiting on the residential
substance abuse wait list during the past fiscal year, and whose denominator is the average number of people
on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
(7) One minus the fraction whose numerator is the average number of days people were on the adult mental
health wait list during the past fiscal, and whose denominator is the average number of days people were on
the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent,
10/81/2010 114
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMM Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 201[-2011
Provider
Name: South Florida Behavioral Health Network, Inc. Contnyct#: KH225 Date: 10V01/2010 Revioion#:
(8) One minus the fraction whose numerator is the average number of people waiting on the adult mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent,
(9) One minus the fraction whose numerator is the average number of days people were on the children's
mental health wait list during the past fiscal, and whose denominator is the average number of days people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1OO provides the percent.
(10)One minus the fraction whose numerator is the average number of people waiting on the chi|dren'omental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(11) One minus the fraction whose numerator is the average number of days people were on the forensic wait
list during the past fiscal, and whose denominator is the average number of days people were on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list
during the past fiscal year, and whose denominator is the average number of people on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal
year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year.
IV. Comments / Explanations
*There should o,anumber,baseline,v,N/A inserted for each target u,outcome in the sections above. *Please explain if a target
population is indicated but there is no corresponding outcome standard for that population,or if there is an Outcome Standard but there|n
nv corresponding target population indicated.
10/01/2010 116
South Florida Behavioral Health Network, Inc. KH226
1001/2810 Managing Entity
SAMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 201/-20Y2
Provider
Name: South Florida Behavioral Health Network, Inc. Contract* KH226 Date: 10/01/2010 Reviuion#:
1' Mental Health Contracted Services
A. Reguired Performance Output Standards for Each Target Population Minimum
(including all clients paid for bySAK8H. Medicaid and Local Match) Numbers to
^p|oowe explain m the comment section below ifa target population|s indicated in the section below,but there inno be Served
corresponding outcome standard for that population.
1. Adult Mental Health
a. Adults with Severe and Persistent Mental |||neoo (SPyN\) (N0016)/(K8HO16) TBO
b. Adults with Serious and Acute Episodes of Mental |Uneoo (yN05301)/(N1H5301) TBD
o. Adults with Mental Health Prob\emu(PNU53O2)/(yWH53O2) �TBD����
d. Adults with Forensic Involvement(K8UU18)/(yWHU18) TBD���
2. Ohi|droo`e YNmnte\ Health
e. Children with Serious Emotional Disturbances (SED) (K8U031)/(N1HO31) TB[}
b, Children with Emotional Disturbances (ED) (K8UU32)/(N1HU32) TBD
o. Children at-risk of Emotional Disturbances(K8UU33)/(N\HO33) TBc�---
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there is an Outcome Standard but there|unv corresponding target Contract
population indicated. Standard
1. Adult Mental Health 'Adults with Severe and Persistent Mental |i\nmeo
a. Percent of adults with severe and persistent mental illnesses who live in stable housing
environment will baat least(K8O742)/K8H742) (Statewide Target—93Y6) 93Y6
b. Average annual number of days (post admission assessments)worked for pay for adults with
severe and persistent mental illness will be at least (K8UU03)/(N1HUO3)—(Statewide Target—
3D) 30
2. Adult Mental Health 'Adults in Mental Health Crisis, including Adults with Serious
and Acute Episodes ofMental \||neeo and Adults with Mental Health Problems
a. Percent of adults in mental health crisis who live in stable housing environment will be at least
(MO744)/yWH744)—(Statewide Target—8O96) 90%
3. Adult Mental Health—Adu|ts with Serious K8mnte\ |||neem(SPK0|' K8H Crisis, Forensic)
m, Percent of adults with serious mental illness who are competitively employed will be at least
(KA0703)/PWH703)—(Statewide TeqQet—15%) 15%
4. Adult Mental Health -Fmnyneio\nvmivennent
bh Percent of adults in forensic involvement who live in stable housing environment will be at
least(K8U743)/K8H743)—(Statewide Target—7O%) 7096
5. Chi|dvan's Mental Health '8erioumiy Emotionally Disturbed
e. Percent of children with serious emotional disturbance who live in stable housing
environment will boat least(K8O779)/(yWH779)—(Statewide Target—S5%) 95%
b. Percent of children with serious emotional disturbance who improve their level of functioning
will beat least(yNU378)/yWH378)—(Statewide Target—G5%) 65%
c� Percent of school days seriously emotionally disturbed children attended will be at least
(N1UU12)/(N1HU12)—(Statewide Target—8GY6) 8696
G. Chi|dren'ey0ente| Health -EnmmtioneUy Disturbed
a. Percent of children who live in stable housing environment will be at least(M0778)/(MH778)
—(Gtetevvidm Target—9S%) 9596
b, Percent of children who improve their level of functioning will be at least(M0377)/(MH377)—
(Statewide Target—64%) 64%
10/01/2010 116
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
DAMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20YY-20/2
Provider
Nome: South Florida Behavioral Health Network, Inc. Contnyct#: NH226 Date: 10/01/2010 Revision#:
7. Chi|dmen`e Mental Health—At-Risk of Emotional Disturbance
a. Percent of children who live in stable housing environment will be at least(M0780) (MH780)
—(Statewide Target—88%) 90%
C. Required Internal Measures
1. Data Submission Outcomes for Mental Health
e. Percent of persons receiving state-contracted mental health service event records which
have matching mental health initial (purpose 1)admission records in the Substance Abuse
and Mental Health Information System will be at least(SAMHIS) (M0759)
The standard target for this measure ieet least g6% 95%
U. Substance Abuse Contracted Services
A. Required Performance Output Standards for Each Target Population (including all clients Minimum
- i K8ed|ooidand Local k8 h Numbers to
,'*as^expw/omtoecvmmen ovcuvnbelow ifa� m mm r population th
e there is
oorn,opvnm^navtovmentanuamm,matn^nu/auvn� be Served
1. Adults with Substance Abuse Problems
a. Number of Adults Served (K8UUS3)/(SAUG3) TBO
2. Children with Substance Abuse Problems
a. Number of Children Served (K8U052)/(SA052) TBO
3. Adults At-Risk mf Substance Abuse Problems-(Non GAA)
a. Number of Adults participating in Prevention Services (N1U785)(SA785) TBO
b. Number of Adults participating in Level 1 Prevention Programs(K8O7G7)/(SA7S7) TBD
o Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD
d. Number ofadults participating in Level 1 Prevention Programs who complete 75 percent of
the proQram'o schedule of activities (K8U7GQ)/(SA7GQ) TBD
e. Number ofadults participating in Level Prevention Programs who complete 75 percent of
the pnogram'u schedule of activities (K8U77U)/(8A77U) TBD
4. Children At-Risk of Substance Abuse Problems-(Non GAA)
a Number uf children participating in Prevention Services(yNU7S2)/(SA7G2) TB[}
h, Number of children participating in Level 1 Prevention Programs (K8O7G1)/(SA7G1) TBD
o. Number of children participating in Level 2 Prevention Pnognymo(yNUG85)/(SAGQ5) TBD
d. Number of children participating in Level 1 Prevention Programs who complete 75percent
of the pnogram'o schedule of activities (yW07G3)/(SA7G3) TBO
e Number of children participating in Level 2 Prevention Programs who complete 75 percent
of the program'u schedule of activities (yWU7G4)(SA7G4) TBO
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain/n the comment section below n there|s*n Outcome Standard but there|sno corresponding target Contract
population indicated.
Standard
1. Adults with Substance Abuse Problems
a. Percent of adults who successfully complete substance abuse treatment services will be at
least(MU755)/SA755)-(Statewide Target—5O%) 50%
b. Percent change in clients who are employed from admission to discharge will be at least
(&40753)/(5A753) (Statewide Target—20%) 20Y6
o. Percent of adults who live ina stable housing environment atthe time of discharge will beat
least(W1U76S)/SA75G)-(Statewide Target—8OY6) 80;6
10/01/2010 117
South Florida Behavioral Health Network, Inc. KH226
1001C010 Managing Entity
5AMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20YY-20Y2
Provider
Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/01/2010 Revioion #:
d, Percent change in the number of adults arrested 30 days prior to admission versus 30 days
prior to discharge (WlO754/SA754) (Statewide Target—35%) 35%
2. Adults At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for Each 50%)
a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of
the program'o schedule of activities will beat least(N1O771)/(SA771) 50%
b. Percent of adults participating in Level 2 Prevention Programs who complete 76 percent of
the pnognam'n schedule of activities will beat least(W1O772)/(SA772) 60%
3. Children with Substance Abuse Problems
a. Percent of children who successfully complete substance abuse treatment services will be at
least (SA725)/N1U725) -(Statewide Target—55%) SS%
b. Percent of children who live in a stable housing environment will be at least(M0752)/SA752)
-(Statewide Target—85%) 8696
c. Percent change in the number ofchildren arrested 30 days prior to admission versus 30
days prior to discharge will beod least(W1U751/SA751) - (Statewide Target—2OY6) 20%
4. Children At-Risk ofSubstance Abuse Problems-(Nmn E;AA) (Statewide Target for each 5096)
a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent
of the pnuOxom'o schedule of activities will baat least(yN07S5)/(SA7G5) 5096
b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent
of the prognam's schedule of activities will be at least(YN0700)/(GA766) 50Y&
5. Data Submission for Prevention Program Tool (Baseline— Non GAA)
m. Percent of approved Prevention Descriptions completed within 30 days of contract
execution. (Statewide Target—5O%) 50Y6
C. Required Internal Measures
1. Data Submission Outcomes for Substance Abuse
a. Percent ofpersons receiving state-contracted substance abuse service event records which
have matching substance abuse initial (purpose 1) admission records in the Substance
Abuse and Mental Health Information System will be at least(SAMHIS) (IM0758)The
standard target for this measure inat least S5Y6 95Y6
|Uy. Managing Entity Contracted Services
a. Performance Measures
(1) BO percent of Network Providers surveyed for satisfaction will rate the administrative services of the
provider ao''Satiofaotory" or higher.
(2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as
"Satimtsotory" or higher,
(]) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as
"Satisfactory" or higher.
(4) 80 percent of the Network Providers will receive reimbursement for verified newio*a from the provider within
15 days following the_managing entity receipt ofavalid invoice,
(5) TBD percent reduction in the average number of days people are on the residential substance abuse wait
list.
10X01/2010 118
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20/Y-2012
Provider
Name: South Florida Behavioral Health Network, Inc. Contmot#: KH225 Date: 10/01/2010 Revision #:
<G\ TBD percent reduction in the average number of people waiting on the residential substance abuse wait list.
( ' TBD percent reduction in the average number of days people are on the adult mental health wait list.
(8) TBD percent reduction in the average number of people waiting on the adult mental health wait list.
(9) TBD percent reduction in the average number of days people are on the children's me~tal health wait list.
(10)TBD percent reduction in the average number of people waiting on the children's mental health wait list,
(11)TBD percent reduction in the average number of days people are on the forensic wait list.
(12)TBD percent reduction in the average number of people waiting on the forensic wait list.
(13)The W1E will manage the utilization of contracted service dollars to prevent any lapse in service dollars.
b. Methodology
(1) The numerator is the number of Network Providers indicating ratings of"satisfactory" or higher on the
satisfaction survey. The denominator iothe number of Network Providers responding to the satisfaction survey.
The measure is based on attainment of 80 percent or greater level of satisfaction.
(2) The numerator iothe number ofstakeholders indicating nodngo of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure io
based on attainment of8U percent or greater level ofsatisfaction.
(3) The numerator is the number ofconsumers indicating xodngo of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of consumers responding to the satisfaction survey. The measure io
based on attainment of80 percent nr greater level ofsatisfaction.
(4) The numerator iothe number ofproperly prepared invoices received from Network Providers that are paid
within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices
with all required backup data received from the Network Providers for each month. The measure io based on
attaining en average ofQ0 percent or greater rate over a12-monthperiod.
(5) One minus the fraction whose numerator is the average number of days people were on the residential
substance abuse wait list during the past fiscal, and whose denominator is the average number ofdays people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
100 provides the percent.
(6) One minus the fraction whose numerator is the average number of people waiting on the residential
substance abuse wait list during the past fiscal year, and whose denominator is the average number of people
on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
(7) one minus the fraction whose numerator is the average number of days people were on the adult mental
health wait list during the past fiscal, and whose denominator is the average number ofdays people were on
the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
10/01/2010 119
South Florida Behavioral Health Network, Inc. KH225
1001/201O
Managing Entity
5AMM Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20/Y-2012
Provider
Name: South Florida Behavioral Health Network, Inc. Contnsot#: KH225 Date: 10V01/2010 Revinion#:
(0) One minus the fraction whose numerator is the average number of people waiting on the adult mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
/9\ One minus the fraction whose numerator is the average number of days people were on the children's
mental health wait list during the past fiscal, and whose denominator is the average number ofdays people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1OO provides the percent.
(10) One minus the fraction whose numerator is the average number of people waiting on the children's mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal,the result of this calculation times 100 provides
the percent.
(11) One minus the fraction whose numerator is the average number of days people were on the forensic wait
list during the past fiscal, and whose denominator is the average number of days people were on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent,
(12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list
during the past fiscal year, and whose denominator iethe average number ofpeople on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal
year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year.
IV. Comments / Explanations
*There should be a number,baseline,or N/A inserted for each target or outcome in the sections above. *Please explain natarget
population is indicated but there is no corresponding outcome standard for that population,or if there is an Outcome Standard but there is
no corresponding target population indicated.
10/01/2010 120
South Florida Behavioral Health Network, Inc. KH225
1001/201O
Managing Entity
SAMH Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 2012-2OY3
Provider
Name: South Florida Behavioral Health Network, Inc. Contneot#: KH225 Date: 10/01/2010 Reviaion#:
1. Mental Health Contracted Services
A. Required Performance Output Standard for Each Target Population Minimum
(including all clients paid for bySAyNH' Medicaid and Local Match) Numbers to
*Please explain in the comment section below ifa target population|u indicated m the section below,but there imno be Served
corresponding outcome standard for that population.
1. Adult Mental Health
e. Adults with Severe and Persistent Mental |Uneao(SP[N|) 8N0O16V([WHO16) TBO
b. Adults with Serious and Acute Episodes of Mental |Uneoo (yW05301)/(K8H5301) TBD
c Adults with Mental Health Pnub|emo(yWU53U2)/(W1H5302) TBD
d. Adults with Forensic |nvo|vement(yNU018)/(N1H018) TBD
2. Chi|dren'eY0ento| Health
a. Children with Serious Emotional Disturbances (SED) (W10U31)/([NH031) TBD
b. Children with Emotional Disturbances (ED) (K80U32)/(K8H032) TBD
c. Children at-risk of Emotional Disturbances (K80033)/(yNH033) TBD
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below n there isanOutcome Standard but there isnn corresponding target Contract
population indicated. Standard
1. Adult Mental Health -Adults with Severe and Persistent Mental Illness
a. Percent of adults with severe and persistent mental illnesses who |iwa in stable housing
environment will be at least(yW0742)/N1H742) (Statewide Target—S396) 9396
b. Average annual number of days (post admission assessments)worked for pay for adults with
severe and persistent mental illness will be at least(N\UU03)/(yWH003)—(Statewide Target—
3O) 30
2. Adult Mental Health -Adu|ts in Mental Health Crisis, including Adults with Serious
and Acute Episodes mfMental |Uneem 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)/[NH744)—(Statewide Target—9O%) 9096
3. Adult Mental Hea|th—Adu|tsvvith Serious Mental |||neae(SPK8|` K0HCr1eie, Forensic)
m. Percent of adults with serious mental illness who are competitively employed will be at least
(N|0703)/yWH703)—(Stetewidm Target—15%) 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)/yNH743)—(Statewide Target—7O%) 70%
S. Ch||dnen'mA8ento| Health -Sehoum|y Emotionally Disturbed
a. Percent of children with serious emotional disturbance who live in stable housing
environment will beat least (yWU773)/(K8H779)—(Statewide Target—95%) 95%
b. Percent of children with serious emotional disturbance who improve their level of functioning
will beat least(K80378)/W1H378)—(Statewide Target—G5%) 65%
o, Percent of school days seriously emotionally disturbed children attended will be at least
(M0O12)/(yWHU12)—(Statewide Target—O6%) 86%
6. Chi|dnen'e Mental Health 'EnnodmnaUy Disturbed
a, Percent ofchildren who live in stable housing environment will beat least(N10778)/([NH778)
—(Statewide Target—S5%) 95%
b. Percent of children who improve their level of functioning will be at least (yN0377)/(K8H377)—
(Statewide Target—G4Y&) 64%
10/01/2010 121
South Florida Behavioral Health Network, Inc. KH335
1001/2010 Managing Entity
GAMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y2-2013
Provider
Name: South Florida Behavioral Health Network, Inc. Contxoot#� KH225 Date: 10/01/2010 Revioion#:
7. Chi|dnen's Mental Hua|th-At-RiakmfEnnmdmna| Disturbance
m. Percent of children who live in stable housing environment will be at least(M0780) (MH780)
-(Statewide Target-SO%) SO%
C. Required Internal Measures
1. Data Submission Outcomes for Mental Health
m, Percent of persons receiving state-contracted mental health service event records which
have matching mental health initial (purpose 1)admission records in the Substance Abuse
and Mental Health Information System will beat |eaot(SAW1H|S) (K80750)
The standard target for this measure ieat least S596 95Y6
||. Substance Abuse Contracted Services
F�equ|red Performance Output Standards for Each Target Population (including all clients Minimum
id for Medicaid and Local M h to
~please e^�mnm the cp umvw|,a�r m«punw|auvnioinmoamuinmono�uonu�vw uu�mnmisnv ''-'�'--'-
curmspvndm8vutonme standard for"�="'` mmnppv|auonw ' be Served
1. Adults with Substance Abuse Problems
e. Number of Adults Served (MU0S3)/(SA0S3) TBO
2. Children with Substance Abuse Problems
a. Number of Children Served (YN0052)/(SAU52) TBO
3. 4du|ha At-Risk of Substance Abuse Problems-(Non 8AA)
a. Number nfAdults participating in Prevention Services (K80785)(SA785) TBO
b, Number of Adults participating in Level 1 Prevention Programs ([NU7G7)/(SA7S7) TBO
r Number of Adults participating in Level 2Prevention Pvogxsmn (KA07G8)/(SA7S8) TBO
d, Number of adults participating in Level 1 Prevention Programs who complete 75 percent of
the pnogram'o schedule of activities(K807SQ)/(SA768) TBO
e. Number ofadults participating in Level 2 Prevention Programs who complete 76 percent of
the prognam'o schedule of activities(yN0770)/(SA770) TBD
4. Children At-Risk of Substance Abuse Problems-(Non GAA)
a, Number of children participating in Prevention Services(YNO782)/(SA782) TBO
b. Number ofchildren participating in Level 1 Prevention Programs(M0761)/(SA761) TBD
c Number ofchildren participating in Level 2 Prevention Pnugnomo(K80SQ5)/(SASS5) TBD
d. Number of children participating in Level 1 Prevention Programs who complete 75percent
of the prognsm'o schedule of activities ([W07S3)/(SA7G3) TBO
e. Number ofchildren participating in Level 2 Prevention Programs who complete 75 percent
of the pmgram'o schedule of activities(W107S4)(SA7S4) TBO
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract
population indicated. Standard
1. Adults with Substance Abuse Problems
a. Percent of adults who successfully complete substance abuse treatment services will be at
least(KAO755)/SA755) -(Statewide Target-5O96) 5096
b. Percent change in clients who are employed from admission to discharge will be at least
(MU753)/(SA763) (Statewide Target-2OY6) 20Y6
c. Percent of adults who live in a stable housing environment at the time of discharge will be at
least(N1O75S)/SA75S) -(Statewide Target-8OY6) 80%
10/01/2010 122
South Florida Behavioral Health Network. Inc. KH225
1001/2010 Managing Entity
5AMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y2-20Y3
Provider
Name: South Florida Behavioral Health Network,Inc. Contxoot#: KH225 Date: 10/01/2010 Revision #:
d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days
prior to discharge ([N0754/SA754) (Statewide Target—35%) 35%
2. Adults At-Risk mfSubstance Abuse Problems '(Non GAA) (Statewide Target for Each 50Y6)
e. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of
the pnogram'o schedule of activities will beat least(&1O771)/(SA771) 5OY6
b. Percent of adults pa�icipating in Level 2 Prevention Programs vvhocomplete 75 percent of
the pnogxom'a schedule of activities will beat least(W1O772)/(5A772) 50%
3. Children with Substance Abuse Problems
a. Percent of children who successfully complete substance abuse treatment services will be at
least(SA725)/[N0725) -(Statewide Target—5596) 5596
b. Percent of children who live in a stable housing environment will be at least(M0752)/SA752)
-(Statewide Target—85Y6) �5Y6
c, Percent change in the number of children arrested 30 days prior to admission versus 30
days prior to discharge will beat least(W1U751/SA751) - (Statewide Target—2O96) 20%
4. Children At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for each 50%)
m, Percent of children participating in Level 1 Prevention Programs who complete 75 percent
of the prognym'o schedule of activities will beat least(K807G5)/(SA7S5) 50%
b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent
of the prognom'o schedule of activities will beat least(yNU7GG)/(SA7S0) 50%
5. Data Submission for Prevention Program Tool(Baseline— Non GAA)
a. Percent of approved Prevention Descriptions completed within 30 days of contract
execution. (Statewide Target—5OY6) 50%
C. Required Internal Measures
i. Data Submission Outcomes for Substance Abuse
a. Percent of persons receiving state-contracted substance abuse service event records which
have matching substance abuse initial (purpose 1) admission records in the Substance
Abuse and Mental Health Information System will beat|eaot(GAK8H|S) (N10758)The
standard target for this measure ieat least S5% 95%
|||' Managing Entity Contracted Services
e. Performance Measures
(I) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the
provider os^Satiofaotory^ or higher.
(2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as
"Satisfactory" or higher.
(3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as
"Satisfactory" or higher.
(4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within
15 days following the_managing entity receipt ofa valid invoice.
10/01/2010 122
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
GAMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20/2-20Y3
Provider
Name: South Florida Behavioral Health Network, Inc. Contract#: KH225 Date: 10/01/2010 Ravioion #:
(5) TBD percent reduction in the average number of days people are on the residential substance abuse wait
list,
(6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list.
/7\ TQO percent reduction inthe average number of days people are on the adult mental health wait list.
(8) TBD percent reduction in the average number of people waiting on the adult mental health wait list.
(9) TBD percent reduction in the average number of days people are on the children's mental health wait list.
(10) TBD percent reduction in the average number of people waiting on the children's mental health wait list.
(11) TBD percent reduction in the average number of days people are on the forensic wait list.
(12) TBD percent reduction in the average number of people waiting on the forensic wait list.
(13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars.
b. Methodology
(1) The numerator is the number of Network Providers indicating ratings of"satisfactory" or higher on the
satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey.
The measure is based on attainment of 80 percent or greater level of satisfaction.
(2) The numerator is the number of stakeholders indicating ratings of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure io
based nn attainment of8U percent or greater level ofsatisfaction.
/3\ The numerator is the number of consumers indicating ratings of"satisfactory"or higher on the satisfaction
survey. The denominator is the number of consumers responding to the satisfaction survey. The measure io
based on attainment of 80 percent or greater level of satisfaction.
(4) The numerator is the number of properly prepared invoices received from Network Providers that are paid
within 16 days of receipt from Network Providers. The denominator io the number of properly prepared invoices
with all required backup data received from the Network Providers for each month. The measure iu based on
attaining an average ofS0 percent or greater rate over a12-monthperiod.
(5) One minus the fraction whose numerator is the average number of days people were on the residential
substance abuse wait list during the past fiscal, and whose denominator is the average number of days people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1OO provides the percent.
(G) One minus the fraction whose numerator is the average number of people waiting on the residential
substance abuse wait list during the past fiscal year, and whose denominator io the average number ofpeople
on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
10/01/2010 124
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 Managing Entity
SAMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y2-20Y3
Provider
Name: South Florida Behavioral Health Network, Inc. Contnsot#: KH225 Date: 10/01/2010 Revioion#:
(7) One minus the fraction whose numerator is the average number of days people were on the adult mental
health wait list during the past fiscal, and whose denominator is the average number ofdays people were on
the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
(B) One minus the fraction whose numerator is the average number of people waiting on the adult mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(9) One minus the fraction whose numerator io the average number of days people were on the ohi|dn*n'o
mental health wait list during the past fiooa|, and whose denominator is the average number ofdays people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1OO provides the percent.
(10)One minus the fraction whose numerator is the average number of people waiting on the children's mental
health wait list during the past fiscal year, and whose denominator iothe average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(11) One minus the fraction whose numerator is the average number of days people were on the forensic wait
list during the past fiscal, and whose denominator is the average number of days people were on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list
during the past fiscal year, and whose denominator is the average number ofpeople on the residential
substance abuse wait list during the previous fiooa|, the result of this calculation times 100 provides the percent.
/13\ The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal
year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year.
IV. Comments / Explanations
*There should be a number,baseline,or N/A inserted for each target or outcome in the sections above. *Please explain na target
population is indicated but there is no corresponding outcome standard for that population,or if there is an Outcome Standard but there is
nv corresponding target population indicated.
10/01/2010 126
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
5AMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20/3-20Y4
Provider
Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/01/2010 Revioion#:
|. Mental Health Contracted Services
A. Required Performance Output Standards for Each Target Population 8nininnurn
(including all clients paid for bySAK8H. Medicaid and Local Match) Numbers to
*Please uxpaminmeco t i umwwi,a��mpovu|muoniwmmca»muinmveo/�mn below,but there ianv be Served
�on*mnnnmne outcome standard for that population.
i. Adult Mental Health
a. Adults with Severe and Persistent Mental |||neoo (SPN1|) (M0O16)/(W1H016) TBO
bh Adults with Serious and Acute Episodes of Mental Illness ([N053U1)/(KAH5301) T8O
c, Adults with Mental Health Problems(N1U53U2)/([NH53U2) TBD�� �
d. Adults with Forensic Involvement(KA0018)/(N1H018) TBD��
2. Chi|dnen^m Mental Health
a. Children with Serious Emotional Disturbances (SEO)(yWUU31)/(KAHO31) TBQ
b Children with Emotional Disturbances (ED) ([N0032)/(N1HO32) TBD
m. Children at-risk of Emotional Disturbances (yW0033)/(yNHO33) TBD ���
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain iv the comment section below n there isan Outcome Standard but there isoo corresponding target Contract
population indicated. Standard
1. Adult Mental Health -Adu|tavvith Severe and Persistent Mental |Unaem
a Percent ofadults with severe and persistent mental illnesses who live in stable housing
environment will beat least (K80742)/K8H742) (Statewide Target—S3%) 93Y6
b. Average annual number ofdays (post admission assessments)worked for pay for adults with
severe and persistent mental illness will be at least (Nl0003)/(N1H003)—
(Statewide Target—3O) 30
2. Adult Mental Health 'Adu|ts in Mental Health Crisis, including Adults with Serious
and Acute Episodes ofMental |||neaa and Adults with Mental Health Problems
e. Percent of adults in mental health crisis who live in stable housing environment will be at least
(YN0744)/N1H744) —(Statewide Target—SOY6) 9096
3. Adult Mental Hea|th—Adu|tavvith Serious Mental Illness(SPK8|, 88H CHeim. Forensic)
a Percent of adults with serious mental illness who are competitively employed will be at least
(N1O703)/NlH7U3)—(Statewide Target—15%) 15Y&
4. Adult Mental Health - Forensic Involvement
a. Percent of adults in forensic involvement who live in stable housing environment will beat
least(yN0743)/K8H743)—(Statewide Target—7OY6) 7096
5. Chi|dren'm Mental Health -Seriously Emotionally Disturbed
a, Percent of children with serious emotional disturbance who live in stable housing
environment will beat least (N10779)/(N1H779)—(Statewide Target—9596) 95%
b. Percent of children with serious emotional disturbance who improve their level of functioning
will be at least(K80378)/K8H378)—(Statewide Target—G5Y6) 65Y6
o. Percent of school days seriously emotionally disturbed children attended will be at least
(K80U12)/([NH012)—(Statewide Target—86%) 86%
6. Chi|dren'aK8ento| Hea|th -EmnmtionaUyOieturbed
a Percent of children who live in stable housing environment will beat least(K80778)/(yWH778)
—(Statewide Target—9596) 9596
b, Percent of children who improve their level of functioning will be at least(W10377)/(yNH377)—
(Statewide Target—64;6) 64%
10/01/2010 126
South Florida Behavioral Health Network. Inc. KH225
1001/2010 Managing Entity
GAMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y3-2OY4
Provider
Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/01/2010 Revioion#:
7. Chi|dren'sK8ento| Health—At-Risk ofEmotional Disturbance
a. Percent of children who live in stable housing environment will be at least(M0780) (MH780)
—(Statewide Target—SO%) 90%
C. Required Internal Measures
1. Data Submission Outcomes for Mental Health
a, Percent nfpersons receiving state-contracted mental health service event records which
have matching mental health initial (purpose 1)admission records in the Substance Abuse
and Mental Health Information System will beat|eaat(SAK8H|S) (K8075Q)
The standard target for this measure ieat least S596 85Y4
U. Substance Abuse Contracted Services
A Required put Standards for Each Target Population (including all clients Minimum
=�
.paid for yNed|ca|dand Local Y0mdch) Numbers to
~
Please oxp�ninmmoo uv|mw|/a�rmpvnu|auonisinmxmoumm°nm�ivnu*|owuu�mmmi�np '''
corresponding outcome standa����hm,nvnwmuunx ' be Served
1. Adults with Substance Abuse Problems
e. Number of Adults Served (N100G3)/(SA0S3) TBD
2. Children with Substance Abuse Problems
a, Number of Children Served (W10052)/(GA053) TBD
3. Adults At-Risk of Substance Abuse Problems-(Non E;AA)
a. Number ofAdults participating in Prevention Services (K80785)(SA785) TBO
b Number ofAdults participating in Level 1 Prevention Pnngnomo(N10767)/(GA787) TBD
o. Number of Adults participating in Level 2 Prevention Programs(M0768)/(SA768) TBD
d, Number of adults participating in Level 1 Prevention Programs who complete 75 percent of
the pvognam'o schedule of activities(K8U768)/(SA7SS) TBO
e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of
the pnngrmm'o schedule of activities(PN0770)/(SA77U) TBO
4. Children At-Risk ofSubstance Abuse Problems-(Non E;AA)
a. Number of children participating in Prevention Services (yWO7S2)/(SA7G2) TBQ
b. Number nf children participating in Level 1 Prevention Programs (N10761)/(SA7S1) TBO
c, Number of children participating in Level 2 Prevention Progxomo(K808S5)/(SAG9S) TBD �
d. Number of children participating in Level 1 Prevention Programs who complete 75 percent
of the pnngram'o schedule of activities (K8O7S3)/(SA7G3) TBD
e, Number ofchildren participating in Level Prevention Programs who complete 75 percent
of the pnngnsm'o schedule of activities (W107G4)(SA7G4) TBO
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract
population indicated. Standard
1. Adults with Substance Abuse Problems
a. Percent of adults who successfully complete substance abuse treatment services will be at
least(yNO765)/SA755) -(Statewide Target—5O96) GO%
b. Percent change in clients who are employed from admission to discharge will be at least ��--�----
(K807S3)/(S4753) (Statewide Target—2OY6) 20%
o. Percent of adults who live in a stable housing environment at the time of discharge will be at
least(K8075S)/SA75S) -(Statewide Target—00%) 00%
10/01/2010 127
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
S8MM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y3-2014
Provider
Nome: South Florida Behavioral Health Network, Inc. Controct#: KH225 Dote: 10/01/2010 Revision#:
d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days
prior to discharge (PNO754/SA754) (Statewide Target—35Y6) 3596
2. Adults At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for Each 50%)
o. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of
the pnngrom'a schedule of activities will beot least(N1O771)/(SA771)
b Percent of adults participating in Love!2 Prevention Programs who complete 75 percent of
the progrom's schedule of activities will beot least (K8O772)/(SA772) 50%
3. Children with Substance Abuse Problems
a. Percent of children who successfully complete substance abuse treatment services will be at
least (SA725)/yNO725) -(Statewide Target—55%) 55%
b� Percent of children who live in a stable housing environment will be at least(M0752)/SA752)
-(Statewide Target—85%) 85%
c� Percent change in the number ofchildren arrested 30 days prior to admission versus 30
days prior to discharge will baod least (PNO751/SA751) - (Statewide Target—2O%) 2094
4. Children At-Risk of Substance Abuse Problems-(Non GAA) (Statewide Target for each 50%)
a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent
of the program'e schedule of activities will beat least (PNO7S5)/(SA7G5) 60%
b Percent of children participating in Leval 2 Prevention Programs who complete 75 percent
of the progrom'o schedule of activities will bao1 least(N1O7GG)/(SA7G8) 50%
5. Data Submission for Prevention Program Tool (Baseline—Non GAA)
a. Percent of approved Prevention Descriptions completed within 30 days of contract
execution. (Statewide Target—SO%) 50Y6
C. Required Internal Measures
1. Data Submission Outcomes for Substance Abuse
a, Percent of persons receiving state-contracted substance abuse service event records which
have matching substance abuse initial (purpose 1) admission records inthe Substance
Abuse and Mental Health Information System will beot|aont(SAK8HIS) (PWO758)The
standard target for this measure is at\eoetS596 9596
YVi' Managing Entity Contracted Services
a. Performance Measures
(1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the
provider am~Satinfoutory^ or higher.
(2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as
^SaUohactory^ orhigher.
(3) OD percent of consumers surveyed for satisfaction will rate the administrative services of the provider an
"Sadmfactory'' orhigher.
(4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within
15 days following the_monoging entity receipt ofovalid invoice.
10/01/2018 128
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
uaMx Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y3-2014
Provider
Name: South Florida Behavioral Health Network. Inc. Contnout#: KH225 Date: 10/01/2010 Revinion#:
(5) TBD percent reduction in the average number of days people are on the residential substance abuse wait
|ist�
(6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list.
(7) TBD percent reduction in the average number of days people are on the adult mental health wait list.
(8) TBD percent reduction in the average number of people waiting on the adult mental health wait list.
(9) TBD percent reduction in the average number of days people are on the children's mental health wait list.
/10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list,
(11) TBD percent reduction in the average number of days people are on the forensic wait list.
/12\ TBD percent reduction in the average number of people waiting on the forensic wait list.
(13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars.
b. Methodology
/1\ The numerator is the number of Network Providers indicating ratings of"satisfactory"or higher on the
satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey.
The measure is based on attainment of 80 percent or greater level of satisfaction.
(2) The numerator is the number of stakeholders indicating ratings of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is
based on attainment of8O percent or greater level ofsatisfaction.
(3) The numerator is the number of consumers indicating ratings of"satisfactory"or higher on the satisfaction
survey. The denominator is the number of consumers responding to the satisfaction survey. The measure io
based on attainment of8O percent or greater level ofsatisfaction.
(4) The numerator is the number of properly prepared invoices received from Network Providers that are paid
within 1S days of receipt from Network Providers. The denominator io the number of properly prepared invoices
with all required backup data received from the Network Providers for each month. The measure in based on
attaining an average of&O percent or greater rate over o12-monthperiod.
(5) One minus the fraction whose numerator is the average number of days people were on the residential
substance abuse wait list during the past fiscal, and whose denominator im the average number of days people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1DO provides the percent.
(6) One minus the fraction whose numerator is the average number of people waiting on the residential
substance abuse wait list during the past fiscal year, and whose denominator in the average number ofpeople
on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
(7) One minus the fraction whose numerator is the average number of days people were on the adult mental
health wait list during the past fiscal, and whose denominator is the average number of days people were on
10/01/2010 129
South Florida Behavioral Health Network. Inc. KH225
1U01/2O10
Managing Entity
S8MM Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y3-2014
Provider
Name: South Florida Behavioral Health Network, Inc. Controut#: KH225 Doha: 10/01/2010 Revision #:
the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent,
(8) One minus the fraction whose numerator is the average number of people waiting on the adult mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(9) One minus the fraction whose numerator is the average number of days people were on the children's
mental health wait list during the past fiscal, and whose denominator is the average number of days people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
10O provides the percent.
(10) One minus the fraction whose numerator is the average number of people waiting on the children's mental
health wait list during the past fiscal year, and whose denominator |n the average number ofpeople on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(11) One minus the fraction whose numerator is the average number of days people were on the forensic wait
list during the past fiscal, and whose denominator is the average number of days people were on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent,
(12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list
during the past fiscal year, and whose denominator in the average number of people onthe residential
substance abuse wait list during the previous finuo|, the nanu8 of this calculation times 100 provides the percent.
(1]) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal
year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year.
IV.
*There should pnanumber,baseline,v,N/A inserted for each target v,outcome in the sections above. *Please explain if a target
population is indicated but there is no corresponding outcome standard for that population,or if there is an Outcome Standard but there is
np corresponding target population indicated.
10/01/2010 130
South Florida Behavioral Health Network, Inc. KH225
1001/2O1O Managing Entity
SAMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y4-2015
Provider
Noma: South Florida Behavioral Health Network' Inc. Contreot#: KH225 Date.. 10V01/2010 Revision#:
8. Mental Health Contracted Services
A. �equiredPa�ornmmnce Output S d d for Each Target Population Minimum(|nu|udingmUo|ientmpoidfdrbySAk8H. Y0ed|coidmndLouo| K8odch) Numbers to
*Please e��ainm the cv t | below na��mtpopu|uUon|smu|cmodm the mumionbelow,but there inno be Served
co,nesnvnomQ outcome standard for that population.
1. Adult Mental Health
a, Adults with Severe and Persistent Mental IUnaan (SPK8!) (WOO16)/(K8HO16) TBD
b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD
c, Adults with Mental Health Problems (yWO53O2)/(yNH53O2) TBD
d. Adults with Forensic |nvo|vament(N1OO18)/(PWHO18) TBD
2. Ch||dren's Mental Health
a. Children with Serious Emotional Disturbances (SEO) (K80031)/(N1HO31) TBD
b, Children with Emotional Disturbances (EO) ([N0032)/([WHO32) TBD
c. Children at-risk of Emotional Disturbances (N10033)/(K8HO33) TBD
B. Required Performance Outcome Standards for Each Target Population Minimum
Tlease explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract
population indicated. Standard
1. Adult Mental Heo|th-Adu|tsxvith Severe and Persistent Mental Illness
a. Percent of adults with severe and persistent mental illnesses who live in stable housing
environment will baot least (W1O742)/K4H742) (Statewide Target—S3%) 93%
b, Average annual number of days (post admission assessments)worked for pay for adults with
severe and persistent mental illness will be at least(M0003)/(MHO03)—
(Statewide Target—30) 30
2. Adult Mental Health-Adu|by in K8mnto| 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
(K8O744)/K4H744)—(Statewide Target—SO%) 9096
3. Adult Mental Hemith—Aduityvvith Serious Mental Illness (SPKOi. K0H Crisis, Forensic)
a. Percent of adults with serious mental illness who are competitively employed will be at least
(N1O7O3)/PNH703)—(Statewide Target—1G%) 15%
4. Adult Mental Health - Forensic Involvement
m. Percent ofadults in forensic involvement who live in otob|a housing environment will be at
least(K8O743)/KAH743)—(Statewide Target—7O96) 7096
5. Cbi|dren's Mental Health -Serioue|y Emotionally Disturbed
a. Percent of children with serious emotional disturbance who live in stable housing
environment will beod least(K8O779)/(KAH779)—(Statewide Target—S5%) 85%
b. Percent of children with serious emotional disturbance who improve their level of functioning
will baat least(PNO378)/PNH378)—(Statewide Target—G5Y6) 65%
c. Percent of school days seriously emotionally disturbed children attended will be at least
(N1OO12)/(K8HO12)—(Statewide Target—DG%) 86Y6
8. Chi|dren'sK8ento! Health -Emotionally Disturbed
a. Percent of children who live in stable housing environment will be at least(M0778)/(MH778)
—(Statewide Target—S5%) 95%
b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) —
(Statewide Target—64%) 64%
10/01/2010 131
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y4-2015
Provider
Name: South Florida Behavioral Health Network, Inc. Contraut#: KH225 Date: 10/01/2010 Revision #�
7. ChUdnnn`e Mental Health—At'RiekofEnmotionm| Disturbance
e. Percent of children who live in stable housing environment will be at least (IM0780) (MH780)
—(Statewide Target—9O%) 80Y6
C. Required Internal Measures
1. Data Submission Outcomes for Mental Health
a. Percent ofpersons 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 beotleont(SAPNH!S) ([WO75Q)
The standard target for this nmeoeun* is at|eoet85Y6 95%
||. Substance Abuse Contracted Services
e uired Performance Output Standards for Each Target Population (including all clients Minimum
.J�a'" ' '° " Medicaid and ~"`^'" Numbers to
,.ease ex�mm/ m below if m popvmmnommoica�oinmomwouonmmvw.but memisnv b�Served
cv,nenpnn�mgovmvmestandard for maa»"pu/auon.
I. Adults with Substance Abuse Problems
a, Number of Adults Served (PNOOG3)/(SAOG3) TBD
2. Children with Substance Abuse Problems
a, Number of Children Served (K8OO52)/(SAO52) TBD
3. Adults At-Risk of Substance Abuse Problems-(Non GAA)
e. Number of Adults participating in Prevention Services (W1O785)(SA785) TBD
b, Number of Adults participating in Level 1 Prevention Programs (K8O7S7)/(SA7G7) TBD
o. Number of Adults participating in Level 2 Prevention Programs (PNO7S8)/(SA7G8) TBD
d, Number of adults participating in Level 1 Prevention Programs who complete 75 percent of
the progrom'a schedule of activities(W1O7G8)/(SA7G8) TBD
e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of
the progrom'n schedule of activities(PWO77O)/(SA77O) TBD
4. Children At-Risk of Substance Abuse Problems-(Non GAA)
a, Number of children participating in Prevention Services (KAO762)/(SA7S2) TBD
b Number of children participating in Level 1 Prevention Programs (yNO7G1)/(SA7G1) TBD
c Number ofchildren participating in Level 2 Prevention Progroma(yN0695)/(SA695) TBD
d. Number of children participating in Level 1 Prevention Programs who complete 75 percent
of the program'a schedule of activities (K8O7G3)/(SA7G3) TBD
a. Number of children participating in Level 2 Prevention Programs who complete 75 percent
of the progrom'o schedule of activities (yWO7G4)(SA7G4) TBD
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract
population indicated. Standard
1. Adults with Substance Abuse Problems
a. Percent of adults who successfully complete substance abuse treatment services will be at
least(K8O755)/SA755) -(Statewide Target—5O%) 50Y6
b. Percent change in clients who are employed from admission to discharge will be at least
(K40753)/(SA753) (Statewide Target—2OY4) 20%
c. Percent of adults who live in a stable housing environment at the time of discharge will be at
least(N1O75S)/SA75G) -(Statewide Target—8DY&) 80%
d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days
10/01/2010 132
South Florida Behavioral Health Network. Inc. KH225
1001/2010 Managing Entity
GAMM Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 2014-20Y5 '
Provider
Name: South Florida Behavioral Health Network, Inc. Contnact#: KH225 Date: 10/01/2010 Revision #:
prior to discharge (K8O754/SA7S4) (Statewide Target—35Y6) 35%
3. Adults At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for Each 50%)
e. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of
the program'n schedule of activities will beot least (yWO771)/(SA771) Go%
b Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of
the proQnam'n schedule of activities will be at |aont (K80772)/(SA772) 50%
3. Children with Substance Abuse Problems
a, Percent of children who successfully complete substance abuse treatment services will be at
least (SA725)/[WO725) -(Statewide Target—55Y6) 55%
b Percent of children who live in o stable housing environment will be at |aont([W0752)/SA752)
-(Statewide Target—O596) 85%
c, Percent change in the number ofchildren arrested 30 days prior to admission versus 30
days prior to discharge will beot least(N1O751/SA751) - (Statewide Target—2O%) 20Y6
4. Children At-Risk of Substance Abuse Problems-(Non GAA) (Statewide Target for each 50%)
a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent
of the proQram's schedule of activities will baot least(yWU785)/(SA7G5) 50%
b, Percent of children participating in Laval 2 Prevention Programs who complete 75 percent
of the program'n schedule of activities will baat least (yWO7GG)/(SA7GG) 50%
5. Data Submission for Prevention Program Tool (Baseline—Non GAA)
e. Percent of approved Prevention Descriptions completed within 30 days of contract
execution. (Statewide Target—5D%) 50%
C. Required Internal Measures
1. Data Submission Outcomes for Substance Abuse
a. Percent of persons receiving state-contracted substance abuse service event records which
have matching substance abuse initial (purpose 1) admission records in the Substance
Abuse and Mental Health Information System will beot|aont(SAPNHIS) (K80758)The
standard target for this measure ieot least S596 9596
UlU' Managing Entity Contracted Services
a. Performance Measures
(1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the
provider as"Satisfactory" or higher.
/2\ BO percent of stakeholders surveyed for satisfaction will nshe the administrative services of the provider on
"Satisfactory" or higher.
(3) 80 percent of consumers surveyed for satisfaction will nsha the administrative services of the provider on
"Satisfactory" or higher.
(4) gU percent of the Network Providers will receive reimbursement for verified namivan from the provider within
15 days following the_monoging entity receipt of o valid invoice.
<5\ TBD percent reduction in the average number ofdays people are on the residential substance abuse wait
!iaL
10/01/2010 133
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMH Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y4'2OY5
Provider
Nome: South Florida Behavioral Health Network, Inc. Controct#: KH225 Dote: 10/01/2010 Ravimion#:
/6\ TBD percent reduction in the average number of people waiting on the residential substance abuse wait list.
<7\ TBD percent reduction in the average number ofdays people are on the adult mental health vvoh list.
(8) TBD percent reduction in the average number of people waiting on the adult mental health wait |ioL
(9) TBD percent reduction in the average number ofdays people are on thechUdnen'a mental health wait list.
/10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list.
(1 1) TBD percent reduction in the average number of days people are on the forensic wait list.
(12) TBD percent reduction in the average number of people waiting on the forensic wait list.
(13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars.
b. Methodology
(1) The numerator is the number of Network Providers indicating ratings of"satisfactory" or higher on the
satisfaction survey, The denominator is the number of Network Providers responding to the satisfaction survey.
The measure in based on attainment of8O percent or greater level of satisfaction.
(2) The numerator is the number of stakeholders indicating ratings of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is
based on attainment of8O percent orgreater level of satisfaction.
(3) The numerator is the number ofconsumers indicating ratings of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of consumers responding to the satisfaction survey. The measure io
based on attainment ofOO percent orgreater level of satisfaction.
(4) The numerator is the number of properly prepared invoices received from Network Providers that are paid
within 15 days of receipt from Network Providers. The denominator io the number of properly prepared invoices
with all required backup data received from the Network Providers for each month. The measure in based on
attaining on average of&O percent orgreater rote over 12-month period.
(5) One minus the fraction whose numerator is the average number of days people were on the residential
substance abuse wait list during the past fiscal, and whose denominator io the average number of days people
were on the residential substance abuse wait list during the previous fiscal,the result of this uo|uu!ohon times
1OO provides the percent.
(G) One minus the fraction whose numerator is the average number of people waiting on the residential
substance abuse wait list during the past fiscal year, and whose denominator is the average number of people
on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
(7) One minus the fraction whose numerator is the average number of days people were on the adult mental
health wait list during the past fiscal, and whose denominator is the average number of days people were on
the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
10/01%2010 134
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
GAMH Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year 20Y4-2O15
Provider
Nome: South Florida Behavioral Health Network, Inc. Controct#: KH225 Date: 10/01/2010 Ravinion #:
(8) One minus the fraction whose numerator is the average number of people waiting on the adult mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(9) One minus the fraction whose numerator is the average number of days people were on the children's
mental health wait list during the past fiscal, and whose denominator in the average number ofdays people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
10O provides the percent.
(10)One minus the fraction whose numerator is the average number of people waiting on the children's mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous finuo!, the result of this calculation times 100 provides
the percent.
(11) One minus the fraction whose numerator is the average number of days people were on the forensic wait
list during the post fiaooi and whose denominator is the average number ofdays people were on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list
during the past fiscal year, and whose denominator is the average number ofpeople on the renidantiol
substance abuse wait list during the previous fiaco|, the nanu!t of this calculation times 100 provides the percent.
(13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal
year, The denominator is the total amount of service dollars allocated to the ME during each fiscal year.
IV. Comments / Explanations
*There should be a number,baseline,or N/A inserted for each target or outcome in the sections above. *Please explain natarget
population is indicated but there is no corresponding outcome standard for that population,or if there is an Outcome Standard but there ie
o^corresponding target population indicated.
10/01/2010 135
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMH Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year July 1' 2D/5- September 30' 2015
Provider
Name: South Florida Behavioral Health Network,Inc. Contract#: KH225 Date: 10/01/2010 Ravinion#:
U' Mental Health Contracted Services
A. Reguired Performance OutpStandards for Each Target Population Minimum
(including all clients paid for by SAMH. Medicaid and Local Match) Numbers to*Please explain m the comment section below|va target pppmaVoniomu|cmmumtoosecu �nnm*/� but there|anv be Served
corresponding outcome standard for that population.
1. Adult Mental Health
a. Adults with Severe and Persistent Mental Illness (SPMI) (MOO16)/(MHO16) TBO
b. Adults with Serious and Acute Episodes ofMental IUnena (K8O53O1)/(N1H53O1) TBQ
o, Adults with Mental Health Problems(K8O53O2)/([WH53O2) KBD
d. Adults with Forensic Involvement (YNOO18)/(K4HO18) |Bu
2. Chi|dren'm Mental Health
a, Children with Serious Emotional Disturbances (SED) (K80031)/(K8HO31) TBO
b. Children with Emotional Disturbances (EO) (yW0032)/([WHO32) |BD
o, Children at-risk ofEmotional Disturbances (N10033)/(K8HO33) TBD
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract
population indicated. Standard
1. Adult Mental Health -Adu|tsvxith Severe and Persistent Mental Illness
e. Percent of adults with severe and persistent mental illnesses who live in stable housing
environment will beat least (yWO742)/N1H742) (Statewide Target—83%) 9396
b. Average annual number of days (post admission assessments)worked for pay for adults with
severe and persistent mental illness will baat least(YWO003)/(KXH003)—
(Statewide Target—3O) 30
2. Adult Mental Health 'Adu|ts in Mental Health Crisis,including Adults with Serious
and Acute Episodes of Mental |||neem and Adults with Mental Health Problems
e Percent of adults in mental health crisis who live in stable housing environment will be at least
(MO744)/K8H744)—(Statewide Target—9O%) SO%
3. Adult Mental Hem|th—Adu|tsxxith Serious K0enbm| U\neee(SP01\, K8H Crisis, Forensic)
o. Percent of adults with serious mental illness who are competitively employed will be at least
(K8O7O3)/yWH7O3)—(Statewide Target—iS%) 15%
4. Adult Mental Health - Forensic Involvement
a. Percent of adults in forensic involvement who live in stable housing environment will be at
least(K4O743)/PWH743) —(Statewide Target—7O96) 70%
5. Ch||dren's Mental Health -Sedous\y Emotionally Disturbed
a. Percent of children with serious emotional disturbance who live in stable housing
environment will baot least (yWO77Q)/(K8H77Q)—(Statewide Target—35%) 9596
b, Percent of children with serious emotional disturbance who improve their level of functioning
will beat least(K80378)/yWH378)—(Statewide Target—G596) 65%
c. Percent of school days seriously emotionally disturbed children attended will be at least
(K4OO12)/(K8HO12)—(Statewide Target—BG%) QG%
G. Chi|dn*n"e 01mnto\ Health -ErnotionaUy Disturbed
m. Percent of children who live in stable housing environment will be at least(M0778)/(MH778)
—(Statewide Target—85%) 9596
b Percent of children who improve their level of functioning will be at least(M0377)/(MH377) —
(Statewide Target—64%) 64%
10/01/2010 136
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
GAMM Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year July Y' 2015- September 3O 2015
Provider
Name: South Florida Behavioral Health Network, Inc. Controct#: KH225 Date: 10/01/2010 Reviaion #:
7. Chi|dren's Mental Health-At'RiskofEnmmtionm| Disturbance
a, Percent of children who live in stable housing environment will be at ieost(N1O78O) (k8H780)
-(Statewide Target-9O%) 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 beot |aont(SAyWH!S) (N1O759)
The standard target for this measure is at |mmstS5% 95%
||. Substance Abuse Contracted Services
A Required Performance Output Standards for Each Target Population (including all clients Minimum
paid for b SAMH, Medicaid and Match) Numbers to
m
^� o,o��!�ninthncommen sec
tion � mm target m utxo,ecuonmyv^ mm below,but --' --d
mvnespono/ngow�nmvstandard nxmsunopu�upn. ~~ ~-~-~
1. Adults with Substance Abuse Problems
o. Number of Adults Served ([WOOG3)/(SAOG3) TBD
2. Children with Substance Abuse Problems
a. Number ofChildren Served (yW0052)/(SA052) TBD
3. Adults At-Risk of Substance Abuse Problems-(Non GAA)
e. Number ofAdults participating in Prevention Services (K40785)(SA785) TBD
b. Number of Adults participating in Level 1 Prevention Programs (PWO787)/(SA7G7) TBD
o, Number of Adults participating in Level 2 Prevention Programs (N10788)/(SA768) TBD
d. Number ofadults participating in Level 1 Prevention Programs who complete 75 percent of
the progrom'o schedule of activities (K8U769)/(SA7G9) TBD
e. Number ofadults participating in Love!2 Prevention Programs who complete 75 percent of
the prognam'o schedule of activities(YNO77O)/(SA77O) TBD
4. Children At-Risk of Substance Abuse Problems-(Non GAA)
o. Number of children participating in Prevention Services (PN0762)/(SA762) TBD
b. Number of children participating in Level 1 Prevention Programs (N1O7G1)/(SA7G1) TBD
c. Number ofchildren participating in Lave!2 Prevention Progromn(PW0695)/(SA695) TBD
d, Number ofchildren participating in Level 1 Prevention Programs who complete 75 percent
of the progrom's schedule of activities (PNO7G3)/(SA7G3) TBD
e. Number ofchildren participating in Level 2 Prevention Programs who complete 75 percent
of the progrom'n schedule of activities (yWO7G4)(SA7G4) TBD
B. Required Performance Outcome Standards for Each Target Population Minimum
*Please explain in the comment section below if there is an Outcome Standard but there is no corresponding Contract
target population indicated. Standard
1. Adults with Substance Abuse Problems
a. Percent of adults who successfully complete substance abuse treatment services will be at
least(yNO755)/SA755) -(Statewide Target-5O%) 50%
b. Percent change in clients who are employed from admission to discharge will be at least
(N1D753)/(SA753) (Statewide Target-2O%) 20%
c. Percent of adults who live in a stable housing environment at the time of discharge will be at
least(yNO75G)/SA75G) -(Statewide Target-DD%) 80%
d. Percent change in the number ofadults arrested 30doya prior to admission versus 30doyo
10/01/2010 137
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMH Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year July 1, 20Y5- September 30, 2015
Provider
Name: South Florida Behavioral Health Network, Inc. Contnact#: KH225 Date: 10/01/2010 Roviaion#:
prior tn discharge(yW0754/GA754) (Statewide Target—35Yt) 35%
2. Adults At-Risk of Substance Abuse Problems -(Non GAA) (Statewide Target for Each 50%)
a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of
the program'a schedule of activities will beat least(N1O771)/(SA771) 5096
b, Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of
the progrom'o schedule of activities will boat least(PNO772)/(8A772) 50q6
3. Children with Substance Abuse Problems
e, Percent of children who successfully complete substance abuse treatment services will be at
least(SA725)/yNO72G)-(Statewide Target—55Y6) 55%
b� Percent of children who live in a stable housing environment will be at least(M0752)/SA752)
-(Statewide Target—$5%) 85q6
o. Percent change in the number of children arrested 30 days prior to admission versus 30
days prior to discharge will beat least(N10751/SA751) - (Statewide Target—2O%) 20%
4. Children At-Risk of Substance Abuse Problems-(Non GAA) (Statewide Target for each 50%)
o. Percent of children participating in Level 1 Prevention Programs who complete 75 percent
of the pnogram'e schedule of activities will boat least(yWO7G5)/(SA7O5) 50%
b, Percent of children participating in Level 2 Prevention Programs who complete 75 percent
of the program'a schedule of activities will boat least(K8O7SS)/(SA7GG) 50%
5. Data Submission for Prevention Program Tool (BaeeUna—Non GAA)
m. Percent of approved Prevention Descriptions completed within 30 days of contract
execution, (Statewide Target—50%) 58%
C. Required Internal Measures
6. Data Submission Outcomes for Substance Abuse
a. Percent of persons receiving state-contracted substance abuse service event records which
have matching substance abuse initial (purpose 1) admission records in the Substance
Abuse and Mental Health Information System will be at least(SAMHIS) (M0758)The
standard target for this measure ieat least 95% 95%
U|U. Managing Entity Contracted Services
a. Performance Measures
(1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the
provider oa''Sadafadory^ orhigher.
(2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as
"Satisfactory" or higher.
(3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as
"Satisfactory" or higher.
(4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within
15 days following the_managing entity receipt ofa valid invoice.
(5) TBD percent reduction in the average number of days people are on the residential substance abuse wait
|ist�
10/01/2010 138
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
GAMM Services Program
Exhibit D
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year July /, 2015- September 30, 20/5
Provider
Name: South Florida Behavioral Health Network, Inc. Contnact#: h[H225 Date: 10101/2010 Revision#:
(6) TBID percent reduction in the average number of people waiting on the residential substance abuse wait list.
(7) TBD percent reduction in the average number of days people are on the adult mental health wait list.
(8) TBD percent reduction in the overage number of people waiting on the adult mental health wait list.
(9) TBD percent reduction in the average number ofdays people are on thouhi|dron'a mental health wait list.
/10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list.
/11\ TBD percent reduction in the average number of days people are on the forensic wait list.
/12\ TBD percent reduction in the average number of people waiting on the forensic wait list.
/13\ The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars.
b. Methodology
(1) The numerator is the number of Network Providers indicating ratings of"satisfactory" or higher on the
satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey.
The measure is based on attainment of 80 percent or greater level of satisfaction.
(2) The numerator is the number of stakeholders indicating ratings of"satisfactory" or higher on the satisfaction
survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure ia
based on attainment of8O percent or greater level ofsatisfaction.
<3\ The numerator is the number of consumers indicating ratings of"satisfactory" or higher on the satisfaction
survey, The denominator is the number of consumers responding to the satisfaction survey. The measure iu
based on attainment ofOO percent or greater level ofsatisfaction.
(4) The numerator is the number of properly prepared invoices received from Network Providers that are paid
within 15days of receipt from Network Providers. The denominator ia the number of properly prepared invoices
with all required backup data received from the Network Providers for each month. The measure in based on
attaining an average of00 percent orgreater rate over 12-month period.
(5) One minus the fraction whose numerator is the average number of days people were on the residential
substance abuse wait list during the past fiscal, and whose denominator is the average number ofdays people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1O0 provides the percent.
(6) One minus the fraction whose numerator is the average number of people waiting on the residential
substance abuse wait list during the past fiscal year, and whose denominator is the average number ofpeople
on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
(7) One minus the fraction whose numerator is the average number of days people were on the adult mental
health wait list during the past fiscal, and whose denominator is the average number of days people were on
the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100
provides the percent.
10/01/2010 139
South Florida Behavioral Health Network, Inc. KH225
1001/2010 Managing Entity
SAMH Services Program
Exhibit
Substance Abuse and Mental Health Required Performance Outcomes and Outputs
For Fiscal Year July /' 20/5- September 30, 2015
Provider
Name: South Florida Behavioral Health Network, Inc. Contnact#: KH225 Date: 10101/3010 Revision#:
(8) One minus the fraction whose numerator is the average number of people waiting on the adult mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
(9) One minus the fraction whose numerator is the average number of days people were on the children's
mental health wait list during the past fiscal, and whose denominator is the average number of days people
were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times
1OO provides the percent.
(10) One minus the fraction whose numerator is the average number of people waiting on the children's mental
health wait list during the past fiscal year, and whose denominator is the average number of people on the
residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides
the percent.
<11> One minus the fraction whose numerator is the average number of days people were on the forensic wait
list during the past fiscal, and whose denominator is the average number of days people were on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list
during the past fiscal year, and whose denominator is the average number of people on the residential
substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent.
(13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal
year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year.
IV. Comments / Explanations
*There should ue a number,baseline,or NIA inserted for each target or outcome in the sections above. *Please explain i,atarget
population is indicated but there is no corresponding outcome standard for that population,or if there is an Outcome Standard but there is
nv corresponding target population indicated.
10/01/2010 140
South Florida Behavioral Health Network, Inc. KH225
07/01/2010 EXHIBIT E
Missing Children
The provider agrees to follow the procedures outlined in Rule 65C-30.019, F.A.C. and Rule
65C-29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175-85,
entitled "Prevention, Reporting, and Services to Missing Children". The provider will perform
the departmental functions as described in Rule 65C-30.019, F.A.C. and CFOP 175-85
which correspond to the functional role of this contract.
1. Definitions
a. Designee - a person, contractual provider or other agency or entity named by the department.
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 provider when they went missing; and who has been or will be reported as
missing to a law enforcement agency.
2. Reporting Missing Children
The provider agrees to instruct caregivers, including relative and non-relative caregivers,
family services counselors, and all other staff that might be required to report a child as
missing to local law enforcement to immediately undertake the following activities, as
applicable, and document all actions and activities related to any efforts made to report
and/or locate any child who is determined to be missing from their care or supervision:
a. If exigent circumstances exist, the caregiver, family services counselor, or provider employee
who has identified that a child is missing from their care or supervision shall immediately call
local law enforcement as soon as a determination has been made that a child is missing and
they shall request that the responding office:
(1) Take a report of the missing child.
(2) Assign a case number to the missing child report and provide the case number back
to the caregiver or person who is reporting the child missing.
South Florida Behavioral Health Network, Inc. 141 KH225
07/01/2010 EXHIBIT E
(3) Provide local law enforcement with a recent high quality photo of the child, or provide
local law enforcement with a recent high quality photo when one becomes available.
(4) Request that a copy of the police report be provided to the family services counselor
once a police report becomes available.
(5) If the responding law enforcement officer refuses to take a missing child report, for
any reason, the individual attempting to report the child as missing will document the
officer's name and specific local law enforcement agency name and request to speak to
the law enforcement agency Watch/Shift Commander. If the law enforcement agency
Watch Commander refuses to take a missing child report and it is a caregiver that is
attempting to report the child as missing, the caregiver will immediately contact the family
services counselor or on-call staff and provide them with all information related to local
law enforcement not issuing a missing child report. Once the family services counselor or
on-call staff have learned that a local law enforcement agency will not issue a missing
child report they will immediately seek assistance from the local area Community Based
Care (CBC) Child Location Specialist or the Department of Children and Families
Regional Criminal Justice Services Coordinator on resolving any issue related to
reporting the child as missing to local law enforcement.
(6) If it is a caregiver who has reported the child as missing to local law enforcement or
attempted to report a child as missing to local law enforcement, they shall immediately
notify the child's family services counselor or emergency on-call staff and provide them
with the following information:
(a) The law enforcement agency name that the child was reported as missing to or
attempted to be reported as missing to;
(b)The law enforcement missing child case number if one was issued by local law
enforcement;
(c) A copy of the law enforcement report when one is made available;
(d) Detailed information on the child's overall state of mind and behavior prior to the
child going missing;
(e) Detailed description of what the child was last seen wearing;
(f) Detailed information on possible locations that the child might be going to; and
(g) Detailed information on any individuals that the child might be traveling with.
b. If exigent circumstances do not exist, the caregiver , family services counselor, or other provider
staff will within the first four (4) hours of learning that a child might be missing check to see what,
if any, of the child's personal belongings are missing or if the child left a note; and,
(1) Contact the following persons as appropriate to ascertain if the child has been seen,
or has given any indications that may explain the child's missing status:
South Florida Behavioral Health Network, Inc. 142 KH225
07/01/2010 EXHIBIT E
(a) School/child's teachers and school resource officer;
(b)The child's relatives/pa rents, both local and non-local, if appropriate, and the
caregiver has the means for such contact;
(c) Any friends or places that the child generally frequents, the local runaway shelter,
if there is one in the community; and,
(d)The child's employer, if applicable.
(2) Write down any information gathered that might help locate the child.
(3) Provide telephone/beeper numbers and ask for the individuals above to call back and
share information if they have further information or see the child.
c. If at any time during the initial four (4) hour search for the child, if the caregiver, family services
counselor, or any other provider employee becomes concerned about the immediate safety and
well-being of the child, or the child's location remains unknown after four (4) hours from the time
that the caregiver, family services counselor, or provider employee learned that the location of
the child was unknown, they shall immediately call local law enforcement and they shall follow
the steps outlined in Section 2.a., above.
d. If at any time, the child is located or returns to the caregivers home after law enforcement has
been notified of the missing child case, all law enforcement agencies and other agencies that
were notified of the missing child episode must be contacted immediately by the caregiver,
family services counselor, or other provider employee. If at any time new information is obtained
on a possible location of the missing child, the caregiver, family services counselor, or any other
employee of the provider shall immediately contact all law enforcement agencies and other
agencies that were notified of the missing child episode as to the possible location of the child.
e. All of the department's documentation related to the missing child episode shall be completed
and entered into the department's approved missing child reporting system within one working
day of the family services counselor, on-call staff, or Community Based Care (CBC) Child
Location Specialist learning of a missing child episode regardless of whether local law
enforcement has issued a missing child report number. This includes the uploading of a recent
high quality photograph of the child into the department's approved missing child reporting
system. If local law enforcement has refused to issue a missing child report a dummy local law
enforcement case number of 00000 and the name of the local law agency that refused to issue
the missing child report shall be used to complete and enter the missing child episode into the
department's approved missing child reporting system.
South Florida Behavioral Health Network, Inc. 143 KH225
10/01/2010 Managing Entity
SAMH Services Program
Exhibit F
Minimum Service Requirements
The provider and its subcontractors shall be knowledgeable of and fully comply with all
applicable state and federal laws, rules and regulations, as amended from time to time, that
affect the subject areas of the contract. Authorities include but are not limited to the
following:
I. PROGRAMMATIC AUTHORITY (FEDERAL)
A. Mental Health
42 U.S.C. 300x to 300x-9 (Block Grant for community Mental Health Services)
B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes)
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42 U.S.C. 300x-21 to 300x-35 and 300x-51 to 300x-66(SA Treatment &
Prevention Block Grants)
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42 CFR, Part 54 (Charitable choice)
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45 CFR 96,120 — 137 (SA Treatment& Prevention Block Grants)
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Restrictions on expenditures of SAPTBG
45 CFR 96.135
I)j121/www.acces oo. oy/nara/cfr/waisidix 01/45efr96 01.html
C. Substance Abuse-Confidentiality
42 CFR, Part 2
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D. Health Insurance Portability and Accountability Act (HIPAA)
45 CFR 164
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Rev.07/01/2010 144
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 Managing Entity
SAMH Services Program
Exhibit F
E. Social Security Income for the Aged, Blind and Disabled
20 CFR 416
,N!p //www.access,npa.Aov/n a ra/cfr/wa isidx cf r4 1.
03/2�0 6 03-�htnfl
F. Endorsement and Payment of Checks Drawn on the United States Treasury
31 CFR 240 relating to SSA
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G. Temporary Assistance to Needy Families (TANF)
Part A, Title IV of the Social Security Act
45 CFR, Part 260
�t I I
VWwww.acce
Section 414.1585, F.S.
e=ViewStatutes&Submenu=1
H. Positive Alternatives to Homelessness (PATH)
Public Health Services Act, Title V, Part C, Section 521, as amended
42 U.S.C. 290cc-21 et. seq.
iLtlg.,//www4,IqW,.qorrlpll,edu/uscode/
Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law
101-645
101-645
42 CFR, Part 54
2cfr54 03,htmi
I. Americans with Disabilities Act of 1990
42 U.S.C. 12101 et seq.
http-,//Www4.law,cornell.edu/uscode/
11. FLORIDA STATUTES
All State of Florida Statutes can be found at the following website:
e=ViewStatutes&Subme nu=1
Rev.07/01/2010 145
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 Managing Entity
SAMH Services Program
Exhibit F
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
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;
Rev.07/01/2010 146
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 Managing Entity
SAMH Services Program
Exhibit F
F. Florida Assertive Community Treatment (FACT)
General Appropriations Act
D=105701865&CFTOKE
N=34016817
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 them 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
t0ttP-1L/—WW e.htm
Ill. FLORIDA ADMINISTRATIVE CODE (RULES)
A. Child Welfare and Community Based Care
All references to F.A.C. may be found at the following website:
bLt2s-'//yyww-f1ru les-_o ra/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-1 5, F.A.C. Child Placing Agencies
B. Substance Abuse and Mental Health Services
Rule 65C-12, F.A.C. Emergency Shelter Care
Rule 65D-30, F.A.C. Substance Abuse Services Office
Rule 65EA F.A.C. Community Mental Health Regulation
Rule 65E-5, F.A.C. Mental Health Act Regulation
Rule 65E-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-1 5, F.A.C. Continuity of Care Case Management
Rule 65E-20, F.A.C. Forensic Client Services Act Regulation
Rev.07/01/2010 147
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 Managing Entity
SAMH Services Program
Exhibit F
C. Financial Penalties
Rule 65-29, F.A.C. Penalties on Service Providers
Reduction/withholding of funds
Rule 65-29.001, F.A.C. Financial Penalties for a Provider's Failure to Comply With a
Requirement for Corrective Action
IV. MISCELLANEOUS
A. Department of Children and Families Operating Procedures
CFOP 155-10, Services for Children with Mental Health & Any Co-occurring
Substance Abuse Treatment Needs In Out of Home Care Placements
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CFOP 215-6, Incident Reporting and Client Risk Prevention
B. Federal Cost Principles
OMB Circular A-21, Cost Principles for Educational Institutions
ka/circulars/a0211a021.html
OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments
Litt p:L/vvww,whiLehoLise,ggaL/orr7b;circulars/af187/a087-all,html
OMB Circular Al 02, Grants and Cooperative Agreements with State and Local
Governments
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OMB Circular A-1 22, Cost Principles for Non-profit Organizations
122.html
C. Audits
OMB Circular A-1 33, Audits of States, Local Governments and Non-Profit
Organizations
133,html
Section 215.97, F.S., Florida Single Audit Act
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Comptrollers Memorandum #03 (1999-2000): Florida Single Audit Act
Implementation
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Rev.07/0112010 148
South Florida Behavioral Health Network, Inc, KH225
10/01/2010 Managing Entity
SAMH Services Program
Exhibit IF
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
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45 CFR, Part 92 - Uniform Administration Requirements (State and Local
Governments)\
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OMB Circular All 0, Uniform Administrative Requirements for Grants and Other
Agreements
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E. Data Collection and Reporting Requirements
Rule 65E-14.022, F.A.C.
5E-14,022
Section 397.321(3)(c), F.S., Data collection & dissemination system
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3971tit10397,htm
Section 394.74(3)(e), F.S., Data Submission
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Section 394.77, F.S., Uniform management information, accounting, and reporting
systems for providers.
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CFP 155-2, Mental Health and Substance Abuse Data Measurement Handbook
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Rev.07/01/2010 149
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 Exhibit G
Required Reports
Rev.0701/2010 150
South Florida Behavioral Health Network, Inc. KH225
10/01/2010 EXHIBIT G Performance Contract
SAW Services Program
REQUIRED REPORTS
Provider Name: South Florida Behavioral Health Network, Inc. Contract No. KH225
Date: October 1, 2010 Amendment#
Due Date # of Send to:
Copies
Required Reports
Response to Monitoring Reports and Corrective Action Within 30 days from the day the 1 Contract Manager
Plans report is received.
Validation of review of subcontractor's Sliding Fee Scale Within 30 days of contract 1 Contract Manager
[reflecting the uniform schedule of discounts referenced in execution
65E-14.018(4)]
Validation of review of subcontractor's Agency Service Prior to contracting for year 2 of 1 Contract Manager
Capacity Report,Projected Cost Center Operating and the contract and every other year
Capital Budget,Cost Center Personnel Detail Report(if thereafter.
applicable)
Consolidated Program Description Prior to contracting for year 2 of I Contract Manager
the contract and every other year
thereafter,or any updates
thereafter.
Monthly Data Required by CFP 155-2 Within 15 days after end of month Electronic SAMH Program
Submission Office as
appropriate
Incident Report Within 48 hours of occurrence 1 to Region As specified in
Incident CFOP 215-6,215-3
Report Liaison and other Regional
1 to Lotus language as
Notes directed by the
contract.
Audit Schedules(for client non-specific unit cost The ME's Audit Schedule is due 1 to Region Contract Manager
performance contracts) 180 days after the end of the ME
fiscal year or 45 days upon
completion of audit,whichever
comes first.
The ME shall submit the network
provider's audit schedules 30 days
after receipt from the network
provider.
Schedule of State Earnings Due 180 days after the end of the 1 to Region Region SAMH
Schedule of related Party Transaction Adjustments fiscal year or 45 days upon
Program/Cost Center Actual Expenses&Revenues completion of audit,whichever
Schedule comes first.
Schedule of Bed-Day Availability Payments
Financial&Compliance Audit per Attachment 11 180 days after the end of the 1 See Attachment It
managing entity's fiscal year or 45 SAMH Contract
days after its completion, Manager
whichever comes first.
South Florida Behavioral Health Network, Inc. 150 KH225
10/01/2010 EXHIBIT G Performance Contract
SAMH Services Program
REQUIRED REPORTS
Reports Required for Substance Abuse Providers
Annual Report for HIV Early Intervention Services, SAPT Upon Request of the department 1 to Circuit Circuit Contract
Block Grant Set Aside Funded Services Only 1 to Manager Substance
Headquarters Abuse Program
Office
Annual Report for Evidenced-based Injection Drug User Upon Request of the department 1 to Circuit Circuit Contract
Outreach Services,SAPT Block Grant Mandate,Designated 1 to Manager Substance
Providers Only Headquarters Abuse Program
Office
Annual Report for Pregnant Women and Women With Upon Request of the department 1 to Circuit Circuit Contract
Dependent Children SAPT Block Grant Set Aside Funded 1 to Manager Substance
Services Only Headquarters Abuse Program
Office
Other Reports'
Quarterly Annual Action Plan Reports on Accomplishments As identified in the Annual Action 1 Contract Manager
and Deliverables Plan
Monthly Service Invoice By 151h of each month 1 Contract Manager
Final Invoice By July 31 of each fiscal year and 1 Contract Manager
31 days after contract end date _
Wait Dist(until department's automated system is Monthly for SA services. 1 Contract Manager
operational) Monthly for MH services as per the
approved annual action plan.
Monitoring Schedule Within 30 days of receipt of the 1 Contract Manager
risk assessment prepared by the
Department's Contract Oversight
Unit.
Contingency Transition Plan 90 days after contract execution 1 Contract Manager
Validation of receipt and review of Network Providers Within 30 days of contract 1 Contract Manager
grievance procedures execution
Validation that all Network Providers produced copies of Within 30 days of contract 1 Contract Manager
their Informed Consent Forms execution
Validation of receipt and review of Network Providers Within 30 days of contract 1 Contract Manager
Emergency Preparedness Plan execution and by June 1 of each
fiscal ear
Validation of Network Providers Civil Rights Compliance Within 30 days of contract 1 Contract Manager
Questionnaire execution
Validation of Network Providers Security Agreements Within 30 days of contract 1 Contract Manager
execution
Affidavit Regarding Debarment Annual for the ME and 1 Contract Manager
15 days prior to contract
negotiation with subcontractor,or
as requested by the contract
manager.
Beginning Inventory Report Within 30 days of contract 1 Contract Manager
execution
Training Schedule Within 15 days prior to the training 1 Contract Manager
quarter.
Invoice Review Supporting Documentation As per the contract and/or as 1 Contract Manager
requested by the contract manager
South Florida Behavioral Health Network, Inc. 151 KH225
10/01/2010 EXHIBIT G Performance Contract
SAMH Services Program
REQUIRED REPORTS
Lapse Analysis Report 30 days after the month of 1 Contract Manager
services
Annualized Line Item Budget&Narrative 60 days before the beginning of 1 Contract Manager
each fiscal year.
Annual Inventory Report May 15t"of each fiscal year 1 Contract Manager
Closeout Inventory Report By July 31,2015 1 Contract Manager
Cooperative Agreements/MOU/MOA/Procedures As identified in the Annual Action 1 Contract Manager
Plan and the contract
Quality Assurance Reviews,Monitoring Reports& Within 30 days after exit 1 Contract Manager
Corrective Action Plans conference
Region Specific
Childr en's Mental Health (see annual action plan and Contract)
Adult Mental Health
Quarterly and Annual PATH Report
FACT Reports Subcontractors to submit to the 1 Contract Manager
(1) Quarterly FACT Enhancement Reconciliation managing entity by October 15"' and SAMH Program
Report and Tracker January 15,April 15 and July 15 Office/Headquarters
(2) Quarterly FACT Ad Hoc Reports of each fiscal year.The managing as specified in the
(3) Monthly Performance Measures Report entity is to submit to the contract
(4) Reporting of significant incidents& department the reports one(1)
interventions,as needed week after the due dates listed
above
Quarterly Contingency Funds Report Subcontractors to submit to the 1 Contract Manager
managing entity by October 31, and SAMH Program
January 30,April 30 and July 31 Office
of each fiscal year.The managing
entity is to submit to the
department a summary of the
quarterly expenditures one(1)
week after the due dates listed
above
Path Quarterly Reports Subcontractors to submit to the 1 Contract Manager
managing entity by October 31, and SAMH Program
January 30,April 30 and July 31 Office
of each fiscal year.The managing
entity is to submit to the
department the reports one(1)
week after the due dates listed
above
PATH Annual Reports Drafts to be submitted to Southern 1 Southern Southern Region
Region SAMH Program Office, Region SAMH SAMH Program
DCF Central Office in Tallahassee for Prior Office,Contract
in April or May of each fiscal year Approval, Manager, and On-
as requested line Site
South Florida Behavioral Health Network, Inc. 152 KH225
10/01/2010 EXHIBIT G Performance Contract
SAMH Services Program
REQUIRED REPORTS
1 final to DCF
Central Office
in Tallahassee
Forensic Services
Monthly Report for Individuals on Conditional Release By 15'h of each month 1 Forensic
Coordinator/MH
Administrator Office
Census Report Weekly 1 SAMH Forensic
Coordinator
Admission Waiting List Weekly 1 SAMH Forensic
Coordinator
Staffing Reports As required,every six month per 1 SAMH Forensic
clients Coordinator
South Florida Behavioral Health Network, Inc. 153 KH225
Exhibit H
Children's Mental Health Comprehensive Community Service Team
Description: Comprehensive Community Service Team (CCST) services take place in
either an outpatient or community-based setting and provide adults and children with
mental illness assistance in identifying goals and making choices to promote resiliency and
facilitate recovery. For individuals/families with mental health problems, recovery is the
personal process of overcoming the negative impact of a psychiatric disability despite its
continued presence. CCST services are intended to restore the individual's function and
participation in the community. The services are designed to assist and guide
individuals/families in reconnecting with society and rebuilding skills in identified roles in
their environment. The focus is on the individual's and family's strengths and resources as
well as their readiness and phase of recovery. A team approach for delivery of services will
be used to guide and support the adults and children served with development of a
recovery plan focusing on the areas of individual and family living, learning, working and
socialization. The expectation is that therapy will be determined by the clinical needs of the
child and family.
a. The treatment approach must be delivered by staff working in a Multi-Disciplinary
Team that includes "Peers" (Peer Specialists or Family Coaches who are or have been
consumers of services)* and meets at least weekly. Staff must be trained and
competent in utilizing Recovery concepts and language. The family and youth's voice
and choice should be seen throughout, starting with a recovery-based self-assessment
tool and continuing with statements of needs, goal-setting and decision-making.
b. The goal is to implement a System of Care that encompasses a coordinated
network of community-based services and supports aimed at utilizing the client's
strengths while simultaneously addressing the multiple and changing needs of youth
and their families.
C. Treatment and services should be based on the following values:
(1) Family Driven Care
(2) Youth Guided Care
(3) Cultural and Linguistic Competence
(4) Evidence-Based practices
(5) Streamlining and expediting access to services
(6) Continuous Quality Assurance
(7) Process Evaluation
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SOUth Florida Behavioral Health Services,Inc.
154
Exhibit H
(8) Data Driven Outcomes
cl. There should be evidence that staff are aware of consumers' needs and
documentation in the service record that identified needs are addressed by the CCST
and the person receiving services. Staff should facilitate families to obtain benefits
(insurance, Social Security and income). Documentation in the service record must
reflect efforts, progress and barriers to individualized goals and treatment objectives,
including school performance. Documentation is necessary to identify changes in
services and continuity of services (i.e., treatment plan updates indicating
new/revised/achieved goals).
e. There must be evidence that the person/family receiving services was offered
support in self-managing wellness via activities such as, but not limited to, education,
supportive counseling, or skills training and was made aware of appropriate self-help or
support groups. Evidence is required that the people receiving services actively takes
part in achieving his/her service goal(s) and chooses the people who are involved in
their recovery (as in Wellness Recovery Action Planning "WRAP Plans" Crisis
Management tools). These persons could be family members, friends or significant
others. CCST staff, Peer support in particular, should have as a primary goal the
creation of natural support systems. There should be evidence that the CCST staff
partners with the consumer, assisting and building confidence in their decision-making
ability.
f. Services provided include Assessment, Case Management, Intensive Case
Management, Supported Housing, Aftercare, Supported Employment, Outreach,
Outpatient, In-home/On-Site, Intervention, Information and Referral, Prevention,
Prevention/intervention and other transition, e-therapy for those who are part of the
Miami Wraparound Grant and non-traditional support services as negotiated by the
department and the Provider The above listed services are reimbursed in a bundled
staff hour rate and may not be contracted for separately. Incidental Expenses may be
utilized for persons served through CCST to purchase medications and other
enhancement and support services not included in this bundled rate that are in concert
with the individuals recovery plan. We expect that there will be no more than 20 clients
for each full time equivalent staff.
9. Productivity: It is our expectation that a minimum of 50% of the staff's time is
spent in direct contact hours.
In. Staff training requirements include:
(1) Motivational Interviewing for all on CCST Team
(2) Wellness Recovery Action Planning for all staff
(3) SSI/SSDI, Outreach, Access and Recovery (SOAR) training for clinical staff
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155
Exhibit H
(4) Wraparound Best Practice for all on CCST Team
(5) Other Best Practices as approved by SAMH
L Programs: Children's Mental Health
Unit of Measure: Staff Hour
Maximum unit cost rate: $ 37.86
Data Elements:
(1) Service Documentation — Duty Roster
(a) Staff name and identification number
(b) Date
(c) Hours scheduled to work— Beginning & Ending Time
(d) Cost Center
(e) Program, and
(f) Signature of Supervisor
(2) Audit Documentation — Time Sheet
(a) Staff name and identification number
(b) Date
(c) Hours Worked — Beginning & Ending Time
(d) Program
(e) Cost Center
(f) Signature of Supervisor
j. Some of the additional elements SAMH will be reviewing include the following:
(1) Number of families linked to Medicaid with the length of time for approval of
benefits
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156
Exhibit H
(2) Number of family groups
(3) Number of treatment team meetings
(4) Number of children receiving Evidence-Based Practices (EBP) and which EBP's
are used
(5) Staff productivity
A Certified Recovery Peer Specialist must either be certified or working towards
certification by the Florida Certification Board and must be a true peer; which means
that the peer specialist is also a consumer of public or private mental health services.
A Certified Recovery Peer Specialist — Family provides peer mentoring and support to
families that include at least one child diagnosed with a mental illness before his or her
24th birthday. This position must be a true peer; which means that the peer specialist
must be a first-degree relative or primary caregiver of a child diagnosed with a mental
illness, and either be certified or working towards certification by the Florida Certification
Board.
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157
10/01/2010 Exhibit
Tangible Property Requirements
1. Definitions
a. As used in this section, "nonexpendable property" is defined as tangible
personal property of a nonconsumable nature that has an acquisition value or
cost of$1,000 or more per unit and an expected useful life of at least one
year, and hardback covered bound books that are not circulated to students
or the general public, the value or cost of which is $250 or more. Hardback
books with a value or cost of$100 or more should be classified as
nonexpendable property only if they are circulated to students or to the
general public. All computers, including all desktop and laptop computers,
regardless of the acquisition cost or value are classified as nonexpendable
property.
b. As used in this section, "motor vehicles" includes any automobile, truck,
airplane, boat, or other mobile equipment used for transporting persons or
cargo.
c. As used in this section, "subcontractor" is an entity under contract with the
managing entity funded from funds contained in this contract.
2. State Property Transferred to the Managing Entity
a. When state property will be assigned to a managing entity for use in
performance of a contract, the title for that property or vehicle shall be
immediately transferred to the managing entity where it shall remain until this
contract is terminated or until other disposition instructions are furnished by the
contract manager. When property is transferred to the managing entity, the
department shall pay for the title transfer. The managing entity's responsibility
starts when the fully accounted for property or vehicle is assigned to and
accepted by the managing entity. Business arrangements made between the
managing entity and its subcontractors shall not permit the transfer of title of
state property to subcontractors. While such business arrangements may
provide for subcontractor participation in the use and maintenance of the
property under their control, the department shall hold the managing entity
solely responsible for the use and condition of said property. Property
inventories shall be conducted in accordance with CFOP 80-2. (The
managing entity shall use the Managing Entity Property Inventory and
Disposition Form.)
b. Before transferring property from the department, all property to be transferred
shall be inventoried, and the inventory shall be agreed upon and signed by
both parties. The property decal for each property item shall be removed by
the department prior to transfer. The department shall be responsible for
adjusting the department's property records to reflect this transfer and change
of ownership. Annually thereafter, the managing entity shall submit to the
South Florida Behavioral Health Network, Inc. 158 KH225
10/01/2010 Exhibit I
Tangible Property Requirements
department a complete inventory of all property transferred from the
department.
The inventory shall include all data elements described in Section 3. below,
and clearly reflect any replacement or disposition of the property.
3. Property Items Purchased by Managing Entity
a. If the managing entity purchases any property with funds provided by this
contract, the managing entity shall inventory all such property, and on an
annual basis, the managing entity shall submit a complete inventory of all
such property to the department.
b. The inventory shall include, at a minimum, a description of the property/unique
identifier, manufacturer's serial number, acquisition date, original acquisition
cost, current location, condition, and clearly reflect any replacement or
disposition of the property.
c. The managing entity's contract with a subcontractor funded from funds
contained in this contract shall not permit the purchase of any motor vehicles.
However, the managing entity may purchase a motor vehicle and
subsequently enter into a lease agreement with the subcontractor for the use
of the motor vehicle.
4. Property Items transferred from Former Department Contractors and
Current Subcontractors
a. Property transferred to or purchased by former contractors through prior
agreements with the department shall be inventoried, agreed upon and signed
by the department and the former contractors. This property shall then be
transferred from the department to the managing entity where the title will vest
until this contract is terminated. The managing entity may not transfer title to
any subcontractor. Any property transferred to or purchased by the managing
entity and used by a subcontractor will be authorized through a written
agreement between the managing entity and the subcontractor. Under the
written agreement, the managing entity will hold the subcontractor responsible
for all repairs, maintenance and insurance for said property, Any property
purchased by the subcontractor must be maintained by the subcontractor and
returned to the managing entity upon termination of the written agreement. This
property will be included on the managing entity's inventory.
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10/01/2010 Exhibit I
Tangible Property Requirements
b. All subcontractors, regardless of the method of payment in the contract, must
provide an annual inventory of all property to the managing entity for inclusion
in the managing entity's annual inventory report. The subcontractor's
inventory shall include all data elements described in 3.b. above.
5. Disposition
a. If the managing entity replaces or disposes of property transferred to or
purchased by the managing entity pursuant to this contract, the managing entity
is required to provide accurate and complete information pertaining to
replacement or disposition of the property on the managing entity's annual
inventory as required by paragraph 3.b.
b. If the subcontractor replaces or disposes of property transferred to or
purchased by the subcontractor pursuant to that contract, the subcontractor is
required to provide accurate and complete information pertaining to
replacement or disposition of the property on the subcontractor's annual
inventory as required by paragraph 3.b.
c. The contract manager must provide disposition instructions to the managing
entity prior to the end of the contract period. The managing entity cannot
dispose of any property that reverts to the department without the contract
manager's approval.
6. Termination
a. The managing entity shall furnish a closeout inventory no later than 30 days
before the completion or termination of this contract. The closeout inventory
shall include all property transferred to or purchased by the managing entity
including any property leased by the managing entity to any subcontractor
and all property purchased by any subcontractor.
b. The closeout inventory shall contain, at a minimum, the same annual
inventory information required by paragraph 3.b.
c. Title (ownership) to and possession of all property transferred to or purchased
by the managing entity pursuant to this contract shall be vested in the
department upon completion or termination of this contract. Upon return to the
department, all property must be in good working order. The managing entity
hereby agrees to pay the cost of transferring title to and possession of any
property for which ownership is evidenced by a certificate of title. Property
items purchased with funds from the federal Miami —Dade Wraparound
Project (MDWP) Cooperative Agreement# 1 U79SM059055-01 and given to
MDWP eligible youth may remain with the client and may not be vested in the
department.
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10/01/2010 Exhibit I
Tangible Property Requirements
d. The managing entity shall be responsible for repaying to the department the
replacement cost of any property inventoried and not returned to the
department upon completion or termination of this contract.
7. General
a. All inventories required by these sections shall be updated and accurate to
the date of inventory certification.
b. With the exception of lease agreements entered into as described in section
3.a. above, during the term of this contract, the managing entity is responsible
for insuring all property included in its annual inventory report and maintaining
such property in good working order.
c. The managing entity hereby agrees to indemnify the department against any
claim or loss arising out of the operations of any motor vehicle transferred to
or purchased by the managing entity pursuant to this contract.
d. A formal contract amendment is required prior to the purchase of any property
item not specifically listed in the approved budget.
South Florida Behavioral Health Network, Inc. 161 KH225
07/01/2008 Exhibit I
Tangible Property Requirements
Managing Entity Property Inventory & Disposition
Managing Entity Name and Contract # Contact person:
Phone Number:
Address:
City,State,Zip:
Inventory
Description of Property/ DCF Transfer ME Original Current Condition Disposition
Description
Identifier Serial# Date If Acquisition Acquisition Location (E-G-F-P) Remarks/Comments
Applicable Date Cost
Disposition____
DCF Transfer ME Original Current Condition Disposition
Description of Property/ Serial# Date If Acquisition Acquisition
Unique Identifier Applicable Date Cost Location (E-G-F-P) Remarks/Comments
By my signature below, I hereby certify that all confidential data, including protected health information, has been permanently removed from all computer related
media that has been transferred to or from my custody. Furthermore, I certify that the removal of this information has been done so in the manner described in the
Department of Children and Families Operating Procedure CFOP 50-2. 1 understand that any violation of that procedure may result in substantial fines and/or
criminal prosecution according to provisions of Federal and State statutes.
I hereby certify that all items of equipment included in this inventory list have been physically checked and are in custody of this contract provider,except as noted in
the remarks section of this inventory,as of this date. I also certify to the location and condition of this equipment and/or furniture as noted.
CONTRACT ME's SIGNATURE: DATE:
(Acknowledging Receipt or inventory of Property)
CONTRACT MANAGER'S SIGNATURE: DATE:
(Acknowledging Receipt which contains a Copy of the Inventory and/or Disposition Property)
South Florida Behavioral Health Network,Inc. 162 KH225
Attachment 11
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an employee
of any agency, a member of congress, an officer or employee of congress, or an employee of
a member of congress in connection with the awarding of any federal contract, the making of
any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a member of congress in
connection with this federal contract, grant, loan, or cooperative agreement, the undersigned
shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
Signature Date
John Dow KH225 --
Name of Authorized Individual Application or Contract Number
South Florida Behavioral Health Network, Inc.
Name of Organization
2140 South Dixie Highway, Suite#204-205, Miami Florida 33133
Address of Organization
CF 1123, PDF 03196 Page 163
ATTACHMENT III
The administration of resources awarded by the Department of Children&Families to the provider may be
subject to audits as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-]33 and Section 215.97,
F.S.,as revised,the department may monitor or conduct oversight reviews to evaluate compliance with
contract, management and programmatic requirements. Such monitoring or other oversight procedures
may include,but not be limited to,on-site visits by department staff, limited scope audits as defined by
OMB Circular A-133,as revised,or other procedures. By entering into this agreement,the recipient agrees
to comply and cooperate with any monitoring procedures deemed appropriate by the department. In the
event the department determines that a limited scope audit of the recipient is appropriate,the recipient
agrees to comply with any additional instructions provided by the department regarding such audit. The
recipient further agrees to comply and cooperate with any inspections,reviews, investigations,or audits
deemed necessary by the department's inspector general,the state's Chief Financial Officer or the Auditor
General.
AUDITS
PART 1: 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-1.33,as revised. In determining the Federal awards expended during its fiscal year,the recipient shall
consider all sources of Federal awards, including Federal resources received from the Department of
Children&Families. The determination of amounts of Federal awards expended should be in accordance
with guidelines established by OMB Circular A-133,as revised. An audit of the recipient conducted by the
Auditor General in accordance with the provisions of OMB Circular A-]33,as revised,will meet the
requirements of this part. In connection with the above audit requirements,the recipient shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133,as
revised.
The schedule of expenditures should disclose the expenditures by contract number for each contract with
the department in effect during the audit period. The financial statements should disclose whether or not
the matching requirement was met for each applicable contract. All questioned costs and liabilities due the
department shall be fully disclosed in the audit report package with reference to the specific contract
number.
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PART 11: STATE REQUIREMENTS
]'his part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2),Florida Statutes.
In the event the recipient expends$500,000 or more in state financial assistance during its fiscal year,the
recipient Must have a State single or project-specific audit conducted in accordance with Section 215.97,
Florida Statutes;applicable rules of the Department of Financial Services-,and Chapters 10.550(local
governmental entities)or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General. In
determining the state financial assistance expended during its fiscal year,the recipient shall consider all
sources of state financial assistance, including state financial assistance received from the Department of
Children& Families,other state agencies,and other nonstate entities. State financial assistance does not
include Federal direct or pass-through awards and resources received by a nonstate entity for Federal
program matching requirements.
In connection with the audit requirements addressed in the preceding paragraph,the recipient shall ensure
that the audit complies with the requirements of Section 215.97(8),Florida Statutes. This includes
submission of a financial reporting package as defined by Section 215.97(2),Florida Statutes,and Chapters
10,550 or 10.650, Rules of the Auditor General.
The schedule of expenditures should disclose the expenditures by contract number for each contract with
the department in effect during the audit period. The financial statements should disclose whether or not
the matching requirement was met for each applicable contract. All questioned costs and liabilities due the
department shall be fully disclosed in the audit report package with reference to the specific contract
number.
PART III: REPORT SUBMISSION
Any reports,management letters,or other information required to be submitted to the department pursuant
to this agreement shall be submitted within 180 days after the end of the provider's fiscal year or within 30
days of the recipient's receipt of the audit report,whichever occurs first,directly to each of the following
unless otherwise required by Florida Statutes:
A. Contract manager for this contract(2 copies)
B. Department of Children&Families( I electronic copy and management letter, if issued
Office of the Inspector General
Single Audit Unit
Building 5,Room 237
1317 Winewood Boulevard
Tallahassee,FL 32399-0700
Email address: sin e a � i azdcf'stat(:,0,us
- �6'1 1 Li ____......__ __
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165
C, Reporting packages for audits conducted in accordance with OMB Circular A-133,as revised,and
required by Part I of this agreement shall be submitted,when required by Section .320(d),OMB
Circular A-133,as revised,by or on behalf of the recipient directly to the Federal Audit Clearinghouse
using the Federal Audit Clearinghouse's Internet Data Entry System at:
http://harvester.census.gov/fac/collect/ddeindex.html
and other Federal agencies and pass-through entities in accordance with Sections.320(e)and
OMB Circular A-133,as revised.
D. Copies of reporting packages required by Part 11 of this agreement shall be submitted by or on behalf
of the recipient directly to the following address:
Auditor General
Local Government Audits/342
Claude Pepper Building, Room 401
111 West Madison Street
Tallahassee,Florida 32399-1450
Email address: flaudgen_localgovt(&,and.state.fl.us
Providers,when submitting audit report packages to the department for audits done in accordance with
OMB Circular A-133 or Chapters 10.550(local governmental entities)or 10.650(nonprofit or for-profit
organizations),Rules of the Auditor General,should include,when available,correspondence from the
auditor indicating the date the audit report package was delivered to them. When such correspondence is
not available,the date that the audit report package was delivered by the auditor to the provider must be
indicated in correspondence submitted to the department in accordance with Chapter 10.558(3)or Chapter
10.657(2),Rules of the Auditor General.
PART IV: RECORD RETENTION
The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement
for a period of six years from the date the audit report is issued and shall allow the department or its
designee,Chief Financial Officer or Auditor General access to such records upon request. The recipient
shall ensure that audit working papers are made available to the department or its designee,Chief Financial
Officer or Auditor General upon request for a period of three years from the date the audit report is issued,
unless extended in writing by the department.
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