Okaloosa County BOCC — October 7, 2014 — AH105 OKALOOSA BCC amendment #7 renewal Fully Executed — reading text

Officer pursuant to Rule 65E- 14.021(8)(d)5., F.A.C. d. Subcontractors The provider shall not subcontract for the provision of any service under this contract. 3. Service Location and Equipment a. Service Delivery Location The location of services will be as specified in the Program Description required by Rule 65E-14.021(5)(e)1. c., F.A.C. b. Service Times (1) The days and times will be as specified in the Program Description. (2) The provider shall notify BBCBC/PSYCHCARE, in writing, at least ten (10) calendar days prior to any changes in days and times where services are being provided pursuant to Rule 65E-14.021(8)(d)5., F.A.C. c. Changes in Location The provider shall notify BBCBC/PSYCHCARE, in writing, at least ten (10) calendar days prior to any changes in locations where services are being provided pursuant to Rule 65E-14.021(5)(e)1.c.(I), F.A.C. d. Equipment The provider shall furnish all appropriate equipment necessary for the effective delivery of the services purchased. 4. Deliverables a. Services The provider shall deliver the services specified in and described in the Program Description submitted by the provider and as set forth in, Exhibit G, Services to be Provided. b. Records and Documentation The provider shall protect confidential records from disclosure and protect client confidentiality in accordance with ss. 397.501(7), 394.455(3), 394.4615, and Okaloosa County Board of County Commissioners Page 13 Contract No.AH105 08/25/14 414.295, F.S., and also the Health Insurance Portability and Accountability Act (HIPAA), and any other applicable State, and Federal laws, rules, and regulations. c. Reports (1) The provider shall submit to BBCBC/PSYCHCARE financial and programmatic reports specified in Exhibit C, Required Reports, by the timeframes specified. (2) The provider shall ensure that its audit report will include the standard schedules that are outlined in Rule 65E-14.003, F.A.C. (3) The provider shall electronically submit treatment data by the Sth of the month following service provision, and specified in the DCF PAM 155-2. The 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 BBCBC data system is consistent with the data maintained in the provider's clients’ files; (c) Data to be submitted will be: i. For Substance Abuse clients Upon Admission to the program: e Demographics Forms (DEMO) e Substance Abuse Outcome Admission form ASAM Admission form For every service provided: e Client Specific Services Form Upon Discharge from the program: e ASAM Discharge e Substance Abuse Outcome Discharge ii. _For Mental Health Clients: Upon Admission to the program: Okaloosa County Board of County Commissioners Page 14 Contract No.AH105 08/25/14 Demographics Forms (DEMO) Mental Health Admission Form (PERF) Mental Health Immediate Discharge for Consumers not admitted to the program Admission FARS for consumers who are admitted to program (on admission, every 6 months and at discharge) For every service provided: e Client Specific Services Form (SERV) Upon Discharge from the program: e Mental Health Discharge e Discharge FARS (4) Delivery of reports shall not be construed to mean acceptance of those reports. BBCBC/PSYCHCARE reserves the right to reject reports as incomplete, inadequate, or unacceptable. 5. Performance Specifications a. Performance Measures (1) The provider shall meet the performance standards and required outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs. (2) The provider agrees that SAMHIS will be the source for all data used to determine compliance with treatment related performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs. The provider shall submit all service related data for clients funded, in whole or in part, by BBCBC funds, Medicaid, or local match. b. Performance Measurement Terms DCF PAM 155-2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used to objectively measure a provider's performance, and contain policies and procedures for submitting the required data into SAMHIS. c. Performance Evaluation Methodology (1) Providers shall collect information and submit performance data and Okaloosa County Board of County Commissioners Page 15 Contract No.AH105 08/25/14 individual client outcomes in compliance with DCF PAM 155-2 requirements. The specific methodologies for each performance measure may be found at the following website: http://dcfdashboard.dcf.state.fl.us. (2) The provider shall have the capability to engage in organized performance improvement activities, and to be able to participate in partnership with 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 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 provider fails to meet these standards, BBCBC/PSYCHCARE may allow a reasonable period, not to exceed six (6) months, for the provider to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of BBCBC within the prescribed time, and if no extenuating circumstances can be documented by the provider to BBCBC’s satisfaction, BBCBC must terminate the contract. BBCBC has the sole authority to determine whether there are extenuating or mitigating circumstances. (4) BBCBC/PSYCHCARE will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, during the contract period, to determine if the provider is achieving the levels that are specified. (5) Performance data information may be found on the department’s web- based performance Dashboard at: http://dcfdashboard.dcf.state.fl.us/. 6. Provider Responsibilities a. Provider Unique Activities (1) The provider shall ensure that the invoices submitted to BBCBC/PSYCHCARE reconcile with the amount of funding and services specified in this contract, as well as the provider's agency audit report and client information system. (2) The 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. (3) Pursuant to s. 394.74(3)(e), F.S., the provider shall maintain data on the performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs,. The provider shall submit such data to BBCBC/PSYCHCARE upon request. Data submission requirements can be found in DCF PAM 155-2. Okaloosa County Board of County Commissioners Page 16 Contract No.AH105 08/25/14 (4) A 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 | and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x-21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (5) A 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. (6) Upon request the provider shall furnish supporting documentation and make available source documentation of units billed to BBCBC. (7) Client Trust Fund (a) All providers shall submit a letter to BBCBC/PSYCHCARE 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 15" of each fiscal year. 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 BBCBC/PSYCHCARE or the provider. (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 provider hereby agrees to fulfill their designated role in implementing and/or maintaining a system of care with the Community-Based Care providers within their communities through the execution of a BBCBC/PSYCHCARE approved working agreement. 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. (4) The working agreement shall be submitted to BBCBC/PSYCHCARE within ninety (90) days of contract execution. c. Minimum Service Requirements Okaloosa County Board of County Commissioners Page 17 Contract No.AH105 08/25/14 See Exhibit F, Minimum Service Requirements 7. BBCBC Responsibilities a. BBCBC Obligations (1) Upon written request to BBCBC/PSYCHCARE and when deemed necessary by BBCBC/PSYCHCARE, BBCBC/PSYCHCARE agrees to provide technical assistance concerning the terms and conditions of this contract. (2) BBCBC/PSYCHCARE will participate in the collaborative development and implementation of the working agreement with the Community-Based Care and Substance Abuse and Mental Health providers to ensure the integration of services and support within the community. b. BBCBC Determinations BBCBC has exclusive authority to make the final approval of services eligible for payment. If these determinations involve the management information or fiscal accounting systems, both parties agree that these determination procedures must comply with the provisions of section 394.77, F.S. c. Monitoring Requirements (1) The provider shall be monitored in accordance with s. 394.741, F.S., and internal monitoring requirements and plans. (2) The provider shall be monitored on its performance of all tasks and special provisions of the contract. ‘ C. Method of Payment Exhibit B, Method of Payment Exhibit E, Invoice Exhibit E-1, Invoice Attachment Exhibit G, Funding by Program/Activity D. Special Provisions 1. Transportation Disadvantaged The provider agrees to comply with the provisions of Chapter 427, F.S., Part |, Transportation Services, and Chapter 41-2, F.A.C., Commission for the Okaloosa County Board of County Commissioners Page 18 Contract No.AH105 08/25/14 Transportation Disadvantaged, if public funds provided under this contract will be used to transport clients. The provider agrees to comply with the provisions of Children and Families Operating Procedures CFOP 40-5 (CFOP 40-5) Acquisition of Vehicles For Transporting Transportation Disadvantaged Clients if public funds provided under this contract will be used to purchase vehicles which will be used to transport clients. 2. Client Satisfaction Survey The provider shall conduct client satisfaction surveys pursuant to DCF PAM 155-2. 3. Incident Reports a. The provider will submit to BBCBC/PSYCHCARE, in writing, information related to client risk prevention and incidents as defined in Children and Families Operating Procedures CFOP 215-6 (CFOP 215-6) Incident Reporting and Client Risk Prevention. b. All providers (inpatient and outpatient) will report seclusion and restraint events in accordance with 65E-5.180(7)(g) F.A.C. 4. National Provider Identifier (NPI)