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

a. All providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. b. An application for an NPI may be submitted online at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart. c. Additional information can be obtained from one of the following websites: (1) The Florida Medicaid HIPAA located at: http://Awww.fdhc.state.fl.us/hipaa/index.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: https://nppes.cms.hhs.gov/NPPES/Welcome.do (3) The CMS NPI located at: http://www.cms.hhs.gov/NationalProvidentStand/ 5. 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 (1) person to act as its representative for dispute resolution purposes and shall notify the other party of the person’s name and business Okaloosa County Board of County Commissioners Page 19 Contract No.AH105 08/25/14 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 BBCBC’s COO of the respective parties. Upon referral to this second step, the Executive Director and the BBCBC’s COO will confer in an attempt to resolve the issue. b. If BBCBC’s COO and Executive Director are unable to resolve the issue within ten (10) working days, the parties’ appointed representatives will meet within ten (10) working days and select a third representative. These three (3) representatives will 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 will make written recommendations to the department's Secretary 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. 6. 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 BBCBC/PSYCHCARE; 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 Children and Families Operating Procedures CFOP 180-4 (CFOP 180-4) Mandatory Reporting Requirements to The Office of The Inspector General. 7. Supplemental Security Income/Social Security Disability Insurance [SSV/SSDI], Outreach, Access and Recovery (SOAR) Okaloosa County Board of County Commissioners Page 20 Contract No.AH105 08/25/14 The provider may participate in the SOAR technical assistance initiative. This strategy helps States and communities increase access to SSI and SSDI for people through training, technical assistance and strategic planning. It utilizes the Substance Abuse and Mental Health Services Administration's (SAMHSA) "Stepping Stones to Recovery" training curriculum. The success factors include approval rates of 65-95% on initial Social Security Administration (SSA) applications. E. The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. 1. Exhibit A, Clients 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, Invoice Exhibit E-1, Invoice Attachment 6. Exhibit F, Minimum Service Requirements, 7. Exhibit G, Funding by Program/Activity Okaloosa County Board of County Commissioners Page 21 Contract No.AH105 ATTACHMENT II The administration of resources awarded by the Department of Children & Families to the provider through Big Bend Community Based Care may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 215.97, F.S., as revised, the department may monitor or conduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring or other oversight procedures may include, but not be limited to, on-site visits by BBCBC 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 BBCBC. In the event BBCBC determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by BBCBC, the department’s inspector general, the state’s Chief Financial Officer or the Auditor General. AUDITS PARTI: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non-profit organization as defined in OMB Circular A-133, as revised. In the event the recipient expends $500,000 or more in Federal awards during its fiscal year, the recipient must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. The recipient agrees to provide a copy of the single audit to BBCBC submitting an electronic copy to mecontracts@bigbendcbc.org . In the event the recipient expends less than $500,000 in Federal awards during its fiscal year, the recipient agrees to provide certification to BBCBC submitting an electronic copy to mecontracts@bigbendcbe.org that a single audit was not required. In determining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from, BBCBC, the Department of Children & Families, Federal government (direct), other state agencies, and other non-state entities. The determination of amounts of Federal awards expended should be in accordance with guidelines established by OMB Circular A-133, as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. The schedule of expenditures should disclose the expenditures by contract number for each contract with BBCBC 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 BBCBC shall be fully disclosed in the audit report package with reference to the specific contract number, Single Audit Information for Recipients of Recovery Act Funds: (a) To maximize the transparency and accountability of funds authorized under the American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5) (Recovery Act) as required by Congress and in accordance with 2 CFR 215.21 ‘‘Uniform Administrative Requirements for Grants and Agreements’ and OMB Circular A-102 Common Rules provisions, recipients agree to maintain records that identify adequately the source and application of Recovery Act funds. OMB Circular A-102 is available at http://www.whitehouse.gov/omb/circulars/a102/a102.html . (b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-133, **Audits of States, Local Governments, and Non-Profit Organizations,’ recipients agree to separately identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of Federal Awards (SEFA) and the Data Collection Form (SF-SAC) required by OMB Circular A—133. OMB Circular A-133 is available at http://www.whitehouse.gov/omb/circulars/al33/al33.html. This shall be accomplished by identifying expenditures for Federal awards made under the Recovery Act separately on the SEFA, and as separate rows under Item 9 of Part III on the SF-SAC by CFDA number, and inclusion of the prefix ‘‘ARRA-”’ in identifying the name of the Federal program on the SEFA and as the first characters in Item 9d of Part III on the SF-SAC. (c) Recipients agree to separately identify to each sub-recipient, and document at the time of sub-award 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 sub-recipients shall distinguish the sub-awards of incremental Recovery Act funds from regular sub-awards under the existing program. (d) Recipients agree to require their sub-recipients to include on their SEFA information to specifically identify Recovery Act funding similar to the requirements for the recipient SEFA described above. This information is needed to allow the recipient to properly monitor sub-recipient expenditure of ARRA funds as well as oversight by the Federal awarding agencies, Offices of Inspector General and the Government Accountability Office. PART Il: STATE REQUIREMENTS This part is applicable if the recipient is a non-state 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. The recipient agrees to provide a copy of the single audit to the Big Bend Community Based Care at mecontracts@bigbendcbc.org . In the event the recipient expends less than $500,000 in State financial assistance during its fiscal year, the recipient agrees to provide certification to BBCBC submitting such certification to mecontracts@bigbendcbc.org stating that a single audit was not required. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from BBCBC, the Department of Children & Families, other state agencies, and other non-state entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a non-state 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 as well as Rule 65E-14.003(2)(a) F.A.C. which requires that the audit package shall contain four