INVITATION TO NEGOTIATE (ITN) ADDENDUM. DATE: June 20, Revisions to ITN and Answers to Respondent s Questions

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1 INVITATION TO NEGOTIATE (ITN) ADDENDUM DATE: June 20, 2013 ADDENDUM #1 DMS CLASS CODE: , ITN# SUBJECT: Revisions to ITN and Answers to Respondent s Questions DATE DUE: Tuesday, July 9, 2013 at 2:00 p.m. Interested Respondents are encouraged to closely review this ITN document for changes. This Addendum # 2 contains questions submitted by Respondents and the Department s answers and revisions to the Invitation to Negotiate specifications. The subject Invitation to Negotiate is hereby amended by deleting, adding, updating or replacing, as indicated by highlighting the section(s) below: REFERENCE: DELETE: ADD: Page 1, Introductory Page, Subject, Paragraph Two The second paragraph is deleted in its entirety. Respondents shall note that the Department desires to begin referring youth for Redirections services no later than November 1, 2013 so interested parties shall currently be a Florida Medicaid Enrolled Type 05 Provider (somewhere currently operating in Florida) or submit proof of application for Enrolled Medicaid Type 05 Provider status through submission to the Department their ATN (Application Tracking Number) if the Provider proposes to deliver Medicaid Redirection services modalities, i.e. Evidence Based treatment/therapies. Submittal requirements are listed in Attachment B, XX, A. 9., (Transmittal Letter). REFERENCE: DELETE: ADD: Page 3, Attachment A, Section I., Introduction and Background, Paragraph Four This paragraph is deleted in its entirety. Respondents shall note that the Department desires to begin referring youth for Redirections services no later than November 1, 2013 so interested parties shall currently be a Florida Medicaid Enrolled Type 05 Provider (somewhere currently operating in Florida) or submit proof of application for Enrolled Medicaid Type 05 Provider status through submission to the Department their ATN (Application Tracking Number) if the Provider proposes to deliver Medicaid Redirection services modalities, i.e. Evidence Based treatment/therapies. Submittal requirements are listed in Attachment B, XX, A. 9., (Transmittal Letter). REFERENCE: Page 34, Attachment B, Section IV, A. Summary of ITN Process DELETE: This section is deleted in its entirety. ADD: A. Summary of ITN Process: The evaluation and negotiation phases of the Department s ITN process will consist of three (3) components: 1. Written Response Evaluations: All Respondents meeting Mandatory requirements shall have their Written Response evaluated and scored. Page 1 of 25

2 2. Negotiation Presentations: As determined by the team of evaluators/negotiators, one or more Respondents shall be required to provide a Presentation as part of the initial negotiation process. 3. Negotiations: The Department will then negotiate with one or more Respondents to determine Contract Award. Additional negotiations may be held if determined necessary by the Department. Following negotiations, the Department will post a notice of Final Agency Decision, identifying the Respondent(s) selected for award. Final contract terms will be established with the selected Respondent(s). REFERENCE: Page 34, Attachment B, Section IV, B. Calendar of Events UPDATE AND ADD: Debriefing Meeting # 3 of the Negotiation Team (occurring Thursday, August 8, 2013) added immediately after Negotiation Presentations, thereby resulting in the renumbering of the remaining Debriefing Sessions. DATE TIME ACTION WHERE: Friday May 24, 2013 C.O.B. Release of solicitation MyFlorida.com web site Tuesday, June 4, 2013 C.O.B. Solicitation Conference Question Deadline Last date and time written questions will be accepted for Discussion at Solicitation Send to Elaine.Atwood@djj.state.fl.us Tuesday, June 4, 2013 Tuesday June 11, 2013 Thursday, June 13, 2013 Thursday, June 20, 2013 Tuesday, July 9, 2013 Friday, July 12, 2013 C.O.B. 2:00 p.m., EST Conference Deadline for Submission of Intent to Attend Solicitation Conference Form (Attachment M). Solicitation Conference/Conference Call (This is a Public Meeting to be held only upon public request) COB Solicitation Question Deadline Last date and time written questions will be accepted. Deadline for Submission of Intent to Respond (Attachment N). COB Anticipated date that answers to written questions will be posted on the web Page 2 of 25 Send to Elaine.Atwood@djj.state.fl.us Bureau of Contracts Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL or telephone and enter code when directed Agenda can be found on MyFlorida.com web site under the solicitation #. Send to Elaine.Atwood@djj.state.fl.us MyFlorida.com web site under the solicitation #. site 2:00 p.m. Responses due and opened Attention: Elaine Atwood, Procurement Manager, CPPB, FCCN DJJ, Bureau of Contracts 2737 Centerview Drive, Suite 1100 Tallahassee, FL :00 a.m. Evaluator Briefing (Instructions and Confirmation or Receipt of Materials for Written Narrative Response Evaluation) Monday, 10:00 a.m. Evaluator Debriefing #1 Bureau of Contracts Bureau of Contracts Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL A recording of the Conference Call will be available at within 48 business hours of briefing.

3 July 29, 2013 Wednesday, July 31, 2013 Tuesday, Wednesday, Thursday August 6, 7, 8, 2013 Meeting (Written Narrative Responses) (Public Meeting/Recorded) 2:00 p.m. Debriefing #2 Meeting of the Evaluation Team to Determine Number of Respondents to Move Forward to Presentations (Public Meeting/Recorded) TBD Negotiation Presentations (Final Dates and Times to be Communicated to Respondents selected for Negotiation Presentations Meetings Not Open to the Public, but Recorded) Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL A recording of the Conference Call will be available at within 48 business hours of debriefing. Bureau of Contracts Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL A recording of the Conference Call will be available at within 48 business hours of debriefing. Specific Room Location TBD Respondents shall go to the Knight Building, DJJ Headquarters, 2737 Centerview Drive, Tallahassee, FL (Go to Lobby for directions and contact the Procurement Manager for this Procurement) Thursday, August 8, 2013 Week of August 14,15,16, 2013 Immediately Following First Round of Negotiations Week of August 19-23, 2013 Tuesday, September 10, 2013 Monday, September 16, 2013 November 1, 2013 Immediately following last presentation Debriefing # 3 of Negotiation Team to Determine Respondents to move Forward to Negotiations TBD Anticipated Weeks/Dates of First Round of Negotiations (Final Dates and Times to be Communicated to Ranking Respondents selected for Final Negotiation - Meetings Not Open to the Public, but Recorded) 3:00 Debriefing #4 of Negotiation Team To Determine Respondents to Move Forward to Second Round of Negotiations (Public Meeting/Recorded) TBD Optional 2 nd Round of Negotiations- Anticipated Weeks/Dates of Second Round of Negotiations (Final Dates and Times to be Communicated to Ranking Respondents selected for Final Negotiation - Meetings Not Open to the Public, but Recorded) 1:00 p.m. Debriefing # 5 - Meeting of Negotiation Team to Determine Recommended Award(s) (Public Meeting/Recorded) Anticipated date of posting of Notice of Final Agency Decision Anticipated Contract Execution Date/Start of Page 3 of 25 Bureau of Contracts Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL A recording of the Conference Call will be available at within 48 business hours of debriefing. Negotiations are anticipated to be held in Tallahassee, Florida- Final Location subject to change at Department discretion. Bureau of Contracts Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL A recording of the Conference Call will be available at within 48 business hours of debriefing. Negotiations are anticipated to be held in Tallahassee, Florida- Final Location subject to change at Department discretion. Bureau of Contracts Knight Building, DJJ Headquarters 2737 Centerview Drive; (Go to Lobby for directions) Tallahassee, FL A recording of the Conference Call will be available at within 48 business hours of debriefing. MyFlorida.com web site

4 Contracts REFERENCE: Page 37 Attachment B, Section IV. G. Debriefing Meetings DELETE: This section is deleted in its entirety. ADD: G. Debriefing Meetings(s) The Department will hold Evaluator/Negotiator Debriefing Sessions in accordance with the Calendar of Events. These meetings are open for public attendance; however, no public comments will be accepted. A recording of the meeting will be available on the Department s website ( within 48 business hours of the end of the Debriefing Meeting(s). Debriefing meetings will be held as follows: 1. There will be an Evaluation Team meeting (Debriefing #1) of the written responses to allow evaluators an opportunity to identify the page number(s) in the responses where information relied on for assessing a score was found and to record the scores assessed for the written responses. Discussions, strengths, weaknesses or other comments on responses will not be made by evaluators. Additional information on the evaluation process is contained in Attachment F of the ITN. 2. The Evaluation Team will meet (Debriefing #2) to determine the number of Respondents, in ranking order, that will move forward for Negotiation Presentations as set for the in subsection H, below. Additional information on the negotiation process is contained in Attachment F of the ITN. 3. The team will meet (Debriefing # 3) to determine the number of Respondents to move to round one negotiations. 4. After first round negotiations are completed, the team will meet (Debriefing #4) to determine the number of Respondents to move to the second round of negotiations or those selected to move to the Summary Supplemental Response Request (SSRR) phase. 5. After receipt of Summary Supplemental Response Request, the Negotiation Team will meet (Debriefing #5) to make a recommendation for contract award(s). 6. Additional information on the negotiation process is contained in Attachment F of the ITN REFERENCE: Page 37, Attachment B, Section IV. I., Negotiations DELETE: This section is deleted in its entirety. ADD: I. Negotiations 1. The team will discuss the results of the Negotiation Presentations and their evaluation of the Written Response to determine which Respondent(s) to move forward for round one negotiations. 2. After round one negotiations, the team will meet to determine which Respondent(s) will move forward to a second round of negotiations and/or move to the SSRR phase. Page 4 of 25

5 REFERENCE: Page 41, Attachment B, Section XX, A, # 9 (Transmittal Letter) DELETE: Delete paragraph # 9 in its entirety ADD: #9. The statement: On behalf of (insert Respondent s name) this letter certifies that the Respondent agrees to work cooperatively with the Department in implementation of Redirections Services for Medicaid eligible youth as specified in the Medicaid State Plan (1951i) Amendment and Attachment A-2 of this document. 1) Providers shall provide either a. proof of their current Enrolled Medicaid Type 05 status or b. submit proof of application for Enrolled Medicaid Type 05 Provider status through submission to the Department their ATN (Application Tracking Number) if the Provider proposes to deliver Medicaid Redirection services modalities, i.e. Evidence Based treatment/therapies. 2) In addition, all Providers wishing to propose Medicaid Redirections must also state their intent to proceed with obtaining further certification as a Medicaid Redirections provider by the Department QIO in order to deliver services in accordance with all Medicaid Requirements as specified in Attachment A-2. 3) All Providers seeking to provide Medicaid Redirections services shall also state their agreement to accept payment for services for Medicaid eligible youth at the established Medicaid rates to be paid direct to Medicaid service providers. REFERENCE: Page 52, Attachment F, D. 3.a., First Round of Negotiations DELETE: This section is deleted in its entirety. ADD: a. After Negotiation Presentations are concluded, the team members will meet to determine the number of Respondents to move to round one negotiations. Additional documentation may be requested from Respondents prior to the first round of negotiations. Page 5 of 25

6 REFERENCE: UPDATE: Page 69, Attachment P, D. Service Coverage D. Service Coverage and Variety of Interventions 1) The Respondent shall complete Exhibit 1 of this ITN outlining the County proposed to be served and the proposed intervention services proposed and the number of initial slots proposed. 2) The Respondent shall complete Exhibit 2 of this ITN outlining details of the specific evidence-based practice (including treatment), promising practice and/or alternative family centered therapies proposed. Note: All interventions proposed must have a family component. Also identify if the specified delinquency intervention proposed is considered mental health or substance abuse treatment. (Weighted: 30 Max Pts: 90) MAX POINTS PAGE/NOTE/COMMENTS RATING CRITERIA EXPLANATION The Respondent clearly and concisely describes and/or details the required information and: The proposed number of initially placed unduplicated 3 slots for delinquency interventions and/or treatment Points services are identified; The evidence based, promising practice or alternative family-centered therapies and/or treatment services proposed are identified ; There is a wide variety of service options and areas of service throughout the State. Appropriate details for the specific intervention and/or therapy/treatment services proposed are clearly detailed, demonstrating an understanding of the services to be provided. All interventions and/or treatment services proposed include some type of family component. The Respondent adequately describes and/or details the required information and: The proposed number of initially placed unduplicated 2 slots for delinquency interventions and/or treatment Points services are identified; The evidence based, promising practice or alternative family-centered therapies and/or treatment services proposed are identified; details for the specific intervention and/or therapy/treatment services proposed are identified, Some interventions and/or treatment services proposed include some type of family component. The Respondent minimally describes and/or details the required 1 information and: point The proposed number of initially placed unduplicated slots for delinquency interventions and/or treatment services are identified; The evidence based, promising practice or alternative family-centered therapies and/or treatment services proposed are identified, ; There is a basic description of intervention and/or therapy/treatment services proposed are identified, interventions and/or treatment services proposed do not clearly contain some type of family component. The Respondent does not provided Exhibit 1 or Exhibit 2; the Exhibits are incomplete and/or do not address each of the required details. 0 Points FINAL SCORE: INITIALS & DATE: Page 6 of 25

7 Return of Addendum #1 is not MANDATORY; however, the Respondent is responsible for its contents and is requested to sign and submit this Addendum with its response to the ITN. SIGNED BY: NAME: COMPANY: TITLE: DATE: Page 7 of 25

8 ITN #10068 DIRECT SERVICE PROVIDERS FOR REDIRECTIONS Initial Questions Received This document is provided for discussion purposes at the Solicitation Conference. (Questions are presented in exact manner received.) QUESTIONS FROM YOUTH VILLAGES INC. Question # 1: Who are the department s current contracted providers for Redirections Services and in which DJJ Circuit do they provide services? Answer #1: Please see the attached Chart of Current Redirection Services by County/Provider. Question # 2: Answer # 2: What are the current Redirections services rates? Does the department envision using similar services and rates to the current contracted Redirections programs? The current rates for Redirections Services are $68.89 per available slot. The Department is seeking a wide variety of intervention services that include Evidence Based practices (treatment/therapy), Promising Practice or Alternative Family-Centered Services and anticipates negotiating various rates depending on the service modality. Question # 3: Answer # 3 Related to the Department s implementation of the 1915i, can the Department label in more detail the complexity of the contractor s relationship with the QIO? The Direct Service Provider shall obtain Redirections certification from the Department s contracted Quality Improvement Organization. In addition, the QIO will be responsible, for authorizing Medicaid Eligible Services for Redirections. When the Direct Service Provider has received such authorization, services for Evidence Based Redirections Services, including therapy and therapeutic support, may be billed directly to the Agency for Health Care Administration at the Medicaid Rates established for the 1915 (1) State Plan Amendment for Medicaid Redirections. Question # 4: Answer # 4: What statute identifies staffing credential requirements for staff delivering services? Chapter 491, Florida Statutes establishes the credentials and licensure requirements for Clinical Social Workers, Mental Health Counselors and Marriage and Family Therapists. Chapter 490, Florida Statutes establishes the credentials and licensure requirements for Psychologists. Chapter 464, Florida Statutes establishes the credentials and licensure requirements for Psychiatric Advanced Registered Nurse Practitioners (Psychiatric ARNP) and Clinical Nurse Specialists with a sub-specialty in Child/Adolescent Psychiatric and Mental Health or Psychiatric and Mental Health Chapter 458 and Chapter 459, Florida Statutes establish the credentials and licensure requirements for Psychiatric Physician Assistants. Chapter 458 and Chapter 459, Florida Statutes establish the credentials and licensure requirements for Physicians and Psychiatrists. Chapter 397 establishes the licensure requirements for licensed substance abuse service providers. These statutes are specified in the ITN, Attachment A-1, Section III, Subsection C, Staffing/Personnel and the ITN, Attachment A-2 (1915(i) Medicaid State Plan Amendment). The ITN Attachment A-1 and Attachment A-2 also contain additional credentialing requirements for staff delivering Redirections Services. Page 8 of 25

9 Question # 5: Answer # 5: Would the department be open to a grant-style funding arrangement where DJJ pays the provider x amount per year for a certain number of youth served for that year? No. Payment will be made in arrears for services delivered. QUESTIONS FROM HENRY AND RILLA WHITE FOUNDATION, INC. Question # 6: Answer # 6: Question # 7: Answer # 7: How long do you anticipate the process will be to receive certification from the Department's QIO? The Department is currently seeking a Qualified Improvement Organization (QIO) to provide Redirections certification. The Department does anticipate Medicaid Enrolled Type 05 Provider will be able to obtain initial Redirections certification and be authorized to implement services by November 1, Are the Medicaid rates for Redirections fully established by AHCA, and if so, what are they? Must the rates for youth who are not Medicaid eligible be the same? Yes. Please see attached Medicaid rate sheet, included with this Addendum # 1 to the ITN. All youth must receive the same level of services for like services. Rates for Evidence Based services shall be paid at comparable rates as the Medicaid rate for DJJ referred youth who are not Medicaid eligible. Question # 8: While it's clear that respondents are encouraged to offer multiple services, can our response include different fixed rates for different services? Answer # 8: Yes. The Department anticipates negotiating different rates for different service modalities. Question # 9: Answer # 9: Question # 10: Answer # 10: On the Table that illustrates the estimated number of Redirection referrals by Circuit/Counties, do those numbers reflect new/expanded cases and capacity only or do they include capacity currently served by already existing Redirections programs? The numbers provided are not based on actual cases or capacity. As per the ITN, the number on the Table reflects the number of youth estimated to be referred for Redirections annually in each county throughout the State of Florida. These estimates are based on numbers of youth on probation or aftercare for the 2012 calendar year. A 15% referral estimated rate is used. Will already existing Redirection programs continue to operate or must they also compete for this ITN? Yes, an existing Redirection service provider must compete to receive a contract resulting from this ITN. The Department has not made a determination regarding any Redirections contracts not set to expire this year (2013). All qualified Providers are encouraged to compete. Question # 11: Under "Youth to be Served", the ITN indicates "11 to 19 years of age at the time of referral for services." However, under "Youth Eligibility" for Medicaid it indicates "Under 18 years of age". Are those differences intentional? Answer # 11: Yes. The Department will refer youth years of age; however only youth under 18 years of age could be Medicaid eligible. Question # 12: Answer # 12: Question # 13: Answer # 13: The ITN indicates that " The DJJ must authorize all individualized treatment plans." Who specifically will have that responsibility and how long will be the turnaround for approval? The Department OR their contracted Quality Improvement Organization (QIO) will authorize treatment plans. The length of the authorization process has not been determined, but is anticipated to take no longer than 48 hours. Our understanding is that Medicaid will reimburse based on an all-inclusive weekly rate. Must the reimbursement for non-medicaid services also be based on a weekly rate? Not necessarily. Final rates for various services, other than Medicaid eligible services, will be negotiated. Page 9 of 25

10 Question # 14: Answer # 14: Under "Method of Payment" in the proposed contract attached to the ITN, it indicates that the Department will pay the provider a filled and unfilled bed rate. Should this read slots instead of beds or will there be some other payment method? The Attachment G is a sample contract document. The final rates will be negotiated. The Department will only pay for services delivered. QUESTIONS FROM CAMELOT COMMUNITY CARE Question # 15: Is there any data on current redirections clients regarding the percentage of Medicaid eligible clients? Answer # 15: The Projected Number of Unduplicated Individuals To Be Served Annually by Medicaid was 403 youth. This number provided the projected funding for Medicaid reimbursement. However, please remember that youth may go and out of Medicaid eligibility during treatment. Question # 16: Is there a Medicaid case rate/reimbursement rate established? If yes, what is that rate? Answer # 16: Please see answer to question # 7. Question # 17: Answer # 17: Question # 18: Answer # 18: Question # 19: Answer # 19: Question # 20: Answer # 20: Will there be any start-up funds provided? No. The Department will only pay for services delivered to youth. Is it expected that the provider provide Substance Abuse/Psychiatric services for this contract or can they refer out for this service? Direct Service Providers shall deliver the specific Redirection Service(s), upon referral from the Department. These services include the Evidence Based practices (treatment/therapy), Promising Practice or Alternative Family-Centered Services proposed by the successful Respondent(s). As indicated in the ITN, Attachment A-1, Section III, Subsection A, 2.e., youths diagnosed with both mental disorder and substance-related disorder must receive an integrated mental health/substance abuse treatment plan. Thus, Redirection Services which provide mental health or substance abuse treatment (individual, group, or family counseling or other therapy service) must be capable of delivering both mental health and substance abuse services for youths with co-occurring disorders. All Redirection services (interventions) proposed do not need a mental health and/or substance abuse treatment component as long as they are Evidence Based, Promising Practices or Alternative Family-Centered services. Since DJJ is giving preference to agencies offering more than 1 model, would this also include giving preference for offering more than 1 model for each circuit that a provider applies? The Department is looking for a variety of services throughout all areas in the State. The intention of the ITN is to have a wide variety of Redirections services throughout the State. Can you please clarify if a provider can respond to specific circuits throughout each of the 3 DJJ designated regions or are they to apply to a region inclusive of all the circuits in that region? This is referenced on the Notice of Intent to Submit a Response intent to submit a response for ITN # for the provision of services as a Provider for a Redirections Services program in each of the Department s three (3) designated geographical regions. That is an error. This ITN is not seeking services specific to any geographical area at this time. Respondents are encouraged to provide a response for any areas of the state they can effectively and efficiently provide services. QUESTIONS FROM COMMUNITY SOLUTIONS Question # 21: Page 14 c 3 The department has final decision regarding disputed referral Does this mean the case is opened regardless of clinical decision or in consult with model? Answer # 21: If a case is not accepted upon referral, the Department will make the final determination (for the youth) based on information from the Provider. If a youth is not appropriate for a specific referral for a modality, the Department may refer the youth for alternative services/modalities. For Medicaid Redirections, the Department s contracted Quality Improvement Organization (QIO) will make the final determination/authorization for services. Page 10 of 25

11 Question # 22: Answer # 22: Page 16 c 1 g Diagnosis ; treatment recommended Neither MST or FFT requires diagnosis such as this (DSMIVR; Axis 1-V) Is this now a requirement? Will the diagnosis now be in the referral packet? Yes. Youth referred for Redirection Therapy Services, including Multisystemic Therapy or Functional Family Therapy must have a current DSM or ICD diagnosis. As indicated in the ITN, Attachment A-1, Section III., Subsection A, 2.c., when further assessment is indicated by the PACT, each youth must receive a Clinical Assessment. The Clinical Assessment must reflect consideration of diagnoses (DSM-IV-TR). Any prior assessments (e.g., Bio-Psychosocial Assessment, Psychological Evaluation, or predisposition Comprehensive Evaluation) obtained by the Department should be sent to the Provider as part of the referral packet. Question # 23: Answer # 23: Question # 24: Answer # 24: Question # 25: Answer # 25: Question # 26: Answer # 26: Question # 27: Answer # 27: Page 17 4 g 4 Administrative discharges. Will this be limited to within 7 days as is the current situation? No, administrative discharges will not be limited to just seven days, but should only be used under the circumstances outlined in the ITN. Page 17: Drug Screening ; Are we going to be the only screeners or are the clients screened by JPO and we just screen for suspected use? Providers will not be the only source of drug screening. Providers must have the capability for screening and shall screen for suspected use. Page 17: Slot Flexibility ; Will slots be added to circuits on top of existing slots i.e. changing the bottom line OR will slots be added to a circuit and removed from another circuit not changing the bottom line of slots being serviced? The Department is seeking the flexibility to move slots between Circuits, not increase the # of slots purchased. The final slot determination will be made during negotiations and is also dependent upon service coverage. The Department is anticipating payment for services at the rates established not to exceed a maximum dollar amount. Shifting of slots may or may not be feasible, depending on the negotiated awards. Page a-c Will we be trained on and have access to JJIS? Yes, as per the ITN, if the Department determines the need for Provider s to enter information into JJIS, the Department s Data Integrity Officer (DIO) will facilitate JJIS training prior to the anticipated Contract start date. The Data Reporting requirement is based on the Department s capability to provide access and utilization of JJIS to the successful Respondents. Pages 26-27: Minimum standards ; Do we come up with our own minimums or did you forget to add them? As per the ITN, the minimum standard (level of performance) shall be determined through the ITN process and set forth in the resultant contract. In addition, the technical response requires that the Respondent describe its approach to meeting the minimum performance outcomes, outputs and proposed Respondent s proposed level of performance for each stated measure. Question # 28: Page 33: Reimbursement Rates ; Which fee do we fall under? Answer # 28: Please see answer to question # 7. Question # 29: Answer # 29: Page 38: Mandatory Reqs ; Are we considered a current Provider since we are currently servicing DJJ clients OR is EBA considered the current Provider since they hold the current contract and we are contracted with EBA? The Department will not make a determination regarding a Provider s eligibilty at this time. A Direct Services Provider is one that renders services similar to those sought by this ITN by its own employees (or individually contracted/subcontracted clinical practioners) who are in direct contact with youth. A respondent/provider who renders administrative services such as a fiduciary agent, third party administrator, lead agency or managing Page 11 of 25

12 entity, without direct service contact with youth providing services similar to those sought by this ITN is not eligible for contract award. Question # 30: Answer # 30: General question: Is the Provider awarded allowed to earn revenue? This is a per diem rate with Medicaid funding. The Department does not understand the questions and asks that the question be clarified and resubmitted for a written response. QUESTIONS FROM VISION QUEST Question # 31: Are there priority points for agencies currently providing Redirections services in the state of Florida? Answer #31: No. However, experience is considered during the evaluation of responses. Question # 32: Answer #32: Question # 33: Answer #33: Question # 34: Answer #34: What is the federal Medicaid service definition that DJJ plans to have providers bill under? Payments will be processed through FLMMIS using the following HCPCs: Service Descriptions HCPC Redirection Service (Weekly) H0046 HY Redirection Therapy H2019 HY Redirection Therapeutic Support H2017 HY Is it expected that the Redirections Services as listed on ITN page 7 will be along the lines of mental health and substance abuse and will be evidence-based models (like FFT, etc.) or promising practices/family-centered therapies, while the Medicaid Redirections Services as separated on page 7 and elsewhere will be different services and will include individual, family, and group therapy? No, it is expected that Redirection Services include evidence based practices, promising practices or alternative family centered treatment/therapies that. Only Evidence-Based services (treatment/therapies) will be eligible for Medicaid reimbursement, after prior authorization by the Department s QIO. If an agency proposes to provide one type of service in a county or circuit, must that service be available for all anticipated referrals annually? (i.e. in Escambia County, Circuit 1, there are 164 anticipated slots: should one proposed service cover all 164 slots?) Could an agency propose to provide one service throughout the state, but only take a select number of slots per circuit/county and leave the rest available for other providers/services? (i.e. provide one service statewide but not use every youth slot?) Can an agency propose to provide multiple services in one circuit or county and divide the slots up accordingly? Please note: The data table in the ITN indicated there were 164 youth available for potential referral, not a need for 164 slots in Escambia County. If a provider offers one type of service in a county/circuit, they should propose the number of slots that would be available for the particular type of service modality. A provider could propose delivering more than one type of modality and one or more slots for each modality proposed. Yes, a provider can propose multiple services and divide their slots accordingly. The Department is seeking a wide variety of Redirections Services, including various service options/modalities for youth being referred for services. The number of slots will be negotiated. The Department cannot anticipate the specific service needs of referred youth, so we are seeking one or more slots for a variety of service modalities throughout the State. Question # 35: Answer #35: In designating geography, is DJJ interested in providers specifying by county or circuit? In the initial response, interested Providers shall submit Exhibit 2 outlining the available Redirection Services (interventions/modalities) in any county throughout the State. The Page 12 of 25

13 Department is seeking Providers who can deliver Redirection Services with a variety of modalities (evidence based, promising practices or alternative family-centered treatment/therapies) in as many areas of the State as possible. Question # 36: Answer #36: Question # 37: Answer # 37: Are multi-agency collaborations/consortiums allowed? Yes. As long as the Respondent is a direct service provider with the specific experience, collaborations/subcontracting may be authorized. If a provider is part of a collaboration or consortium and are not the lead entity, may they submit a separate proposal to provide services as the lead entity? The Department does not wish to limit the number of Respondents offering services. Respondents should note, not all modalities must be provided. Question # 38: May an agency submit several proposals with different consortiums/collaborative arrangements as the lead entity? Answer # 38: Please see answer to # 37. QUESTIONS FROM THE STARTING PLACE Question # 39: Attachment A, Section X (pp. 9-10) Target Population Data, Estimated Number of Redirection Referrals Annually (by County). a. Does this data reflect youth who are also Medicaid eligible? b. What is the estimated Medicaid Redirections Referrals Annually (by County)? Answer # 39: a. No, this is an estimated number of youth that could potentially be referred for Redirections as explained in the ITN text. b. Please see answer to Question # 15. The Department does not have this information by County/Circuit. Question # 40: Attachment A, Section XII (pp ) Additional Resources. a. Does the Evidenced-Based Practice for this service need to be one of those listed in the Florida DJJ guidelines? b. Does the Evidenced-Based Practice for this service need to have a primary family-focus model? Answer # 40: a. No, The DJJ Sourcebook for Delinquency Intervention is a resource guide of DJJ approved delinquency interventions. It is not meant to be all inclusive of all available service modalities. b. All interventions and/or treatment services proposed shall include some type of family component, wherein at least one parent/guardian actively and directly participates in a service component of the intervention. QUESTIONS FROM PSYCHOLOGICAL ASSESSMENT & TREATMENT SERVICES Question # 41: What is the department s stance on offering funds prior to program start-up for the specialized training required of evidenced based services? Answer # 41: The Department will not pay start-up funding. All costs shall be included in the final rates to be negotiated. Question # 42: Answer # 42: Question # 43: Answer # 43: Will the department allow for a partnership of agencies who each have different expertise appropriate to providing the service to engage in a MOU/MOA etc? For instance one agency performing the direct service delivery, while the other providing fiduciary, financial, etc? The Department is requesting responses from Respondents that have provided direct service delivery in the past. The Respondent is free to subcontract as necessary, but must meet the mandatory experience requirement for direct service delivery experience. The department stated in the bid states, Department desires to begin referring youth for Redirections services no later than November 1, 2013 so interested parties shall have or shall obtain Medicaid Enrolled Type O5 provider status (or have substantially completed the process) and then obtain Redirections certification from the Department s Contracted QIO by that date. There is no question asked. Page 13 of 25

14 Question # 44: Answer # 44: Question # 45: Has the Department anticipated any complications from Medicaid to billing for services such as in the case of MST: the Medicaid code for provider reimbursement is described as H2033 Multisystemic Therapy for juveniles, per 15 minutes. This code is not found or available in the current Florida Medicaid fee schedule description. Will the department seek inclusion of this code in the Florida fee schedule? And if so, when is this change anticipated to occur? Florida Medicaid will not use H2033 for Redirection Services billing. The rates and HCPC s for Medicaid Redirection Services are included in this Addendum to the ITN. Also see answer to question #32. On a related matter to question #3, how does the department intend to address the following issue as it pertains to the delivery of MST services, if MST is used? According to MST policy statement on Medicaid : Position Statement Memo Author(s): Keller Strother and Melanie Duncan Date: 06/19/09 Topic: Issue: Programs Medicaid Funding for MST Programs Strengths and Weaknesses of Using Medicaid Funding for MST The purpose of this position statement is to summarize the state of the learning regarding the strengths and challenges of using Medicaid funding to support MST implementation. Medicaid funding has emerged as an important part of the MST landscape and is playing a critical role in the financial sustainability of many MST programs across the United States. However, we caution stakeholders against viewing Medicaid funding as a silver bullet solution to their funding troubles, due to the potential limitations and challenges of using Medicaid funds to support the model-adherent implementation of MST as outlined below. Strengths: Many youth and families who can benefit from standard MST are Medicaid eligible. Medicaid funding allows states to receive partial federal support for their evidence-based MST programs. Once a funding standard for MST is added to the state plan, funding is readily available. Medicaid waivers, 1915(b) Managed Care waivers and 1915(c) Home and Community-based Services waivers, and the 1915(i) Home and Community-Based Services state plan option, can be used to give states the flexibility to structure the funding for MST in the form of a per diem, weekly or monthly, billing rate. Weaknesses: Medicaid funding alone is often insufficient to support an MST program. Under the Rehabilitative Services Option of the Medicaid code (a.k.a.the Rehab option), Medicaid funding will never fully sustain an MST program. (See below for more on this topic.) Not all families in need of MST meet the eligibility criteria for Medicaid. The current MST HCPCS (Healthcare Common Procedure Coding System) code available for use by states is based on a 15-minute billing increment. The nature of this increment, being a relatively short increment of time, is leading systems to establish reimbursement structures based on client contacts and is encouraging greater administrative/management focus on the billable nature of clinical work in practice settings. (See below for elaboration on each topic.) Page 14 of 25

15 Under the Rehabilitative Services Option, the Centers for Medicare and Medicaid Services (CMS) is not able to create per diem, weekly or monthly billing rates for MST due to the number of non-allowable activities that are required as part of implementing MST. (See below for more.) Many Medicaid systems only reimburse for face-to-face contacts and, at times, only contacts with family members when the youth is present. This type of funding structure can easily lead to non-model adherent practices that over emphasize face-to-face contacts in clinical implementation. In MST implementation, a therapist who gets the same high-quality outcome with less face-to-face contact is doing a better job. A common revenue management practice in fee-for-service Medicaid systems is the use of productivity metrics to focus staff on certain activities that are viewed as most appropriate. Many organizations, however, define productivity solely on revenue generation (billable activity) rather than clinical outcomes. In the most extreme examples of this, administrators post lists of productivity rates (a.k.a. revenue generation rates) publicly within the agency to shame staff into engaging in more billable activity. When properly used, productivity metrics can be used to ensure that therapist activities, as monitored through activity logging, are clinically appropriate, model-adherent and are focused on producing better outcomes for clients. No states currently have Medicaid funding available for the MST- Psychiatric adaptation of MST. This can lead to inappropriate referrals to standard MST programs of youth with significant psychiatric service needs and for whom these psychiatric service needs are viewed as the primary driver for the youth s inappropriate behaviors. CMS feedback regarding funding under the Rehab Options: Our understanding of the feedback from staff at the federal offices of the CMS is that the following types of services and expenses included in the delivery of MST are not allowable and can neither be reimbursed directly nor built into rates for MST under the Rehabilitative Services Option. It is our estimate that these kinds of activities constitute at least 10%, to over 30%, of an MST program s annual budget, depending on the program size, structure, and case-specific service requirements. Five-day MST orientation training Quarterly MST Booster training Ongoing training, work sample review, etc. with supervisor and/or teammates Staff time spent reading relevant clinical material for training purposes or reviewing reference materials General supervision activities, including on-site supervision and case review (The exception to this would be the rare situation when the MST client is present.) Administrative functions executed by the Supervisor Face-to-face delivery of marital therapies to adult caregivers without youth present (only allowable if issues are directly related to the youth s behavior or needs) Time spent trying to contact and engage families when no shows occur and/or when overall commitment to participation in treatment is low Staff meetings and non-clinical discussions Flex funds Court appearances Start-up expenses prior to client referrals Services delivered prior to authorization for billing Two additional areas worthy of comment are phone contacts and collateral Page 15 of 25

16 contacts. While CMS does allow these types of activities, they MAY or MAY NOT be allowable in individual states, depending on the standards established by each state. Phone contacts with caregivers Collateral contacts with significant others that affect the youth including, but not limited to, the neighborhood, social, educational, and vocational environments, as well as those from the criminal justice, child welfare, health and mental health systems. Phone contacts with collateral contacts Conclusions: While Medicaid funding can be a meaningful part of an MST funding strategy, it is seldom a sufficient source of funding on its own. MST program administrators, operating programs under the Rehabilitative Services Option, consistently report that Medicaid reimbursements can reliably cover about 40% to 60% of a modeladherent MST team s operating budget. States operating under waivers that grant the flexibility to structure funding for MST in the form of a per diem, weekly or monthly billing rate are often more successful in using Medicaid to fund a greater proportion, or even all, of an MST program s budget. Absent such a waiver, we recommend that MST programs create a multi-faceted funding stream that braids multiple sources of funding at a budgetary level and incorporates the available Medicaid reimbursements with these other sources of funding (e.g., state services funds from juvenile justice, mental health, etc.) in such a way that model adherence and client outcomes are always the primary focus for every MST clinician and program administrator. Answer # 45: The Redirection service rate under the 1915(i) State Plan Amendment is a weekly rate based on a minimum number of direct services being provided. This rate also accounts for the cost of supportive services that are required to effectively treat this population. This service model is designed to support the effective payment of an array of evidenced based treatment approaches, not just MST. Medicaid requires that recipient is the primary beneficiary of services, but this does not disallow services to be provided to family members and other supports on the recipients behahlf, Providers are tasked with providing sufficient documentation as to how the treatment tasks performed are related to the recipient s individualized treatment plan. ADDITIONAL QUESTIONS FROM CAMELOT COMMUNITY CARE Question # 46: If a youth is referred to the program and is Medicaid eligible, but does not qualify for a billable diagnosis for Medicaid Redirections will DJJ cover the case rate? Answer # 46: Yes, The Department will pay for services for referred youth who are not authorized reimbursement by Medicaid. Question # 47: Answer # 47: Question # 48: Answer # 48: Please confirm that there is not a Tab 3 for the Technical proposal and there is not a Tab 2 for the Financial Proposal. Please see revisions to the ITN. There is not a Tab 3 for the Technical proposal and there is not a Tab 2 for the Financial proposal. Does the response require any information for the negotiation presentation on page 44 or was this information to assist providers to prepare if they are requested to present? In the technical response there is not a requirement for information on the presentation. The information is required as per the following at the time of Presentations: As per the ITN Attachment B, Section XX, F. 2. The Negotiation Presentation portion of the response must be designed to be presented within a one (1) hour timeframe, submitted as PowerPoint file with eight (8) hard copies of the entire power point presentation to be submitted to the Procurement Manager at the time of presentation as scheduled in the Calendar of Events. The Negotiation presentation response shall be Page 16 of 25

17 formatted as PowerPoint Slides with Notes that correspond to the presentation. The PowerPoint and Notes must be numbered in a logical, consistent fashion. The PowerPoint Slides with Notes supporting the Negotiation Presentation on the services to be provided and other required tasks must address all items referenced below, in the order presented, in accordance with the format instructions specified above. Question # 49: Exhibit 1 If we are proposing more than 1 modality in a county should we complete an Exhibit 1 for each modality or include both on the same line item? If we include both on the same line item then do we combine the total number of available slots or separate them out on the form? Answer # 49: The Respondent shall submit one response for their proposed services, utilizing a single Exhibit 1 form with identification of each modality proposed for each county area where the Provider can offer services throughout the State. Question # 50: Answer # 50: Page 9 provides the number of referrals annually expected, Exhibit 1 asks for slots available which I assume are 2 different measures. Can you provide us with the current number of slots available by county to correspond with the Exhibit 1 worksheet There are no current slots identified by County. The Respondent shall propose the number of slots for each County and the modalities that can be offered within the County area by their organization. The number of youth in the targeted population table is the number of potential referrals, based on extrapolating data from aftercare and probation demographics. The Department is seeking the availability of service slots for a variety of modalities throughout the State. It is up to the Respondent to determine the number of slots they can offer in their response. The Department does not guarantee that slots will be utilized, as they cannot anticipate the number of youth needing referral nor specific delinquency intervention/redirection service a youth may need. QUESTION FROM INSTITUTE FOR CHILD AND FAMILY HEALTH Question # 51: The rates discussed on the conference call mentioned that the equivalent for one of the Medicaid Redirection rates is Targeted Case Management. Targeted Case Management is billed only when the youth receives more than one mental health services that needs to be coordinated. Will that be waived for the purposes of this program as it is likely that these youth will not be receiving more than one treatment service, but will need case management? Answer # 51: Mental health targeted case management is not a component of the Redirection Medicaid services; it is a separate Medicaid state plan service that must be provided by properly enrolled mental health targeted case management providers. The unit rate for mental health targeted case management was considered during the development of the Medicaid Redirection services rate, as it provided a reference to the estimated cost of providing care coordination services. ADDITIONAL QUESTIONS FROM VISION QUEST Question # 52: Can you explain the process to become certified by QIO as a Medicaid Redirections Service Provider? How long does that process take? Answer # 52: The Department will be determining this information with the QIO they are currently seeking through another ITN. We do not have that information, but do not anticipate the process for initial certification and authority to provide services will take very long, as the Department is seeking services to youth to start November 1, Question # 53: Answer # 53: Is the DSM diagnosis (as mentioned at the solicitation conference) required for the Medicaid Redirections services or for all services funded by DJJ/resulting from this ITN? The targeted criteria for Medicaid Redirections are a youth who has an emotional disturbance or severe emotional disturbance as defined in Chapter 394, Florida Statutes. Child or adolescent who has an emotional disturbance means a person under 18 years of age who is diagnosed with a mental, emotional, or behavioral disorder of sufficient duration to meet one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, but who does not exhibit behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community. The emotional disturbance must not be considered to be a temporary response to a stressful situation. The term does not include Page 17 of 25

18 a child or adolescent who meets the criteria for involuntary placement under Florida Statutes, Chapter (1). Question # 54: Answer # 54: Question # 55: Answer # 55: Question # 56: Answer # 56: If submitting a response as a consortium, do all providers need to be Medicaid provider status or may one agency within the consortium provide all Medicaid funded services? The Department is seeking the availability of Medicaid funded services in all geographical areas of the state to ensure service availability for Medicaid eligible DJJ youth. However, there are other Redirection services/intervention that can be provided that do not have to meet Medicaid requirements. A consortium could potentially have a mix of providers. If submitting a response as a consortium, must there be a designated lead entity? Or will DJJ prefer to contract with each consortium component for specific services described in consortium s proposal? The Department is seeking two-party agreements (contracts) with providers of services. Subcontracting relationships may be authorized. If submitting a proposal for multiple services in multiple geographic regions, will the Department negotiate with identified providers to finalize geographic regions and services, or will DJJ either accept or reject proposals as they are written? The Department intends to negotiate with qualified ranking respondents in such a manner to ensure that services are available throughout the State in all Judicial Circuits. ADDITIONAL QUESTION FROM HENRY AND RILLA WHITE FOUNDATION, INC. Question # 57: Will there be specific Medicaid standards governing the Redirection services in addition to the general standards outlined in AHCA's Community Behavioral Health Services Handbook? If so, will these be published before release of the current handbook's final revision? Answer # 57: Medicaid Redirection Services will have a separate handbook that has not started the rule making process. A notice of rulemaking will be issued once this process is initiated. Prior to the promulgation of this rule, providers will adhere to the policy set forth in the 1915(i) state plan amendment or revisions to that document. Question # 58: Answer # 58: Question # 59: Answer # 59: Question # 60: Answer # 60: Can you please the list of organizations that have expressed an interest in forming a coalition or collaboration on this ITN? Please see screen shot of interested parties attached to this Addendum. This information was also sent to all entities who notified the Department they were interested in the ITN on June 13, Can you please me the electronic formats of the following: Attachment D Certificate of Experience Attachment E Client Reference Form Attachment O Cross Reference Table Exhibit 1 Counties / Proposed Interventions Exhibit 2 Intervention Details Exhibit 3 Budget Form The requested word and excel documents were sent to all entities who notified they Department they were interested in the ITN on June 13, Additional requests may be sent to the Procurement Manager. Page 3 The ITN states Respondents shall note that the Department desires to begin referring youth for Redirections services no later than November 1, 2013 so interested Providers shall have or shall obtain Medicaid Enrolled Type O5 provider status (or have substantially completed the process) Can the Department define what it means by substantially completed the process? We understand from AHCA, you cannot apply for enrollment in an area where you do not currently have a location (address) in which to tie the provider services to therefore you must have an office location before beginning the O5 process. At what point in the ITN process (ie During/After Negotiation), would the Department expect the Respondent to begin securing office locations to begin the Medicaid Enrollment process? The Department is seeking Respondents that currently are Type 05 providers or can show Page 18 of 25

19 intent to obtain the Type 05 status if the Provider proposes to deliver Medicaid Redirection services modalities, i.e. Evidence Based treatment/therapies. Please see the revisions to the ITN. The Department is asking Providers to identify in the ITN Response Transmittal Letter (Attachment B, Section XX, A. # 9) whether or not the company currently is enrolled as a Florida Medicaid Type 05 Provider with one or more locations of record in the State of Florida. If so, the Department requests that the Responder provide the associated Medicaid Provider ID# and address of record. If not, the Department requests that the Responder submit a copy of the Florida Medicaid Type 05 Application and the ATN (Application Tracking Number) as provided by the Florida Medicaid fiscal agent, HP (Hewlett Packard) Enterprise Services, should the Provider propose to deliver Medicaid Redirection Services, (i.e. Evidence Based treatment/therapies). The Agency for Health Care Administration (AHCA) has indicated that any mental health or community behavioral health provider currently operational in Florida may begin the process to become a Medicaid Enrolled Type 05 provider by taking the steps outlined online at A summary of those steps is as follows: 1) Complete the Medicaid application with the request for Type 05 certification specified. 2) Indicate that the applicant has at least one office in the State of Florida and its location with staff, policies and procedures. The initial Type 05 Provider Certification will be associated with this location. 3) Submit the background screening and fingerprints as required by AHCA. It is suggested that Providers have required staff go to a Care Provider Background Screening Clearinghouse to expedite the process. More information can be found online at esources.shtml#elecscreen/. The following is the site of current LiveScan Vendors for AHCA s level 2 background screening, which Type 05 providers must go through. While the application to be a Medicaid provider is free, background screening and fingerprinting requires a fee. sources.shtml#livescanvendors 4) Upon submission of the application to HP Enterprise Services, the Provider is advised to telephone HP Enterprise Services and obtain Application Tracking Number (ATN) associated with your application and to submit the ATN with the ITN Response. Successful providers can obtain the Medicaid Enrolled Type 05 status for each service location through an expedited approval process and site certification after award. ADDITIONAL QUESTIONS FROM YOUTH VILLAGES Question # 61: Does the department have any data on the amount of Redirections youth that would have child welfare involvement/history? Mental Health involvement? Answer # 61: The link below provides the information the Department has available in an interactive Profile. This new interactive program features maps, tables and charts comparing the general population of youth served by the Department and those receiving foster care or other services provided by the Florida Department of Children and Families (DCF). Offenses and levels of placement within DJJ s continuum of services are presented in interactive displays enabling the user to filter by location down to the ZIP code, gender, race/ethnicity and gang involvement. Page 19 of 25

20 The DJJ/DCF Profile uses information collected from the Juvenile Justice Information System database managed by DJJ. This data is then matched to the Florida Safe Families Network Database maintained by DCF. All data is for calendar year Question # 62: Is the pricing for the ITN negotiable? Answer # 62: See Answer to Question # 8. QUESTION SUBMITTED FROM KIDS CENTRAL, INC. Question # 63: If a bidder develops a coalition of agencies to respond to the ITN, must all partnering entities be Direct Service Providers or may one organization act as a Administrative Service Organization and provide, for instance: Financial and Claims Management, Referral and Assessment, Quality Assurance / Improvement, and other similar oversight activities? Answer # 63 We are not seeking an Administrative Service Organization. The Respondent to the ITN must be a Direct Service Provider meeting the definition for experience as specified in the ITN. The Department intends to refer youth to Direct Service Providers. Question # 64: Answer # 64: Please explain how billing will work. Will we bill DJJ for each service or will there be a set rate for each youth in the program. If there is a per youth rate will there be an unfilled rate? Will we bill Medicaid or will DJJ bill Medicaid and pay the program the service or filled/unfilled rate? Payment methods and rates will be negotiated. The Department will pay for services on a filled rate only. Non Medicaid eligible services will be billed directly to the Department on a monthly basis. When a DJJ referred youth is Medicaid eligible and authorized by the QIO for Medicaid Redirections, services for that youth will be billed directly to the Agency for Health Care Administration (AHCA) at the established Medicaid rate. The bundle Medicaid rate is a weekly rate that can be billed once the service week is completed. The breakout services, Redirection Therapy H2019 HY and Redirection Therapeutic Support H2017 HY, are billed by the provider once they have determined they bundle rate requirements were not met. For general questions about Medicaid billing providers can refer the Medicaid Provider Reimbursement Handbook, CMS1500 located at: CMS-1500_ver1_4.pdf/ Question # 65: Answer # 65: Question # 66: Answer # 66: Question # 67: Answer # 67: If we bill Medicaid are Medicaid funds considered matching funds in the budget? Attachments 4.1, 4.2, 4.3, and H-5 don t have a column for matching. No, there are no match funds required for this contract. Medicaid funding is a funding stream the Department will utilize to pay for services. Providers will bill the Department directly, for services provided to non-medicaid eligible DJJ youth and will bill AHCA directly for authorized Medicaid eligible services. See answer to # 64. In the conference call for Question 10 (Will already existing Redirections programs continue to operate or must they also compete for this ITN) the answer was that this issue has not been decided. When will a decision be made on existing programs? Redirections services provided under contracts X1522, X1523 and X1524 expiring November 2013 are being procured under this ITN. The Department has not made any decision regarding additional contracts providing similar modalities. All direct service providers are encouraged to compete. If two providers establish a partnership to provide the full array of redirections services, will both providers need to have Type 05 provider status/enrollment by November 01? No. The Provider who is the party to the DJJ contract and the party who will be responsible for billing Medicaid for Medicaid Redirection Services (evidence based treatment/therapies) must be a Medicaid Enrolled Type 05 provider. Not all services under this ITN must be Medicaid Redirections services. Page 20 of 25

21 QUESTION SUBMITTED FROM CIRCLES OF CARE Question # 68: How will a current Medicaid Provider become certified in Redirections? Thanks Answer # 68: See answer to Question # 52. Question # 69: Answer # 69: Page 21 of 25

22 CHART OF CURRENT REDIRECTION SERVICES AND CURRENT SERVICE PROVIDERS Circuit County Current Services Current Provider 1 Escambia BSFT ; MST Evidence Based Associates through subcontractor Eckerd Youth Alternatives(BSFT); White Foundation(MST) 1 Okaloosa No Services No Services 1 Santa Rosa BSFT Evidence Based Associates through subcontractor Eckerd Youth Alternatives (BSFT) 1 Walton No Services No Services 14 Bay No Services No Services 14 Calhoun FFT AMI (FFT) 14 Gulf FFT AMI (FFT) 14 Holmes No Services No Services 14 Jackson FFT AMI (FFT) 14 Washington No Services No Services 2 Franklin No Services No Services 2 Gadsden No Services No Services 2 Jefferson No Services No Services 2 Leon FFT AMI (FFT) 2 Liberty No Services No Services 2 Wakulla No Services No Services 3 Columbia FFT AMI (FFT) 3 Dixie No Services No Services 3 Hamilton No Services No Services 3 Lafayette No Services No Services 3 Madison No Services No Services 3 Suwannee No Services No Services 3 Taylor No Services No Services 4 Clay FFT Evidence Based Associates through subcontractor Camelot Community Care (FFT) 4 Duval FFT Evidence Based Associates through subcontractor Camelot Community Care (FFT) 4 Nassau FFT Evidence Based Associates through subcontractor Camelot Community Care (FFT) 5 Citrus No Services No Services 5 Hernando No Services No Services 5 Lake FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 5 Marion FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 5 Sumter FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 7 Flagler FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 7 Putnam FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 7 St. Johns FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 7 Volusia FFT Evidence Based Associates through subcontractor Community Solutions, Inc. (FFT) 8 Alachua MST White Foundation (MST); 8 Baker No Services No Services 8 Bradford No Services No Services 8 Gilchrist No Services No Services 8 Levy No Services No Services 8 Union No Services No Services Page 22 of 25

23 6 Pasco FFT EBA-(Subcontractor Vision Quest) 6 Pinellas FFT EBA-(Subcontractor Vision Quest) 9 Osceola FFT EBA-(Subcontractor Community Solutions Inc) 9 Orange FFT EBA-(Subcontractor Community Solutions Inc) 10 Hardee No Services 10 Highlands No Services 10 Polk MST EBA-(Subcontractor Community Solutions Inc) 12 Desoto No Services 12 Manatee MST EBA-(Subcontractor Community Solutions Inc) 12 Sarasota MST EBA-(Subcontractor Community Solutions Inc) 13 Hillsborough FFT EBA-(Subcontractor Vision Quest) 18 Brevard BSFT EBA-(Subcontractor Crosswinds Youth Services, Inc.) 18 Seminole FFT EBA-(Subcontractor Community Solutions Inc) 15 Palm Beach FFT EBA-(Subcontractor Camelot Community Care) 16 Monroe BSFT EBA-(A Positive Step) 17 Broward FFT EBA-(Subcontractor with Camelot Community Care & The Starting Place (TSP)) 19 Indian River, MST EBA-(Subcontractor Human Services Associates, Inc) 19 Martin FFT No FFT services are provided 19 Okeechobee FFT No FFT services are provided 19 St. Lucie FFT No FFT services are provided 11 Miami-Dade FFT; MST; and BSFT * EBA-(Subcontractor with Institute for Child and Family (ICFH) for MST & FFT EBA-(A Positive Step) for BSFT 20 Charlotte, No Services 20 Collier FFT EBA-(Subcontractor Camelot Community Care) 20 Glades No Services 20 Lee FFT EBA-(Subcontractor Camelot Community Care) 20 Hendry No Services KEY: FFT Functional Family Therapy MST Multi-systemic Therapy BSFT Brief Strategic Family Therapy Page 23 of 25

24 REDIRECTIONS SERVICE MEDICAID RATES Florida Medicaid has developed the weekly rate of $ for Redirection services. The following rates and HCPC s for Redirections Services shall be used for billing Medicaid Redirections. At least two Therapies and 1 Therapeutic Support must be delivered to bill for the weekly rate. : Redirection Service (Weekly) H0046 HY $ H2019 HY $18.44 per Redirection Therapy quarter hour H2017 HY $9.00 per Redirection Therapeutic Support quarter hour The Redirection Service rate is based on rates currently set by Florida Medicaid for State Plan approved services. The rates for each Redirection service are multiplied by the anticipated service frequency per week, and are then multiplied by 26 (the number of weeks in an authorization period). The rate results are then averaged and divided by 26 (the number of weeks in an authorization period). Medicaid will only reimburse providers for the weekly rate if each element of the comprehensive Redirection Service is provided. Table 1 Weekly Rate HCPC Freq./ Proposed Service Rate Wk. Weeks Total Redirection Therapy H2019 HY $ $3, Redirection Therapeutic Support H2017 HY $ $ Redirection Services Care Coordination and Redirection 24 Hour Crisis Therapeutic Support $ $6, Treatment Plan Development $ $97.00 Treatment Plan Review $ $ Week Total: $11, Weekly Rate: H0046 HY $ Table 2 Individual Service Rates Proposed Service HCPC Rate Per Quarter-Hour Redirection Therapy H2019 HY $18.33 Redirection Therapeutic Support H2017 HY $9.00 Page 24 of 25

25 Screen Shot of all Interested Parties that have submitted questions or intent for this ITN. Page 25 of 25