CONTRACT BETWEEN FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES AND LUTHERAN SERVICES FLORIDA, INC. TWENTY SECOND AMENDMENT

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1 Amendment # 22 CONTRACT BETWEEN FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES AND LUTHERAN SERVICES FLORIDA, INC. TWENTY SECOND AMENDMENT THIS AMENDMENT is entered into between the Florida Department of Children and Families, hereinafter referred to as the "Department" and, hereinafter referred to as the "Provider". The Department wishes to amend contract number EH003, entered into between said parties on June 29, 2012, for the period July 1, 2012 through June 30, The purpose of this amendment is to increase the contract amount and update the Schedule of Funds for FY , as follows: I. Page 1, Legacy Standard Contract, Section 3, Payment for Services, is hereby amended to read: "3. Payment for Services. The Department shall pay for contracted services performed by the Provider during the service performance period of this Contract according to the terms and conditions of this Contract of an amount not to exceed $378,600, or the rate schedule, subject to the availability of funds and the Department's determination of satisfactory performance of all terms by the Provider. The State of Florida's performance and obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature. Any costs or services paid for under any other contract or from any other source are not eligible for payment under this Contract." II. Page 30, Attachment I, Section C., Paragraph C.1.c., Payment Clause, is hereby amended to read: "c. The contract total dollar amount shall not exceed $378,600,357.00, subject to the availability of funds, as outlined below: Tabl e 1 C on t rac t F un d mg State Fiscal Managing Entity Direct Total Value of Year Operational Cost Services Cost Contract $15,813, $73,983, $89,796, $13,877, $78,641, $92,519, $13,178, $80,953, $94,132, $12,794, $89,356, $102,151, Total* $55,664, $322,935, $378,600, *Dlfference IS due to roundmg. " Page 1 of2

2 Amendment # 22 III. IV. Page 53, Attachment I, Exhibit E, ME Schedule of Funds, FY As of 04/11/2016 is hereby deleted and replaced by a revised Exhibit E, ME Schedule of Funds, FY As of 05/11/2016, attached hereto. Pages 54 through 59, Attachment I,, Region Specific Provisions, (19 th Amendment) are hereby deleted and replaced by revised, Region Specific Provisions, (22 nd Amendment), attached hereto. This amendment shall be effective OS/27/2016, or the date signed by both parties, whichever is later. All provisions in the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform to this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment and all its attachments are hereby made a part of the contract. IN WITNESS THEREOF, the parties hereto have caused this nine (9) page amendment to be executed by their undersigned officials as duly authorized. PROVIDER: LUTHERAN SERVICES FLORIDA, INC. Signature: Xh,~~ PrintlType Name: Dr. Christine Cauffield Title: Vice President of LSF Health Systems Date: I FEID #: S/iM//b I' FLORIDA DEPARTMENT OF CHILDREN AND :::~~~~es 6J~ 13 I...'"( KW (;t( PrintlType Name: atricia Medlock Title: Northeast Regional Managing Director Date: ~ /, / /(, T ' Page 2 of2

3 05/11/2016 Exhibit E ME Schedule of Funds Other Cost Accumulators Title Total 53 22nd Amendment

4 REGION-SPECIFIC PROVISIONS Notwithstanding the provisions of Attachment I, the Managing Entity and the Department agree that the following provisions are of specific importance to the community the Managing Entity serves, and will be undertaken in addition to the obligations of Attachment I. A. Pursuant to the terms of Attachment I, Section B.3.b., the Managing Entity shall subcontract for the legislatively appropriated program-specific funds listed in Table A with each specified Network Service Provider. Each subcontract shall require the Network Service Provider to use these funds only for the legislatively specified service and to report the unique numbers of persons served or services provided with these funds as distinct reporting elements within the subcontract report requirements. B. The Managing Entity shall provide the Department with a copy of the executed subcontract document for each program-specific fund no later than 30 days after this exhibit is incorporated into the Managing Entity's contract. The subcontract document shall include: 1. A description of the service purchased with the specific appropriation; 2. The payment methodology and rate applied to the service; 3. Output and outcome performance measures applied to the service; and 4. The reporting requirements implemented to ensure regular and ad hoc status updates to the Department. C. At a minimum, the managing entity shall ensure each Network Service Provider: 1. Reports the following performance metrics in the format specified by the Department: a. Number of clients served, b. Number of adults served, c. Number of children served, d. Number of clients admitted in a residential treatment center, e. Type of services provided to the clients, and f. Number of clients discharged; and 2. Beginning with Fiscal Year , provide reports directly to the Executive Office of the Governor Office of Policy and Budget (EOG/OPB) documenting the return on investment for any specific appropriation identified with the acronym "EOG/OPB" in Table A. a. An initial report identifying the positive return the state will receive by providing the funding shall be submitted to EOG/OPB on or before July 31, b. The initial report shall include actual returns by fiscal year if the provider previously received state funding, and projected positive returns based on the Fiscal Year funding. c. Quarterly update reports shall be submitted to EOG/OPB within 30 days after the end of each fiscal year quarter thereafter. d. All reports shall be submitted to MaryBeth.Vickers@laspbs.state.fl.us and a copy submitted to the Managing Entity subcontract file. Table A - Program-Specific Fund Summary Year Specific Appropriation Provider Amount FY BayCare Behavioral Health Inc. $ 150, Clay Behavioral Health Care Center $ 300, nnd Amendment

5 Year FY15-16 through FY17-18 FY15-16 FY15-16 Specific Appropriation 372 PPG Solicitation LHZ03 377J 377J 377M Table A - Program-Specific Fund Summary Provider Amount Pregnant and Post-Partum Women Funding $1,425, Allocated to the following providers and amounts 1. Gateway Community Services: $463, River Region Human Services: $280, Haven Recovery Center: $101, Meridian Behavioral Healthcare: $333, Lifestream Behavioral Center: $147, Stewart Marchman Act: $93, The Centers: $5, Family Intensive Treatment (FIT) funding, allocated to the following amounts for services in the designated locations. The Managing Entity shall designate a service provider for each location in accordance with Section C.4. of this Exhibit. 1. Vol usia County $ 683, Alachua County $ 391, Citrus County $ 200, Hernando County $ 294, Nassau Alcohol Crime Drug Abatement Coalition (NACDAC) $150, Epic Behavioral Healthcare $150, Meridian Behavioral Healthcare, Inc.- Bradford County $150, Meridian Behavioral Healthcare, Inc. - Alachua County $150, Hanley Center Foundation, Inc. $150, Lifestream Behavioral Center, Inc. $139, Pregnant Women, Mothers, and Affected Families Funding $1,425, Allocated to the following providers 1. Gateway Community Services: $463, River Region Human Services: $280, Meridian Behavioral Healthcare: $333, Lifestream Behavioral Center: $147, Stewart Marchman Act: $195, The Centers: $5, Family Intensive Treatment (FIT) funding, allocated to the following amounts for services in the designated locations. The Managing Entity shall designate a service provider for each location in accordance with Section F.3. of this Exhibit. EOG/OPB 1. Volusia County $683, Alachua County $391, Citrus County $200, Hernando County $294, Clay Behavioral Health Center $300, EOG/OPB 55 nnd Amendment

6 Year Specific Appropriation 386 Table A ~ Program.,.Specific Fund Summary Provider Meridian Behavioral Healthcare, Inc. EOG/OPB Lifestream Behavioral Center Centralized Receiving Systems (CRS) Solicitation: RFA10H141 Amount $410, $225, D. Fiscal Year Appropriations Pursuant to the FY14-15 General Appropriations Act, Ch , Laws of Fla., the Managing Entity shall implement the following: 1. Specific Appropriation BayCare Behavioral Health Inc. During Fiscal Year , from the funds in Specific Appropriation 350, the nonrecurring sum of $150, from the General Revenue Fund is provided to BayCare for behavioral health services to children and their families. 2. Specific Appropriation 351- Clay Behavioral Health Center From the funds in Specific Appropriation 351, the nonrecurring sum of $300, from the General Revenue Fund is provided to Clay Behavioral Health Care Center. 3. Specific Appropriation Pregnant and Post-Partum Women Funding From the funds in Specific Appropriation 372, the recurring sum of $1,425, from the General Revenue fund is provided for the expansion of substance abuse services for pregnant women and their affected families. These services shall include the expansion of residential treatment, outpatient treatment with housing support, outreach, detoxification, child care and post-partum case management supporting both the mother and child consistent with recommendations from the Statewide Task Force on Prescription Drug Abuse and Newborns. Priority for services shall be given to counties with greatest need and available treatment capacity. 4. Specific Appropriation Family Intensive Treatment Funding From the funds in Specific Appropriation 372, the recurring sum of $1,570, from the General Revenue Fund is provided to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team-based, family-focused, comprehensive services to families in the child welfare system with parental substance abuse. Treatment shall be available and provided in accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. a. The Managing Entity shall designate a Network Service Provider to deliver the FIT model for each location specified above and shall subcontract with the provider to implement this proviso appropriation by August 15, b. The Managing Entity shall subcontract with the Network Service Providers providing FIT model services for the full amount of funding specified in Table A and shall not reduce payment to these providers for any operational costs, including behavioral health fees, of the Managing Entity associated with the administration of the subcontracts. c. To ensure the implementation and administration of the FIT team model complies with the Department's programmatic standards, the Managing Entity shall require Network Service Providers providing FIT model services adhere to the staffing, service delivery and reporting requirements of Incorporated Document 32: Family Intensive Treatment (FIT) Model Guidelines and Requirements, which is hereby incorporated by reference nd Amendment

7 E. Prevention Partnership Grants Pursuant to the Notice of Award for the PPG procurement RFA #LHZ03, the Managing Entity shall execute 3 year subcontracts with Network Service Providers for the annual amounts detailed in Table A for the implementation of the PPG program. 1. The Managing Entity shall negotiate PPG services within the scope of work detailed in the Network Service Provider's application. 2. The Subcontract shall incorporate the specifications and elements detailed in the RFA, including but not limited to objectives, measures, and reporting. 3. The Subcontract shall incorporate funding as detailed in the Table A for reasonable, allowable, and necessary expenditures required to perform PPG services. 4. The Subcontract shall require the Network Service Provider to enter all prevention data into the Department's Performance Based Prevention System (PBPS). F. Fiscal Year Appropriations Pursuant to the FY15-16 General Appropriations Act, Ch , Laws of Fla., the Managing Entity shall implement the following: 1. Specific Appropriation 377J - Pregnant Women, Mothers, and Affected Families Funding From the funds in Specific Appropriation 377J, the recurring sum of $1,425, from the General Revenue fund is provided for the expansion of substance abuse services for pregnant women and their affected families. These services shall include the expansion of residential treatment, outpatient treatment with housing support, outreach, detoxification, child care and post-partum case management supporting both the mother and child consistent with recommendations from the Statewide Task Force on Prescription Drug Abuse and Newborns. Priority for services shall be given to counties with greatest need and available treatment capacity. The Managing Entity shall subcontract with the Network Service Providers for this funding as listed in Table A. With the submission of the Final Fiscal Year Invoice, the Managing Entity will submit a report that details for each provider the sub contractual amount, actual amount paid, and total units purchased. This report shall also contain the total of any anticipated carry forward funds of Specific Appropriation 377J - Pregnant and Post-Partum Women Funding. These anticipated carry forward funds will also be included on Incorporated Document 27: Managing Entity Carry Forward Expenditure Report. 2. Specific Appropriation 377J - Family Intensive Treatment Funding From the funds in Specific Appropriation 377J, the recurring sum of $1,570, from the General Revenue Fund is provided to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team-based, family-focused, comprehensive services to families in the child welfare system with parental substance abuse. Treatment shall be available and provided in accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. a. The Managing Entity shall designate Network Service Providers to deliver the FIT model for each location specified above and shall subcontract with the provider to implement this proviso appropriation by July 31, b. The Managing Entity shall subcontract with the Network Service Providers providing FIT model services for the full amount of funding specified in Table A and shall not reduce payment to these providers for any operational costs, including behavioral health fees, of the Managing Entity associated with the administration of the subcontracts. 57 nnd Amendment

8 c. To ensure the implementation and administration of the FIT team model complies with the Department's programmatic standards, the Managing Entity shall require Network Service Providers providing FIT model services adhere to the staffing, service delivery and reporting requirements of Incorporated Document 32: FIT Model Guidelines and Requirements, which is hereby incorporated by reference. 3. Specific Appropriation 377M - Clay Behavioral Health Center From the funds in Specific Appropriation 377M, the nonrecurring sum of $300,000 from the General Revenue Fund is provided to Clay Behavioral Health for Crisis Prevention Team services. 4. Specific Appropriation 377M - Meridian Behavioral Healthcare From the funds in Specific Appropriation 377M, the nonrecurring sum of $410,000 from the General Revenue Fund is provided to Meridian Behavioral Healthcare, Inc. for operational expenses associated with a Health Home for Individuals with Severe Mentallilnesses and Substance Use Disorders. S. Specific Appropriation 377M - LifeStream Behavioral Center - CSU From the funds in Specific Appropriation 377M, the nonrecurring sum of $454,000 from the General Revenue Fund is provided to LifeStream for crisis stabilization units. 6. Specific Appropriation LifeStream Behavioral Center - Central Receiving Facility (CRS) Solicitation: RFA10H141 Pursuant to the Notice of Award for the CRS solicitation under RFA #LHZ03, as revised by Specific Appropriation 386 of the FY15-16 General Appropriations Act, the Managing Entity shall execute 5 year subcontracts with Network Service Providers for the annual amounts detailed in Table 1. The Managing Entity shall implement the CRS projects in accordance with the terms of Incorporated Document 36 - Centralized Receiving System (CRS) Grant, hereby incorporated herein by reference. G. Northeast Region Specific Performance Metrics The Managing Entity will assist in developing performance metrics as determined by the Department's Regional Leadership to support the Northeast Region's Priorities. These metrics will be reported quarterly at the quarterly meetings between the Managing Entity and the Department's Northeast Region staff. H. Family Intervention Specialist (FIS) 1. The Managing Entity will participate in the FIS Real Time Rapid Feedback QA Review Process. The Department's Northeast Region Substance Abuse and Mental Health Program Office (SAMH) and the Managing Entity will participate in a process to review quality assurance of the cases chosen by the Department in the Northeast Region. This process is defined in the Incorporated Document 33- FIS Real Time Rapid Feedback QA Review Process, which is incorporated herein by reference, and provided by the Contract Manager. 2. Changes in the system of care as it related to integration with child welfare, including FIS positions cannot be modified without the approval of the Department's Northeast Region SAMH Director. This is to ensure that Department's Family Safety Program is aware of pending changes and has the opportunity to voice concerns and problem solve with the Managing Entity's staff. The Managing Entity must continue to participate in quarterly planning sessions with the Department's staff in regards to child welfare and SAMH service integration and FIS services. 3. Incorporated Guidance Document 23 states that a "clearly targeted population will be identified" for the FIS, it further states that "transformation uses the classification of safe and unsafe child and it's expected that unsafe children will be the focus." As the new Safety Methodology becomes practice in nd Amendment

9 the Northeast Region, the Managing Entity will develop with the Department a definition for their target population with the goal of prioritizing " unsafe" and or high risk children and their families. 4. Incorporated Guidance Document 23 states that the Managing Entity shall ensure that the FIS position "will provide ancillary support to the CBC case manager" and "where possible, co-location with CBC case managers." Current practice in the Northeast Region has FIS aligned with Child Protective Investigators and as the new Safety Methodology becomes practice this alignment may change to fit the needs of the Northeast Region Family Safety Program Office. The Department will oversee the alignment ofthe FIS and work with the Managing Entity to ensure the FIS services best fit the needs of the Northeast Region. I. Communication All communications from the Managing Entity to the Department must include the Regional Contract Manager and the Regional SAMH Program Office. J. Monthly Meetings The Managing Entity and the Northeast Region SAMH Program Staff will meet monthly regarding programmatic issues and updates in the SAMH System of Care in the Northeast Region. K. Children's Mental Health The Managing Entity will keep a master list of children involved in the Children's Mental Health System of Care in a SIPP residential placement, as managed by the Managing Entity. The Managing Entity will exchange this information with the Northeast Region SAMH Program Office on a monthly basis at a minimum. L. Client and/or Provider Incident/Issues/Complaints When a client and/or provider incident/issue/complaint rises to the level where further investigation appears warranted, the Managing Entity will proceed with a commitment to coordination and transparency with the Northeast Region SAMH Program Office. The Managing Entity will: 1. Share currently available information about the incident/issue/complaint with the Northeast Region SAMH Program Office, 2. Coordinate with the Northeast Region SAMH Program Office, the investigation process that will be utilized, 3. Review findings of the investigation with the Northeast Region SAMH Program Office, and 4. Coordinate with the Northeast Region SAMH Program Office the release of a findings statement and, when appropriate, a request for corrective action. M. Support Services. As specified in Section S.b. of the Legacy Standard Contract, the Department shall not furnish support services normally available to Career Service employees except when the Managing Entity is subcontracting to provide services for Department clients seen at the River House location. Only when considered to be more cost-effective, the Department shall furnish the space known as the River House as further described in Attachment V and subject to the conditions as described therein conducive to effective services being provided pursuant to this contract. See Attachment V, Use of Facilities nd Amendment