SCPart 2 DCF RFP 2324 081.pdf

CONTRACT NO. [Enter Contract No.]

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EXHIBIT A – SPECIAL PROVISIONS

The following provisions supplement or modify the provisions of Items 1 through 11 of the Standard Contract, as provided herein:

A.1. ENGAGEMENT, TERM AND CONTRACT DOCUMENT

A.1.1. Additional Definitions as specified in Standard Contract, 1.6.1.3., is hereby added to read:

A.1.1.1. 60-Day Review – An independent review of the child’s progress towards achieving the goals and objectives of the treatment plan.

A.1.1.2. 90-Day Assessment– A clinical evaluation conducted by the subcontracted agent of the Provider (ref: Qualified Evaluator) to assess the suitability of the least restrictive level of care and/or review of residential psychiatric treatment as defined within § 39.407, F.S..

This evaluation, at a minimum, consists of a record review, face-to-face interview (65C-

28.021 F.A.C.), and preparation of a written report of findings.

A.1.1.3. Ad Hoc Report – A report designed for a specific purpose, case, or situation, pulled on an as-needed basis.

A.1.1.4. Centers for Medicare and Medicaid Services (CMS) – The Department within the U.S.

Department of Health and Human Services with responsibility for the Medicare, Medicaid, and State Children’s Health Insurance Program.

A.1.1.5. Child and Adolescent Needs and Strengths (CANS) Trauma Comprehensive Assessment - A multi-purpose instrument developed to support decision making, including level of need and service planning to facilitate quality improvement initiatives to allow for the monitoring of outcomes of services. The tool assesses a child’s needs and strengths.

A.1.1.6. Community Based Care Lead Agency (Lead Agency)– The Lead Agency delivers a comprehensive array of child protection and child welfare services as defined in s.

409.986 and 409.988, Florida Statutes (F.S.) to children and families, while ensuring each child’s safety, well-being, and permanency.

A.1.1.7. Comprehensive Behavioral Health Assessments - An in-depth assessment of the child’s emotional, social, behavioral, and developmental functioning within the family home, school, and community, as well as the clinical setting, as defined in 65C-30.001 F.A.C.

A.1.1.8. Comprehensive Placement Assessment- An assessment that determines the level of care needed by the child to ensure and match the child with the most appropriate placement in accordance with § 39.4022, F.S.

A.1.1.9. Full BQRTP Assessment – A clinical evaluation conducted by the subcontracted agent of the Provider to assess the child for placement in a BQRTP level of care as outlined in F.A.C., Rule 65C-28.021.

A.1.1.10. Initial Suitability Assessment – A clinical evaluation performed by a Qualified Evaluator of a child in the custody of the Department who is being referred for admission to residential psychiatric treatment to assess the suitability for residential treatment as defined within §39.407, F.S. Initial Suitability Assessments consist of a review of mental health treatment records, a face-to-face interview, contact with collaterals and/or providers who have pertinent information regarding the child.

https://m.flsenate.gov/Statutes/39.407 https://flrules.org/gateway/ruleNo.asp?id=65C-28.021 https://flrules.org/gateway/ruleNo.asp?id=65C-28.021 https://flrules.org/gateway/ruleNo.asp?id=65C-28.021 https://m.flsenate.gov/Statutes/39.4022

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A.1.1.11. Inter-Rater Reliability (IRR) - A measure of consistency and agreement between two or more raters or observers in their assessments.

A.1.1.12. Key Performance Indicator (KPI) Tool - A management tool that allows companies to monitor and analyze their most important performance data in real-time.

A.1.1.13. Medicaid – The medical assistance program authorized by Title XIX of the Social Security Act, 42 U.S.C., §1396, and regulations there under, as administered in this state by the Department under Chapter 409, F.S.

A.1.1.14. Medical Director – A board certified physician serving members of the Seminole Tribe of Florida, designated by the Seminole Tribe of Florida.

A.1.1.15. Point of Contact (POC) - Also known as the Behavioral Health Coordinator, means the person or entity designated by each Community Based Care Lead Agency as the central point of contact for accessing residential treatment services.

A.1.1.16. Project Manager – An individual employed by the Provider, designated to be responsible for the management of the Contract.

A.1.1.17. Preliminary BQRTP Assessment - A clinical evaluation conducted by the subcontracted agent of the Provider to assess the child for placement in a BQRTP level of care as outlined in 65C-28.021 F.A.C. This Assessment, at minimum, consists of an attempted face-to-face interview with child, review of the Comprehensive Placement Assessment during the multidisciplinary team staffing, and evidence that supports the preliminary recommendation for placement.

A.1.1.18. Psychological Services Administrator for the Seminole Tribe of Florida (Psychological Services Administrator) - Someone who plans, coordinates, directs and supervises the psychology programs and staff at a state institution; provides clinical supervision and underwrites psychological services provided by psychologists for purposes of licensure, accreditation, and reimbursements; performs related work as required.

A.1.1.19. Quality Assurance – The process of assuring that the delivery of health care meets professionally recognized standards of health care.

A.1.1.20. Qualified Evaluator(s) (QE) – For the purposes of this Contract, a QE is defined as an evaluator who satisfies the requirements outlined in §39.407(6)(b)1- §39.407(6)(b)2., F.S., and refers to both Non-Seminole and Seminole Tribe QEs.

A.1.1.21. Seminole Tribe Qualified Evaluator (STQE) - QE specifically qualified and recognized by the Seminole Tribe to perform Assessments within the tribe's jurisdiction or for tribal children.

A.1.1.22. Qualified Evaluator Network (QEN) - A network consisting of Non-Seminole and Seminole Tribe QEs.

A.1.1.23. Quality Improvement Organization (QIO) – An organization certified through the CMS, Office of Clinical Standards and Quality to perform medical and utilization review functions required by law.

A.1.1.24. Quality Improvement Organization (QIO) like entity – A Quality Improvement Organization (QIO)-like entity is an organization that performs similar activities to a QIO and can be contracted to perform medical and utilization reviews.

A.1.1.25. Qualified Individual (QI) - the child’s treating licensed clinical professional, a Qualified Evaluator outlined in §39.407(6), F.S., or a Comprehensive Behavioral Health Assessor who meets the qualifications as required in the Agency for Health Care Administration, PCMT-03 3 v.24.1

“Specialized Therapeutic Services Coverage and Limitations Handbook,” March 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16546 .

A.1.1.26. Qualified Residential Treatment Program (QRTP) – As defined in FAC, Rule 65C- 28.021, is a licensed child-caring agency that provides care for youth who have serious emotional or behavioral disorders or disturbances.

A.1.1.26.1. Behavioral Qualified Residential Treatment Program (BQRTP) as defined in 65C- 46.0211, FAC, is a licensed child caring agency that provides services for youth who have serious emotional or behavioral disorders.

A.1.1.27. Reconsideration Suitability Assessment – An area request for a separate, second independent evaluation, due to the rationale that the original evaluation recommended a level of care that does not meet the current needs of the child.

A.1.1.28. Residential Treatment Center (RTC) – a placement for observation, diagnosis, or treatment of an emotional disturbance in a facility licensed in accordance with §394.875, F.S., or a hospital licensed under chapter 395, F.S.

A.1.1.28.1. Statewide Inpatient Psychiatric Program (SIPP) – Intensive psychiatric services, provided to children in a secure residential setting, that are designed to serve those high-risk youth that fail to benefit from acute inpatient or traditional outpatient treatment settings.

A.1.1.28.2. Therapeutic Group Home (TGH) – A Residential Treatment Center that offers a 24-hour residential program providing community-based mental health treatment and mental health support services to children who meet the criteria in §394.492(5) or (6), F.S., in a nonsecure, homelike setting.

A.1.1.29. Second Level Assessment – A review that may be recommended at the completion of a 60-day Independent Assessment and 90- Day Independent Assessment for those children in a Therapeutic Group Home conducted by a QE satisfying §39.407(6)(b)2.

F.S.

A.1.1.30. State of Florida Observed Holidays – New Year’s Day, Martin Luther King Day, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and the Friday after Thanksgiving Day, and Christmas Day.

A.1.1.31. Telecommute – An arrangement where an employee works either part or all of their workweek from home or a location other than the standard place of work (office).

A.2. STATEMENT OF WORK

A.2.1. There are no additional provisions to this section of the Standard Contract.

A.3. PAYMENT, INVOICE AND RELATED TERMS

A.3.1. There are no additional provisions to this section of the Standard Contract.

A.4. GENERAL TERMS AND CONDITIONS

A.4.1. There are no additional provisions to this section of the Standard Contract.

A.5. RECORDS, AUDITS AND DATA SECURITY

A.5.1. There are no additional provisions to this section of the Standard Contract.

A.6. INSPECTIONS, PENALTIES, AND TERMINATION

A.6.1. There are no additional provisions to this section of the Standard Contract.

http://www.flrules.org/Gateway/reference.asp?No=Ref-16546 https://www.flrules.org/gateway/ruleNo.asp?id=65C-28.021 https://www.flrules.org/gateway/ruleNo.asp?id=65C-28.021 https://www.flrules.org/gateway/ruleNo.asp?id=65C-28.021

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A.7. OTHER TERMS

A.7.1. There are no additional provisions to this section of the Standard Contract.

A.8. FEDERAL FUNDS APPLICABILITY

A.8.1. There are no additional provisions to this section of the Standard Contract.

A.9. CLIENT SERVICES APPLICABILITY

A.9.1. There are no additional provisions to this section of the Standard Contract.

A.10. PROPERTY

A.10.1. There are no additional provisions to this section of the Standard Contract.

A.11. AMENDMENT IMPACT

A.11.1. There are no additional provisions to this section of the Standard Contract.

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EXHIBIT B – SCOPE OF WORK

B.1. SCOPE OF SERVICE

The Provider shall deliver comprehensive services as specified in this Contract to support the State of Florida in conducting Suitability Assessments, Behavioral Qualified Residential Treatment Program Assessments, managing the QEs, and ensuring effective communication and support through a toll-free customer service system. The Provider shall develop and maintain educational and outreach materials, ensuring compliance with all relevant state and federal laws, particularly those governing child welfare and residential treatment services. The Provider shall establish and maintain QEs that are qualified to perform assessments on children in the care and custody of the Department, specifically those being placed or already in an RTC.

B.2. MAJOR CONTRACT GOALS

The major goals of this Contract are to ensure children in the child welfare system receive timely and accurate clinical assessments for residential treatment placements through a network of QEs.

Additionally, the Provider shall support policy development, stakeholder collaboration, and continuous improvement of the QEs.

B.3. SERVICE AREA/LOCATIONS/TIMES

B.3.1. The Provider’s administrative offices are located at the address specified in the Standard

Contract, 1.3.3.

B.3.2. The Provider’s administrative offices shall be open for 8:00 A.M. to 5:00 P.M., Eastern Standard

Time, Monday through Friday, excluding State of Florida Observed Holidays B.3.3. The Provider shall notify the Department’s Contract Manager, in writing, thirty (30) calendar days, in advance, of any changes in the street or mailing address, telephone number, or electronic mail address, or facsimile number that affects the Department’s ability to contact the Provider.

B.4. CLIENTS TO BE SERVED

The Provider shall serve children in out-of-home care who require assessments for potential placement into RTC. This includes assessments for placement in TGHs and BQRTPs. The Provider shall also process referrals for assessments submitted by the Department's contracted Lead Agencies.

B.5. CLIENT ELIGIBILITY

Eligible clients include children/adolescents in the custody of the Department who are being referred for admission to residential psychiatric treatment.

B.6. CLIENT DETERMINATION

Refer to B.4 and B.5.

B.7. EQUIPMENT

No equipment, property, or information technology resources shall be purchased with these Contract funds.

B.8. CONTRACT LIMITS

B.8.1. The Provider recognizes and agrees that any and all work performed without specific direction from the Department shall be deemed to be gratuitous and not subject to charge by the Provider or compensation by the Department.

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EXHIBIT C – TASK LIST

The Provider shall perform all functions necessary for the proper delivery of services including, but not limited to, the following:

C.1. SERVICE TASKS

C.1.1. The Provider shall perform the following tasks and document completion of described tasks by completing and delivering all reports and deliverables as specified in C.2.5. and D.1.1.

C.1.2. Provider Licensing and Compliance. The Provider shall maintain all necessary licenses and certifications required to perform assessments and related services as outlined in this Contract.

C.1.2.1. The Provider shall have thorough knowledge and understanding of Florida Statutes, codes, and regulations governing child welfare and residential treatment services.

C.1.2.2. The Provider shall comply with all relevant state and federal laws, including the Florida

Administrative Code and the requirements for RTCs.

C.1.3. Administrative Oversight. The Provider shall demonstrate high-quality administrative leadership and possess qualified professional knowledge regarding the quality assurance standards of the Florida Medicaid program, with the ability to design and implement cost-saving methodologies applicable to the QEN.

C.1.3.1. The Provider shall maintain an acceptable Quality Improvement Organization-like entity (QIO) status as approved by the CMS.

C.1.3.2. The Provider shall develop and maintain a QEN that meets the required standards and can perform assessments on children in the care and custody of the Department, especially those being placed in or already residing in an RTC. The Provider shall ensure that all assessments comply with the requirements for Suitability Assessments as set forth in section 39.407, Florida Statutes, and the standards applicable to Behavioral Qualified Residential Treatment Programs as prescribed in Rule 65C-28.021, Florida Administrative Code.

C.1.3.3. The Provider shall ensure that all QEs are adequately trained annually, onboarded, and compliant with the criteria set forth in this Contract.

C.1.3.4. The Provider shall collaborate and receive approval from the Department to establish and maintain procedures for conducting suitability assessments and assessments for BQRTPs.

The Provider shall provide, upon Department request:

C.1.3.4.1. Coordination with the Department, and other state agencies, as required.

C.1.3.4.2. Assistance with consumer and practitioner inquiries and complaints related to the QEN.

C.1.3.4.3. Availability of staff to testify and provide supportive documentation in connection with civil or administrative litigation arising from the QEN.

C.1.3.4.4. QEN training materials.

C.1.3.4.5. Records of any complaints and grievances received by the Provider in relation to the activities of the Contract.

C.1.3.5. The Provider shall comply with the Health Insurance Portability and Accountability Act

(HIPAA).

C.1.3.6. The Provider shall maintain secure digital document‑upload and scanning capabilities, PCMT-03 7 v.24.1 support standard internet-based communications, and provide the Department with real‑time online access to all relevant Provider databases, reports, and contract-related information at no cost to the Department. The Provider shall also furnish the Department with secure API access to required data, consistent with all applicable security and confidentiality standards.

C.1.3.7. The Provider shall have the necessary information technology to fully manage and report on the tasks and deliverables of this Contract, including the capacity (hardware, software, and personnel) sufficient to access and generate all data and reports needed for this Contract.

Specifically, the following is required:

C.1.3.7.1. The Provider shall have the capability to provide electronic imaging and storage of all supporting suitability assessment documentation.

C.1.3.7.2. The Provider shall have protocols and internal procedures for ensuring system security and the confidentiality of recipient identifiable data.

C.1.3.7.3. Information systems and websites shall be compatible with common platforms and internet browsers.

C.1.3.8. The Provider shall develop and maintain a Disaster Recovery Plan for restoring the application of software and current master files and for hardware backup in the event the production systems are disabled or destroyed. The Disaster Recovery Plan shall limit service interruption to a period of 72 hours and shall ensure compliance with all requirements under this Contract.

The records back-up standards and a comprehensive Disaster Recovery Plan shall be developed and maintained by the Provider for the entire period of this Contract.

C.1.3.8.1. The Provider shall maintain a Disaster Recovery and Business Continuity Plan designed to ensure continuity of operations and restoration of critical systems within seventy-two

(72) hours of a disruption. The Provider shall maintain redundant network connectivity, secure data backup procedures, and failover capabilities sufficient to minimize service interruptions and prevent loss of data. The Provider shall maintain a Disaster Recovery Plan for restoring day-to-day operations, including alternative locations, for the Provider to conduct the requirements of this Contract.

C.1.3.8.2. The Provider shall maintain database backups in a manner that shall eliminate disruption of service or loss of data due to system or program failures or destruction.

C.1.3.8.3. The Disaster Recovery Plan shall be finalized no later than thirty (30) calendar days prior to the Contract effective date. The Department will review the Provider’s Disaster Recovery Plan during the readiness review.

C.1.3.8.4. The Department reserves the right to direct the Provider to amend or update its Disaster Recovery Plan in accordance with the best interests of the state and at no additional cost to the Department.

C.1.3.8.5. The Provider shall make all aspects of the Disaster Recovery Plan available to the Department at all times.

C.1.4. Internal Quality Control Program Administrative and Clinical Requirements. The Provider shall implement a comprehensive Internal Quality Control (IQC) Program to ensure compliance with all contractual responsibilities. The IQC Program shall outline the administrative and clinical procedures used to monitor and ensure timely performance of all contractual functions.

C.1.4.1. Designated staff, qualified to oversee IQC activities, shall address and follow up on any performance issues that fall below professional standards.

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C.1.4.2. The Provider shall implement a systematic process to identify and address areas for improvement in service delivery.

C.1.4.3. The IQC Program shall include secure methods for receiving and responding to client and Provider input, complaints, and grievances in a timely manner.

C.1.4.4. The Provider shall conduct an orientation for new employees, and ongoing training regarding QRTP, TGH and BQRTP and monitoring for all clinical staff, including physicians, therapists, and other relevant personnel.

C.1.4.5. Training shall be updated annually or as needed, based on quality review outcomes, IRR, and the Department’s recommendations, in accordance with Florida Administrative Code 65C-

28.021 Qualified Residential Treatment Programs.

C.1.4.6. The Provider shall conduct periodic evaluations of IRR to ensure consistency and accuracy in clinical assessments.

C.1.4.7. The Provider shall have established procedures to intervene when clinical performance does not meet required standards, including quality of work and professional conduct.

C.1.4.8. The Provider shall monitor at least one percent (1%) of the total Assessment volume or ten

(10) Assessment cases (whichever is greater), per employee (includes work performed by clinical reviewers, physician reviewers, and temporary or contracted review staff), per month.

This volume is excluding any Assessments submitted using a rules-based system. The Provider shall maintain a separate process for monitoring the accuracy and effectiveness of their rules-based certification system.

C.1.4.9. The Provider shall submit the sample Assessment cases to include the Initial, 60 day, 90 day and Reconsideration Assessments with the IRR evaluation criteria to the Department for approval.

C.1.4.10. The Provider shall have a written policy for escalation of technical problems or manpower problems or shortages that threaten to, or actually prevent, the meeting of the Provider’s quality and/or timeliness requirements. The policy shall require escalation of the problem within the Provider’s organization, if not resolved in a timely manner, and shall call for disciplinary action for any staff that does not perform according to the escalation policy.

C.1.5. QEN Management. The Provider shall manage the QEN and ensure a seamless integration and collaboration for the STQEs to become part of the Provider’s system. The Department will provide the STQEs’ contact information to the Provider.

C.1.5.1. The Provider shall onboard and train the STQEs within 60 business days of the Contract execution, and in the event of new hires, the Provider shall train the new STQEs within 60 business days of onboarding. The Provider shall issue a certificate to the STQEs upon completion of the training. The certificates shall be submitted to the Department in accordance with D.1., Deliverables.

C.1.5.2. The Provider shall onboard and train the Non-STQEs within 30 business days of the Contract execution, and in the event of new hires, the Provider shall train the new Non- STQEs within 30 business days of onboarding. The Provider shall issue a certificate to the Non-STQEs upon completion of the training. The certificates shall be submitted to the Department in accordance with D.1., Deliverables.

C.1.5.3. The Provider shall ensure that all QEs operate under a standard of documented good faith

PCMT-03 9 v.24.1 efforts when conducting evaluations with children. This involves taking all reasonable steps, considering the child's age, intelligence, emotional development, stability, and demeanor, to facilitate the child's participation in a conversation with a QE, to determine whether a child meets the criteria for placement in a RTC or BQRTP, even if those efforts were not fully successful.

The requirement is to gather the necessary information to assess whether the child meets the criteria for placement in a RTC or BQRTP.

C.1.5.3.1. The Provider shall ensure that these efforts are thoroughly documented, demonstrating that the QE made every possible attempt to engage the child. Documentation shall reflect that the QE considered the child’s unique characteristics and employed strategies appropriate to the child's level of understanding and emotional state.

C.1.5.3.2. In cases where these efforts are not fully successful, the documentation in consultation with the Lead Agency shall clearly indicate the steps taken and the reasons why the expected outcomes were not achieved. This documentation shall be included as part of the child’s assessment and submitted to the Lead Agency.

C.1.5.3.3. The Provider shall be responsible for all required information being properly documented and maintained for all components of this Contract, including but not limited to: referrals, assessments, reviews, evaluations, assessment tools, reports, training materials, logs and records, and all other applicable information related to this Contract. The documentation shall be submitted to the Contract Manager in accordance with C.2.5., Reports.

C.1.5.3.4. The Department reserves the right to request any and all information, logs, documents, reports, and written or digital content related to the performance of this Contract from any party performing work on behalf of the Department. This includes, but is not limited to, all tasks and services provided under this Contract, at any time.

C.1.6. Referrals. The Provider shall receive the referrals for the Initial Suitability Assessments from the Department, or the Department’s designee. Upon receiving the referral, the Provider shall ensure all pertinent information, including the child’s identifying details and any relevant background necessary for conducting the assessment is documented accurately.

C.1.6.1. Referral Database. The Provider shall develop and maintain a database for the management of referral information. The Provider shall:

C.1.6.1.1. Input all relevant details into the database and assign a unique case number for tracking purposes.

C.1.6.1.2. Ensure the database is capable of categorizing referrals based on whether the assessment requires a Non-STQE or a STQE.

C.1.6.1.3. The Provider shall ensure the database is active and the Department can access the Referral database within 30 days of Contract execution.

C.1.6.2. Non-STQE Referral and Assessment Timeline. For referrals for children who do not fall under the jurisdiction of the Seminole Tribe, the Provider shall:

C.1.6.2.1. Select a Non-STQE from the approved panel of QEs within one (1) business day of receiving the referral.

C.1.6.2.2. Coordinate scheduling, confirm appointments, and notify the Non-STQE of any cancellations or changes.

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C.1.6.2.3. Ensure the Non-STQE completes the Initial Suitability Assessment within seven (7) business days of receiving the referral.

C.1.6.2.4. Ensure the Non-STQE submits the assessment to the Provider within seven (7) business days of completing the assessment.

C.1.6.2.5. Review the assessment within three (3) business days and request any necessary edits.

C.1.6.2.6. Ensure the Non-STQE submits the requested edits within three (3) business days of receiving the request from the Provider.

C.1.6.3. STQE Referral and Assessment Timeline. For referrals involving children under the jurisdiction of the Seminole Tribe, the Provider shall:

C.1.6.3.1. Coordinate with the Psychological Services Administrator to select an STQE within three

(3) business days of receiving the referral.

C.1.6.3.2. Ensure the STQE completes the assessment within seven (7) business days from the date of referral.

C.1.6.3.3. Ensure the STQE submits the Assessment to the Provider within seven (7) business days of completing the evaluation.

C.1.6.3.4. Review the Assessment within three (3) business days and request any necessary edits.

C.1.6.3.5. Ensure the STQE submits the requested edits within three (3) business days of receiving the request. None of the Performance Measures in Attachment 1 apply to services rendered by the Provider to the Seminole Tribe.

C.1.6.3.6. Seminole Tribe Exclusions. No count of events or days unique to the Seminole Tribe shall be included in any aggregate count or percentage described in the Monthly Performance Measures Compliance Reports.

C.1.7. Assessments. The Provider shall ensure assessments are conducted to evaluate the suitability and ongoing needs of children in the care and custody of the Department, particularly those placed or considered for placement in RTCs, BQRTPs, or similar settings. The Provider shall ensure all assessments are conducted by QEs, or QIs, as appropriate. All assessments shall be clinically sound, evidence-based, and sufficient to support determinations of least restrictive placement in accordance with §39.407, F.S., and 65C-28.021, F.A.C., C.1.7.1. All assessments, including Initial Suitability Assessments, in-state 60-Day Independent Assessments, in-state 90-Day Assessments, Reconsideration Suitability Assessments, out-of-state 60-Day Independent Assessments and 90-Day Assessments, and BQRTP Assessments (unless otherwise specified in C.1.7.7.) shall include a comprehensive, documented review and analysis of the following:

C.1.7.1.1. The child’s medical records, placement documentation, treatment plans, and progress notes, including but not limited to mental health records, educational records (for example:

psychological evaluations, psychiatric evaluations, IEP, behavioral reports, and school performance data), when available and applicable.

C.1.7.1.2. Information provided during the interview with the child’s caseworker, either prior to or at the time of the appointment. This information may include but is not limited to:

C.1.7.1.2.1. Demographic information, including the child’s current living arrangements.

C.1.7.1.2.2. Reason for the referral and the desired outcome of residential treatment.

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C.1.7.1.2.3. Permanency plan and goals for the child.

C.1.7.1.2.4. Discharge plan for the child following residential treatment.

C.1.7.1.2.5. Comprehensive Behavioral Health Assessments or individual and family history

(when available and applicable) and bio-psychosocial evaluations.

C.1.7.1.2.6. Previous suicidal, self-destructive, or aggressive behaviors.

C.1.7.1.2.7. History of outpatient treatment and outcomes.

C.1.7.1.2.8. History of previous inpatient treatment and outcomes; and

C.1.7.1.2.9. Medication (current and history).

C.1.7.1.3. For In-State Assessments, the Provider shall conduct the assessment through a face-to-face clinical interview or secure video teleconference with the child. For Out-of-State Assessments, the interview may be conducted via telephone if video teleconferencing is not feasible.

C.1.7.1.4. The Provider shall ensure the QE makes and documents good faith efforts to directly contact and obtain input from relevant individuals to obtain insight/information into the child’s behaviors, needs, etc., consistent with 65C-28.021, F.A.C. At a minimum, these individuals shall include, when available:

C.1.7.1.4.1. Parent(s) or legal guardian(s) C.1.7.1.4.2. Current caregiver or foster parent C.1.7.1.4.3. Child Welfare Case Manager C.1.7.1.4.4. Guardian Ad Litem C.1.7.1.4.5. Treating clinical professional(s) C.1.7.1.4.6. Educational representatives (when applicable) C.1.7.1.4.7. Department of Juvenile Justice staff (when available) C.1.7.1.4.8. The child’s attorney

C.1.7.1.5. The assessment shall clearly document:

C.1.7.1.5.1. Each individual contacted, including unsuccessful contact attempts, with documentation of the date, method, and outcome of each attempt.

C.1.7.1.5.2. The method and outcome of each contact.

C.1.7.1.5.3. Relevant information obtained from each relevant individual

C.1.7.1.6. The Provider shall ensure the CANS Trauma Comprehensive Assessment instrument is implemented and completed as part of the assessment process.

C.1.7.1.7. Required Assessment Output: Each assessment shall include, at a minimum, the following clearly labeled components:

C.1.7.1.7.1. Clinical summary of presenting needs.

C.1.7.1.7.2. Functional assessment across key areas of functioning including home, school, community, and placement stability.

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C.1.7.1.7.3. Risk assessment (harm to self, harm to others, risk of placement disruption).

C.1.7.1.7.4. Analysis of prior treatment history and effectiveness.

C.1.7.1.7.5. Medical necessity determination aligned to §39.407, F.S.

C.1.7.1.7.6. Evaluation of least restrictive placement options, including why lower levels of care are not clinically appropriate based on assessment findings (when applicable and appropriate).

C.1.7.1.7.7. Clear placement recommendation.

C.1.7.1.7.8. Clinical rationale directly supporting the recommendation.

C.1.7.1.8. Assessment Submission and Review. The Provider shall be responsible for the submission of the typed assessment, following the completion of the assessment. The Provider shall:

C.1.7.1.8.1. Notify the Child Welfare Liaison or the POC with the name of the QE, the appointment details, any other relevant information, method for conducting the assessment within two (2) business days of referral.

C.1.7.1.8.2. Ensure the QE completes and submits the typed assessment(s) within the required timelines.

C.1.7.1.8.3. Ensure the QE applies standardized criteria in making their determinations.

C.1.7.1.8.4. Ensure the QE submits the assessment electronically or via facsimile.

C.1.7.1.8.5. Ensure that upon receipt of the assessment during business hour, the assessment is logged and dated immediately.

C.1.7.1.8.6. Ensure that if an assessment is received after business hours, it is logged and dated on the next business day.

C.1.7.1.8.7. Review all completed assessments and request any necessary edits.

C.1.7.1.8.8. Ensure no changes are made to the findings or recommendations within the assessment, except for those made by the authorized QEs.

C.1.7.1.9. Cancellations and Rescheduling. In the event a scheduled assessment is cancelled, by the Lead Agency, the Provider shall:

C.1.7.1.9.1. Reschedule the appointment via consultation with the POC, Child Welfare caseworker, the SIPP, the Residential Treatment Center, Department of Juvenile Justice, or Crisis Stabilization Unit Facility and any other relevant parties.

C.1.7.1.9.2. If the Provider cancels the assessment appointment, the rescheduling will be done at no cost to the Department.

C.1.7.1.9.3. The QE shall allow for a 15-minute grace period from a scheduled assessment appointment time before the appointment is cancelled due to a no-show.

C.1.7.1.10. Initial Suitability Assessment. The Initial Suitability Assessments are conducted to determine whether a child is appropriate for placement in an RTC based on their emotional and behavioral needs. The Provider shall conduct the Initial Suitability Assessment on the children in the care and custody of the Department, prior to placement in an RTC. The provider shall include all information obtained from required collaterals outlined in 65C- 28.021, F.A.C.

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C.1.7.1.10.1. The QE shall conduct a thorough evaluation of the child, which includes reviewing the child's background, medical history, and any other relevant documentation as outlined in C.1.7.

C.1.7.1.10.2. The assessment shall be completed within seven (7) business days from the date of referral.

C.1.7.1.10.3. The QE shall submit the assessment to the Provider within seven (7) business days of completing the evaluation.

C.1.7.1.10.4. The Provider shall review the assessment within three (3) business days and request any necessary edits.

C.1.7.1.11. The QE shall submit requested edits within three (3) business days after receiving the request.

C.1.7.1.12. The assessment shall provide a clear, clinically supported recommendation regarding the appropriate level of care, including justification for placement in, continuation of, or step up/step-down from residential treatment, supported by detailed findings and rationale. The assessment shall be submitted to the Lead Agency.

C.1.7.2. 60-Day Independent Assessments. The Provider shall conduct 60-Day Independent Assessments to assess the child’s progress toward achieving the goals and objectives of their treatment plan. These Assessments are clinical interviews, required for evaluating whether the current placement continues to meet the child’s needs, discharge recommendations, specific activities need to support the discharge as applicable, and for making any necessary adjustments to their care plan.

C.1.7.2.1. The Provider shall schedule the 60-Day Independent Assessment with the facility providing treatment to the child within 30 calendar days of receipt of referral.

C.1.7.2.2. The Provider's POC shall inform the facility of the need for a suitable space to conduct the 60-Day Independent Assessment.

C.1.7.2.3. The Provider shall inform the facility of the QE’s need to assess the child’s medical records, including the treatment plan, assessments, and progress notes.

C.1.7.2.4. If the QE did not perform the Initial Suitability Assessment, the Provider shall supply the QE with a copy of this report before the 60-Day Independent Assessment.

C.1.7.2.5. The QE shall review all relevant medical records, including the child’s treatment plan, prior assessments, and any progress notes made available, as outlined in C.1.7.

C.1.7.2.6. The 60-Day Independent Assessment shall provide a comprehensive evaluation of the child’s progress, including any recommendations for continued placement or necessary adjustments to the treatment plan.

C.1.7.2.7. The 60-Day Independent Assessment shall outline whether the current placement continues to be clinically appropriate and evaluates the child’s progress toward achieving the goals and objectives of the treatment plan, or if alternative placements may better meet the child’s needs. The 60-Day Independent Assessment shall be submitted to the Lead Agency.

C.1.7.2.8. The assessment shall incorporate, when available:

C.1.7.2.8.1. Input from the Multidisciplinary Team

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C.1.7.2.8.2. Parent, caregiver, or foster parent feedback regarding the child’s functioning and needs.

C.1.7.2.9. In cases where a previously recommended level of care has not been secured within 90 days due to system limitations (for example: waitlists, placement unavailability), the new assessment shall document whether the originally recommended level of care remains clinically appropriate, regardless of external system factors that may be in place for short-term support.

C.1.7.2.10. Clearly state whether any change in recommendation is due to true clinical improvement or external/system factors.

C.1.7.3. 90-Day Suitability Assessments. The Provider shall conduct 90-Day Suitability Assessments to evaluate the suitability of the least restrictive level of care and review the child’s progress in residential psychiatric treatment.

C.1.7.3.1. The Provider shall schedule the 90-Day Suitability Assessment with the facility within 30 calendar days of receipt of referral.

C.1.7.3.2. The Provider's POC shall inform the facility of the need for a suitable space to conduct the assessment.

C.1.7.3.3. The Provider shall inform the facility of the QE’s need to review the child’s medical records.

C.1.7.3.4. If the QE did not perform the Initial Suitability Assessment, the Provider shall supply the QE with a copy of this report before the 90-Day Suitability Assessment. The QE shall review all relevant medical records, including the child’s treatment plan, prior assessments, and any progress notes made available, as outlined in C.1.7.

C.1.7.3.5. The 90-Day Suitability Assessment shall provide details of the child’s response to treatment, progress made toward treatment goals and determine if the child continues to need the same level of care offered by their current placement.

C.1.7.3.6. The 90-Day Suitability Assessment shall outline whether the current placement continues to be clinically appropriate or if alternative placements may better meet the child’s needs. The 90-Day Suitability Assessment shall be submitted to the Lead Agency.

C.1.7.4. Second Level Review. For children in TGHs, a Second Level Review may be recommended at the completion of the 60-Day Independent Assessment and 90-Day Assessment conducted by a QE. The Provider shall report on the Second Level Reviews in the Monthly Billing and Tracking Report (C.2.5., Reports), for the service period the Second Level Reviews were conducted.

C.1.7.5. Reconsideration Suitability Assessments. When a second independent evaluation is required because the original assessment recommended a level of care that does not meet the child’s current needs based on Lead Agency or judicial feedback, the Provider shall schedule the Reconsideration Assessment within eleven (11) calendar days of receiving the referral and participate in a formal staffing requested by the Lead Agency regarding the reconsideration. This reconsideration process applies to both in-state and out-of-state placements in residential mental health treatment.

C.1.7.5.1. The Provider shall conduct a separate Reconsideration Suitability Assessment if one or both of the following criteria are met:

C.1.7.5.1.1. Additional clinical information not available at the time has since been received

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C.1.7.5.1.2. The child’s mental health has significantly decompensated since the time of the

Assessment (e.g., Baker Acts, self-injurious behavior).

C.1.7.5.2. The Provider shall receive the request for reconsideration via email from the POC.

C.1.7.5.3. The Provider shall review the request to ensure it is complete and contains all necessary information, as outlined in C.1.7.

C.1.7.5.3.1. If a reconsideration is court-ordered, the Provider shall require and verify a copy of the signed court order is included with the request for reconsideration.

C.1.7.5.4. The Provider shall make every effort to staff requests for reconsiderations within two (2) business days of receipt and notify the POC via email of the determination.

C.1.7.5.4.1. The email from the Provider shall indicate whether the request for reconsideration is approved or denied.

C.1.7.5.4.2. In the event the request for reconsideration is approved, the Provider shall include instructions on the additional steps and information needed for a new assessment, including but not limited to:

C.1.7.5.4.2.1. A reconsideration referral.

C.1.7.5.4.2.2. A signed authorization allowing the assessment to be conducted.

C.1.7.5.4.3. In the event the request for reconsideration is denied, the Provider shall include the rationale and reason for denial in the email.

C.1.7.5.5. The Reconsideration Suitability Assessment shall provide details of the child’s response to treatment, progress made toward treatment goals and determine if the child continues to need the same level of care offered by their current placement.

C.1.7.5.6. The Reconsideration Suitability Assessment shall outline whether the current placement continues to be clinically appropriate or if alternative placements may better meet the child’s needs. The Reconsideration Suitability Assessment shall be submitted to the Lead Agency.

C.1.7.5.7. Reconsideration Tracking. The Provider shall maintain and report data regarding Reconsideration Suitability Assessments and all assessments prescribed in Rule 65C- 28.021, FAC. At a minimum, the Provider shall track:

C.1.7.5.7.1. Total reconsideration requests received;

C.1.7.5.7.2. Total reconsideration requests approved and denied;

C.1.7.5.7.3. Total Reconsideration Suitability Assessments completed;

C.1.7.5.7.4. Number of Reconsideration Suitability Assessments resulting in a recommendation different from the original assessment recommendation;

C.1.7.5.7.5. Original recommended level of care and final recommended level of care;

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C.1.7.5.8. Reason for any change in recommendation, including but not limited to:

C.1.7.5.8.1. Additional clinical information received after the original assessment;

C.1.7.5.8.2. Significant change in the child's mental health, behavioral health, or functioning;

C.1.7.5.8.3. Court-ordered reconsideration;

C.1.7.5.8.4. Incomplete or unavailable information at the time of the original assessment; or

C.1.7.5.8.5. Other clinically relevant factors identified by the Qualified Evaluator.

C.1.7.6. BQRTP Assessments. The Provider shall conduct assessments specifically for children being considered for or placed in BQRTPs. These assessments will be used for determining the appropriateness and necessity of a child’s placement in a BQRTP.

C.1.7.6.1. Preliminary BQRTP Assessments. The Provider shall ensure each Preliminary BQRTP

Assessment is completed within three (3) business days from receipt of referral. The Preliminary BQRTP Assessments may be conducted by either a QE or QI only if the child is known to the QI.

C.1.7.6.1.1. The Provider shall attempt to make face-to-face contact with the child to conduct the Preliminary BQRTP Assessment. If the face-to-face contact is not feasible, alternative methods may be utilized.

C.1.7.6.1.2. The assessment shall include:

C.1.7.6.1.2.1. A review of the Comprehensive Placement Assessment.

C.1.7.6.1.2.2. Evidence supporting the preliminary recommendation for placement in a

BQRTP.

C.1.7.6.1.2.3. This is the only assessment that does not require the CANS Trauma

Comprehensive Assessment.

C.1.7.6.1.2.4. The Preliminary BQRTP Assessment shall be submitted to the Lead

Agency.

C.1.7.6.2. Full BQRTP Assessments.

C.1.7.6.2.1. A QI may complete a full BQRTP Assessment when the QI has a preexisting clinical relationship with the child and the child has not received a QE recommendation for placement in a Psychiatric Residential Treatment Center or Therapeutic Group Home within the preceding ninety (90) days.

C.1.7.6.2.2. A Full BQRTP Assessment must be completed by a QE under the following circumstances:

C.1.7.6.2.2.1. The child does not have a preexisting clinical relationship with a QI; or C.1.7.6.2.2.2. The child has received a QE recommendation for placement in a

Psychiatric Residential Treatment Center or Therapeutic Group Home within the preceding ninety (90) days.

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C.1.7.6.2.3. The Provider must submit the Full BQRTP Assessment to the Lead Agency within 30 days of the child’s placement in a BQRTP. The components for the Full BQRTP Assessments are:

C.1.7.6.2.3.1. A detailed review of the child's records and placement documentation.

C.1.7.6.2.3.2. Examination of available treatment plans and progress notes.

C.1.7.6.2.3.3. A face-to-face clinical interview or secure video teleconference with the child.

C.1.7.6.2.3.4. Interviews with collateral contacts knowledgeable about the child’s condition, in line with 65C-28.021 F.A.C. and as outlined in C.1.7.1.4.

C.1.7.6.2.3.5. Completion of the CANS Trauma Comprehensive Assessment.

C.1.7.6.2.4. The full assessment shall meet the requirements and support the 60-day court review as outlined in 65C-28.021(9)(a), F.A.C.

C.1.7.6.3. 90-Day BQRTP Assessments. The Provider shall conduct 90-Day Assessments to evaluate the suitability of the least restrictive level of care and review the child’s progress in a BQRTP.

C.1.7.6.3.1. The Provider shall schedule the 90-Day BQRTP Assessment with the facility within 30 calendar days of receipt of referral.

C.1.7.6.3.2. The Provider's POC shall inform the facility of the need for a suitable space to conduct the assessment.

C.1.7.6.3.3. The Provider shall inform the facility of the QE’s need to review the child’s medical records.

C.1.7.6.3.4. The QE shall review all relevant medical records, including the child’s treatment plan, prior assessments, and any progress notes made available, as outlined in C.1.7.

C.1.7.6.3.5. The 90-Day BQRTP Assessment shall provide details of the child’s response to treatment, progress made toward treatment goals and determine if the child continues to need the same level of care offered by their current placement.

C.1.7.6.3.6. The 90-Day BQRTP Assessment shall outline whether the current placement continues to be clinically appropriate or if alternative placements may better meet the child’s needs. The assessment shall be submitted to the Lead Agency.

C.1.7.6.4. Reconsideration for BQRTP. When a second independent evaluation is required because the BQRTP Assessment recommended a level of care that no longer meets the child’s current needs, the Provider shall:

C.1.7.6.4.1. Receive the BQRTP Reconsideration request from the POC, via email.

C.1.7.6.4.2. Schedule the Reconsideration Suitability Assessment within five (5) calendar days of receiving the referral. The assessment shall take place in a setting appropriate to the child's current location.

C.1.7.6.4.3. The Provider shall notify the POC of the reconsideration appointment. The POC will ensure all supporting documentation has been provided.

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C.1.7.6.4.4. The Provider shall participate in a reconsideration staffing as requested by the Lead Agency.

C.1.7.6.4.5. The Provider shall conduct a separate, Reconsideration Suitability Assessment if it has been determined one (or more) of the following criteria have been met:

C.1.7.6.4.5.1. There are missing components in the clinical reports.

C.1.7.6.4.5.2. The child has experienced a decompensation in mental, emotional, or behavioral health functioning.

C.1.7.6.4.5.3. The QE did not recommend a BQRTP placement, but the court has ordered the child to be placed in a BQRTP setting.

C.1.7.7. Assessment Criteria and Instrument Development.

C.1.7.7.1. The Provider shall develop the criteria and instruments for the Initial Assessment, 60-Day Independent Assessment, and 90-Day Assessment. The criteria and Suitability Assessment instruments shall be submitted to the Department for prior approval.

C.1.7.7.2. The Provider shall ensure that all assessment tools, methodologies, and clinical criteria are consistent with nationally recognized evidence-based practices.

C.1.7.7.3. The Provider shall conduct, at a minimum, an annual review and update of all assessment instruments and criteria to ensure alignment with current research, clinical standards, and state and federal requirements.

C.1.7.7.4. The Department reserves the right to require modifications to ensure alignment with evolving best practices.

C.1.7.7.5. The instruments used by QEs shall include the following:

C.1.7.7.5.1. Identifying information for the child, family, and key individuals, such as the

Guardian Ad-Litem and Child Welfare Caseworker.

C.1.7.7.5.2. The reason for the assessment.

C.1…