Indirect/Administrative Costs This Cost Pool Includes

Program Guidance for Contract Deliverables Incorporated Document 20

XYZ ME

Managing Entity Cost Allocation Plan

(Name), CEO (Street Address) (City, Florida zip)

Date XYZ ME

Managing Entity Cost Allocation Plan

Table of Contents Page

I. Certification

II. Background and System of Care Description

III. Accounting System Description

IV. Purpose and General Statements

V. General Approach

VI. Allocation of Cost Overview

VII. Managing Entity Operational Cost Section A Cost Pools

VIII. General Substance Abuse and Mental Health Services Section B Cost Pools

IX. Specific Federal and State Funded Projects

Section C Cost Pools

X. Non-Managing Entity Funded Activities, Contracts or Grants

Attachment I – Funding Matrix

Attachment II – Organizational Chart

Attachment III - Chart of Accounts

Attachment IV - Name other attachments

Version FY 13-14 July 1, 2013 2 Version FY 13-14 July 1, 2013 3 Section I – Certification

XYZ ME

Certification by Responsible Individual

I hereby certify, as the responsible official of XYZ ME, that the following is correct to the best of my knowledge and belief:

 This Cost Allocation Plan has been developed in accordance with the requirements of Title 2 CFR, Part 230 "Cost Principles for Non-Profit Organizations" (OMB Circular A-122).

 The allocation methodologies contained in this Cost Allocation Plan have been developed on the basis of a beneficial or causal relationship between the expenses incurred and the receiving organizational units or programs.

 Costs related to each activity are based on the current reporting month. All costs have been screened for allowable costs in accordance with Title 2 CFR, Part 230 "Cost Principles for Non-Profit Organizations" (OMB Circular A-122).

 An adequate accounting and statistical system exists to support claims that will be made under the Cost Allocation Plan.

 The same costs that have been treated as indirect costs have not been claimed as direct costs. Similar types of costs have been accounted for on a consistent basis.

 The information provided in support of the proposed Cost Allocation Plan is accurate.

______Signature

Printed Name

Version FY 13-14 July 1, 2013 4 Section II – Background and System of Care Description

Narrative

Eg. Principles of the System of Care

Key Features of the System of Care

The Array of Services Offered

Section III – Accounting System and Description

Describe the ME’s accounting system and complete general ledger coding structure

Also provide a description of how equipment is treated for acquisition and disposition in the ME’s General Ledger.

Section IV – Purpose and General Statements

The purpose of this cost allocation plan is to summarize, in writing, the methods and procedures that this organization will use to allocate costs to various programs, grants, contracts and agreements.

Title 2 CFR, Part 230 "Cost Principles for Non-Profit Organizations" (OMB Circular A-122),” establishes the principles for determining costs of grants, contracts and other agreements with the Federal Government. ME XYZ Cost Allocation Plan is based on the Direct Allocation method described in Title 2 CFR, Part 230 "Cost Principles for Non-Profit Organizations" (OMB Circular A- 122). The Direct Allocation Method treats all costs as direct costs except general administration and general expenses.

Direct costs are those that can be identified specifically with a particular final cost objective. General administrative costs are those that have been incurred for common or joint objectives and cannot be readily identified with a particular final cost objective.

Only costs that are allowable, in accordance with the cost principles, will be allocated to benefiting programs by ME XYZ.

Section V – General Approach

The general approach of ME XYZ in allocating costs to particular grants and contracts is as follows:

Version FY 13-14 July 1, 2013 5 A. All allowable direct costs are charged directly to program, grants, activities, or contracts. B. Allowable direct costs that can be identified to more than one program or cost pool are prorated individually as direct costs using a base most appropriate to the particular cost being prorated. C. All other allowable general and administrative costs (costs that benefit all programs and cannot be identified to a specific program) are allocated to programs, grants, contracts using a base that results in an equitable distribution as further described below.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description of how general costs such as rent or lease costs, telephone, supplies, insurance, legal are allocated to the various cost pools.

Section VI – Allocation of Cost Overview

The Managing Entity (ME) Cost Allocation Plan is presented in four sections. The expenditures charged to the first three sections will be reported to the Department of Children and Families through the monthly expenditure report. The first section includes expenditures that are associated with the Managing Entity’s operational cost. This includes any costs that are expended by the Managing Entity that are not related to substance abuse or mental health services.

The second section of the cost allocation plan reflects the expenditures for general substance abuse and mental health services. Costs recorded in this section include the services identified from the Substance Abuse and Mental Health block grants.

The third section of the cost allocation plan contains the cost related to specific services or projects. Activities described in this section include specialty federal grants, special state projects, and specific targeted programs.

The last section of the cost allocation plan describes those grants, programs, and contracts that are outside the purview of the substance abuse and mental health services covered in the Managing Entity contract. These cost pools are presented to give a complete overview of the services and activities conducted by the XYZ ME, and the other funding sources available.

Section VII – Managing Entity Operational Cost Section A Cost Pools

Version FY 13-14 July 1, 2013 6 Operational Costs – This cost pool includes administrative or indirect costs as defined in Title 2 CFR, Part 225 "Cost Principles for State, Local, and Tribal Governments" (OMB Circular A-87,) or Title 2 CFR, Part 230 "Cost Principles for Non-Profit Organizations" (OMB Circular A-122). Typical examples of costs included in this cost pool include general administrative and general expenses such as those for executive officers, personnel administration and accounting. These costs may also include items such as costs of facility maintenance and operation, and grounds maintenance.

Allocation methodology – Costs are allocated to cost pools based on their proportion of the cost to the total costs of all included cost pools. The cost pools to receive a portion of the costs in this cost pool are all of those in the fixed price section of this plan.

ME Cost Allocation Plan Requirement – In this section, the ME should define what types of costs are included in this cost pool and a description of how the ME’s accounting system captures these costs. Organizational charts should be provided and referenced in the narrative to the extent feasible. Any positions with allocated costs should be fully explained as to who is being allocated, where (what cost pools) they are being allocated and the basis of allocation. Attachments may be used to simplify the explanation of allocated costs.

Section VIII – General Substance Abuse and Mental Health Services Section B Cost Pools

This section describes expenditures related to general substance abuse and mental health services. Costs recorded in this section include the services identified from the Substance Abuse and Mental Health block grants.

Adult Mental Health

MHA01 – 24 Hour Care (Non-Hospitalization) Residential – This BE/OCA combination captures the allowable expenditures for 24 hour residential care (non-hospitalization) of eligible adult mental health residential treatment.

The purpose is to enable adults with symptoms or disabilities associated with mental illness to live, work, learn, and socialize in a community-based residential setting.

The authorized services assist individuals with acquiring / maintaining / monitoring needed housing, social support, vocational training, and treatment related to symptoms or disabilities associated with mental illnesses.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an

Version FY 13-14 July 1, 2013 7 indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MHA09 – Ambulatory/Community Non-24 Hour Care – This BE/OCA combination captures the allowable non-residential care cost of eligible adult community mental health treatment (excluding Residential and Crisis Services).

The purpose is to enable adults with symptoms or disabilities associated with mental illness to live, work, learn and socialize in a community-based setting.

Services that assist individuals with acquiring / maintaining / monitoring needed housing, social support, vocational training, and treatment related to symptoms or disabilities associated with mental illnesses.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MHA18 – CSU, Baker Act, Inpatient Crisis Services – This BE/OCA combination captures the allowable cost of eligible adult mental health crisis services, excluding Baker Act inpatient hospitals licensed Under Chapter 395.

The purpose is to provide immediate support to adults with severe and persistent mental illness, adults with acute episode, and adults with forensic involvement in community programs designed to avert more restrictive level of care, such as longer-term inpatient / incarceration.

Services include, but are not limited to, crisis assessment, crisis outreach, crisis intervention, including crisis stabilization units and Short-term Residential Treatment Centers (Baker Act), walk-in crisis centers, and mobile crisis.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types

Version FY 13-14 July 1, 2013 8 of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MHA25 – Prevention Services – This BE/OCA combination captures the allowable cost of eligible adult mental health prevention services.

The purpose is to serve adults at risk of more serious mental health problems and need of brief counseling or supportive services on a short- term basis (e.g., up to three (3) sessions) to avert a crisis and a more restrictive level or care.

Prevention services include brief counseling, treatment planning, education, problem identification and referral services.

MHA72 – Community Forensic Beds – This BE/OCA combination captures the allowable costs for community forensic beds, which provide treatment and training services to those individuals who have been charged with a felony and have been found to be incompetent to proceed (ITP) or not guilty by reason of insanity (NGI) due to their mental illness and are committed to the Department of Children and Families under the provision of Chapter 916 of the Florida Statutes.

Services may also be provided to individuals who have been charged with a misdemeanor and are believed to be at risk of moving further into criminal justice system due to their mental illness.

The goal is to provide community-based treatment aimed at diverting individuals from the forensic system to the mental health treatment system in order to reduce commitments to the Department of Children and Families under the provision of Chapter 916 of the Florida Statutes.

These services include, but are not limited to, residential services, mental health courts, and wraparound services/incidentals.

Community forensic beds (secure or non-secure) significantly improve timely access to court-ordered forensic treatment and thereby reduce the growing forensic waitlist. Community forensic treatment includes, but is

Version FY 13-14 July 1, 2013 9 not limited to, admission, assessment, evaluation, treatment and various individualized services including competency restoration training.

This excludes services for individuals who are served in an inpatient hospital licensed under Chapter 395 or state mental health treatment facility.

MHATB – Temporary Assistance for Needy Families (TANF) – This BE/OCA combination captures the allowable costs of eligible adult mental health services for Temporary Assistance for Needy Families (TANF) eligible participants.

The purpose is to provide interim services for TANF eligible participants who would either be required to wait on a list for treatment, or have no other method of payment. This is to be used to give priority to families with child welfare involvement.

These non-medical services must be in line with the Federal TANF Legislative Goals, TANF State Plan (in accordance with Florida Statute 414.1585), and must be for TANF eligible consumers. TANF is the last payer for services.

Eligible services include; aftercare, assessment, case management, crisis support / emergency, day care, day-night, incidental expenses, in-home / on-site, intensive case management, intervention, outpatient, outreach, prevention, residential levels I through IV, room and board with supervision, supported employment, supported housing / living (non-rent) and Treatment Alternative to Street Crime (TASC).

Community Support Services include, but are not limited to, income supports, social supports, housing supports and vocational supports.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are

Version FY 13-14 July 1, 2013 10 charged to this cost pool and how their accounting system captures these costs.

Children’s Mental Health

MHC01 – 24 Hour Care (Non-Hospitalization) Residential – This BE/OCA combination captures the allowable expenditures for 24 hour residential care (non-hospitalization) of eligible children's mental health residential treatment.

The purpose is to provide services for children and adolescents with severe emotional disturbance, emotional disturbance or those at risk of developing emotional disturbance and assist them to live successfully in the community.

The authorized services include, community-based residential services and supports including therapeutic foster homes, group homes and other residential community-based services.

MHC09 – Ambulatory/Community Non-24 Hour Care – This BE/OCA combination captures the allowable non-residential care cost of eligible children's mental health treatment (excluding Residential and Crisis Services).

The purpose is to enable children and adolescents with severe emotional disturbance, emotional disturbance or those at risk of developing emotional disturbance and assist them to live successfully in the community.

Community-based services and supports include, but are not limited to, assessment, outpatient treatment, in-home or on-site community-based services and supports that are individualized and developmentally appropriate.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should

Version FY 13-14 July 1, 2013 11 provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MHC18 – CSU, Baker Act, Inpatient Crisis Services – This BE/OCA combination captures the allowable cost of eligible children’s mental health crisis services, excluding Baker Act inpatient hospitals licensed under Chapter 395.

The purpose is to provide immediate support to children with severe and persistent mental illness, adults with acute episode, and children with forensic involvement in community programs designed to avert more restrictive level of care, such as longer-term inpatient / incarceration.

Services include, but are not limited to, crisis assessment, crisis outreach, crisis intervention, including crisis stabilization units and Short-term Residential Treatment Centers (Baker Act), walk-in crisis centers, and mobile crisis.

MHC25 – Prevention Services – This BE/OCA combination captures the allowable cost of eligible children's mental health prevention services.

The purpose is to help children at-risk of emotional disturbance and their family in need of short-term counseling.

Services include: education, mental health consultation to education / child care provider for identified children, or intervention services.

MHC77 – Children at Risk of Emotional Disturbances – This BE/OCA combination captures the allowable costs for community-based services

Version FY 13-14 July 1, 2013 12 that support and promote the positive potential of children and adolescents who have an increased risk of developing emotional disturbance due to certain risk factors.

Services include, but are not limited to, assessment, information and referral, crisis and stabilization services, case management, in-home and other community based services and supports that prevent emotional and behavioral problems from developing or escalating. Services and supports purchased with these funds promote improved outcomes, such as school attendance, academic achievement and decreased involvement in the juvenile justice and child welfare systems.

Adult Substance Abuse

MSA03 – 24 Hour Care (Non-Hospitalization) Residential (Alcohol) – This BE/OCA combination captures the allowable expenditures for 24 hour residential care (non-hospitalization) of eligible adult substance abuse residential treatment for alcohol.

This purpose is to provide services for adult substance abuse disorders.

The authorized services include, residential 24-hours, 7 days per week services to promote recovery.

MSA04 – 24 Hour Care (Non-Hospitalization) Residential (Drug) – This BE/OCA combination captures the allowable expenditures for 24 hour residential care (non-hospitalization) of eligible adult substance abuse residential treatment for drugs.

This purpose is to provide services for adult substance abuse disorders.

Version FY 13-14 July 1, 2013 13 The authorized services include, residential 24-hours, 7 days per week services to promote recovery.

MSA05 – 24 Hour Care (Non-Hospitalization) Pregnant Women – This BE/OCA combination captures the allowable expenditures for 24 hour residential non-hospitalization) of eligible adult substance abuse for pregnant women and women with dependent children, including women attempting to regain custody of their children.

Pregnant women should be given preference to admission to treatment facilities. The provider must also provide or arrange for case management, transportation, and child care services (45 Code of Federal Regulation 93.124 and 96.131).

MSA11 – Ambulatory/Community Non-24 Hour Care A/C (Alcohol) – This BE/OCA combination captures the allowable non-residential care cost of eligible adult community substance abuse services for alcohol (excluding Residential and Crisis Services).

The purpose is to provide services in all levels including counseling, treatment planning and various ancillary services, such as, formal school and adult education.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are

Version FY 13-14 July 1, 2013 14 charged to this cost pool and how their accounting system captures these costs.

MSA12 – Ambulatory/Community Non-24 Hour Care A/C (Drug) – This BE/OCA combination captures the allowable non-residential care cost of eligible adult community substance abuse services for drugs (excluding Residential and Crisis Services).

MSA13 – Ambulatory/Community Non-24 Hour Care A/C (Pregnant Women) – This BE/OCA combination captures the allowable non- residential care cost of eligible adult community substance abuse services for drugs(excluding Residential and Crisis Services).

MSA21 – Detoxification Services (Alcohol) – This BE/OCA combination captures the allowable eligible alcohol detoxification program costs. Detoxification programs utilize medical and clinical procedures to assist adults in their efforts to withdraw from the physiological and psychological effects of substance abuse.

Detoxification programs utilize medical and clinical procedures to assist adults in their efforts to withdraw from the physiological and psychological effects of substance abuse.

Version FY 13-14 July 1, 2013 15 Services include screening, assessment, short-term stabilization, detoxification and counseling. These services include activities associated with case management, referral, coordination and monitoring of services; assisting in the application process for services; facilitating client access and outreach for services and program and policy development.

Detoxification services may occur in a nonsecure, residential or outpatient setting.

MSA22 – Detoxification Services (Drug) – This BE/OCA combination captures the allowable eligible drug detoxification program costs. Detoxification programs utilize medical and clinical procedures to assist adults in their efforts to withdraw from the physiological and psychological effects of substance abuse.

Detoxification programs utilize medical and clinical procedures to assist adults in their efforts to withdraw from the physiological and psychological effects of substance abuse.

Services include screening, assessment, short-term stabilization, detoxification and counseling. These services include activities associated with case management, referral, coordination and monitoring of services; assisting in the application process for services; facilitating client access and outreach for services and program and policy development.

Detoxification services may occur in a nonsecure, residential or outpatient setting.

Version FY 13-14 July 1, 2013 16 MSA23 – HIV Services – This BE/OCA combination captures the allowable eligible cost relating to early intervention services for adults with the Human Immunodeficiency Virus (HIV).

Per 45 Code of Federal Regulation 96.128, organizations who serve individuals in treatment of substance abuse must make available free test counseling and testing, and post-testing counseling and therapy for HIV and the Acquired Immune Deficiency Syndrome (AIDS).

MSA25 – Prevention Services – This BE/OCA combination captures the allowable cost of eligible primary prevention services for adults at risk of substance use disorders.

Prevention services include counseling, treatment planning, education, alternative activities, problem identification and referral services, community-based processes and environmental strategies.

MSATB – Temporary Assistance for Needy Families (TANF) – This BE/OCA combination captures the allowable costs of eligible adult substance abuse services for Temporary Assistance for Needy Families (TANF) eligible participants.

These non-medical services must be in line with the Federal TANF Legislative Goals, TANF State Plan (in accordance with Florida Statute

Version FY 13-14 July 1, 2013 17 414.1585), and must be for TANF eligible consumers. TANF is the last payer for services.

Children’s Substance Abuse

MSC03 – 24 Hour Care (Non-Hospitalization) Residential (Alcohol) – This BE/OCA combination captures the allowable expenditures for 24 hour residential care (non-hospitalization) of eligible children's substance abuse residential treatment for alcohol.

This purpose is to provide services for children and adolescent with substance use disorders.

MSC04 – 24 Hour Care (Non-Hospitalization) Residential (Drug) – This BE/OCA combination captures the allowable expenditures for 24 hour residential care (non-hospitalization) of eligible children's substance abuse residential treatment for drugs.

Version FY 13-14 July 1, 2013 18 This purpose is to provide services for children and adolescent with substance use disorders.

MSC11 – Ambulatory/Community Non-24 Hour Care A/C (Alcohol) – This BE/OCA combination captures the allowable non-residential care cost of eligible children's substance abuse services for alcohol (excluding Residential and Crisis Services).

MSC12 – Ambulatory/Community Non-24 Hour Care A/C (Drug) – This BE/OCA combination captures the allowable non-residential care cost of eligible children's substance abuse services for drug (excluding Residential and Crisis Services).

MSC21 – Detoxification Services (Alcohol) – This BE/OCA combination captures the allowable costs of the alcohol detoxification and addiction program services utilizing medical and clinical procedures to assist children in the efforts to withdraw from the psychological effects of substance abuse.

Services include screening, assessment, short-term stabilization and counseling for children. These services include activities associated with case management, referral, coordination and monitoring of services, assisting in the application process for services, facilitating client access and outreach for services and program planning and policy development.

MSC22 – Detoxification Services (Drug) – This BE/OCA combination captures the allowable costs of the drug detoxification and addiction program services utilizing medical and clinical procedures to assist children in the efforts to withdraw from the psychological effects of substance abuse.

Services include screening, assessment, short-term stabilization and counseling for children. These services include activities associated with case management, referral, coordination and monitoring of services, assisting in the application process for services, facilitating client access and outreach for services and program planning and policy development.

Version FY 13-14 July 1, 2013 20 MSC23 – HIV Services – This BE/OCA combination captures the allowable eligible cost relating to early intervention services for adults with the Human Immunodeficiency Virus (HIV).

Per 45 Code of Federal Regulation 96.128, organizations who serve individuals in treatment of substance abuse must make available free test counseling and testing, and post-testing counseling and therapy for HIV and the Acquired Immune Deficiency Syndrome (AIDS).

MSC25 – Prevention Services – This BE/OCA combination captures the allowable cost of eligible primary prevention services for children at risk of substance use disorders.

Prevention services are directed toward children who do not require treatment. Prevention services preclude, forestall or impede the development of a substance abuse problem in children and youth.

MSCTB – Temporary Assistance for Needy Families (TANF) – This BE/OCA combination captures the allowable costs of eligible children's substance abuse services for Temporary Assistance for Needy Families (TANF) eligible participants.

These non-medical services must be in line with the Federal TANF Legislative Goals, TANF State Plan (in accordance with Florida Statute

Version FY 13-14 July 1, 2013 21 414.1585), and must be for TANF eligible consumers. TANF is the last payer for services.

Section IX – Specific Federal and State Funded Projects Section C Cost Pools

Adult Mental Health

MHA70 – Adult Mental Health Projects – This BE/OCA combination captures the allowable cost of adult mental health projects funded by the Legislature in the General Appropriations Act workpapers.

The purpose is to provide immediate support to adults with severe and persistent mental illness, adults with acute crisis episode and adults with forensic involvement.

Costs include community-based treatment, rehabilitation and supportive services along with community services that are provided to assist adults to live successfully in environments of their choice.

Authorized services include those that assist individuals with acquiring / maintaining / monitoring needed housing, social support, vocational training, treatment related to symptoms or disabilities associated with mental illnesses, crisis support, and treatment provided in crisis stabilization units, short-term residential treatment programs, services from mobile crisis, outpatient crisis intervention and outreach/referral.

Version FY 13-14 July 1, 2013 22 These activities provide immediate support to adults with severe and persistent mental illnesses, adult with acute crisis episode and adults with forensic involvement in community programs designed to avert more restrictive level of care, such as long-term inpatient / incarceration.

MHA73 – Florida Assertive Community Treatment (FACT) - Administration – This BE/OCA combination captures the allowable costs of salaries and expenses for the operation of the Florida Assertive Community Treatment (FACT) program. A portion of these costs are to be claimed from the Centers for Medicare and Medicaid Services (CMS) as Medicaid administrative costs in accordance with an Interagency Agreement between the Department and the Florida Agency for Health Care Administration (AHCA). The costs charged to AHCA is determined by the percentage of FACT clients that are Medicaid eligible.

MHA74 – CSU Florida Assertive Community Treatment (FACT) - Services – This BE/OCA combination captures the allowable enhancement funding needed by persons served by the Florida Assertive Community Treatment (FACT) program. Funding is used to increase or maintain a person's independence and integration into their community. For example, funding may be used for costs related to housing, pharmaceuticals, tangible items needed for employment or other meaningful activity or specialized treatment not provided by the FACT team (nor paid by any other means). Providers will be paid a fixed amount per client enrolled each month for these items.

Providers will maintain records of actual expenditures for these items and repay the Department for any unspent funds.

Version FY 13-14 July 1, 2013 23 ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MHA76 – Indigent Psychiatric Medication Program – This BE/OCA combination captures the allowable costs of providing the Indigent Psychiatric Drug Program (IDP). This program is authorized to assist Adults with serious mental illnesses and meets the Federal guidelines for indigent person.

Identified contracted providers my use the IDP to order additional psychotropic medications from either the IDP warehouse or a pharmacy of their choice (for urgent needs). This funding can also be used to pay dispending fees for individuals who cannot afford them.

IDP providers are required by contract to actively participate in patient assistance programs (PAP) for medications offered by pharmaceutical manufacturers. Medications from PAP must be exhausted before used of IDP is permitted.

Funds may be used for person's with co-occurring substance use problems and mental illness.

The IDP providers are also issued a separate line of credit at the IDP program at Florida State Hospital's pharmacy which is not captured in this OCA, which they order medications that are shipped monthly to a licensed pharmacy.

MHA79 – Projects Clay Behavioral Center Community Crisis Prevention Team – This BE/OCA combination captures the allowable costs associated with the Clay Behavioral Health Center Community Crisis Prevention Team, which was appropriated in line 354 of the Fiscal Year 2013-2014 General Appropriations Act.

Version FY 13-14 July 1, 2013 24 ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MHAJD – Grants Jail Diversion and Trauma Recovery – This BE/OCA combination captures the administrative and general program costs in the Regions/Circuits associated with the "Miami-Dade Wraparound Project" (MDWP), a collaborative effort to enhance, expand and strengthen the existing community-based family and youth mental health services in Miami-Dade County, in order to better serve adolescents who have serious emotional disturbances (SED) and a co-occurring substance abuse diagnosis and their families or caretakers in Miami-Dade County, Florida.

Costs include, but are not limited to implementing the MDWP for the Comprehensive Community Mental Health Services for Children with SED six year Grant.

MHAPG – Grants PATH – This BE/OCA combination captures the allowable administrative and general program costs in the Regions / Circuits that are incurred under the Projects for Assistance in Transition from Homelessness (PATH) Grant. Community-based services are for individuals that are homeless or at risk of being homeless due to mental illnesses / co-occurring mental health and substance use disorders. The services assist individuals in living successfully in environments of their choice and include:

• Outreach; • Screening and diagnostic treatment; • Habilitation and rehabilitation; • Community mental health services; • Alcohol or drug treatment;

Version FY 13-14 July 1, 2013 25 • Staff training, including the training of individuals who work in shelters, mental health clinics, substance abuse programs, and other sites where homeless individuals require services; • Case management services; • Providing assistance to the eligible homeless individual in obtaining income support services, including housing assistance, food stamps, and supplemental security income benefits; • Referring the eligible homeless individual for such other services as may be appropriate; • Providing representative payee services in accordance with Section 1631(a)(2) of the Social Security Act if the eligible homeless individual is receiving aid under Title XVI of such act and if the applicant is designated by the Secretary to provide such services. • Supportive and supervisory services in residential settings; • Referrals for primary health services, job training, education services and relevant housing services; • Housing services [subject to Section 522(h)(1)] including minor renovation, expansion, and repair of housing; Planning of housing; Technical assistance in applying for housing assistance; Improving the coordination of housing services; • Security deposits; • The costs associated with matching eligible homeless individuals with appropriate housing situations; • One-time rental payments to prevent eviction.

The PATH Grant requires a 25% in-kind or cash match, in addition to being limited to a 4% administrative cap.

Children’s Mental Health

MHC70 – Children's Mental Health Projects – This BE/OCA combination captures the allowable cost of children's mental health projects funded by the Legislature in the General Appropriations Act workpapers.

Costs include community-based services and supports provide immediate supports that promote the positive potential of children and adolescents

Version FY 13-14 July 1, 2013 26 with severe emotional disturbance, emotional disturbance or those at risk of developing emotional disturbance to help them remain successfully in the community in the least restrictive setting possible.

Authorized services include, but are not limited to, assessment, outpatient treatment, in-home or on-site community-based services and supports that are individualized and developmentally appropriate, as well as crisis support and treatment provided in crisis stabilization units, services from mobile crisis, outpatient crisis intervention and outreach/referral.

MHCBN – Title XXI Children's Health Insurance Program (aka Behavioral Health Network) – This BE/OCA combination captures the allowable Behavioral Health Network expenditures of the services provided under the Florida Statewide Child Health Insurance Program that will assist children and their families to live successfully in the community.

These services include, but are not limited to, supported housing, supported living, crisis support and treatment provided in crisis stabilization units and inpatient facilities.

The purpose of these services is to provide immediate support to children with a serious emotional disturbance in acute emotional distress, enable children with serious emotional disturbance to live in stable settings, function appropriately, attend school and stay of the Juvenile Justice System.

In accordance with an interagency agreement with the Department of Health (DOH), the Department of Children and Families (DCF) is authorized to establish the scope of behavioral health services, clinical guidelines for referral, service standards, performance-based measures and practice guidelines. To deliver the services, DCF will create a Behavioral Health Specialty Network comprised of member providers throughout the state.

MHCMD – Grants Miami-Dade County Wraparound – This BE/OCA combination captures the allowable administrative and general program costs in the Regions / Circuits associated with the "Miami-Dade Wraparound Project" (MDWP), a collaborative effort to enhance, expand and strengthen the existing community-based family and youth mental health services in Miami-Dade County, in order to better serve adolescents who have serious emotional disturbance (SED) and a co- occurring substance abuse diagnosis and their families or caretakers in Miami Dade County, Florida.

Costs include, but are not limited to implementing the MDWP for the Comprehensive Community Mental Health Services for Children with SED six year Grant.

MHCPL – Grants Project Launch – This BE/OCA combination captures the administrative and general program costs in the Regions/Circuits associated with mental health counseling.

Costs include, but are not limited to the project to promote the wellness of young children from birth to 8 years by addressing the gaps in existing prevention and targeted intervention services and to strengthen the partnership between state and local agencies serving young children and their families. The Florida (FL) LAUNCH Project enhances the partnership between the Department of Children and Families (DCF), Department of Health (DOH), and service providers in Pinellas County, FL. The project is aimed at preventing youth substance use and mental, emotional, and behavioral disorders by improving family function and the quality of the parent-child relationship through parenting training and skill building and selective intervention for young children.

Adult Substance Abuse

MSA70 – Adult Substance Abuse Projects – This BE/OCA combination captures the allowable cost of adult substance abuse projects funded by the Legislature in the General Appropriations Act workpapers.

Treatment services include, but are not limited to, non-residential, residential, crisis stabilization and a range of community based services designed to advance substance abuse recovery.

Services exclude inpatient hospitalization for adult substance abuse.

MSA81 – Projects Expansion of Substance Abuse Services for Pregnant Women and their affected families – This BE/OCA combination captures the allowable costs associated with the expansion of substance abuse services for pregnant women and their affected families, which was appropriated in line 375 of the Fiscal Year 2013-2014 General Appropriations Act.

From the funds in Specific Appropriation 375, $8,967,700 of nonrecurring funds 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, 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.

ME Cost Allocation Plan Requirement – In this section, the ME should provide a description as to how these services are provided including an indication as to whether they are provided by ME staff or sub-contracted agencies (or both), an organizational chart, and a description of the types

Version FY 13-14 July 1, 2013 29 of costs that are charged to the cost pool. In addition, the ME should provide a description as to how the ME ensures that only eligible costs are charged to this cost pool and how their accounting system captures these costs.

MSA82 – Projects St. Johns County Sheriff's Office – This BE/OCA combination captures the allowable costs associated with the St. Johns Sheriff's Office which was appropriated in line 375 of the Fiscal Year 2013- 2014 General Appropriations Act.

From the funds in Specific Appropriation 375, $1,300,000 from recurring general revenue funds is provided for the St. Johns Sheriff's Office substance abuse detoxification program.

Children’s Substance Abuse

MSC70 – Children's Substance Abuse Projects – This BE/OCA combination captures the allowable cost of children's and youth substance abuse projects funded by the Legislature in the General Appropriations Act workpapers.

Treatment and aftercare services include, but are not limited to, residential care (24-hours, 7 days per week), day/night outpatient, assessment, recovery support, intervention, outreach and case management, outpatient services, maintenance and assessment. Aftercare includes structure provided to those who have continued observation and support to maintain recovery. Principle services in all levels of counseling, treatment planning and various ancillary services, such as, formal school and adult education.

MSC80 – Projects Informed Families of Florida – This BE/OCA combination captures the costs associated with Informed Families of Florida, which was provided in the proviso language in line 374 of the Fiscal Year 2013-2014 General Appropriations Act.

From the funds in Specific Appropriation 374, $750,000 from the General Revenue Fund is provided for Informed Families of Florida for the purpose

Version FY 13-14 July 1, 2013 30 of providing a statewide program for the prevention of child and adolescent substance abuse.

MSCPP – Prevention Partnership Grant (PPG) – This BE/OCA combination captures the allowable, eligible costs of the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) relating to the Prevention Partnership Program. The prevention services are based on a partnership between community service providers and schools and are directed toward child and youth who do not require treatment.

Section X – Non-Managing Entity Funded Activities, Contracts or Grants

Version FY 13-14 July 1, 2013 31 Cost Allocation Plan Attachment I

M SA S TANF Miam PATH M Gene T H Block A MOE i e ral i Grant Dade d Reve t B B Wrap i nue l l l Arou c e o o nd a c c i X k k d X I G G A r r d a a m n n i t t n

M O Funding Sources E F Feder S State Feder Feder F State F e al t al al e e d a d d e t e e r e r r a a a l l l Section A MHAOP Managing Entity Operational Cost - Adult Mental Health MHCOP Managing Entity Operational Cost - Children's Mental Health MSAOP Managing Entity Operational Cost - Adult Substance Abuse X MSCOP Managing Entity Operational Cost - Children's Substance Abuse X Section B MHA02 24 Hour Care (Non-Hospitalization) Residential X X MHA09 Ambulatory/Community Non-24 Hour Care X X MHA17 CSU, Baker Act, Inpatient Crisis Services X X MHA26 Prevention Services X X MHA72 Community Forensic Beds X X MHATB Temporary Assistance for Needy Families (TANF) MHC02 24 Hour Care (Non-Hospitalization) Residential X X MHC09 Ambulatory/Community Non-24 Hour Care X X MHC17 CSU, Baker Act, Inpatient Crisis Services X X MHC26 Prevention Services X X MHC77 Children at Risk of Emotional Disturbances X X

32 MSA03 24 Hour Care (Non-Hospitalization) Residential (Alcohol) X X MSA04 24 Hour Care (Non-Hospitalization) Residential (Drug) X X MSA06 24 Hour Care (Non-Hospitalization) Pregnant Women X X MSA11 Ambulatory/Community Non-24 Hour Care A/C (Alcohol) X X MSA12 Ambulatory/Community Non-24 Hour Care A/C (Drug) X X MSA14 Ambulatory/Community Non-24 Hour Care A/C (Pregnant Women) X X MSA21 Detoxification Services (Alcohol) X X MSA22 Detoxification Services (Drug) X X MSA23 HIV Services X X MSA25 Prevention Services X X MSATB Temporary Assistance for Needy Families (TANF) X MSC03 24 Hour Care (Non-Hospitalization) Residential (Alcohol) X X MSC04 24 Hour Care (Non-Hospitalization) Residential (Drug) X X MSC11 Ambulatory/Community Non-24 Hour Care A/C (Alcohol) X X MSC12 Ambulatory/Community Non-24 Hour Care A/C (Drug) X X MSC21 Detoxification Services (Alcohol) X X MSC22 Detoxification Services (Drug) X X MSC23 HIV Services X X MSC25 Prevention Services X X MSCTB Temporary Assistance for Needy Families (TANF) Section C MHA70 Adult Mental Health Projects MHA73 Florida Assertive Community Treatment (FACT) - Administration X X MHA74 Florida Assertive Community Treatment (FACT) - Services MHA76 Indigent Psychiatric Medication Program MHA79 Projects Clay Behavioral Center Community Crisis Prevention Team MHAJD Grants Jail Diversion and Trauma Recovery MHAPG Grants PATH X MHC70 Children's Mental Health Projects MHCBN Title XXI Children's Health Insurance Program X MHCMD Grants Miami-Dade County Wraparound X MHCPL Grants Project Launch MSA70 Adult Substance Abuse Projects X

Projects Expansion of Substance Abuse Services for Pregnant Women and their affected X MSA81 families MSA82 Projects St. Johns County Sheriff's Office X 33 MSC70 Children's Substance Abuse Projects X MSC80 Projects Informed Families of Florida X MSCPP Prevention Partnership Grant (PPG) X

34 Attachment II – Organizational Chart

(Add ORG Chart)

Attachment III – Chart of Accounts

(Add Chart of Accounts all levels)

Attachment IV – (Other attachments)