Network Service Provider contract documents:

(Required)

LSF Standard Contract: LSF Standard Contract – FY 21-22 – rev. 090121

Attachment I: Network Service Provider Attachment I – FY 21-22

Attachment II (Lobbying): Network Service Provider Attachment II CF 1123_Lobbying – FY 21-22

Attachment III (Audit): Network Service Provider Attachment III CF 1120_Audit – FY 21-22

Attachment IV (HIPAA): Network Service Provider Attachment IV – HIPAA – FY 21-22

Exhibit A – Required Reports – FY 21-22

Exhibit B – Performance Outcome Measures – FY 21-22

Exhibit C and D – Projected Operating and Capital Budget – FY 21-22

Exhibit C-1 – Actual Expenses and Revenues Schedule – CF-MH 1037 FY 2021-2022-Reconciliation Template

Exhibit C-1 – Actual Expenses and Revenues Schedule – FY 21-22

Exhibit E – Agency Capacity Report – FY 21-22

Exhibit F – Program Descriptions – FY 21-22

Exhibit G – Submission of Information – Fillable – FY 21-22 – Rev. 11.01.21

Exhibit H – Funding Detail – FY 21-22

Exhibit J – Local Match Calculation Form – FY 21-22

Exhibit K – Federal Block Grant Requirements – FY 21-22

Exhibit L – Covered Service Rates by Program – FY 21-22

Exhibit M – Bed Hold Request Form – Fillable – FY 21-22

Exhibit N – Incidental Expenses Request Approval Form – Fillable – FY 21-22

Exhibit O – Expenditure Reconciliation Report – FY 21-22

Exhibit P – Cost Reimbursement Template – Part 1 – FY 21-22

Exhibit P – Cost Reimbursement Template – Part 2 – FY 21-22

Incorporated Document 1 – LSF Glossary of Contract Terms – FY 21-22

Incorporated Document 2 – Evidence Based Practice Guidelines – FY 21-22

Incorporated Document 3 – State and Federal Laws, Rules, Regulations – FY 21-22

Incorporated Document 4 – Auxilliary Aids for Deaf and Hard of Hearing – FY 21-22

Incorporated Document 5 – SAMH Funding Resource Guide – FY 21-22

Incorporated Document 6 – SIPP – FY 21-22

Incorporated Document 7 – Outpatient Forensic MH Services – FY 21-22 rev. 10.01.21

Incorporated Document 8 – SMHTF Admission and Discharge Processes – FY 21-22

Incorporated Document 9 – LMH-ALF Monitoring – FY 21-22

Incorporated Document 10 – SOAR – FY 21-22

Incorporated Document 11 – Expiration Termination Transition Planning – FY 21-22

Incorporated Document 12 – Crisis Counseling Program – FY 20-21

Incorporated Document 13 – Tangible Property Reqs – FY 21-22

Incorporated Document 14 – Performance Outcomes Manual – FY 21-22

Incorporated Document 15 – Prevention Services and Prevention Partnership Grants (PPG) – FY 21-22 rev. 09.01.21

Incorporated Document 16 – Integration with Child Welfare – FY 21-22

Incorporated Document 16 – Integration with CW – CW Integration Manual – FY 21-22

Incorporated Document 17 – SDC – FY 21-22

Incorporated Document 18 – BNET – FY 21-22

Incorporated Document 19 – Financial Management Requirements – FY 21-22

Incorporated Document 20 – FACT – FY 21-22 rev. 110121

Incorporated Document 20 – FACT Monthly Referral Report – FY 21-22

Incorporated Document 20 – Outcome Measure Data Collection Tool – FY 21-22

Incorporated Document 20 – Transitional Voucher – FACT Monthly Report FY 21-22

Incorporated Document 21 – TANF – FY 21-22

Incorporated Document 22 – Crisis Respite Services – FY 21-22

Incorporated Document 23 – Womens Special Funding SA Services for PWM – FY 21-22

Incorporated Document 24 – PATH – FY 21-22

Incorporated Document 24 – PATH – FY 21-22 – Monthly LSF Homeless HU Search and Update List

Incorporated Document 24 – PATH – FY 21-22 – PATH Incidental Expenses Summary Rep

Incorporated Document 24 – PATH – FY 21-22 – PATH Quarterly Housed Report

Incorporated Document 25 – IDP – FY 21-22

Incorporated Document 25 – IDP – IDP Report – FY 21-22

Incorporated Document 26 – HIV Early Intervention Services – FY 21-22

Incorporated Document 27 – National Voter Registration Act – FY 21-22

Incorporated Document 28 – FIT – FY 21-22 rev. 09.01.21

Incorporated Document 28 – FIT Continued Enrollment Staffing Form – FY 21-22

Incorporated Document 29 – Seclusion and Restraint Reporting – FY 20-21

Incorporated Document 30 – Children’s Mental Health Care Coordination Program – FY 21-22

Incorporated Document 30 – FSPT Montly POS Template-Appendix K – FY 21-22

Incorporated Document 31 – Care Coordination – FY 21-22

Incorporated Document 31 – Care Coordination Spreadsheet – FY 21-22 rev. 10.01.21

Incorporated Document 31 & 40 – CCSU Care Coordination Report

Incorporated Document 31 & 40 – SEN Prevention Program Report

Incorporated Document 32 – Suicide Prevention Best Practices – formerly STR – FY 20-21

Incorporated Document 33 – Central Receiving System – FY 20-21

Incorporated Document 33 – Central Receiving System – CRS Performance Measures Report – FY 20-21

Incorporated Document 34 – Transitional Voucher – FY 21-22 – Rev. 11.4.2021

Incorporated Document 34 – Transitional Voucher – EXH A – Trans Vouch Pur Req (Fillable) – FY 21-22

Incorporated Document 34 – Transitional Voucher – EXH B – Grad Asses Scale (Fillable) – FY 20-21

Incorporated Document 34 – Transitional Voucher – Appendix 1 -Transitional Voucher Incidental Expenses 11.4.21

Incorporated Document 35 – State Opioid Response (SOR) – FY 21-22

Incorporated Document 35 – SOR – RCO Monthly Report – FY 21-22

Florida SOR Guidance 1.7.21

Florida SOR Q & A 1.7.21

Incorporated Document 36 – Recovery Management Practices – FY 21-22

Incorporated Document 37 – Supported Employment – FY 21-22 – rev. 100121

Incorporated Document 37 – Supported Employment – Supp Emp Tracking Sheet – FY 21-22

Incorporated Document 38 – Juvenile Incompetent to Proceed (JITP) – FY 21-22

Incorporated Document 38 – Juvenile Incompetent to Proceed (JITP) – JITP Tracker – FY 21-22

Incorporated Document 39 – Co-Responder Program (CoR) – FY 20-21

Incorporated Document 39 – Co-Responder Program (CoR) Report FY 21-22

Incorporated Document 40 – CARES Act – FY 21-22

Incorporated Document 40 – CARES Act – Jail-Based Forensic Diversion Program Report

Incorporated Document 41 – School Telehealth Proviso

Incorporated Document 42 – Community Action Treatment (CAT) Team – FY 21-22

Incorporated Document 42 – CAT Authorization Form – FY 21-22

Incorporated Document 43 – Mobile Response Team (MRT) – FY 21-22 – Rev. 11.01.2021

Incorporated Document 43 – Mobile Response Team (MRT) Report – FY 21-22 rev. 092021

Incorporated Document 44 – Forensic Multi-Disciplinary Team (FMT) FY 21-22

Incorporated Document 44 – Forensic Multi-Disciplinary Team (FMT) – Template 25 FMT – LSFHS Version FY 21-22

Incorporated Document 45 – Supported Housing FY 21-22

Incorporated Document 46 – Coordinated Specialty Care for ESMI – First Episode Psychosis FY 21-22 – pending

Incorporated Document 47 – Clubhouse FY 21-22

*Network Service Provider Attachments for specific/special programs are incorporated in the appropriate contracts and not included here. Requests to view the Attachments can be made to LSF Health Systems.

Reporting Templates:

Early Psychosis Intervention and Care – Exhibit A – FY 21-22

HBSAS – FBT – Monthly Report Template

SMHTF Transitional Program Report FY 21-22

Transitional Beds – Exhibit A-C – FY 21-22