Central Florida Cares

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1 Finance Committee Meeting Minutes Friday, June 5, 2015 Central Florida Cares Health System, Inc. Training Room Central Florida Cares ATTENDANCE Central Florida Cares Health System - Finance Committee Members and Guests Richard Barlow, Park Place Behavioral Healthcare Eric Horst, Aspire Health Partners Carla Caponi, Aspire Health Partners Linda Kellermann, The Grove Counseling Center Bill Vintroux, Circles of Care Ehab Azer, MSL, Guest Central Florida Cares Health System, Inc. Staff Claudia Mason, Chief Financial Officer Maria Bledsoe, Chief Executive Officer Sharon Ramsaran, Senior Accountant Agnes Mcintosh, Financial Analyst Stephanie Turner, Contract Manager Karla Pease, Administrative Assistant/Recording Secretary Meeting Called to Order The Central Florida Health Cares System, Inc. (CFCHS) Finance Committee Meeting was held on Friday, June 5, at 12:30 p.m. at 707 Mendham Blvd., Suite 104, Orlando, FL The meeting was called to order at 12:32 p.m. Treasurer's Report The May 1, 2015 Finance Committee meeting minutes were presented to the committee. A motion to approve the minutes was made by Linda Kellermann, seconded by Bill Vintroux, and approved by the committee. Ehab Azer presented the Audit Planning 2015 year ended June 30, 2015 communications with the Finance Committee. Ehab went over briefly the Auditor responsibilities on page 2, Management responsibilities on page 3, Audit Procedures were mentioned on page 5, as well as Internal Control on page 6, and Compliance on page 7. The schedule was mentioned on page 8. CFO Report Financial Highlights YTD April 2015 Claudia went over the April 2015 results. She mentioned the provider network is behind by $1.6M, ME is behind $168K, and Total is behind $1.8M. Last year the network was behind by a lower amount so less pressure to bum the dollars at this point. The next chart shows the top 9 providers underspending, all other providers are lumped together in the last bar of the chart. The bottom left slide shows amount spent per provider. The bottom right slide shows how much Page I of2

2 money has to be spent in order for Providers to draw the total amount of their contracts in the next 2 months. The next slide shows a comparison in expenditures from FY and this current year. Adult Substance Abuse is the only program that is ahead due to new FIT funding and increased funding for PPW. All pregnant women' s dollars are spent. TANF dollars will revert back to the Federal government. Rollover funds come from Children' s Mental Health and Children' s Substance Abuse. The Administrative Rate is at 11.76% and maximum allowed is 15%. Amendment 13 incorporated a schedule of funds that changed in April. This reduced funds in the BNET program by $96,000. Slide shows how the budget is divided by provider. Balance Sheet and Statement of Revenues & Expenses At the end of April we had $4.7M which is why we could not pay all the provider invoices. AP is over $5M and most of that was for provider invoices. We paid out 80%, 20% should go out today. The last chart shows revenues and expenses. Old Business - Sliding Fee Scale Trinity indicated the bum rate sheets sent out monthly shows what we pay providers based on the data in the system. Last month was the first time we could say these are your sliding fees. Some providers did not have a process for collecting fees so they are trying to work through that. Most providers over produced so it does not affect their payments. Claudia attached the new and old versions of 65E There is nothing really new between the old and the new 65E The Schedule of Discounts grid was removed and exempted cost centers are now listed. What changed was CFCHS telling Providers what their invoice amount is based on data reported and not giving Providers a way to report sliding fee co-pay data. That particular part of the process changed; whereas before you would have sent your invoice over and taken the co-pays into consideration. New Business Claudia discussed the nomination of new member Cary Seaborg. CEO asked if members wanted a formalized process. Members agreed that a formalized process was not necessary. Other/Public Input None Next Financial Committee This is scheduled for Friday, June 26, 2015 at 12:30. Bill made the motion to adjourn, Richard seconded. The motion passed. The meeting was adjourned at 1 :01 pm.. c::o~ Richard Barlow, OBO Charles Rogers Date: (, /2~,f? ~ Karla Pease, Recording Secretary I Page 2 of2

3 Finance Committee Agenda Friday, June 5, :30 PM - 2:30 PM Central Florida Cares Central Florida Cares Health System, Inc. Training Room I. Welcome/Introductions Richard Barlow OBO Charles Rogers II. Treasurer's Report Richard Barlow OBO Charles Rogers a. Minutes from May 1, 2015 Finance Committee Meeting b. Introduce Moore Stephen Lovelace Auditor III. Moore Stephens Lovelace Ehab Azer Presentation of Audit Plan Document IV. CFO Report Claudia Mason a. Financial Statements-April 2015 L Spending Highlights 11. Balance Sheet V. Old Business Stephanie Turner a. Sliding Fee Scale Implementation i. Sliding Fee Co-pay Reporting 5 minutes 10 minutes 10 minutes 15 minutes 15 minutes VI. New Business Claudia Mason 5 minutes Nomination of new member Caryn Seaborg, CFO STEPS to replace Amy Ciampia ofubc VII. Other/Public Input 3 minutes per person VIII. Adjourn - Next Finance Committee Meeting Friday, June 26, :30-2:00 pm

4 Finance Committee Meeting Minutes Friday, May 1, 2015 Central Florida Cares Health System, Inc. Training Room Central Florida Cares ATTENDANCE Central Florida Cares Health System - Finance Committee Members Richard Barlow, Park Place Behavioral Healthcare Eric Horst, Aspire Health Partners Carla Caponi, Aspire Health Partners Linda Kellerman, The Grove Counseling Center Bill Vintroux, Circles of Care Central Florida Cares Health System, Inc. Staff Claudia Mason, Chief Financial Officer Sharon Ramsaran, Senior Accountant Agnes Mcintosh, Financial Analyst Stephanie Turner, Contract Manager Karla Pease, Administrative Assistant/Recording Secretary Meeting Called to Order The Central Florida Health Cares System, Inc. (CFCHS) Finance Committee Meeting was held on Friday, May 1, at 12:30 p.m. at 707 Mendham Blvd., Suite 104, Orlando, FL The meeting was called to order at 12:31 p.m. Treasurer's Report The March 2015 Finance Committee meeting minutes were presented to the committee. A motion to approve the minutes was made by Carla Caponi, seconded by Bill Vintroux, and approved by the committee. Auditors requested a date to conduct audit planning. The date has been set for June 5, Amy Ciampa resigned from the Finance Committee. Members recommended asking another provider to replace Amy. CFO Report Financial Highlights YTD March 2015 Claudia went over the March 2015 results. She mentioned the provider network is behind by $ l.4m, ME is behind $209K, and Total is behind $ l.6m. Last year the network was behind $713K, ME behind $432K, and overall was behind $1. lm last March. The next chart shows the underspending by provider. The bottom left slide shows $40.5M spent and amount spent per provider. The bottom right slide shows $15M has to be spent in order to draw their total amount of their contract, showing the top 9 providers. Claudia mentioned there will be $776K available to roll forward as well as $193K from TANF to be reverted. Adult Substance Abuse is the only Pagel of2

5 program that is ahead. It is projected all the Adult Mental Health funds will be spent. Rollover funds come from Children's Mental Health and Children' s Substance Abuse. The Administrative Rate is at 11.65% and maximum allowed is 15%. The ME Schedule of Funds for the BNET program has been reduced by $96K. Balance Sheet There is a $1.3M balance at the end of the month. The $8.2M is February and March invoices due from DCF, $3.9M is the advance, $12.7K has been used out of deferred revenues to pay for two undocumented state hospital clients that were assigned to our area. Budget Florida Individuals in Need of Care (FLINC) is a new contract for $62K where we received $5K for March. Old Business - Sliding Fee Scale Claudia reported that starting with March bum rate sheets, the providers would self-report the copays collected so we can properly charge the state. We have received clarification from DCF on fees used to adjust SAMH invoices. We also asked if we can use SAMH funds to pay for services to clients who have high deductibles and co-pays. We will share the information once we get clarification from the state. New Business Claudia discussed next the reversion of T ANF funds and the potential rollover funds. Providers have been encouraged to use their funds. Other/Public Input None Next Financial Committee This is scheduled for Friday, June 5, 2015 at 12:30. Eric made the motion to adjourn, Linda seconded. The motion passed. The meeting was adjourned at 1 :05 pm. Page 2 of2

6 6/3/2015 CFCHS Finance Report April 2015 Central Florida Cares Health Systemfinanclal Highlights ($000 April 2015 Burn Rates Diff YT Programs Service Adllin Total YTDBud Unspent Actual% Prorated% Var% Mental Health (MH)i Adult MH 19,820 1,701 21,521 21,768 (247) 82.4% 83.3% 0.9'k (17) ChlldMH 4, ,114 5,563!449) 76.6% 83.3% Total MH 24,W S 2,172 26,635 27,331 (697) 81.2% 83.3%. Substance Abuse (SA): ult SA ,033 12, ns (280) 81.5% 83.3% 1.8'k (233) Child SA 5, ,874 6,556!682) 74.7% 83.3% Total SA.. $ 16,838 ; $ 1,536 1!!,373 19,335 ( % 83.3% Total Providers :s 41,301 $ 3,707 1$ 45,«18 $ 46,666 ' $ 1 1 ~ % 83.3% Managing Entity.... ; 1,796 ' 1,196 1,~ l (168) 76.2% 83.3% 7.1% (447) Total Network S 41,301 : $ 5,504 $.-46,804 $ 48,630 $ (1, 80.2%. 83.3%' 3.1% $ (1,125 CFC HS Finance Report April $1~~ ~---~~~~~~~~~~~~~~~~~~~~~~~~~~~~~"'""" $>81 $50,000 $45,000 $40,000 $35,000 $3.0,000.. $25, $20,000 YTD Apr 2015 Spend ($000) 120.0% $45, % 100. $12, %.,. $~ $15, $1,000 $10,000 '$0,000 $5,000 $-... ~~<:- ~~~ ~<:- ~~<:- fc..,..c ~~~ ~~ ~ -s- "'t-& ~.. #' ~"'..., #"'~~"' <!-'',f-.,.,,,,,, #' ~ ~ i,,.? $4,000 $>,000 $- Ne1Wor1< Unspent Dollars by Provider ($000) Apr 2015 $10,991 i,r.: ; J: ",..~ :a ~ i,..,, I E {' ~....,.. ~ ~ '! i ~ I f f s ~ ~ 1

7 6/3/2015 YTDAfri Program; Actual Adual Mental Health (MH): PY_13_14 CY_14_15 D_ iff_. 11 Mult MH 21,758,009 21,521,079 (236,930 Child MH 5,668,733 5,113,Gro 555,043 TotalMH 27,426,742 26,634,763 91,974 Substance Abuse!SA): MultSA CFCHS Finance Report A r bpendlturos CY vs PY By Progrom 1$000) Aprll 2015 ~.ooo ".; r_;;i t Ji,ooo l.io.-'!'! ' l..j! U,000 10, ,llOO Sll!IO ~J_-~..J...flJLJ~.l-.!!~~LJ~ 11,007,831 12,499, ,489 1 ;::;;:::;:::;;;:::=:;;:;::;::::===:;=:;;;;;:;::::;:;;:;:;::;;r=:==;::;;::==;;;.. Child SA 6,388,901 5,873, ,006 TotalSA 18,356,732 18,373,216 CFCHS Finance Report April 2015 Program Rollover TANF Total AdultMH 138, ,047 Child Ml-I ,865. Child Ml-I PRTS 228,113 ' 228,113 Adult SA Child SA 326,312 55,230 ' 381,542 Total Revert & Rollfrwd s 775,928 s 193,277 s 969,205 Ad.Jlnatrltlve f!llle Apr.'20{5, > 2

8 6/3/2015 $60,000 $50,000 $40,000 $30, $10, % ' " $ 27,467 $ 9,242 s 3,022 $ 2,418 s 2,397 s 2,373 s 1,746 s 1,604 s 1,186 s 531 s 420 s 3592 s M lklle<l..i. fj'wfmi C.ntnol Fi. MlilOC..fM H lth t.~m "' C.en tr nll G MMll rv lell&.i ~ u Cl, JOlS r.. = =::: :::::;;;;;;;;; ;;;~..,_,_,., ~ MH<<U. M"'O'- MH<n ""..., ~,.. vlno,.. nrl.,,, 1 3

9 6/3/2015 C::: "t:.- I Fle>rlcl- c::: Health Sy t:- m, lcn.c: Stot m-="t: c.r,..,..,,..,,c:1- Pe> lt:1e>n. A e>f 4/310/20 :1.15 cu..,,.... c11t:.,c:1> a.-1- n.ce Sh-«:tt: Apr U1n.- 2 0::1..4 C:t..a.-r«:trllt A et. TC> B ank Gulf' Stnl:e~ Cr-udl l: Union "T"c>~ t C::-""'h... C:- h Eq1U c:.. Prc:>gram Scrvl C<IEll AR. Due Fro m DCP P r e p e>ldl H Q"l'l lth Oent"I Vis ion C:>1.'.'. h ol'.:'lr R.-c-lvDbl e s &...,l sc:;;. A~$Cttv Pre paid Prop.-.srty C>&O & Pre~ lc;;l Exµ.en ve!s Oopc:>sl t :c;r Te>tat C_..,,.. 'I: A eot:s L c:>ng- t:::arm A Zi:GCBt:::S Furnlturo S.. F ixtures C:o""' 'p'""t:::" 'r- Equlprr"ll-nt: S oftware Ot:::h e r A ccurt\. Oopr eclat lon - Sof"tvvore T-~ L-no -t:~.-m A --=- Ll-blllt:l-- :Shc>rt-t:-.-m Ll- blll t:.i _.._ Accounts Payeobl e &. A c:.crved VVnges Payabl e Fodlcrol Payroll T su,-,c.,. P.,...veibl e n><es Pay l!l b l e Dec:tu c:t::: l o n :s P aynble Retl remor-.t P l e n P a y a b l e Xntero:;o:t &. Other Pnva b l e t o DC:P Adve:.nce P.ave.ble to OC:F D a f'ol'lorrc d R.ov-n...-s Tc>~I She>rt::-t:~rm Ll-l>lllt:l.aa N-st A -~t.. Unrest:rlc t:::e d N e t:: A.:08.st.t:::s P r ior Veer excess Revenu es C urre nt Vee r excess IR.e v e n... es Totn l Unrestrlc:;;ted N et Asset s Tc>~t... --= A - -t:-. Tc>~I c>#... ~t A.a98~t::s --d L.l-1:>11111::1_,. c;._.rrant: R.Bt;I C> Qu i c k R.etl o $.. 4,790,652. $ 63..., 668 4,.7"PC>,91S 2 934,868 3,092, ,~:S.J.., ,53a 1 e ,737 26, z po15-4!!1!.. & 4i1! ::t ,010»2. 327, 956 ( ) (16 230): 22.p g::u::s =-~;& 02,15 psa aaz H a.07rz?!i'n1- E....S, 1 0 3,262 4,1 64,054 87,816 6e, seo 6, , ,1SQ ::;J, ,358, , ,506 z VZ;& i&fti'n :It; es:;;;r,a, z pz;a, :&ft:& ""... 1!581!5 52: , ,413 (;t.q;z 572 ) 2.!i!~ ~2;! :: ZC>IS 2 1. ;a,a;;p : Z~IE 13'5,... ;!: Z Central Fk>rlda Cares Heatth System April 30, 2015 Statement of Revenues& ExpensH Actual Budget - Revlsed v arnmce - Opu;1ting Revenue Prosra m Revenue 4,692,611 4,863,047 $ tl70,436) FUNC Revenues 5,167 5,167 Deferred Revenues 2,2n 2,277 Totill Revenue 4,700,054 4,863,047 (162,993) YTD Apr. 30, 2015 Actu1t Bud1/et Revised V1riance - 46,804,312 48,630,472 tl,826,160) 10,333 10,333 22,363 22,363 46,837,008 48,630,472 (1,793,464) Expenditur~: Ma naging Entity Ex pen~s 248, ,444 t52,431) Adult Mental Health 2,231,313 2,176,840 (54,472) Children's Mental Health 516, ,293 39,821 Adult Substance Abuse 1,126,512 1,277, ,400 Children's Substa nce Abuse 582, ,558 72,563 Total Program Servke-s 4,457,291 4,666, , ,106 l,964,439 47,334 21,535,479 21,768, ,923 S,113,690 5,562, ,241 12,499,320 u,n9,ll8 279,798 S,873,895 6,555, ,687 45,022,384 46,666,033 1,643,649 Totlil Expenditures 4, , ,881 46,93~,489 48,630,473 1,690,983 Net Revenue Over Expenditures (6,112) to) (6,112) tt02,482) to) s (102,481) 4

10 published in the Federal Register June 27, 2003 and June 26, and (d) OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments, revised May 10, Ref (5) All SAMH-Funded Entities contracting directly with the department shall also report actual expenditure data on a monthly basis to the department according to the reporting requirements and templates included in the terms of each entity's contract. Rulemaking Authority (1), (11) FS. Law implemented , , (1), FS. Histo1y-New , Amended , Formerly JOE-14.17, Amended , Formerly JOE , Amended , , E Sliding Fee Scale. (I) Definitions and Intent. (a) The service provider shall make a determination of ability to pay in accordance with the sliding fee scale for all individuals seeking substance abuse or mental health services. Payment of fees shall not be a pre-requisite to treatment or the receipt of services. The sliding fee scale shall not apply to services provided under the following Covered Services as defined in Rule 65E F.A.C: I. Case Management; 2. Crisis Stabilization, when charging a fee is contraindicated as specified in Section (2), F.S.; 3. Crisis Support/Emergency; 4. Drop-In/Self Help Centers; 5. Information and Referral; 6. Intensive Case Management; 7. Mental Health Clubhouse Services; 8. Outreach; 9. Prevention - Indicated; 10. Prevention - Selective; 11. Prevention - Universal Direct 12. Prevention - Universal Indirect; 13. Substance Abuse Inpatient Detoxification; and 14. Substance Abuse Outpatient Detoxification. (b) It is not the intent of this rule to prohibit or regulate the collection of fees on behalf of an individual from third party payers and commercial insurers such as Workers' Compensation, TRJCARE, Medicaid, or Medicare. However, service providers shall make every reasonable effort to identify and collect benefits from third party payers for services rendered to eligible individuals. (c) For the purposes of this rule, household income is defined by l.r.c. 36B(d)(2) (1986), with exceptions pursuant to 42 CFR (e), October 1, 2012, l 96, hereby incorporated by reference, copies of which may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida (2) General Provisions. (a) Each service provider shall develop a sliding fee scale, that is updated annually, in conjunction with the Federal Poverty Guidelines, and applies to individuals receiving services that are paid for by state, federal, or local matching funds. (b) The service provider shall request a sliding fee payment from persons not eligible for Medicaid or receiving services ineligible under Medicaid; and whose household income is less than 150 percent of the federal poverty income guidelines in accordance with Section , F.S. Nominal co-payments for the following substance abuse and mental health services shall apply: I. Outpatient treatment services - $3 per day. 2. Residential treatment services - $2 per day. (c) The service provider shall require persons meeting the criteria listed below to contribute to their treatment costs consistent with the provisions of Section , F.S.: 1. Persons who receive optional supplementation payments or are receiving a supplemental security income check; 2. Persons determined to be eligible for optional supplementation by the department; and Page 12 of36 65E-114

11 3. Persons who meet program eligibility criteria for assisted living faci lities, foster care family placements, long-term residential care, or any other special living arrangements. (3) Fee Liability Exceptions. The following parties shall not be liable for payment of fees: (a) Parents of minors, when the minor has been permanently committed to the department and parental rights have been permanently terminated; or (b) Parents of a minor, when the minor has requested and is receiving services without parental consent. (4) Unifom1 Schedule of Discounts and Sliding Fee Scale. (a) Each service provider shall develop a uniform schedule of discounts and sliding fee scale, as specified in Section (4)(a), F.S. (b) The uniform schedule of discounts shall be based on household income, financial assets and family size, as declared by the person or the person's guardian, relative to the family's percent of poverty level. (c) The percent of poverty level shall be calculated by dividing the household income by the U.S. Department of Health and Human Services Annual Update of the Health and Human Services Poverty Guidelines. The poverty guidelines establish poverty income levels for various family sizes. ( d) The total charges to an individual shall not exceed 5% of gross household income. (e) Nothing in this rule shall prevent a service provider from further discounting or writing off charges individually or in the aggregate. (t) An individual's failure to make payment under a provider's sliding fee scale shall not prevent the individual from receiving services. Rulemaking Authority (2), (4), (1), (11), (5) FS. Law Implemented (2), (3), (4), (3)(c), , FS. History-New , Amended E Methods of Paying for Services. (1) When purchasing substance abuse and mental health services pursuant to Rule 65E , F.A.C., the department or a Managing Entity shall use one or a combination of the payment methodologies provided for in subsection 65E (2), F.A.C. Each contract or subcontract shall specify the payment methodology or methodologies to be used. (2) Pursuant to Section (2)(b), F.S., the following payment methodologies may be negotiated for use in a contract or subcontract: (a) Fee-for-service rate: a method of making payment for services, based on a negotiated schedule of fees set by contract or subcontract. (b) Case rate: a negotiated payment for a clinically-defined episode of care for an individual served, based on a contractually defined for package of services to be delivered within a defined period of time. (c) Capitation rate: a negotiated monthly fee that is paid for an enrolled individual, whether or not the individual receives the services in that time period. (d) Cost reimbursement: This payment methodology may be used to reimburse for operational start-up costs for new services; for specific service contracts when required by statute, grant or funding source; or for specific fixed capital outlay projects appropriated by the legislature. (3) All supporting documentation shall comply with the Department of Financial Services Reference Guide for State Expenditures, February 2011, which is hereby incorporated by reference, a copy of which may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida (4) All contracts and subcontracts, regardless of payment methodology, shall comply with any requirements which are conditions of the receipt of state or federal grant funds as specified in the contract or subcontract. Rulemaking Authority (2), (1), (5), (11) FS. Law linplemented (2), (4), (/), (5), FS. History New , Amended , E Cost Reimbursement Method of Payment. (1) This rule establishes requirements applicable to service providers under direct contract with the department or service providers under subcontracts with a Managing Entity regarding the implementation of a cost reimbursement method of payment for Page 13 of36 65E-114

12 85, Formerly JOE-14.17, Amended , Former~y JOE , Amended , E Sliding Fee Scale. (1) It is not the intent of this section to prohibit or regulate the collection of fees on behalf of a client from third party payers and commercial insurers such as Workers' Compensation, CHAMP USN A or Medicare. However, contractors must make every reasonable effort to identify and collect benefits from third party payers for services rendered to eligible clients. (2) Sliding Fee Scale. (a) The contractor shall develop a sliding fee scale that applies to persons for services that are paid for by state, federal, or local matching funds who have an annual gross family income at or above 150 percent of the Federal Poverty Income Guidelines. The sliding fee scale does not apply to services paid for by Medicaid. (b) The contractor shall update the sliding fee scale annually. If payments from a third party payer and client or responsible party exceed the usual and customary charge, the client or responsible party must be refunded the excess recovered. (c) The contractor shall make a determination of ability to pay in accordance with the sliding fee scale for all clients seeking substance abuse and mental health services. Payment of fees shall not be a pre-requisite to treatment or the receipt of services. ( d) The contractor shall inform clients and responsible parties of the state laws that require the assessment and collection of fees. ( e) The contractor shall retain fees collected for children mental health services and use them to expand child and adolescent treatment services in the service district. (f) The contractor shall require payment of fees from persons not eligible for Medicaid and whose gross family income is less than 150 percent of the federal poverty income guidelines in accordance with Section , F.S. Nominal co-payments for the following substance abuse and mental health services shall apply: 1. Outpatient treatment services - $3 per day. 2. Residential treatment services - $2 per day. (g) The contractor shall require persons meeting the criteria listed below to contribute to their treatment costs consistent with the provisions in Section , F.S.: 1. Persons who receive optional supplementation payments or are receiving a supplemental security income check. 2. Persons determined to be eligible for optional supplementation by the department. 3. Persons who meet program eligibility criteria for assisted living facilities, foster care family placements, long-term residential care, or any other special living arrangements. (h) The contractor shall require persons who are involuntarily admitted for substance abuse treatment and mental health examination pursuant to Sections and , F.S., to contribute to the cost of care in accordance with the sliding fee scale, unless charging a fee is contraindicated because of the crisis situation. The contractor shall inform the client and responsible party when the fee is not charged for this reason and shall document such circumstances in the client's file. (i) The contractor shall have written procedures for determining annual gross family income for the purpose of assessing, billing and collecting client fees. 1. Current income, from either part-time or full-time employment, received by an adult client and all other adult family members of the household, including the spouse, is derived by multiplying: a. An hourly wage by 2080 hours (for part-time employment use anticipated annual hours); or b. A weekly wage by 52 weeks; or c. A biweekly wage by 26 weeks; or d. A monthly wage by 12 months. 2. Income from such sources as seasonal type work or other work of less than 12 months duration, commissions, overtime, bonuses and unemployment compensation will be computed as the estimated annual amount of such income for the ensuing 12 months. Historical data based on the past 12 months may be used if a determination of expected income cannot logically be made. 3. The contractor shall accept the client's statements related to income and family size at the initial assessment. (3) Fee Liability Exceptions. The following parties shall not be liable for payment of fees: (a) Parents of minor clients, when the client has been permanently committed to the department and parental rights have been permanently terminated. (b) Parents of a minor child, when the child has requested and is receiving services without parental consent. (4) Uniform Schedule of Discounts. Page 22of46 OLD

13 (a) The contractor shall develop a sliding fee scale that reflects the uniform discounts in paragraph (b) below, applied to the contractor's usual and customary charges. (b) The applicable discount to be applied to a contractor's usual and customary charges to create the contractor's sliding fee scale is determined at the intersection o_f the row for percentage of poverty level with the column for the applicable type of uniform discount. Uniform Discounts Percent of Poverty Level Standard Discount Percentage!Accelerated Discount 0% to 150% K:;o-pay 0 150% to 165% ~6% See 4. Below 165% to 180% 94% See 4. Below 180% to 195% 89% See 4. Below 195% to 210% 81 % See4. Below 1210% to 225% 70% See 4. Below 225% to 240% ~6% See 4. Below 240% to 255% 139% See 4. Below 255% to 270% 19% See 4. Below 270% to 285% 10% See 4. Below 1285% to 300% 5% See 4. Below 1300% and above 0% Kl 1. The "Percent of Poverty Level" shall be calculated by dividing the declared gross family income by the Department of Health and Human Services (DHHS) Annual Update of the Health and Human Services Poverty Guidelines. The poverty guidelines establish poverty income levels for various family sizes. 2. If the calculated percent of poverty level percentage is rounded and equals a percentage that appears in two adjacent rows in the Percent of Poverty Level column of the table above, the greater of the two discounts shall apply. 3. The total negotiated charges to a client shall not exceed 5% of gross household income. 4. Nothing in this section shall prevent a contractor from further discounting or writing off charges individually or in the aggregate. Rulemaking Authority (2), (4), (1), (5) FS. Law Implemented (2), (3), (4), (3)(c), FS. History-New E Methods of Paying for Services. (1) Unit Cost Performance Contracts. When purchasing substance abuse and mental health services on a unit cost basis, the department may use the following methods of payment: (a) Client Non-specific Performance Contracts. These contracts shall be used to purchase units of service within statedesignated cost centers at unit cost rates. Client eligibility and service determinations, unless otherwise specified, are the responsibility of the contractor based on eligibility criteria and services purchased. (b) Client-specific Performance Contracts. 1. These contracts may be used to purchase services for a specific individual or group, but only in the following circumstances: a. Wh~n specialized services are needed from a contractor to serve clients in more than one district; b. When specialized services are not available from contractors with whom the department already has client non-specific performance contracts; or c. When emergency care is required and providers with whom the department has client non-specific performance contracts have no available capacity. 2. Individual clients or groups to be served must either be specified in the contract or otherwise approved by the department in advance of receiving service. (2) Cost Reimbursement Contracts. (a) These contracts may only be used to reimburse for operational start-up costs for new services or for specific fixed capital Page 23 of 46

14 Central Florida Cares Health System, Inc Finance Committee Meeting June 5, 2015 Azer, Ehab Barlow, Richard Caponi, Carla Horst, Eric Park Place Behavioral Healthcare As ire Health Partners As ire Health Partners Kellerm inda The Grove Rogers, Charles Sadri, Parissa Scheck, Garry Seaborg, Caryn Van Kaam, Linda Vintroux, Bill Finance Chair Centennial Bank Circles of Care ) I I (