EXHIBIT C3 – ME REQUIRED REPORTS, PLANS, AND FUNCTIONAL TASKS All Requirements in Table 2 must be submitted to the Contract Manager electronically and be uploaded to the ME’s secure web-based document vault. Table 2 – Required Submissions Section # Requirement Required by Frequency Due No Later Than: Required Reports and Plans Provider Tangible Property Inventory Template 1 Section B-7.2 Guidance 2 Initial; and Annually Initial: within 30 days of execution; Annual: July 31 Regional planning documents Section C-1.1.2 As Needed As Needed Triennial Needs Assessment Section C-1.1.3 Every 3 years, beginning 2016 October 31 Managing Entity Annual Business Operations Plan Template 4 Section C-1.1.6 Annually July 31 Plan for Reintegrating Discharge-Ready Individuals Section C-1.1.7 Annually July 15 Record Transition Plan Guidance 3 Section C-1.1.8 Once Within 90 days of execution Enhancement Plan Section C-1.1.12 Annually, beginning 2017 September 1 Care Coordination Plan Section C-1.2.2 Initial; and Annual Update Initial: within 60 days of execution; Annual Update: July 15 Fraud and Abuse Prevention Protocol Section C-1.3.4 Once Within 60 days of execution Quality Assurance Plan Section C-1.3.5.2 Initial; and Annual Update Initial: within 60 days of execution; Annual Update August 31 Network Service Provider Management Plan Section C-1.4.1 Initial; and Annual Update Initial: within 30 days of execution; Annual Update: July 31 Information Technology Plan Section C-1.5.6 Once Within 60 days of execution Reviewed annually Procurement Policy Section C-2.2.5 Within 90 days of execution Network Service Provider’s EOG/OPB Return on Investment Projected Estimates Section C2-3.2.1 Annually July 20 Network Service Provider’s EOG/OPB Actual Return on Investment Reports Section C2-3.2.2 Quarterly October 20, January 20, April 20, July 20 ALF-LMH Annual Plan Template 5 Guidance 8 Annual December 1 National Voters Registration Act Quarterly Report Guidance 25 Quarterly January 10; April 10; July 10; October 10 Required Financial Forms and Documents
Managing Entity Operating and Capital Budget Template: Form CF-MH 1042, per ch. 65E-14, F.A.C. Section C-2.4.3 As Needed 30 days after any amendment to Exhibit F1 Network Service Provider forms pursuant to ch. 65E-14.005, F.A.C. Templates available at Managing Entity Fixed Payment Invoice (Advance Payment) Template 10 Sections F-2.2 and F-3.1.1 Annually July 1 Interest remittance and documentation of interest on advances Section F-2.3 Quarterly As Needed Managing Entity Monthly Fixed Payment Invoice Template 10 Section F-3.1.1 Monthly; and FY Final: Annually 20th of month following service delivery FY Final: August 15 SAMH Managing Entity Monthly Progress Report Template 11 Sections F-3.1.2 and F-3.3 SAMH Managing Entity Monthly Expenditure Report Template 12 Section F-3.1.3 SAMH Managing Entity Monthly Carry Forward Expenditure Report Template 13 Section F-3.1.4 Monthly 20th of month following service delivery; FY Final: August 15 Cost Allocation Plan Template 14 Section F-4 Initial, and Annual Update, and Revisions as needed Initial: Within 30 days of execution; Annual Update: August 31; Revisions: Within 20 days of notifying the Department Managing Entity Spending Plan for Carry Forward Report Template 15 Section F-5.2 Annually Within 30 days of confirmation of approved amount from the Department Financial and Compliance Audit Attachment 1 Annually, and As needed The earlier of: 180 days after the end of the provider’s fiscal year or 30 days after the ME’s receipt of the audit report BNet Statement of Program Cost Guidance 12 Annually September 1 Required Data Submission and Performance Reporting Substance Abuse and Mental Health Block Grant Report Template 2 Section B1-4.2 Semi-annually February 15 August 15 Narrative Report for the SAMH Grant Template 3 Section B1-4.3 Annually May 30 Monthly Data Submission to SAMH Data System Section C-1.5.4 Monthly 18th of each month Submission of Corrected Records to SAMH Data System Section C-1.5.14 As needed Within 60 days after initial record submission
Establish & maintain internet-based electronic vault for access contract-related documents Sections C-2.2.6 and C-2.4.2 Once; and As needed Initial Within 60 days of assignment As Needed: All new documents within 10 business days