Guidelines | Templates | Forms
Central Florida Cares funds a services network comprised of many organizations offering various levels of treatment options.
Guidelines | Templates | Forms
- Contracts
- Exception Report Guidance
- FASAMS
- Fiscal
- Incidental Pre-Authorization
- Network Monitoring
- Network Training
- Policies and Procedures
- Quality Assurance
- Service Programs
- WITS
The Block Grant Requirements Manual released by the Department of Children and Families for Managing Entities and Providers is to offer direction as to the requirements for the Substance Use Prevention and Treatment Grant (Grant) administered by the U.S. Substance Use and Mental Health Services Administration (SAMHSA). The elements in this document are requirements that the Federal government has imposed on recipients of the Grant.
Block Grant Manual for ME’s v2.0
Block Grant Manual for Providers v2.0
The Chart 8’s are issued by the Department of Children and Families Revenue Management Department. A Chart 8 is issued for each funding Other Cost Accumulator (OCA). It provides the budget entity, purpose of the funding, funding restrictions, type of funds and CFDA/CFSA category. Chart 8’s are useful in understanding how funding can be utilized as well as creating cost allocation plans.
MH0TB – MH TANF
MH0PG – MH PATH Grant
MH0FH – Community Forensic Multidisciplinary Teams
MH0CN – MH Care Coordination Direct Client Services
MH0BN – MH BNET
MH000 – MH Services & Support
MSTRV – Transitions Vouchers Substance Use
MSOPM – FL Response To The Opioid Crisis Mat
MSOPH – FL Targeted Response Opioid Crisis-Hospital
MSOCN – SA Care Coordination Direct Client Services
MS091 – SA Family Intensive Treatment (FIT)
MS081 – ME Expand SA Services For Pregnant Women & their Family
MS025 – SA Prevention Services
MS023 – SA HIV Services
MS0TB – ME SA TANF
MS0PP – SA Prevention Partnership Program
MS000 – SA Services & Support
MHTRV – MH Transitions Vouchers
MHSHG – Housing Coordination
MHSFP – MH State Funded For Profit Sub-Recipients
MHSCR – Centralized Receiving Systems
MHSCD – Care Coordination
MHS55 – Circles of Care – Geropsychiatric Care
MHS52 – Circles of Care-Crisis Stabilization
MHS51 – Circles of Care-Cedar Village
MHS00 – ME Administration
MHHIP – Hurricane Irma Immediate Services Program
MHCAT – ME MH Community Action Teams (CAT)
MH076 – MH Indig Psych Meds Program
MH073 – MH Fact Program Admin
MH072 – MH Comm Forensic Beds
MH071 – MH PRTS Emot Disturb Child/Youth
MS917 – ME STEPS Women’s Residential Treatment
MS911 – ME Phoenix Affiliates-Family Stabiliz For Opioid
MH028 – ME Osceola Mental Health –Park Place
MSSOR – ME State Opioid Response Services-MAT
MSSOP – ME State Opioid Response Disc Grant Services-Prevent
MSCBS – ME SA Community Based Services
MHC0V – ME Emergency COVID-19 Grant
MHFMH – ME MH Forensic Transitional Beds
MS917 – ME STEPS Women’s Residential Treatment
MSCS0 – ME SA Seminole Co Sheriff Opioid ARC Partnership
MSRC2 – ME State Opioid Response Disc-Rec Comm Org-Yr-2
MSSGP- ME State Opioid Response Disc Grant-GPRA
CFCHS strives to ensure our subcontractors as well as community stakeholders are informed of new or revised policies. These policy memos from Department of Children and Families Substance Use and Mental Health office include decisions, guidance and/or policy stance on various topics.
Repeal of Prohibition on Use of CMHS BG funds in Prisons or Jails (2/26/2020)
Opioid STR Funds to For-Profits OTPs Memo (2/20/2018)
Clarification of Language in HB 1121: re: Initiation of Involuntary Examination of Minors (11/3/2017)
Policy Memo Regarding Mental Health First Aid and Block Grant Funding (10/16/2017)
STR MAT Service Period Memo (5/11/2017)
Ensuring Forensic Case Managers are Attending Court (9/9/2016)
Policy memo to clarify scope of svcs funded by BG HIV EIS funding (12/31/2015)
Housing Choice Memo (10/9/2015)
CSU-SRT Designated Smoking Area Guidance (8/12/2015)
Performance Based Prevention System (7/1/2015)
SAMH-funded services to persons pending admission to non-SAMH benefits programs (4/8/2015)
Family Intensive Treatment Service Areas Signed Memo (4/2/2015)
Memo Regarding Primary Prevention Block Grant Funding for Parenting Classes (3/13/2015)
Revised Definition of Psychiatric Nurse (1/30/2015)
It is the policy of CFCHS to obtain in a cost-effective and responsive manner the goods and services required by CFCHS, ensuring a review of prospective procurements to avoid unnecessary duplication and receive best value; to provide safeguards for the maintenance of a procurement system of quality and integrity; to establish clear lines of procurement authority and accountability; to provide for increased public confidence in the procedures followed in public procurement; to promote the fair and equitable treatment of all persons who deal with CFCHS’ procurement system; and to foster broad-based competition within the free enterprise system.
School Telehealth Platform FY2020-2021 – Proposals due 5/18/2021
RFP 2021-001-MH CFCHS School Telehealth
RFP-2021-001-MH Written Responses
RFP 2021-001-MH Notice of Intent to Award
Housing Success Specialist FY2019-2020 – Proposals due 1/17/2020
Notice of Intent to Award
Housing Success Specialist RFP
Notice of Intent to Award 2-4-2020
Community Action Treatment Team (CAT) FY2018-2019 – Proposals Due 6/25/2018
Community Action Treatment Team (CAT) FY2018-2019
Response to Inquiries
Intent to Award
Opioid State Targeted Response (STR) FY 2017-2018 – Proposals Due 6/16/2017 (Extended due date 8am 1/29/2018)
Proposal Instructions
Governor’s Executive Order
A Briefing on Florida’s Opioid STR Grant
MAT Service Period Memo
Chart 8 MSOPM-Original
Chart 8 MSOPM rev 12-6-17
DCF’s FAQ about Florida’s Opioid STR Grant
Forensic Multidisciplinary Team for FY 2016-2017– Applications Due 8/25/2016
Forensic Team FINAL
Response To Inquiries
Schedule Of Activities (revised 8-26-16)
Notice of Intent To Negotiate-9-9-16
Debrief Meeting 9-9-16
Notice of Intent to Award 9-23-16
SUPPORTIVE HOUSING PROJECT-Applications Due 12/29/2015
Supportive Housing ITN Final
Supportive Housing ITN Addendum#1
MH1038 budget with instructions
Supportive Housing ITN QA
Notice of Intent to Negotiate 1-6-16
Notice of Intent to Award 1-12-16
PPW EXPANSION LCP
PPW Expansion LCP Final
PPW Expansion QA
PPW LCP Scores
FIT LCP
FIT LCP FINAL
FIT LCP QA
FIT LCP Scores
Per 65E-14 F.A.C. subcontractors must provide a program description to include an organizational profile. The program description is provided for each program funded under the Managing Entity and provides important information explaining the structure, population served, covered services, staffing levels and admission/discharge criteria within the program. The organizational profile provides an overview of the organization, populations served as a whole and performance measures pertinent to the funded programs.
Network Program Description Template (rev 3/2019)
Organization Profile Template (revised 3/2019)
FASAMS is the Financial and Services Accountability Management System, developed for the Department of Children and Families, to track data specific to State and Federal reporting requirements.
Frequently Asked Questions
Videos Tutorials
System Training
Mod 4 to Expenditure OCA Crosswalk
Incidental expenses are temporary expenses incurred to facilitate the continuation of treatment and stabilization in the community when no other resources are available. All incidental expenses higher than $500 shall be authorized by CFCHS only to the extent that they are reasonable, allowable, and necessary as determined through the individual’s treatment plan. CFCHS will only authorize expenses for individuals admitted under CFCHS funded programs. This does not include outreach specific programs; these must be programs where the individual is receiving person specific services. CFCHS will approve up to (3) three months in advance housing costs per request. Please complete and submit all requests using the following form:
Incidental/Residential Pre-Authorization Request Form
The following links are form field descriptions and the incidental procedure codes when completing the form above:
Descriptions of Required Fields in Pre-Authorization Request Form
Incidental Procedure Codes
For any questions or concerns on the pre-authorization process, you may contact:
Incidental Expenses, Transitional Vouchers – Miralys Martinez, Risk Management Specialist, email: mmartinez@cfchs.org
Forensic Residential – Michelle Arroyo, Forensic Coordinator, email: marroyo@cfchs.org
Civil State Hospital – Stephanie Smith, System of Care Manager, email: ssmith@cfchs.org
PRTS
Elisa Bustamante, Children’s Care Coordinator – For Brevard and Seminole counties (Circuit 18), email: ebustamante@cfchs.org
Rachel Bishop, Children’s Care Coordinator – For Orange and Osceola counties (Circuit 9), email: rbishop@cfchs.org
Incidental Expense Pre-Authorization Policy
CFCHS FY2425 Programmatic Monitoring Schedule
CFCHS Monitoring Handbook For Network Providers
MONITORING TOOLS:
Auxiliary Aid Monitoring Tools
Block Grant Requirement Clinical Records Review (rev 10/2023)
BNET Clinical Records Review (rev 3/2018)
BHC Clinical Records Review (rev 7/2019)
Children’s Care Coordination Records Review (rev 10/2023)
Adult Care Coordination Records Review (rev 10/2023)
CAT Clinical Records Review (rev 9/2022)
Child Welfare Integration Protocol Clinical Records
Civil & Forensic Clinical Records Review (rev 10/2023)
Clinical Performance Measure Monitoring Tool (rev 10/2023)
DOTT Monitoring Tool (Revised 3/2024)
FACT Clinical Records Review (rev 9/2022)
Fiscal Monitoring Tool
FIT Clinical Records Review (rev 2/2023)
FIT Performance Measure (3/7/22)
HIPAA Security and Privacy Monitoring Tool (rev 9/23/2024)
HR Monitoring Tool (rev 10/12/2023)
IR Monitoring Tool (rev 09/19/2023)
Mental Health Adult Residential Clinical Records (rev 3/2018)
Mental Health Children Residential Clinical (rev 7/2019)
Mental Health CSU & SRT Clinical Records (rev 7/2019)
Mental Health FFT Clinical Records (rev 2/2024)
Mental Health Standards For Clinical Records (rev 7/2019)
Mental Health LMF-ALF Clinical Records Review (rev 7/2019)
Monitoring Interview-Person Served (rev 11/12/1019)
Monitoring Interview-Staff (rev 11/12/2019)
MRT Clinical Records Review (rev 10/2023)
Outcomes Monitoring Tool (rev 9/23/2024)
NAVIGATE Model Fidelity Tool (rev 8/2019)
PATH Monitoring Tool (rev 10/2021)
Performance Measure Data Validation Monitoring Tools
Policy & Procedure Monitoring Tool (rev 2023)
ROSC Monitoring Tool (rev 10/2021)
SANDR Monitoring Tool (rev 1/15/2016)
Service Validation Tool_Day Availability (rev 11/2018)
Service Validation Tool_Day Utilization (rev 11/2018)
Service Validation Tool_Dir Staff Hr Availability (rev 11/2018)
Service Validation Tool_Dir Staff Hr Utilization (rev 11/2018)
Service Validation Tool_Dosage (rev 11/2018)
Service Validation Tool_Incidentals (rev 11/2018)
Service Validation Tool_Non-Direct Staff Hour Availability (rev 11/2018)
Service Validation Tool_Non-Direct Staff Hour Utilization (rev 11/2018)
Substance Use Clinical Records Review (rev 10/2021)
TANF Clinical Records Review (rev 7/2019)
Wraparound Clinical Records Review (rev 10/2023)
CFCHS has a responsibility to the community and to the people it serves to ensure that all Subcontractors are knowledgeable of the system of care services, how to navigate those services, proper referral and transfer procedures throughout the system of care, contract requirements, and offering technical assistance on an as-needed basis.
CFCHS Incidentals Training
CFCHS Contracts Onboard Training (rev 2-29-24)
Exhibit B Required Reports (rev 2-16-24)
Report Tracking System (RTS)
ROSC 101
Incident Report Training
Incident Report Training (Archive 4-27-2021)
FY 1213 CFCHS Provider New Contract Webinar 2-7-2013
FY1314 CFCHS Funding and Program Change Requests July 2013
FY1314 CFCHS Funding Distribution by Provider 1-14-14
FY1314 CFCHS Network Budget Allocation presentation with notes 3-7-14
FY1415 CFCHS Sanctions and Penalties 12-18-14
FY1415 CFCHS The Importance of Block Grant Reporting 01-14-2015
FY1415 CFCHS Performance Measures 2-25-2015
FY1415 Eligibility Documentation and Sliding Fee Scale 3-11-2015
FY1516 cfchsdata.org Financial 3.0 Training July 2015
FY1516 Bed Count Module Webinar September 2015
FY1516 Incidentals Pre-Authorization Process 12-10-2015
FY1617 Transitional Voucher Process 12-1-2016
Sanctions and Penalties webinar 12-18-2014
Performance Measures webinar 02-25-2015
Eligibility Documentation and Sliding Fee Scale 3-11-2015
Bed Count Module Webinar September 2015
Incidentals Pre-authorization Process 12-10-2015
Current
Access to Care, Waiting List, and Capacity Management
Behavioral Health Service Procurement
Children’s Mental Health-Residential Treatment
Network Complaints and Grievances
Payer of Last Resort and Financial Eligibility
Priority Population Eligibility
Specified Programs Performance Measure Analysis Monitoring and Validation
Subcontractor Compliance and Performance Improvement
Subcontractor Dispute Resolution
Subcontractor Incident Reporting to CFCHS’ Reporting and Management System
Central Florida Cares Health Systems, Inc.’s (CFCHS) goal is to ensure quality services are rendered to all individuals receiving services and closely works with its subcontracted network to make improvements and support best practices. To achieve this, CFCHS Subcontractors obtain feedback on service provision through the Department of Children and Families Community Person Served Satisfaction Survey (CPSSS).
The CPSSS assess the individual’s level of satisfaction in seven (7) domains, which include, general satisfaction, access to care, appropriateness and quality of care, outcomes of care, involvement in treatment, social connectedness, and functional satisfaction; and consists of 14 questions for adults and 8 questions for children.
Please refer to Pamphlet 155-2, Appendix 4, Community Person Served Satisfaction Survey (CPSSS) for additional details.
You can share your experience about the services you, or a loved one, are receiving by accessing the CPSSS at the following link and QR code:
https://floridadcf.iad1.qualtrics.com/jfe/form/SV_2mmcxrBueRZjw6W
Provision of services must never be based upon individuals completing the survey.
If you have additional questions, please contact:
Jerrymar Foster
Quality Improvement Specialist
jfoster@cfchs.org
407-985-3571
The National Voter Registration Act (NVRA) enacted in 1995 introduced national procedures for voter registration by designated governmental or public entities. It requires agencies to offer voter registration opportunities at the same time as application for agency’s services. As part of the contract with CFCHS, Subcontractors are to report on voter registration activity on a quarterly schedule. To learn more about NVRA please click on the links below or contact CFCHS Risk Management Specialist Miralys Martinez at mmartinez@cfchs.org.
Florida Division of Elections- National Voter Registration Act (NVRA)
2021 Florida Statutes (Including 2021B Session)
National Voter Registration Form
National Voter Registration Form (Spanish)
National Voter Registration Act/State Law Overview & Training for Voter Registration Agencies
National Voter Registration Act Preference Form/Application
National Voter Registration Act Preference Form/Application (Spanish Version)
Guidance 25
NVRA Voter Registration Agencies Quarterly Activities Report Form
Political Party List (06-10-2024)
CAT – Community Action Treatment (CAT) teams provide community-based services to children ages 11 to 21 with a mental health or co-occurring substance Use diagnosis with any accompanying characteristics such as being at-risk for out-of-home placement as demonstrated by repeated failures at less intensive levels of care; having two or more hospitalizations or repeated failures; involvement with the Department of Juvenile Justice or multiple episodes involving law enforcement; or poor academic performance or suspensions. Children younger than 11 may be candidates if they display two or more of the aforementioned characteristics.
CAT Monthly Census Template (Rev. July 2, 2024)
CAT Provider YTD Total- Appendix I & II
CAT COC Vacant Position Template
CAT Aspire Vacant Position Template
Appendix-3 CAT ROI Template
CAT Example ROI Formula
Guidance 32 CAT
Central Florida Health Care System (CFCHS), Department of Children and Families (DCF), Embrace Families and Brevard Family Partnership have agreed to work together to coordinate services and supports for the adult parents and caregivers involved in both the child welfare system and behavioral health system. The Integration Protocols outlines the guiding principles and goals in assisting parents/caregivers in ongoing coordination and collaboration of behavioral health services to ensure engagement and retention in treatment.
DCF CFCHS CBCCF Integration Protocol
DCF CFCHS BFP Integration Protocol
Integration Protocol Flow Chart for Providers – Brevard
Integration Protocol Flow Chart for Providers – C9 Seminole
Civil – CFCHS contracts with Community Mental Health Treatment Centers in each of its covered counties to provide a Community Case Manager for individuals residing in State Mental Health Treatment Facilities. The Community Case Manager coordinates admission and discharge planning for the civil system. They track individuals during their state mental health treatment stay and post-discharge to ensure treatment engagement, stable housing, resumption or acquisition of benefits, and meaningful involvement in the community.
Forensic – CFCHS contracts with Community Mental Health Treatment Centers in each of its covered counties to provide forensic case management services for individuals charged with or at-risk of being charged with a felony offense. These are individuals who have been court ordered for an evaluation or who have been committed to the Department of Children and Families (DCF) under the provisions of Chapter 916, F.S. Specifically, these are individuals who have received an Order for Evaluation of Competency or Sanity or have been adjudicated as Incompetent to Proceed (ITP) or Not Guilty by Reason of Insanity (NGI) due to mental illness.
State Mental Health Reintegration Plan
Civil Client Info Template (rev 10-2023)
Circuit Transfer Request (rev 7-2017)
CFCHS FMT Guide (Jan 2023)
FMT Monthly Census
Forensic Census Template
Guidance 6 – Outpatient Forensic Mental Health Services
Guidance 7 – Forensic and Civil Treatment Facility Admission and Discharge Processes
Guidance 28 – Forensic Multidisciplinary Team
CFCHS Forensic Specialist Guide
SMHTF Meetings Report Template
FACT – In an effort to promote independent, integrated living for individuals with serious psychiatric disabilities, Florida Assertive Community Treatment (FACT) teams provide a 24-hour-a-day, seven-days-a week, multidisciplinary approach to deliver comprehensive care to people where they live, work or go to school, and spend their leisure time. The programmatic goals are to prevent recurrent hospitalization and incarceration and improve community involvement and overall quality of life for program participants.
Aspire Orange FACT Team Referral
MHRC Osceola FACT Referral
MHRC Brevard FACT Referral
FACT Quarterly AdHoc Report
FACT Monthly Reports
FACT Monthly Census – Template
Guidance 16 – Florida Assertive Community Treatment (FACT) Handbook
Medication Assisted Treatment (MAT) services include assessments, case management, peer support services, recovery planning, residential and detoxification services and medication management. The delivery of medications for the treatment of substance use disorder which are prescribed by a licensed health care professional. Service is in conjunction with a clinical assessment and substance Use treatment.
BREVARD COUNTY
Aspire Health Partners (407) 245-0014
Central Florida Treatment Center (321) 951-9750
Circles of Care (321) 722-5261
RASE Project (321) 305-4397
Specialized Treatment Education and Prevention Services, Inc./S.T.E.P.S. (407) 522-2144
ORANGE COUNTY
Aspire Health Partners (407) 245-0014
Central Florida Treatment Center (407) 843-0041
LifeStream Behavioral Center (866) 355-9394 or (352) 315-7800
RASE Project (407) 518-1094
Specialized Treatment Education and Prevention Services, Inc./S.T.E.P.S. (407) 522-2144
OSCEOLA COUNTY
House of Freedom (407) 957-9077 ext. 204
Park Place Behavioral Healthcare (407) 846-0023
RASE Project (407) 518-1094
The Transition House (407) 892-4202, ext. 169 or ext.164
SEMINOLE COUNTY
Advent Health Hope and Healing Center (407) 303-2200
Aspire Health Partners (407) 323-2036
Longwood Comprehensive Treatment Center (321) 999-9617
RASE Project (407) 518-1094
Specialized Treatment Education and Prevention Services, Inc./S.T.E.P.S. (407) 522-2144
Short Term Residential – The Short Term Residential Treatment Facility (SRT) is a co-ed adult inpatient unit providing services to individuals with a mental health diagnosis and/or co-occurring substance Use diagnosis. SRT provides a high level of care for individuals who are no longer experiencing a psychiatric emergency but who are still in need of additional inpatient treatment prior to community placement. SRT also serves clients waiting for placement at the state hospital. The length of stay on SRT varies but the average is usually 3 months.
SRT Waitlist Template (Rev. August 9, 2019)
SSI/SSDI Outreach, Access, and Recovery (SOAR) is a model designed to increase access to Social Security Administration (SSA) disability benefits for eligible individuals who are experiencing or at risk of homelessness and have a mental illness, medical impairment, and/or a co-occurring substance use disorder.
Online training: https://soarworks.prainc.com/content/soar-online-course-catalog
Online Application Tracking: https://soartrack.samhsa.gov/
TANF – Temporary Assistance to Needy Families (TANF) is a federal block grant program which provides funding to states to help move recipients into work and turn welfare into a program of temporary assistance. Central Florida Cares Health System, Inc. oversees the portion of TANF funding used to provide services to families receiving welfare benefits and families at-risk of receiving welfare benefits who may suffer from substance Use and/or mental health illnesses.
TANF Forms
TANF EZ-1 Form (Rev January 2024) | Download
TANF EZ-1 Form – Spanish (Rev January 2024) | Download
TANF Contingency Funding Request Form (Rev January 2016) | Download
TANF Financial Information Form (Rev February 2017) | Download
TANF Non-Custodial Parent Form | Download
TANF Participant Log | Download
TANF Monthly Income Verification Form (Rev February 2017) | Download
TANF Guidelines
CFCHS TANF Guide (rev February 2020)
TANF Flowchart (rev November 2018)
2024 Federal Poverty Guidelines | Download