ࡱ> %` hbjbj |t̟̟ e F $ .).).)8f))jl*,,,,79d:h(k*k*k*k*k*k*k$mh pPNk ;67|7;;Nk,, kAAA;~V, ,(kA;(kAANcl dg,* ʇ.)X=0e0hDk0l`eYp>\Yp`dgYp dg:0:"A;:;:::NkNk>A^:::l;;;;jjj.)jjj.) $* B  A N N E X A PROGRAM COMMITMENTS INTEGRATED CASE MANAGEMENT SERVICES  NAME OF AGENCY:  FORMTEXT       CONTRACT NUMBER:  FORMTEXT       CONTRACT TERM:  FORMTEXT       TO  FORMTEXT        BUDGET MATRIX CODE: BUDGET MODIFICATION NO: 32 (0 = Original)  FORMTEXT        IndividualGroup1. FORMTEXT       FORMTEXT      Staff face-to-face contacts with clients in state or county hospital will take place on-site (i.e., at your office). 2. FORMTEXT       FORMTEXT      Staff face-to-face contacts with clients in state or county hospital will take place off-site (include contacts at the hospital). 3. FORMTEXT       FORMTEXT      Staff face-to-face contacts with clients in the community will take place on-site. 4. FORMTEXT       FORMTEXT      Staff face-to-face contacts with clients in the community will take place off-site. 5. FORMTEXT       FORMTEXT      Staff face-to-face contacts with an enrolled client s family will take place on-site. 6. FORMTEXT       FORMTEXT      Staff face-to-face contacts with an enrolled client s family will take place off-site. 7. FORMTEXT       FORMTEXT      Collateral contacts on behalf of enrolled clients will take place on-site. 8. FORMTEXT       FORMTEXT      Collateral contacts on behalf of enrolled clients will take place off-site. 9. =SUM(ABOVE) 0 =SUM(ABOVE) 0Units of service will be provided. (Sum of lines 1 thru 8) 10. FORMTEXT      Aggregate hours of telephone contacts with client or collateral will be made. 11. FORMTEXT      Clients will be linked to another mental health program within your agency. 12. FORMTEXT      Clients will be linked to other mental health program in agency not your own. 13. FORMTEXT      Will be linked to non-mental health providers.   FACE-TO-FACE CONTACTS: Refers to direct contact with or on behalf of the consumers for 15 continuous minutes. If a contact exceeds more than 15 continuous minutes, count as multiple contacts. If two staff members simultaneously serve one client, count as one staff contact. If one staff member serves between two and six clients simultaneously, count as one group contact per client (group contacts of seven or more clients by 1 staff member are not reportable). Travel time is to be excluded from overall contact time. ON-SITE CONTACTS: Refers to staff face-to-face contacts provided at the agency site. OFF-SITE CONTACTS: Refers to all other face-to-face contacts with enrolled clients. Contacts with clients at State and County Hospitals should be counted as off-site. COLLATERAL CONTACTS: Refers to face-to-face contacts made to persons by the case management staff on behalf of the enrolled client. May include contacts with persons such as other service providers, friends, landlords, etc. Enter the number of contacts to be provided in lines 7 and 8. TELEPHONE CONTACTS: (P   Ź簗fG.1jh$wSh#35OJQJUfHq <jh$wSh05OJQJUfHmHnHq u7jh$wShjd5OJQJUfHq (h$wSh05OJQJfHq 1jh$wSh05OJQJUfHq h ]5OJQJh6rht 6OJQJ+jh6rht 6OJQJUmHnHuh6rhS5OJQJh6rht 5OJQJh6rht CJOJQJ(P ~ $Ifgd_G$If p^p` $ !a$$a$^deh $ & ( 2 4 Z ^ ` t v x ϶iT8i7jh$wShjd5OJQJUfHq (h$wSh05OJQJfHq 1jh$wSh05OJQJUfHq h ]5OJQJh6rht 5OJQJ<jh$wSh#35OJQJUfHmHnHq u1jh$wSh#35OJQJUfHq 7jvh$wShiX_5OJQJUfHq (h$wSh#35OJQJfHq x & * , 4 V ȿȪȿmbTFT8h6rht 5OJQJ\h6rhS5>*OJQJh6rht 5>*OJQJh6rht OJQJ(jh6rht OJQJUmHnHuh6rht 5OJQJ7jh$wShjd5OJQJUfHq (h$wSh05OJQJfHq h ]5OJQJ1jh$wSh05OJQJUfHq <jh$wSh05OJQJUfHmHnHq uV X l n p z | ~ ϱmaYQFQFQ>QhqkUOJQJhhh:OJQJhq\OJQJht OJQJh6rht 5OJQJ+jh6rht 5OJQJUmHnHuh6rht 5OJQJ\?jh$wSh05OJQJU\fHmHnHq u:jh$wShjd5OJQJU\fHq +h$wSh05OJQJ\fHq 4jh$wSh05OJQJU\fHq   [RII<< b@$Ifgda $Ifgd_G $Ifgd_)nkd$$Ifl\b* t0644 laytP  ~      ۃxpxhhM4jh h^OJQJUfHq hqkUOJQJh:OJQJh6rh:OJQJ4jh h^OJQJUfHq hq\OJQJ3jh OJQJUfHmHnHq u4j h h^OJQJUfHq h OJQJfHq (jh OJQJUfHq   F J L [RIIRR $Ifgd_G $Ifgd_)nkd $$Ifl\b* t0644 laytP 4 6 8 B D F D H J L N R T V j l n x z | ~ Կzz_D4jh h^OJQJUfHq 4j)h h^OJQJUfHq hqkUOJQJhl&OJQJh:OJQJh6rh:OJQJhq\OJQJ3jh OJQJUfHmHnHq u(jh OJQJUfHq 4j"h h^OJQJUfHq h OJQJfHq L N T | NP[RII<< b@$Ifgd_)n $Ifgd_G $Ifgd_)nkd$$Ifl\b* t0644 laytP LNPRVXZnpr|~NPRTXZ\prȽȵȵХХoȽȵȵХT4j? h h^OJQJUfHq 4j8h h^OJQJUfHq 4jh h^OJQJUfHq h OJQJfHq hqkUOJQJh6rhl&OJQJhq\OJQJ(jh OJQJUfHq 3jh OJQJUfHmHnHq u PRXPR[RII<< b$Ifgd_)n $Ifgd_G $Ifgd_)nkd'$$Ifl\b* t0644 laytPRTZVX[RII<< b$Ifgd_)n $Ifgd_G $Ifgd_)nkd$$Ifl\b* t0644 laytPrt~TVXZ^`bvxz빞ɓɋɋvfKv4j h;h^OJQJUfHq h;OJQJfHq (jh;OJQJUfHq hqkUOJQJh6rhl&OJQJ4j h h^OJQJUfHq h OJQJfHq hq\OJQJ3jh OJQJUfHmHnHq u(jh OJQJUfHq XZ`^`[RII<< b@$Ifgd_)n $Ifgd_G $Ifgd_)nkd= $$Ifl\b* t0644 laytPz\^`bfhj~иȒȊȊиoиT4j h;h^OJQJUfHq 4jU h;h^OJQJUfHq hqkUOJQJh6rhl&OJQJ4jN h;h^OJQJUfHq h;OJQJfHq hq\OJQJ(jh;OJQJUfHq 3jh;OJQJUfHmHnHq u`bhNP[RII<< b$Ifgd_)n $Ifgd_G $Ifgd_)nkd $$Ifl\b* t0644 laytPLNPRVXZnpr|~>@BDHJLfhjЋpЋd\dOhrxOJQJmHnHuhrxOJQJjhrxOJQJU4jdh;h^OJQJUfHq 3jh;OJQJUfHmHnHq u4j h;h^OJQJUfHq h;OJQJfHq (jh;OJQJUfHq hqkUOJQJhq\OJQJh6rh4OOJQJPRX@B[RII<< b$Ifgd_)n $Ifgd_G $Ifgd_)nkdS $$Ifl\b* t0644 laytPBDJn  [RIIRR $Ifgd_G $Ifgd_)nkd$$Ifl\b* t0644 laytPjlnp   468BDF뻰ÛpVKhhh4OOJQJ3jh;OJQJUfHmHnHq u4jqh;h^OJQJUfHq h;OJQJfHq (jh;OJQJUfHq hhhqkUOJQJhqkUOJQJh4OOJQJh6rh4OOJQJhrxOJQJmHnHuhrxOJQJhq\OJQJjhrxOJQJU [UL? b@$Ifgd4O $Ifgd_G$Ifkdk$$Ifl\b* t0644 laytPFnh_RR b@$Ifgd4O $Ifgd_G$Ifkd$$IflFb* t06    44 laytP|~˻ˆ{˻`ˆ{˻4jWh;h^OJQJUfHq h6rh?bOJQJ3jh;OJQJUfHmHnHq u4j`h;h^OJQJUfHq h;OJQJfHq (jh;OJQJUfHq h?bOJQJhqkUOJQJh4OOJQJh_)nOJQJ nh_RR b$Ifgd?b $Ifgd_G$Ifkd$$IflFb* t06    44 laytP~nh_RR b$Ifgd?b $Ifgd_G$Ifkd$$IflFb* t06    44 laytPnh_Rh b$Ifgd0 $Ifgd_G$Ifkd$$IflFb* t06    44 laytP(*48:<>@PTжЮzrf]V@f4h6rh'4]5OJQJ+jh6rht 5OJQJUmHnHu hGh6rhG5OJQJh6rht 5OJQJhBOJQJhh.3OJQJh.3OJQJh6rh'4]OJQJh6rht OJQJh6rh0OJQJh?bOJQJ3jh;OJQJUfHmHnHq u(jh;OJQJUfHq 4jNh;h^OJQJUfHq *,.ne\\\SJJ bgdB b@gd.3 bgd'4] b@gdl&kd$$IflFb* t06    44 laytP.8:<BDFHJLNPRT$ !h^ha$gd'4]  !h^h $ !a$ bgdB"BmUh"\n\p\\D`|`cc&cHdJdPdRdVd\dvjvbvjhGI!OJQJh6rhb5OJQJh6rhbOJQJh6rh^OJQJh6rh^5OJQJhz'h'4]OJQJhz'hO OJQJUh6rhOJQJh6rh'4]5OJQJhz'ht OJQJhz'h%hOJQJh,,OJQJh%hOJQJh24OJQJh6rh'4]OJQJ$Aggregate phone time with or on behalf of the consumer. 11. MENTAL HEALTH LINKAGES: Refers to the number of clients referred to mental health programs during the contract year where an intake has been completed and the client was accepted for service into the mental health program or service. Mental health programs and services include state/county hospitals, local inpatient units, emergency/screening units, outpatient, partial care, residential services, community advocates, private practitioners, systems advocacy, legal services, etc. NON-MENTAL HEALTH LINKAGES: Refers to the number of clients referred to and enrolled in services needed by the client outside the realm of mental health during the contract year. These include shelters, boarding homes, county welfare agency, social security, Medicaid, support groups, churches, jails, criminal justice system, vocational programs. UNITS OF SERVICE: The sum of all staff face-to-face contacts with clients on-site and off-site, collateral contacts on behalf of clients (Sum of lines 1 through 8.)     7/07 ANNEX A: Integrated Case Management Services 7/07 ANNEX A: Integrated Case Management Services Page  PAGE 1 of 1 2/02 Page 1 of 1 ANNEX A: Supported Employment INTEGRATED CASE MANAGEMENT SERVICES Personalized collaborative and flexible outreach services, offered primarily off-site, designed to engage, support and integrate individuals with serious mental illness into the community of their choice and facilitate their use of available resources and supports in order to maximize their independence. p\r\D`F`ccPdRdVdXdZd\dyyy $ !a$gd^ $ !a$gdb$ !h^ha$gdb$ & F !^`a$gdb$ !^`a$gd^$ !h^ha$gd^$ & F 8!^`a$gd^ \d^dbdddhdjdndpdtdvdxdddddze|e~eeeeeeeee$a$$a$gdt gdt $a$  !h^h\d^d`dbdddfdhdjdldndpdrdtdvdxdzddddddddddeLeZe\ehejeĵĵߪss^s^(jht hN=CJOJQJUaJhht hN=CJOJQJaJhh'4]CJOJQJaJhhQ`CJOJQJaJhhN=CJOJQJaJhhN=CJOJQJhh6rhN=CJOJQJaJh6rhbCJOJQJaJh_(CJOJQJaJhN=h!hp3jhp3Uh6rht 5OJQJjelenevexeze|eeeeeefJfLfNfhhhhhȻȷ}pl`h6rht 5OJQJht h'hN=CJOJQJh'h'4]OJQJ\hN=5CJ\aJh'4]5CJ\aJh!hN=5CJOJQJhN=5OJQJhN=h6rCJOJQJaJhht hN=CJOJQJaJh(jht hN=CJOJQJUaJh$h!CJOJQJaJhmHnHueeefffLfNfhhhhhh  !h^h$a$gd'4]gd'4]$a$gd'4] z&P+p,p-p.p/R4567:pt / =! 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