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HomeMy WebLinkAbout20131643.tiffRESOLUTION RE: APPROVE CONTRACT FOR JAIL BASED BEHAVIORAL HEALTH SERVICES AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Contract for Jail Based Behavioral Health Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Sheriff's Office, and the Colorado Department of Human Services, Office of Behavioral Health, commencing July 1, 2013, and ending June 30, 2014, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said contract, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Contract for Jail Based Behavioral Health Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Sheriff's Office, and the Colorado Department of Human Services, Office of Behavioral Health, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said contract. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 1st day of July, A.D., 2013. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST EXCUSED o,u�,� Willi F. Garcia, Chair Weld County Cle to the BY: Co2eti Attorney 3no, sa(Nativ� r1(� Date of signature: 7/(O Douglas Rademacher, Pro-Tem Sean P. Conway Mike Freeman arbara Kirkmeyer 2013-1643 SO0034 to. ®® ®® WELD COUNTY SHERIFF'S OFFICE sheriff John B. Cooke From the Desk of: Sterling Geesaman, Bureau Chief Offender Supervision Bureau (970) 356-4015 Extension 3933 The Sheriff's Office is requesting to contract with the State of Colorado to acquire funds to assist in providing screening, assessment and treatment for substance use disorders and co-occurring substance use and mental health disorders to people who need such services while they are in jail. Background: In May 2010, the Colorado General Assembly passed House Bill 10-1352 which lowered the penalties for drug use and possession and directed expected savings to the Drug Offender Treatment fund for substance abuse treatment of offenders. In May 2012, the Drug Offender Treatment fund was consolidated into the Correctional Treatment Cash Fund by passage of Senate Bill 12-163. Section 18-19-103 (5) C.R.S. allowed the appointment of an interagency advisory body called the Correctional Treatment Board to develop a plan for the allocation of the moneys in the Correctional Treatment Cash Fund and facilitate the statutory responsibilities and implementation of these funds. The Office of Behavioral Health was appointed to support County Sheriff's in providing services to people in custody and manage the funds for this project. Goal: The goal of the Jail Based Behavioral Health Services is to provide appropriate behavioral health services to inmates while supporting continuity of care within the community after release from incarceration. This approach should result in shorter jail sentences and decreased recidivism through better identification and treatment of behavioral health needs. Requirements: 1. All funds must be used to provide behavioral health services for adults (18 yrs. of age and older) with substance use disorders or co-occurring substance use and mental health disorders. The Sheriff's Office will use the funds to provide the services for adult offenders housed at the Weld County Jail. 2. A partnership must be established with local community providers who are currently licensed by the Office of Behavioral Health and who can provide services within the jail and have the capacity to provide free or low cost services in the community to inmates upon release. The Sheriff's Office will partner with North Range Behavioral Health and Interventions, Inc to provide services to inmates who meet the criteria required while they are in custody. Both agencies have committed to provide free or low cost services in the community upon an inmate's release, thus enhancing continuity of care. 2013-1643 Weld County Sheriffs Office 1950 "O" Street Greeley, CO 80631 Phone (970) 356-4015 Fax (970) 304-6467 c WELD COUNTY SHERIFF'S OFFICE Sheriff lofin 0. Cooke From the Desk of: Sterling Geesaman, Bureau Chief Offender Supervision Bureau (970) 356-4015 Extension 3933 3. The program shall have two FTE's; a clinician position to offer screenings, assessments and treatment in the jail; a case manager position dedicated to transitional care and a seamless re-entry in treatment services in the community. North Range Behavioral Health (NRBH) will provide 1 Master Counselor, licensed therapist with a CAC background and/or credentialing, to conduct screening, assessments and therapeutic interventions or treatment to qualifying inmates, as well as cognitive structured groups to this inmate population. This FTE will work together with the existing Jail Mental Health Team enhancing our ability to screen, assess and provide treatment. Upon an inmate's release from custody, the inmate will be an open client of NRBH and services will be available without a time delay, assuring continuity of care into the community. Intervention, inc will provide 1 Case Manager to assist in addressing the inmate needs as they transition from jail to the community upon release. The Case Manager will also provide reentry groups to the inmate population meeting criteria of this program. This FTE will work alongside the existing Jail Mental Health Team, enhancing the current ability in continuity of care and communication between the criminal justice system and community providers. The State of Colorado is proposing to award contracted funds to Weld County in the amount of $106,187.00 for fiscal year beginning July1, 2013 through June 30, 2014. The funding may be continued for an addition period of 3 one-year contracts upon the agreement of the parties. Attached is copy of the proposed budget. Weld County Sheriff's Office will be the fiduciary agent for the program. Contract providers will bill the Sheriff's Office monthly for services. The Sheriff's Office will submit an invoice to the State of Colorado for reimbursement monthly. Weld County Sheriffs Office 1950 "O" Street Greeley, CO 80631 Phone (970) 356-4015 Fax (970) 304-6467 STATE OF COLORADO Colorado Department of Huata Services people who help people OFFICE OF BEHAVIORAL HEALTH Lisa M. Clements, Ph.D., Director OFFICE OF BEHAVIORAL HEALTH Lori Banks, LCSW, Interim Deputy Director Community Programs 3824 West Princeton Circle Denver, Colorado 80236 Phone 303-866-7400 Fax 303-866-7481,303-866-7428 June 3, 2013 Sheriff John Cooke 1950 O Street Greeley, Colorado 80631 Dear Sheriff Cooke, John W. Hickenlooper Governor Reggie Bicha Executive Director Please find enclosed three copies of the FY2013-2014 contract. Please sign all three copies and return all three copies to me. Also, please note that no work on these contracts can begin until the State Controller has signed the contract. Thank you. Respectfully, Becca Lembke Manager, Contracts and Finance Our Mission is to Design and Deliver Quality Human Services that Improve the Safety and Independence of the People of Colorado DEPARTMENT OF HUMAN SERVICES ROUTING NO. 14 IID 5 5 0 6 0 CONTRACT This contract is made and entered into by and between the named parties. In accordance purposes stated herein, it is hereby agreed as follows: STATE CONTRACTOR State of Colorado for the use & benefit of the Department of Human Services Office of Behavioral Health 3824 West Princeton Circle Denver, CO 80236 Weld County Sheriffs Office 1950 O Street Greeley, Colorado 80631 CONTRACT MADE DATE: 05/31/2013 PO/SC ENCUMBRANCE NUMBER: PO IIDDBHS1455060 CONTRACTOR'S ENTITY TYPE: Government CONTRACTOR'S STATE OF INCORPORATION: TERM: This contract shall be effective upon approval by the State Controller, or designee, or on 07/01/2013, whichever is later. The contract shall end on 06/30/2014. BILLING STATEMENTS RECEIVED: Monthly STATUTORY AUTHORITY: C.RS. § 27-80-106 PROCUREMENT METHOD: Exempt BID/ RFP/LIST PRICE AGREEMENT NUMBER: Not Applicable LAW SPECIFIED VENDOR STATUTE: Not Applicable CONTRACT PRICE NOT TO EXCEED: $106,187.00 MAXIMUM AMOUNT AVM, 4BLE PER FISCAL YEAR: FY 14: $106,187.00 PRICE STRUCTURE: Cost Reimbursement FUND SOURCE -NAME OF FEDERAL PROGRAM/GRANT AND FUNDS ID# STATE REPRPSFNTATIVE: Andrew Martinez Office of Behavioral Health 3824 West Princeton Circle Denver, CO 80236 CONTRACTOR REPRESENTATIVE: John Cooke Weld County Sheriffs Office 1950 O Street Greeley, Colorado 80631 SCOPE OF WORK: In accordance with the provisions of this contract and its exhibits and attachments, the Contractor shall: Provide therapeutic interventions to treat alcoholism and illicit drug use disorders as well as mental illness related to these addictions in the county jails. For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 1 of 16 Revised 04/10/12 EXHIBITS: The following exhibits are hereby incorporated: Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Statement of Work Budget Miscellaneous Provisions Sample Option Letter Performance Measures HIPAA COORDINATION: The State warrants that required approval, clearance and coordination has been accomplished from and with appropriate agencies. APPROVAL In no event shall this contract be deemed valid until it shall have been approved by the State Controller or his/her designee. PROCUREMENT: This contractor has been selected in accordance with the requirements of the Colorado Procurement Code. PRICE PROVISIONS: For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 2 of 16 Revised 04/10/12 Payments pursuant to this contract shall be made as earned, in whole or in part, from available funds, encumbered for the purchase of the described services and/or deliverables. The liability of the State at any time for such payments shall be limited to the encumbered amount remaining of such funds. Authority exists in the laws and funds have been budgeted, appropriated and otherwise made available, and a sufficient unencumbered balance thereof remains available for payment. Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. The Contractor understands and agrees that the State shall not be liable for payment for work or services or for costs or expenses incurred by the Contractor prior to the proper execution and State Controller approval of this contract. For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 3 of 16 Revised 04/10/12 GENERAL PROVISIONS The following clauses apply to this contract: A. Governmental Immunity/Limitation of Liability: Notwithstanding anything herein to the contrary, no term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection, or other provisions of the "Colorado Governmental Immunity Act", C.R.S. §24-10-101, et seg., as now or hereinafter amended. The parties understand and agree that the liability of the State for claims for injuries to persons or property arising out of negligence of the State of Colorado, its departments, institutions, agencies, boards, officials and employees is controlled and limited by the provisions of C.R.S. §24-10-101, et seq., as now or hereafter amended and the risk management statutes, C.R.S. §24-30-1501, et seq., as now or hereafter amended. Any liability of the State created under any other provision of this contract, whether or not incorporated herein by reference, shall be controlled by, limited to, and otherwise modified so as to conform with, the above cited laws. B. Federal Funds Contingency: Payment pursuant to this contract, if in federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of federal funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable, as determined by the State, the State may immediately terminate this contract or amend it accordingly. C. Billing Procedures: The State shall establish billing procedures and requirements for payment due the Contractor in providing performance pursuant to this contract. The Contractor shall comply with the established billing procedures and requirements for submission of billing statements. The State shall comply with CRS 24-30-202(24) when paying vendors upon receipt of a correct notice of the amount due for goods or services provided hereunder. D. Exhibits- Interpretation: Unless otherwise stated, all referenced exhibits are incorporated herein and made a part of this contract. And, unless otherwise stated, in the event of conflicts or inconsistencies between this contract and its exhibits or attachments, such conflicts shall be resolved by reference to the For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management documents in the following order of priority: 1) the Special Provisions of this contract shall always be controlling over other provisions in the contract or amendments; 2) the contract "cover" pages; 3) the exhibits to this contract 4) the General Provisions of this contract. E. Notice and Representatives: For the purposes of this contract, the representative for each party is as designated herein. Any notice required or permitted may be delivered in person or sent by registered or certified mail, return receipt requested, to the party at the address provided, and if sent by mail it is effective when posted in a U.S. Mail Depository with sufficient postage attached thereto. Notice of change of address or change or representative shall be treated as any other notice. F. Contractor Representations: I. Licenses and Certifications: The Contractor certifies that, at the time of entering into this contract, it and its agents have currently in effect all necessary licenses, certifications, approvals, insurance, etc. required to properly provide the services and/or supplies covered by this contract in the state of Colorado. Proof of such licenses, certifications, approvals, insurance, etc. shall be provided upon the State's request. Any revocation, withdrawal or nonrenewal of necessary license, certification, approval, insurance, etc. required for the Contractor to properly perform this contract, shall be grounds for termination of this contract by the State. 2. Qualification: Contractor certifies that it is qualified to perform such services or provide such deliverables as delineated in this contract. 3. Exclusion. Debarment and/or Suspension: Contractor represents and warrants that Contractor, or its employees or authorized subcontractors, are not presently excluded from participation, debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded, or otherwise ineligible to participate in a "federal health care program" as defined in 42 U.S.C. § 1320a-7b(f) or in any other government payment program by any federal or State of Colorado department or agency. In the event Contractor, or one of its employees or authorized subcontractors, is excluded from participation, or becomes otherwise ineligible to participate in any such program during the Page 4 of 16 Revised 04/10/12 Term, Contractor will notify the State in writing within three (3) days after such event. Upon the occurrence of such event, whether or not such notice is given to Contractor, the State reserves the right to immediately cease contracting with Contractor. 4. Work Performed Outside the United States or Colorado, pursuant to C.R.S. §24-102-206: The Contractor certifies all work performed under this Contract, including any subcontracts, is anticipated to be and will be performed within the United States or Colorado, unless otherwise specified in the Statement of Work. If work under this Contract is anticipated to be or will be performed outside the United States or Colorado, the countries and/or states where work will be performed, and the reasons it is necessary or advantageous to go outside the United States or Colorado to perform the work are also specified in the Statement of Work. G. Legal Authority: The Contractor warrants that it possesses the legal authority to enter into this contract and that it has taken all actions required by its procedures, by-laws, and/or applicable law to exercise that authority, and to lawfully authorize its undersigned signatory to execute this contract and bind the Contractor to its terms. The person(s) executing this contract on behalf of the Contractor warrant(s) that such person(s) have full authorization to execute this contract. H. Indemnification: Contractor shall indemnify, save, and hold harmless the State, its employees and agents, against any and all claims, damages, liability and court awards including costs, expenses, and attorney fees and related costs, incurred as a result of any act or omission by Contractor, or its employees, agents, subcontractors, or assignees pursuant to the terms of this contract. [Applicable Only to Intergovernmental Contracts] No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection, or other provisions, of the Colorado Governmental Immunity Act, CRS §24-10-101 et seq., or the Federal Tort Claims Act, 28 U.S.C. 2671 et seq., as applicable, as now or hereafter amended. I. Insurance: Contractor and its Subcontractors shall obtain and maintain insurance as specified in this section at all times during the term of this Contract. All policies evidencing the insurance For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 5 of 16 coverage required hereunder shall be issued by insurance companies satisfactory to Contractor and the State. 1. Contractor a. Public Entities: If Contractor is a "public entity" within the meaning of the Colorado Governmental Immunity Act, CRS §24-10- 101, et seq., as amended (the "GIA"), then Contractor shall maintain at all times during the term of this Contract such liability insurance, by commercial policy or self- insurance, as is necessary to meet its liabilities under the GIA. Contractor shall show proof of such insurance satisfactory to the State, if requested by the State. Contractor shall require each contract with a Subcontractor that is a public entity, to include the insurance requirements necessary to meet such Subcontractor's liabilities under the GIA. b. Non -Public Entities: If Contractor is not a "public entity" within the meaning of the GIA, Contractor shall obtain and maintain during the term of this Contract insurance coverage and policies meeting the same requirements set forth in provision 1.2 below with respect to Subcontractors that are not "public entities". 2. Contractors —Subcontractors Contractor shall require each contract with Subcontractors other than those that are public entities, providing Goods or Services in connection with this Contract, to include insurance requirements substantially similar to the following: a. Worker's Compensation: Worker's Compensation Insurance as required by State statute, and Employer's Liability Insurance covering all of Contractor or Subcontractor employees acting within the course and scope of their employment. b. General Liability: Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: (a) $1,000,000 each occurrence; (b) $1,000,000 general aggregate; (c) $1,000,000 products and completed operations aggregate; and (d) $50,000 any one fire. Revised 04/10/12 If any aggregate limit is reduced below $1,000,000 because of claims made or paid, Subcontractor shall immediately obtain additional insurance to restore the full aggregate limit and furnish to Contractor a certificate or other document satisfactory to Contractor showing compliance with this provision. c. Automobile Liability: Automobile Liability Insurance covering any auto (including owned, hired and non -owned autos) with a minimum limit of $1,000,000 each accident combined single limit. d. Professional Liability: Professional liability insurance with minimum limits of liability of not less than $1,000,000, unless waived by the State. e. Privacy Insurance If this Contract includes a HIPAA Business Associates Addendum exhibit, Contractor shall obtain and maintain during the teen of this Contract liability insurance covering all loss of Protected Health Information data and claims based upon alleged violations of privacy rights through improper use or disclosure of Protected Health Information with a minimum annual limit of $1,000,000. f Additional Insured: The State shall be named as additional insured on all Commercial General Liability and Automobile Liability Insurance policies (leases and construction contracts require additional insured coverage for completed operations on endorsements CG 2010 11/85, CG 2037, or equivalent) required of Contractor and any Subcontractors hereunder. g. Primacy of Coverage: Coverage required of Contractor and Subcontractor shall be primary over any insurance or self- insurance program canied by Contractor or the State. h. Cancellation: The above insurance policies shall include provisions preventing cancellation or non -renewal without at least 30 days prior notice to Contractor and Contractor shall forward such notice to the State in accordance with provision E. Notice and Representatives within seven days of Contractor's receipt of such notice. i. Subrogation Waiver: All insurance policies in any way related to this Contract and secured and maintained by Contractor or its Subcontractors as required herein shall include clauses stating that each carrier shall waive all rights of recovery, under For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management subrogation or otherwise, against Contractor or the State, its agencies, institutions, organizations, officers, agents, employees, and volunteers. 3. Certificates: Contractor and all Subcontractors shall provide certificates showing insurance coverage required hereunder to the State within seven business days of the Effective Date of this Contract. No later than 15 days prior to the expiration date of any such coverage, Contractor and each Subcontractor shall deliver to the State or Contractor certificates of insurance evidencing renewals thereof. In addition, upon request by the State at any other time during the term of this Contract or any subcontract, Contractor and each Subcontractor shall, within 10 days of such request, supply to the State evidence satisfactory to the State of compliance with the provisions of this provision I. J. Disaster Planning and Pandemic Outbreaks: The State may require the Contractor to submit a Disaster Response Plan (Plan) to ensure the delivery hereunder of essential government services during a disaster, declared emergency, and/or pandemic outbreak. The Plan would take precedence over and nullify any contractual provision relating to force majeure or "Acts of God" Accordingly, should the work performed by the Contractor under this contract include the provision of any essential government services, the State may request a Plan from the Contractor, and, upon such request, the Contractor shall forthwith submit a Plan, and the Contractor shall be bound to perform hereunder in accordance therewith. K. Rights in Data. Documents and Computer Software or Other Intellectual Property: All intellectual property including without limitation, databases, software, documents, research, programs and codes, as well as all, reports, studies, data, photographs, negatives or other documents, drawings or materials prepared by the contractor in the performance of its obligations under this contract shall be the exclusive property of the State. Unless otherwise stated, all such materials shall be delivered to the State by the contractor upon completion, termination, or cancellation of this contract. Contractor shall not use, willingly allow or cause to have such materials used for any purpose other than the performance of the contractor's obligations under this contract without a prior written consent of the State. All documentation, accompanying the intellectual property or otherwise, shall comply with the State Page 6 of 16 Revised 04/10/12 requirements which include but is not limited to all documentation being in a paper, human readable format which is useable by one who is reasonably proficient in the given subject area. L. Proprietary Information: Proprietary information for the purpose of this contract is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information lawfully obtained by third parties, which is in the public domain, or which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this contract. Any proprietary information removed from the State's site by the Contractor in the course of providing services under this contract will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. M. Records Maintenance, Performance Monitorinu & Audits: The Contractor shall maintain a complete file of all records, documents, communications, and other materialsthat pertain to the operation of the program/project or the delivery of services under this contract. Such files shall be sufficient to properly reflect all direct and indirect costs of labor, materials, equipment, supplies and services, and other costs of whatever nature for which a contract payment was made. These records shall be maintained according to generally accepted accounting principles and shall be easily separable from other Contractor records. The Contractor shall protect the confidentiality of all records and other materials containing personally identifying information that are maintained in accordance with this contract. Except as provided by law, no information in possession of the Contractor about any individual constituent shall be disclosed in a form including identifying information without the prior written consent of the person in interest, a minor's parent, guardian, or the State. The Contractor shall have written policies governing access to, duplication and dissemination of, all such information and advise its agents, if any, that they are subject to these confidentiality requirements. The Contractor shall provide its agents, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management The Contractor authorizes the State, the federal government or their designee, to perform audits and/or inspections of its records, at any reasonable time, to assure compliance with the state or federal government's terms and/or to evaluate the Contractor's performance. Any amounts the State paid improperly shall be immediately returned to the State or may be recovered in accordance with other remedies. All such records, documents, communications, and other materials shall be the property of the State unless otherwise specified herein and shall be maintained by the Contractor, for a period of three (3) years from the date of final payment or submission of the final federal expenditure report under this contract, unless the State requests that the records be retained for a longer period, or until an audit has been completed with the following qualification. If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the three (3) year period, or if audit findings have not been resolved after a three (3) year period, the materials shall be retained until the resolution of the audit findings. The Contractor shall permit the State, any other governmental agency authorized by law, or an authorized designee thereof, in its sole discretion, to monitor all activities conducted by the Contractor pursuant to the terms of this contract. Monitoring may consist of internal evaluation procedures, reexamination of program data, special analyses, on -site verification, formal audit examinations, or any other procedures as deemed reasonable and relevant. All such monitoring shall be performed in a manner that will not unduly interfere with contract work. N. Taxes: The State, as purchaser, is exempt from all federal excise taxes under Chapter 32 of the Internal Revenue Code [No. 84-730123K] and from all state and local government use taxes [C.R.S. §39- 26-114(a) and 203, as amended]. The contractor is hereby notified that when materials are purchased for the benefit of the State, such exemptions apply except that in certain political subdivisions the vendor may be required to pay sales or use taxes even though the ultimate product or service is provided to the State. These sales or use taxes will not be reimbursed by the State. O. Conflict of Interest: During the term of this contract, the Contractor shall not engage in any business or personal activities or practices or Page 7 of 16 Revised 04/10/12 maintain any relationships which conflict in any way with the Contractor fully performing his/her obligations under this contract. Additionally, the Contractor acknowledges that, in governmental contracting, even the appearance of a conflict of interest is harmful to the interests of the State. Thus, the Contractor agrees to refrain from any practices, activities or relationships which could reasonably be considered to be in conflict with the Contractor's fully performing his/her obligations to the State under the terms of this contract, without the prior written approval of the State. In the event that the Contractor is uncertain whether the appearance of a conflict of interest may reasonably exist, the Contractor shall submit to the State a full disclosure statement setting forth the relevant details for the State's consideration and direction. Failure to promptly submit a disclosure statement or to follow the State's direction in regard to the apparent conflict shall be grounds for termination of the contract. Further, the Contractor shall maintain a written code of standards governing the performance of its agent(s) engaged in the award and administration of contracts. Neither the Contractor nor its agent(s) shall participate in the selection, or in the award or administration of a contract or subcontract supported by Federal funds if a conflict of interest, real or apparent, would be involved. Such a conflict would arise when: 1. The employee, officer or agent; 2. Any member of the employee's immediate family; 3. The employee's partner; or 4. An organization which employees, or is about to employ, any of the above, has a financial or other interest in the firm selected for award. Neither the Contractor nor its agent(s) will solicit nor accept gratuities, favors, or anything of monetary value from Contractor's potential contractors, or parties to subagreements. P. Conformance with Law: The Contractor and its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws, state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be amended. Without limitation, these federal laws and regulations include: • Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et seq. and its implementing regulation, 45 C.F.R. Part 91; For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 8of16 Age Discrimination in Employment Act of 1967, 29 U.S.C. 621 et sew Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. 12101 et . The Drug Free Workplace Act of 1988, 41 U.S.C. 701 et seq.• Equal Pay Act of 1963, 29 U.S.C. 206; Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d et seq. and implementing regulations, 45 C.F.R. Parts 160 and 164; Immigration Reform and Control Act of 1986, 8 U.S.C. 1324b; • Pro -Children Act of 1994, 20 U.S.C. 6081 et seg.; • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as amended, and implementing regulation 45 C.F.R. Part 84; Titles VI & VII of the Civil Rights Act of 1964, 42 U.S.C. 2000(d) & (e); The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 42 USC 604a, PL 104-193. See also State Executive Order D 015 00; Title IX of the Education Amendments of 1972, 20 U.S.C. 1681 et seq.• The Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments (Common Rule), at 45 CFR, Part 92; The Uniform Administrative Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, Other Non -Profit Organizations, and Commercial Organizations (Common Rule), at 2 CFR 215; Office of Management and Budget Circulars A- 87, A-21 or A-122, and A-102 or A-110, whichever is applicable. The Hatch Act (5 USC 1501-1508) and Civil Service Reform Act, Public Law 95-454 Section 4728. Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Act, 1990, PL 101-166, Section 511. 45 CFR Subtitle A, Department of Health and Human Services regulations. The Single Audit Act Amendments of 1996, 31 USC 7501, Public Law 104-156, OMB Circular A-133, and 45 CRF 74.26. The Federal Funding Accountability and Transparency Act of 2006 (Public Law 109- 282), as amended by §6062 of Public Law 110-252, including without limitation all data Revised 04/10/12 reporting requirements required thereunder. This Act is also referred to as FFATA. The American Recovery and Reinvestment Act of 2009 (Public Law 111-5), including without limitation all data reporting requirements required thereunder. This Act is also referred to as ARRA. Q. Restrictions on Public Benefits: Pursuant to House Bill 06S-1023, as codified at C.R.S. § 24-76.5-101 et seq., except as otherwise provided therein or where exempt by federal law, the State is required to verify the lawful presence in the United States of each natural person 18 years of age or older who applies for state or local public benefits or for federal public benefits for the applicant. Accordingly, should the work performed by the Contractor under this contract include the provision of any of said benefits to any natural person 18 years of age or older who applies therefore for the applicant, the Contractor shall follow the requirements of said law in the provision of said benefits as if it were the State. The State will provide the Contractor with specific instruction on the identification documentation required and the process to be followed by the Contractor to properly comply with the law if the work done under this contract is subject to these requirements. R. Statewide Contract Management System: 1. When Applicable. If the maximum amount payable to Contractor under this Contract is $100,000 or greater, either on the Effective Date or at anytime thereafter, this provision applies. 2. Governing State Statutes. Contractor agrees to be governed, and to abide, by the provisions of CRS §24-102-205, §24-102-206, §24-103- 601, §24-103,5-101 and §24-105-102 concerning the monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide contract management system. 3. Performance Evaluation and Review. Contractor's performance shall be subject to Evaluation and Review in accordance with the terms and conditions of this Contract, State law (including without limitation CRS §24- 103.5-101), and State Fiscal Rules, Policies and Guidance. Evaluation and Review of Contractor's performance shall be part of the normal contract administration process and Contractor's performance will be systematically recorded in the statewide Contract Management System. Areas of Evaluation and Review shall include without For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management limitation quality, cost and timeliness. Collection of information relevant to the performance of Contractor's obligations under this Contract shall be determined by the specific requirements of such obligations and shall include factors tailored to match the requirements of Contractor's obligations hereunder. Such performance information shall be entered into the statewide Contract Management System at intervals during the term hereof determined appropriate by the State, and a final Evaluation, Review and Rating shall be rendered by the State within 30 days of the end of the Contract term. Contractor shall be notified following each performance Evaluation and Review, and shall address or correct any identified problem in a timely manner and maintain work progress. 4. Gross Failure to Meet Performance Measures. Should the final performance Evaluation and Review determine that Contractor demonstrated a gross failure to meet the performance measures established hereunder, the Executive Director of the Colorado Department of Personnel and Administration (Executive Director), upon request by the Department of Human Services, for good cause shown, may debar Contractor and prohibit Contractor from bidding on future contracts. Contractor may contest the final Evaluation and Review and Rating by: (a) filing rebuttal statement(s), which may result in either removal or correction of the evaluation (CRS §24-105-102(6)), or (b) under CRS §24-105-102(6), exercising the debarment protest and appeal rights provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and reinstatement of Contractor by the Executive Director upon showing of good cause. 5. CORA Disclosure: To the extent not prohibited by federal law, this Contract and the performance measures and standards under CRS §24-103.5-101 are subject to public release through the Colorado Open Records Act, CRS §24-72-101, et seq. S. Performance Ratings and Guidelines: The Contractor will be given a Final Contractor Performance Evaluation at the end of the contract term in accordance with C.R.S. §24-102-205(6) and General Provision R. above. The list of available Performance Ratings, along with guidelines for what final rating will be given, are as follows: Page 9of16 Revised 04/10/12 1. Above Standard: This rating may be given where Contractor consistently performs in a manner that exceeds the requirements of this Contract, and where such performance is measurable against objective factors specifically identified for use in achieving the purposes of this provision. If applicable to work performed under this Contract, the objective factors and performance required to merit an "Above Standard" rating are specified in a so dedicated Exhibit to this Contract, which may be included herein from the start of the contract or subsequently be added by formal contract amendment at any time before the end of the contract term. If there is no such dedicated Exhibit included or subsequently added herein, this rating is unavailable. 2. Standard: This rating will be given where: I.) Contractor's performance hereunder meets the requirements of this Contract in areas of quality, cost, and timeliness; 2.) Contractor's work is accepted by the State; and 3.) full payment hereunder is made to Contractor for such performance. 3. Below Standard: This rating may be given where Contractor materially fails to perform the requirements of this Contract and such failure results in' the State's invocation of contract remedies and/or contract termination in accordance with General Provision X. below. T. Discrimination: The Contractor during the performance of this contract shall: 1. not discriminate against any person on the basis of race, color, national origin, age, sex, religion and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions. 2. not exclude from participation in, or deny benefits to any qualified individual with a disability, by reason of such disability. Any person who thinks he/she has been discriminated against as related to the performance of this contract has the right to assert a claim, Colorado Civil Rights Division, C.R.S. §24-34- 302, et seq. U. Criminal Background Check: Pursuant to C.R.S. §27-90-111 and Department of Human Services Policy VI -2.4, any independent contractor, and its agent(s), who is designated by the Executive Director or the Executive Director's designee to be a contracting employee under C.R.S. §27-90-111, who has direct contact with vulnerable persons in a For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management state -operated facility, or who provides state - funded services that involve direct contact with vulnerable persons in the vulnerable person's home or residence, shall: 1. submit to a criminal background check, and 2. report any arrests, charges, or summonses for any disqualifying offense as specified by C.R.S. §27-90-111 to the State. Any Contractor or its agent(s), who does not comply with C.R.S. §27-90-111 and DHS Policy VI -2.4, may, at the sole discretion of the State, be suspended or terminated. V. Litigation: The Contractor shall within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency notify the State that it is a party defendant in a case which involves services provided under this contract. The Contractor shall deliver copies of such document(s) to the State's Executive Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganization and/or foreclosure. W. Disputes: Except as herein specifically provided otherwise, disputes concerning the performance of this contract which cannot be resolved by the designated contract representatives shall be referred in writing to a senior departmental management staff designated by the department and a senior manager designated by the Contractor. Failing resolution at that level, disputes shall be presented in writing to the Executive Director and the Contractor's chief executive officer for resolution. This process is not intended to supersede any other process for the resolution of controversies provided by law. X. Remedies: Acceptance is dependent upon completion of all applicable inspection procedures. The State reserves the right to inspect the goods and/or services provided under this contract at all reasonable times and places. The Executive Director of the State or her/his designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this contract. Substantial failure to satisfy the scope of work shall be defined to mean substantially insufficient, incorrect or improper activities or inaction by the Contractor. Without limitation, the State has the right to: 1. withhold payment until performance is cured, Page 10 of 16 Revised 04/10/12 2. require the vendor to take necessary action to ensure that the future performance conforms to contract requirements, 3. request removal of a Contractor's agent from contract work, 4. equitably reduce the payment due the vendor to reflect the reduced value of the services performed, 5. recover payment for work that due to the Contractor cannot be performed or would be of no value to the State, 6. modify or recover payments (from payments under this contract or other contracts between the State and the vendor as a debt due to the State) to correct an error due to omission, error, fraud and/or defalcation, 7. terminate the contract. These remedies in no way limit the remedies available to the State in the termination provisions of this contract, or remedies otherwise available at law. Y. Termination: 1. Termination for Default: The State may terminate the contract for cause. If the State terminates the contract for cause, it will first give ten (10) days prior written notice to the Contractor, stating the reasons for cancellation, procedures to correct problems, if any, and the date the contract will be terminated in the event problems have not been corrected. In the event this contract is terminated for cause, the State will only reimburse the Contractor for accepted work or deliverables received up to the date of termination. In the event this contract is terminated for cause, final payment to the Contractor may be withheld at the discretion of the State until completion of final audit. Notwithstanding the above, the Contractor may be liable to the State for the State's damages. If it is determined that the Contractor was not in default then such termination shall be treated as a termination for convenience as described herein. 2. Termination for Convenience: The State shall have the right to terminate this contract by giving the Contractor at least twenty (20) days prior written notice. If notice is so given, this contract shall terminate on the expiration of the specified time period, and the liability of the parties hereunder for further performance of the terms of this contract shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 11 of 16 3. Immediate Termination: This contract is subject to immediate termination by the State in the event that the State determines that the health, safety, or welfare of persons receiving services may be in jeopardy. Additionally, the State may immediately terminate this contract upon verifying that the Contractor has engaged in or is about to participate in fraudulent or other illegal acts. 4. Termination for Financial Exinencv: The State shall have the right to terminate this contract for financial exigency by giving the Contractor at least thirty (30) days prior written notice. For the purposes of this provision, a financial exigency shall be a determination made by the Colorado legislature or its Joint Budget Committee that the financial circumstances of the State are such that it is in the best interest of the State to terminate this contract. If notice of such termination is so given, this contract shall terminate on the expiration of the time period specified in the notice, and the liability of the parties hereunder for further performance of the terms of this contract shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. In the event that the State terminates this contract under the Termination for Convenience or Termination for Financial Exigency provisions, the Contractor is entitled to submit a termination claim within ten (10) days of the effective date of termination. The termination claim shall address and the State shall consider paying the following costs: a. the contract price for performance of work, which is accepted by the State, up to the effective date of the termination. b. reasonable and necessary costs incurred in preparing to perform the terminated portion of the contract c. reasonable profit on the completed but undelivered work up to the date of termination d. the costs of settling claims arising out of the termination of subcontracts or orders, not to exceed 30 days pay for each subcontractor e. reasonable accounting, legal, clerical, and other costs arising out of the termination settlement. In no event shall reimbursement under this clause exceed the contract amount reduced by Revised 04/10/12 amounts previously paid by the State to the Contractor. Z. Venue: The parties agree that venue for any action related to performance of this contract shall be in the City and County of Denver, Colorado. AA. Understanding of the Parties: 1. Complete Understanding: This contract is intended as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever, unless embodied herein in writing. No subsequent novation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied in a written contract executed and approved pursuant to the State Fiscal Rules. Descriptive headings as used herein are for convenience and shall not control or affect the meaning or construction of any provision of this contract. 2. Severability: To the extent that this contract may be executed and performance of the obligations of the parties may be accomplished within the intent of the contract, the terms of this contract are severable, and should any term or provision hereof be declared invalid or become inoperative for any reason, such invalidity or failure shall not affect the validity of any other term or provision hereof. 3. Benefit and Right of Action: Except as herein specifically provided otherwise, it is expressly understood and agreed that this contract shall inure to the benefit of and be binding upon the parties hereto and their respective successors and assigns. All rights of action relating to enforcement of the terms and conditions shall be strictly reserved to the State and the named Contractor. Nothing contained in this agreement shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of the State and the Contractor that any such person or entity, other than the State or the Contractor, receiving services or benefits under this agreement shall be deemed an incidental beneficiary only. 4. Waiver: The waiver of any breach of a teen hereof shall not be construed as a waiver of any other term, or the same term upon subsequent breach. 5. Survival: The State and the Contractor's obligations under this contract shall survive following termination or expiration to the extent For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management necessary to give effect to the intent and understanding of the parties. 6. Subcontracting: Except as herein specifically provided otherwise, the duties and obligations of the Contractor arising hereunder cannot be assigned, delegated, subgranted or subcontracted except with the express prior written consent of the State. The subgrants and subcontracts permitted by the State shall be subject to the requirements of this contract. The Contractor is responsible for all subcontracting arrangements, delivery of services, and performance of any subgrantor or subcontractor. The Contractor warrants and agrees that any subgrant or subcontract, resulting from its performance under the terms and conditions of this contract, shall include a provision that the said subgrantor or subcontractor shall abide by the terms and conditions hereof. Also, the Contractor warrants and agrees that all subgrants or subcontracts shall include a provision that the subgrantor or subcontractor shall indemnify and hold harmless the State. The subgrantors or subcontractors must be certified to work on any equipment for which their services are obtained. BB. Holdover: In the event that the State desires to continue the services provided for in this Contract and a replacement contract has not been fully executed by the expiration date of the Contract, this Contract may be extended unilaterally by the State for a period of up to two (2) months upon written notice to the Contractor under the same terms and conditions of the original Contract including, but not limited to, prices, rates, and service delivery requirements. However, this extension terminates when the replacement contract becomes effective when signed by the State Controller or an authorized delegate. CC. Health Insurance Portability & Accountability Act of 1996 ("HIPAA"). Federal law and regulations governing the privacy of certain health information requires a "Business Associate Contract" between the State and the Contractor. 45 C.F.R. Section I64.504(e). If applicable to this Contract, attached and incorporated herein by reference and agreed to by the parties is a HIPAA Business Associate Addendum for HIPAA compliance. Terms of the Addendum shall be considered binding upon execution of this contract and shall remain in effect during the term of the contract including any extensions. Page 12 of 16 Revised 04/10/12 DD. Colorado Department of Human Services (CDHS) Fraud Policy. The CDHS Fraud Policy addresses the need for effective and consistent measures for preventing, detecting, and deterring fraud. The relevant parties discussed in the policy include CDHS employees, CDHS management, CDHS appointees, and community partners, including contractors, grantees, vendors, and other sub - recipients. CDHS employees, clients, and community partners will all benefit from an effective fraud prevention, detection, and deterrence policy because fraud can damage the reputation and public trust of CDHS. All appointees and employees of the CDHS must comply with the standards of conduct set forth in Title 24, Article 18 of the Colorado Revised Statutes, known as the Code of Ethics, including exposing corruption or impropriety in government, whenever discovered. The CDHS Fraud Policy outlines how the CDHS employees and community partners should report fraud and how fraud will be investigated once it is reported. The full text of the CDHS Fraud Policy, which Contractor hereby agrees to be subject to and abide by, can be found on the CDHS Fraud Policy and Training web page at: http://www. colorado.gov/es/Satellite/CDHS- Em n/C B ON/ 1251610724004. EE. C-Stat - Performance Based Program Analysis and Management Strategy (C-Stat Strategy): For the sole purpose of providing support to the State's internal C-Stat Strategy, the parties understand and agree that upon request from the State, and without any additional cost to the State, the Contractor shall collect, maintain, and provide to the State certain contract performance data determined by the State during the term hereof to assist the State to measure and assess the programmatic effectiveness of the Contractor's performance hereunder, all in support of the State's internal continuous quality improvement working towards positive outcomes and managing its performance for the betterment of all Colorado residents. The parties understand and agree that the exercise of the requirements of this provision shall not be used by the State to effect unilateral changes to the performance requirements of the Contractor hereunder. For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 13 of 16 Revised 04/10/12 These Special Provisions apply to all contracts except where noted in italics. 1. CONTROLLER'S APPROVAL. CRS §24-30-202(1). This contract shall not be valid until it has been approved by the Colorado State Controller or designee. 2. FUND AVAILABILITY. CRS §24-30-202(5.5). Financial obligations of the State payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted, and otherwise made available. 3. GOVERNMENTAL IMMUNITY. No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections, or other provisions, of the Colorado Governmental Immunity Act, CRS §24-10-101 et seq., or the Federal Tort Claims Act, 28 U.S.C. §§1346(b) and 2671 et seq., as applicable now or hereafter amended. 4. INDEPENDENT CONTRACTOR. Contractor shall perform its duties hereunder as an independent contractor and not as an employee. Neither Contractor nor any agent or employee of Contractor shall be deemed to be an agent or employee of the State. Contractor and its employees and agents are not entitled to unemployment insurance or workers compensation benefits through the State and the State shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes incurred pursuant to this contract. Contractor shall not have authorization, express or implied, to bind the State to any agreement, liability or understanding, except as expressly set forth herein. Contractor shall (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, (b) provide proof thereof when requested by the State, and (c) be solely responsible for its acts and those of its employees and agents. 5. COMPLIANCE WITH LAW. Contractor shall strictly comply with all applicable federal and State laws, rules, and regulations in effect or hereafter established, including, without limitation, laws applicable to discrimination and unfair employment practices. 6. CHOICE OF LAW. Colorado law, and rules and regulations issued pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this contract. Any provision included or incorporated herein by reference which conflicts with said laws, rules, and regulations shall be null and void. Any provision incorporated herein by reference which purports to negate this or any other Special Provision in whole or in part shall not be valid or enforceable or available in any action at law, whether by way of complaint, defense, or otherwise. My provision rendered null and void by the operation of this provision shall not invalidate the remainder of this contract, to the extent capable of execution. 7. BINDING ARBITRATION PROHIBITED. The State of Colorado does not agree to binding arbitration by any extra judicial body or person. Any provision to the contrary in this contact or incorporated herein by reference shall be null and void. 8. SOFTWARE PIRACY PROHIBITION. Governor's Executive Order D 002 00. State or other public funds payable under this contract shall not be used for the acquisition, operation, or maintenance of computer software in violation of federal copyright laws or applicable licensing restrictions. Contractor hereby certifies and warrants that, during the term of this contract and any extensions, Contractor has and shall maintain in place appropriate systems and controls to prevent such improper use of public funds. If the State determines that Contractor is in violation of this provision, the State may exercise any remedy available at law or in equity or under this contract, including, without limitation, immediate termination of this contract and any remedy consistent with federal copyright laws or applicable licensing restrictions. 9. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST. CRS §§24-18-201 and 24-50- 507. The signatories aver that to their knowledge, no employee of the State has any personal or beneficial For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 14 of 16 Revised 04/10/12 interest whatsoever in the service or property described in this contract. Contractor has no interest and shall not acquire any interest, direct or indirect, that would conflict in any manner or degree with the performance of Contractor's services and Contractor shall not employ any person having such known interests. 10. VENDOR OFFSET. CRS §§24-30-202 (1) and 24-30-202.4. [Not Applicable to intergovernmental agreements] Subject to CRS §24-30-202.4 (3.5), the State Controller may withhold payment under the State's vendor offset intercept system for debts owed to State agencies for: (a) unpaid child support debts or child support arrearages; (b) unpaid balances of tax, accrued interest, or other charges specified in CRS §39-21-101, et seq.; (c) unpaid loans due to the Student Loan Division of the Department of Higher Education; (d) amounts required to be paid to the Unemployment Compensation Fund; and (e) other unpaid debts owing to the State as a result of final agency determination or judicial action. 11. PUBLIC CONTRACTS FOR SERVICES. CRS §8-17.5-101. [Not Applicable to agreements relating to the offer, issuance, or sale of securities, investment advisory services or fund management services, sponsored projects, intergovernmental agreements, or information technology services or products and services] Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract and will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this contract through participation in the E -Verify Program or the Department program established pursuant to CRS §8- 17.5-102(5)(c), Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this contract. Contractor (a) shall not use E -Verify Program or Department program procedures to undertake pre- employment screening of job applicants while this contract is being performed, (b) shall notify the subcontractor and the contracting State agency within three days if Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien for work under this contract, (c) shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three days of receiving the notice, and (d) shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to CRS §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the Department program, Contractor shall deliver to the contracting State agency, Institution of Higher Education or political subdivision a written, notarized affirmation, affirming that Contractor has examined the legal work status of such employee, and shall comply with all of the other requirements of the Department program. If Contractor fails to comply with any requirement of this provision or CRS §8-17.5-101 et seq., the contracting State agency, institution of higher education or political subdivision may terminate this contract for breach and, if so terminated, Contractor shall be liable for damages. 12. PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24-76.5-103 prior to the effective date of this contract. Revised 1-1-09 For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Page 15 of 16 Revised 04/10/12 oSoo t met al Sign^.tune Page -Rev 08(1S23 Contract Routing Number 14 III) 55060 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT M Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and acknowledge that the State is relying on their representations to that effect. By: Jo Title: Sh CONTRACTOR Weld County Sheriff's Office Cooke 'ff Date: 7-! ) STATE OF COLORADO John W. Hickenlooper, GOVERNOR Department of Human Servi Reggie Bicha, Executive y: Andrew Martinez Community Programs CFO, Office of Behavib l Health Date: Z-'2---- ('3 2nd Contractor Signature if Needed BY: Douglas Rademacher Title: Weld County Commissioner, Chair , Pro-tem (fit 1 119 S * Signature Date: JUL 0 12013 LEGAL REVIEW John W. Suthers, Attorney General By: Signature - Assistant Attorney General Date: ALL CONTRACTS REQUIRE APPROVAL by the STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. Page 16 of 16 Revised 04/10/12 For Contract Wizard Version 3.15 Colorado Department of Human Services Division of Contract Management Exhibit A Statement of Work Weld County Sheriff's Office A. Ability 1. Demonstrate partnership with OBH-licensed substance use disorder treatment provider(s) to deliver appropriate behavioral health care to inmates; The Weld County Sherriff s Office (WCSO) will be partnering with North Range Behavioral Health (NRBH) and Intervention, Inc. to deliver behavioral health services to inmates in the Weld County Jail (WCJ). NRBH is licensed by the Office of Behavioral Health (OBH) to provide substance use and mental health services. 2. Demonstrate capacity for community based treatment to continue with the same provider within that community following release; NRBH will open inmates and enroll them from the Jail Based Behavioral Health Services (JBBS) Program as a client at the center when appropriate. As a new program, it is difficult to determine the number of enrollees. However, we do expect that the NRBH therapist will contact at least six inmates per day and that some of them will be one-time contacts, while others may take several hours of service time based on their needs and/or the length of time of their incarceration. Therefore, we anticipate this provider will serve 100 incarcerated individuals annually. Prior to the inmate's release from WCJ, the JBBS provider will begin coordination efforts with the Adult Service Division at NRBH to ensure a seamless transition to community -based care. Typically, they will funnel most of these transitioning inmates through the Behavioral Alternative Services In Community (BASIC), which is the interface treatment program at NRBH that addresses forensic issues. Additionally, this transition to the community can also include NRBH's full range of primary and adjunctive services that exists within a full continuum of care model. The attached Letter of Supports from NRBH and Interventions confirms their willingness and their ability to provide services to these identified criminal justice inmates. 3. Exhibit ability to screen all inmates for presence of substance use disorders, mental health disorders, trauma and traumatic brain injury; All inmates entering the Weld County Jail undergo an initial screening/assessment process by WCSO Classification staff. These screens are for substance use and mental health disorders by self -report. Individuals who are identified for behavioral services will be further assessed by the NRBH Criminal Justice Specialists (CJS) who will complete a battery of assessments on the inmate. Depending on the clinical needs, the mental health screening instruments may include: Psychotherapy Assessment Checklist (Leigh McCullough, 2001); Texas Christian University of Criminal Thinking Scale (TCUCTS), Brief Psychiatric Rating Scale (BPRS); or the Adult Self -Assessment Profile/Rating Adults Problems Scale (ADSAP/RAPS). While the substance use tools may include: Substance Abuse Subtle Screening Inventory (SASSI); Addiction Severity Index (ASI); Page 1 of 14 Exhibit A Stages of Change Readiness and Treatment Eagerness (SOCRATES); the Patient Placement Criteria, Second Edition — Revised (PPC-2R) through the American Society of Addiction Medicine (ASAM). All potential participants in JBBS will be screened also for trauma and traumatic brain injury (TBI). Trauma will be assessed by using the PTSD Checklist or Trauma Symptom Inventory (TSI) and TBI concerns will be screened via the HELPS Brain Injury Screening Tool. 4. Exhibit ability to identify inmates with active duty or veteran military status; Military status is obtained during booking or at assessment which is at the beginning of the inmate's incarceration. 5. Propose an organizational structure designed to facilitate and promote effective administration of the program. A steering committee comprised of NRBH, Intervention and Weld County Jail Management will provide program oversight. The JBBS Oversight Committee will meet on a regular basis with the option to meet and act when necessary to improve the program and to remove barriers to effective and efficient services. Additionally, this committee will monitor, direct, evaluate and plan the direction of the JBBS Grant Program. The CJS and the CJCM will be embedded into an already existing jail -based behavioral team employed by the County. These two newly created, specialized positions would be employed and answer directly to their respective organizations: NRBH and Intervention. However, while in the jail facility, the WCSO Licensed Clinical Supervisor will direct and guide their activities to meet the objectives of the program. 6. Demonstrate financial resources and fiscal management skills to perform the work proposed. Weld County Sherriffs Office (WCSO) will be the fiduciary agent for the grant program. The WCSO will contract with NRBH and Intervention for oversight, general management of the JBBS providers and services. The WCSO has a long standing history of receiving and managing federal and state grants. NRBH also has a similar record. Thus, the agencies involved use state of the art information systems and are closely audited fiscally around their record keeping and accountability methods. All agencies have experience with working together and with the state to accomplish common goals. All accounting activities are guided by accounting policies and procedures that are prepared using time tested accounting practices and guidelines. Monthly financial statements are prepared and compared against budget and prior years for appropriateness. These statements are reviewed monthly by these entities. Common accounting practices are implemented by the parties involved. 7. Exhibit the ability to provide culturally competent and appropriate services. All agencies receive regular training to increase staff member ability to look for and respond to the impact of individual differences among clients or inmates related to Page 2 of 14 Exhibit A gender, race, religion, ethnicity, language, sexual orientation and ability. All entities have employees who are fluent in languages other than English, mainly Spanish. Additionally, these agencies require cultural awareness and standards be met in accordance with their respective state and national associations, organization or by government standards as it relates to cultural issues. 8. Exhibit the ability to meet the needs of individuals who are physically challenged, deaf or hearing impaired, or blind. The WCJ meets the needs of inmates who are physically challenged, hearing impaired or blind within State and national standards in accordance with the Americans with Disabilities Act. Outside of the jail facility, when inmates transition to the community, all participating agencies can work with clients to meet their needs. Services can be set up to accommodate the physically handicapped in term of accesibility, the hearing and/or visually impaired. 9. Demonstrate an ability to interface with other agencies serving persons with substance use disorders or co-occurring mental illnesses, i.e., community mental health centers, substance use disorder treatment programs, service programs for Veterans and other community service agencies. The WCSO, Intervention and NRBH are members of the Criminal Justice Advisory Committee (CJAC). NRBH chairs and hosts one of its subcommittees associated with Mental Health/Criminal Justice. Their goal is to find solutions to further reduce recidivism of individual's involved in the criminal justice system with behavioral health needs. All three agencies interface regularly with entities like probation and parole to address systemic and case -by -case issues. County collaborative efforts include: • City, County and State: Housing/Homeless; Department of Human Services; Weld County Health Department; Drug Court; Family Court; Workforce; Department of Corrections; etc. • Veterans Groups: Veteran's Administration • Mutual referral relationships: Safe Houses; homeless shelters; suicide prevention programs; food banks; University of Northern Colorado; etc. • Community Partnerships: Integrative care clinics with Sunrise Monfort Family Clinic and Monfort Children's Clinic; Regional Care Collaborative Organization where NRBH is a partner with the Northern Colorado Health Alliance to identify and reduce cost of health care. 10. Demonstrate an ability to provide services in a manner that respects and protects client rights. All employees with WCSO, NRBH and Intervention who have direct contact with Page 3 of 14 Exhibit A inmates treat them respectfully and courteously. Employees are aware of and protect inmate rights, both civil and legal, according to set standards that include: • Freedom from discrimination based on race, religion, national origin, sex, disability, or political beliefs. • Equal access to program and work assignments and involvement in decisions based on their classification level. • Protection from personal abuse, corporal punishment, personal injury, disease, property damage, and harassment. • Freedom from reprisals or penalties as result of seeking administrative or judicial redress. As open clients to the mental health system, inmates will have client treatment rights as defined in federal and state law. This would include information on their rights regarding grievances and complaints, which includes a referral process with an appeals mechanism. This information is provided to all consumers within the NRBH system at time of admission as well as the Weld County Jail when an inmate receives counseling services. 11. Demonstrate an ability to provide OBH with the required data submissions as defined below under Section C — Monitoring and Data Collection. The intent of all agencies is to cooperate fully with the State in gathering the information required to comply with our obligations. IT Departments will coordinate their efforts to generate necessary reports for data collection. The Oversight Committee will monitor this process while NRBH already has in place most of the data collection capabilities. The JBBS providers will work with the jail staff to coordinate and collect data as it relates to reducing recidivism among clients in the program. The data requirements for OBH will be monitored by NRBH staff and management team. This tracking and monitoring will include: • Basic demographic information about the inmate who is receiving services; • The number of client served under the JBBS Program; • The type and qualities of services provided; • The number or percentage who successfully transition to community -based services upon release; • Program termination outcomes; • Prevalence data gathered from administering mental health, substance use disorder, trauma and traumatic brain injury screens; • Licensed substance abuse disorder treatment providers will submit Drug/Alcohol Coordinated Data System (DACOD) for services provided in the jail to Office of Behavioral Health (OBH); • Licensed mental health professionals will submit Colorado Client Assessment Record (CCAR) data to OBH through the NRBH system. Page 4 of 14 Exhibit A 12. Demonstrate the ability to transition individuals from jail based services to appropriate behavioral health and other needed community services upon release from incarceration. Intervention has a long history of effective case management services and has established strong linkages with numerous community resources. The CJCM, in cooperation with the CJS and other JBBS providers, will be an essential element to the success of this program. Creating a transitional plan for inmates to community -oriented services prior to release from jail should create a solid model to ensure the most efficient and effective transition possible. It is essential that an inmate leaving the jail has supports and resources available to them. Otherwise, the outcomes of this program will be questionable. This will include coordination of housing, employment, transportation, benefit acquisition (SSI, SSDI, food stamps, etc.) and any other basic needs or concerns. By working closely with the community, a smooth transition can occur to move the client back into the community at large. A difficult transition is medication services from the WCJ to the community. With careful and thoughtful planning, the CJCM can work with the community to ensure medication needs are met during this change. This programming should "bridge" a client around obtaining their medication needs until their first psychiatric or medical appointment in the community. 13. Demonstrate support by local probation department(s) of this proposal. Please see attached a Letter of Support from the local Judicial District Probation Department in Greeley, Colorado. 14. The funds associated with this LOI may increase or decrease depending upon state appropriations. As a result of this, the State may require the contractor to increase or decrease services and budgets. It is understood that funding may vary depending upon State appropriations. The Oversight Committee associated with the JBBS will continue to explore sustainability and consistency of the program over time whenever this is required. B. Technical Elements of the Proposal: 1. The applicant's response will explain how they will identify and provide services to the jail based population. When entering the WCJ, inmates are screened for initial identification of a substance abuse and/or mental health disorder(s) by the WCSO Classification staff. Following this screen, further assessment can be completed by using the instruments identified in A. 3 above. The criteria for moving an inmate to the CJS and/or CJCM are when: • An inmate is identified as already enrolled as a NRBH client; • An inmate could benefit from case management activities; Page 5 of 14 Exhibit A • An inmate presents with a high level of acuity and may requires long-term and/or higher levels of care after release; • Any inmate whose needs can be met through NRBH services and programs and by doing so meets the State's goals of the JBBS Program: Shorter jail time and/or decreased recidivism. An Initial Treatment Plan will be developed by the CJS and will include a case management component for transitional planning in assisting the inmate in their release to the community. When appropriate, this plan will include medical services and medications. Services while incarcerated will also be determined. They will consist mainly of group treatment; however, some individual treatment may occur as clinically indicated. Groups will be based on client needs and evidence -based practices. Groups will include: Strategies for Self -Improvement and Change (SCC) and Seeking Safety programs. These programs have proven to be effective in addressing substance abuse and mental health issues within the criminal justice system. Both these program can be started within the jail and will continue in the inmate's community -based programs since they are available in the NRBH system. Strategies for Self Improvement and Change (SCC): This is a cognitive and behavioral treatment program for adults with substance abusing offenders involved in criminal conduct. SSC is a long-term program lasting up to a year. Phase I develops the offender's self-awareness and motivation to change. It also includes a relapse and recidivism prevention plan. Most of this can be done while incarcerated. Phase II of the program focuses on skill -building to change thinking and behaviors, while Phase III helps establish stabilization and maintenance of the newly acquired behavioral patterns. Phases II and III will mainly occur in out -patient services in the community at NRBH. Seeking Safety: This cognitive -based approach is for both substance abusing and trauma - oriented clients. This gender -responsive and evidence -based practice has been used with success in the criminal justice system. Women prisoners have significantly different histories and needs than their male counterparts. According to the Bureau of Justice, more than 57% of women in state prisons and 55% in local jails have a history of physical and/or sexual abuse, often perpetrated by an intimate partner. Additionally, 37% of women in prison have been raped in the past which is two times higher than the general population. Thus, the Seeking Safety program actively links Post Traumatic Stress Disorder (PTSD) issues with unsafe substance use behaviors. The Seeking Safety program has 25 stand alone topics or units which is fluid enough to start while the inmate is in jail and continue on an out -patient basis when they leave. Case management assessment and planning services will begin immediately. Appropriate Releases of Information will be determined and signed. This would include any collaborative data from the inmate's family and/or community supports that can also be obtained. Recognizing that reintegration into the community will be a significant factor in the success of the program, the CJCM will look at housing, employment, medical/dental, benefits to access care, education, vocational, and medication needs. This will allow for a smooth transition. The CJCM will also conduct "Reentry Groups" which will be available to individuals in the Weld County jail and JBBS participants. Re -Entry Group Curriculum includes 25 topics such as Job Resume Building, Finances/Budgeting, Relapse Prevention/Safety Plan and Time Management. Page 6 of 14 Exhibit A A dispositional staffing will occur when the inmate is nearing release. The purpose will be to finalize plans and make sure all linkages are covered. If psychotropic medications are part of the plan, CJCM will make sure that a 30 -day bridge prescription is supplied along with a psychiatric or medical appointment. If appropriate, the client will be enrolled in pharmaceutical patient assistance programs. In an effort to make this process seamless, the inmate will have established contact with their community -based providers prior to release. This will allow for a continuation of services without a split or break in the person's care. 2. The response will identify resources that exist and resources to be developed. NRBH offers a wide range of resources for clients, which will be available to JBBS clients once they enter the community. All enrolled clients have access to the entire menu of services listed on an individualized treatment plan. The following existing programs are more likely to be utilized by this population: • Center -Wide 24 hour, 7 days a week emergency services. This would include Detox and Acute Treatment Unit services. • Housing and Residential Programs: Subsidized housing services; transitional residential programming; Alternative Care Facility; supervised rental properties; and services to the homeless (PATH). • Psychiatric medications management and an on -site pharmacy. • Adult Service Division: Outpatient services; Assertive Community Team (ACT); Adult Recovery Program (ARP); Frontier Clubhouse; Transitional Residential Treatment (TRT) and Intensive Out patient substance abuse services; Senior/geriatric services; Drop -in services; and Peer specialist services. • BASIC: Domestic violence, Victim services, and substance abuse services with forensic treatment. • Child and Family Division: Outpatient services; Multi -systemic therapy; Functional family services; Early childhood; and Parenting services. • Prevention: Suicide; Early childhood; and Special Connection for prenatal and young mothers. • Case management services: Office, community -based and intensive levels. • Services are located in the Greeley area and Fort Lupton. NRBH also has some community -oriented services where providers travel throughout the county to meet client's needs. Services to be developed are: • Criminal Justice Specialist (CJS): 1.0 FTE Master, licensed therapist with a CAC background or credentialing. This position will be embedded in the already existing Jail Mental Health Team and be designated for the criteria outlined above in B. 1. It will enhance and provide better coordination of care than what currently exists in Page 7 of 14 Exhibit A Weld County between the criminal justice system and NRBH. (The Job Description is enclosed). • Criminal Justice Case Manager (CJCM): 1.0 FTE Bachelor level position to be incorporated into the existing Jail Mental Health Team that does not have any of these services currently available. Thus, they will be addressing the transitional aspect involved in making this program seamless from incarceration to release. (The Job Description is enclosed). • Development of an Oversight Committee as discussed previously. 3. The response shall indicate how services needed upon release shall be identified and detail how the offender shall be linked to the appropriate services in the community without a break in services. The CIS is responsible for the treatment plan and its implementation. They are the clinical care coordinator and will direct and oversee the treatment of their client. The CJCM will assist by providing linkages to resources in the community in anticipation of the inmate's eventual return to the community. This coordination may include: employment support, benefits acquisition, housing, food, health care and other basic needs. Individuals involved in the JBBS Program will receive coordinated services through the relevant human service agencies in the community. When participants transition back into their community and become clients at NRBH, they will receive on -going case management support as needed. NRBH has long-standing relationships with human service agencies across Weld County. This will aid this project in providing a smooth transition for clients. Case management services are an essential aspect to all NRBH clients' recovery process. Visually, the process of seamless care from incarceration to community will look like the following: JAIL Initial TX Plan includes: a. Social/Emotional needs b. Medical/medication c. Case management(Transitional needs) COMMUNITY Updated TX Plan INITIAL STAFFING -* TRANSITIONAL STAFFING COMMUNITY STAFFING 4. The response will identify how services will be coordinated across relevant human service agencies. Services will be identified and will be coordinated across relevant human services agencies through several mechanisms: • From initial contact, the CJCM will be linking inmates to resources and services in the community as they move through the criminal justice system to their release; Page 8of14 Exhibit A • Staffing as described above in B. 3. are dynamic and flexible in who attends. This allows significant key community partners to be part of the individualized treatment planning as the client moves from the jail to the community; • JBBS Oversight Committee is responsible for systemic flow of care. They will be able to monitor, evaluate, plan and modify workflows when they determine barriers to appropriate use of human service entities in the community; • As a client enters community -base care, NRBH already has in place numerous meetings to address client and systemic issues in the coordination of services for criminal justice and other human service agencies. These include: TASC; Probation; Parole; Criminal Justice/Mental Health Subcommittee; and Criminal Justice Advisory Committee (CJAC). • NRBH has been the recipient of SB 97 funding for several years that has laid the groundwork for community relationships and has provided the structure for developing coordination of care with these types of clients. 5. The response will provide the number of incarcerated consumers with substance use disorders or co-occurring substance use disorders and mental health disorders and how many will actually be enrolled in jail based behavioral health services. JBBS will serve about 100 individuals over a year. At any given time, we estimate that groups will have 6-10 members. We would anticipate that the CJS will have contact with up to six different inmate contacts per day. 6. The response will describe the basic services that will be utilized for this targeted group. These services may include, but are not limited to: a. Standardized screening and assessment; All participants in JBBS will undergo the screening and assessment as outlined above in (3.). Depending on needs, the DADCOD's and CCAR's will be submitted as required. When clients enter the community, they will be re -assessed as needed. b. Behavioral health services including any use of evidence based practices or promising practices (please note that medications outside of one-time emergency medications will not be funded by the jail based behavioral health disorder treatment program) While incarcerated, inmates will receive evidence -based treatment as previously described: Strategies for Self -Improvement and Change (SSC) or Seeking Safety. Individuals who require medication will obtain them through the Jail and in coordination with NRBH or the community when needed. Additionally, NRBH provides proven practices throughout our services with Integrated Dual Disordered Treatment (IDDT); Motivational interviewing; Cognitive Behavioral Therapy; Intensive outpatient services; and, Relapse Prevention programming. Participants in these services will receive quality and proven care. Page 9 of 14 Exhibit A Psychiatric services may include medication evaluations and management; medication assisted therapy for a client with cravings; antabuse monitoring; breathalyzer; and toxicology testing/monitoring. Clients may be referred to various community support -oriented programs like Alcoholics Anonymous, Narcotics Anonymous, Alanon or Alateen, etc. NRBH is licensed by the State Office of Behavioral Health (OBH) and by the Alcohol and Drug Abuse Division (ADAD). c. Case management services Case managers establish and maintain a therapeutic relationship with the client on a continuing basis. They provide assistance that will help clients to adapt and live successfully within the community. They focus on community safety, acquiring basic needs, linking mental health and substance abuse needs, medication compliance, and benefit acquisition. d. Referrals for primary health services, job training, educational services, and relevant housing services NRBH works closely with numerous medical centers including Northern Colorado Medical Center (NCMC), Salud, Poudre Valley Health System, and the Northern Colorado Health Alliance. NRBH has several integrative care programs where mental health professionals are embedded in a medical facility: Sunrise Family Clinic and Monfort Children's Clinic. JBBS clients will receive the same coordination of care with these medical providers as all NRBH clients receive. NRBH collaborates with the Division of Vocational Services and the Workforce Center of Weld County. Supportive employment services are available through Frontier House. Educationally, NRBH coordinates and makes referrals to the University of Northern Colorado, Aims College, GED providers, the Community College system and vocational training programs. And finally, NRBH has numerous supportive housing services that would be available for JBBS clients, i.e., Section 8 HUD Housing, Shelter Plus Care, and Supportive rental services. C. Monitoring and Data Collection The response shall be written with the intent to comply with the requirement to collect, maintain and submit certain data to be reported on a quarterly basis. This information shall include: ❑ Basic demographic information about the persons receiving services with these funds ❑ Numbers of clients served ❑ The types and quantities of services delivered ❑ Number and percentage who successfully transition to community based services upon release D Program termination outcomes Page 10of14 Exhibit A ❑ Prevalence data gathered from administering mental health, substance use disorder, trauma and traumatic brain injury screens OBH requires all programs to submit the above data on a web -based database. The data must be submitted and maintained on a quarterly basis. Detailed information regarding this requirement shall be provided upon contract implementation. ❑ Licensed SUD treatment providers will submit DACODS and when appropriate, CCAR data to the Office of Behavioral Health. The WCJ, Interventions and NRBH IT Departments will coordinate their efforts to generate reports containing the required data from initial incarceration through the course of treatment to the community. The Oversight Committee will be responsible for ensuring that the data collection, coordination, and reporting is accomplished. The entities involved have numerous years of experience meeting State data requirements. The JBBS program will report quarterly on a web -based database the following information: ❑ Basic demographic information about the persons receiving services with these funds ❑ Numbers of clients served ❑ The types and quantities of services delivered ❑ Number and percentage who successfully transition to community based services upon release ❑ Program termination outcomes ❑ Prevalence data gathered from administering mental health, substance use disorder, trauma and traumatic brain injury screens ❑ Licensed Mental Health and Substance Use Disordered (SUD) treatment providers will submit DACOD's and when appropriate, CCAR data to the Office of Behavioral Health. C. DEMONSTRATED EXPERIENCE AND CAPABILITIES 1. What is the name and mailing address of the legal entity submitting this proposal? John Cooke, Sherriff Weld County Sheriff's Office 1950 O Street Greeley, Colorado 80631 970-356-4015 2. Please provide the name of the individual who will be the Project Director (or equivalent title) and his/her contact information. Nancy Kroll, Director Inmate Services Weld County Jail 2110 O Street Greeley, Colorado 80631 970-356-4013 ext. 3956 Page 11 of 14 Exhibit A 3. Provide a description of the partner provider organization(s) receiving funds including name, type of organization, services provided by the organization and region served. North Range Behavioral Health (NRBH) is a private 501(c) (3) non-profit provider of quality behavioral health services that includes mental health as well as substance abuse treatment to children, adolescents, adults, and families. NRBH served over 11,926 of clients in the last year with a staff of full and part-time personnel of 295. It was incorporated in 1971 NRBH has 20 facilities in Weld County with a budget of over $19 million. Services include: • Center -Wide 24 hour, 7 days a week emergency services. This would include Detox and Acute Treatment Unit services. • Housing and Residential Programs: Subsidized housing services; transitional residential programming; Alternative Care Facility; supervised rental properties; and services to the homeless (PATH). • Psychiatric medications management and an on -site pharmacy. • Adult Service Division: Outpatient services; Assertive Community Team (ACT); Adult Recovery Program (ARP); Frontier Clubhouse; Transitional Residential Treatment (TRT); Intensive Out patient substance abuse services; Senior/geriatric services; Drop -in services; and peer specialist services. • BASIC: Domestic violence; Victim services; and substance abuse services with forensic treatment. • Child and Family Division: Outpatient services; Multi -systemic therapy; Functional family services; Early childhood; and parenting services. • Prevention: Suicide; Early childhood; and Special Connection for prenatal and young mothers. • Case management services: Office, community -based and intensive levels. • Services are located in the Greeley area and Fort Lupton. NRBH also has some community -oriented services where providers travel throughout the county to meet client's needs. Intervention Clinical Services is an OBH Licensed Private Non -Profit treatment provider that has been servicing clients in Weld County for three years. They currently are staffed with three full time therapists, one intern, a clinical supervisor, and a clinical director. 4. Describe the service array available within the community to program participants upon their release from jail, including behavioral health services. Described above in response to B. 2. Page 12 of 14 Exhibit A 5. Indicate the amount of jail based behavioral health funds the organization is requesting. $106,187.00 6. Describe the plan to provide coordinated and comprehensive services to eligible clients, including the projected number of clients to be served in the 2013-2014 contract year. A target of 100 clients will be served over the course of the grant year. 7. Please describe the jail -based services to be provided using these funds. Two benefit -eligible FTE's, one a master level therapist and the other a case manager will be hired to the JBBS Team. Expenditures will include computer, travel and other supplies for preforming their duties as described in their respective job descriptions. They will be supervised by their respective agencies: NRBH for the CJS and Intervention for the CJCM. An oversight committee will be established to provide direction, overcome obstacles and make sure that data is collected as planned. Upon release from jai, the inmate will receive on -going services from NRBH based on level of care and needs and/or with other community service providers. 8. Describe the demographics of persons to be served, including race/ethnicity, age range, veteran status, geographic area, disabilities, sexual orientation. Report the counties to be served. County: Weld County Average inmate population in the past year: 575 Jail Population breakdown according to race: White 334/Black 24/Hispanic 215/Indian 2 Gender breakdown: 467 males/108females Substance abuse population: unknown Mental Health Population: unknown Age: unknown Sentenced inmates: 35.8 % Average length of incarceration for total population: 22 days Veterans: unknown For the JBBS Program the participants will have entered the WCJ on adult charges. There will be no distinction of who enters the program based on race, ethnicity, age, veteran status, religion, disabilities and/or sexual orientation. Clients will reside in Weld County, Colorado. Page 13 of 14 Exhibit A 9. Describe how staff providing services to the target population will be sensitive to diversity issues. Indicate the extent to which staff is representative of diversity and receive periodic training in cultural competence. Recruiting of new employees will be conducted with cultural awareness and competence in mind. All employees will receive cultural awareness training through their respective agency requirements and mandates. Page 14 of 14 Exhibit B BUDGET Weld County Sherriff's Office Budget Narrative: The 2.0 I. described below is for a Behavioral Health Professional (CJS) employed by NRBH at a mid- range salary of $44,953. This position would be a State of Colorado licensed, master level clinician with a CAC II. The Case Manager (CJCM) would be employed by Intervention at $35,020. The position would be a bachelor level position. Equipment is for two computers from the Dell Corporation. The price is based on a recent quote from WCSO IT department. Furniture is for two office desks and was a quote from a local office supply store. The reminder went to an Administrative Fee (1%). The JBBS Program will have contact with 100 clients at a $ 1,060 per client cost. Time Period: 7/1/13 through 6/30/14 JBBS Program 1352 FTE* Dollars Match Dollars Total Program Costs Direct Personnel Cost Employee compensation 2.0 79,973 Employee benefits 2.0,551 Payroll Taxes Contractual . (Specify Line Items and describe in narrative) Subtotal 2.0 100,524 0 100,534 Client One Time or Emergency Medications Purchases From Other Providers (Specify Line Items and describe in narrative) Subtotal 0 0 0 0 Occupancy (Specify Line Items and describe in narrative) _ Subtotal 0 0 0 0 Opera . P • Equipment Rental, Lease and Maintenance/computers x2 1,404 1,404 Insurance Supplies _ Postage, Printing, Photocopying Telephone and Pagers Travel, Conferences and Staff Development Vehicles - Fuel, Oil, Lease and Maintenance (Specify Line Items and describe in narrative) Furniture 2,783.00 2,783.00 Subtotal 0 4,187.00 0 4,187.00 Other (Specify Line Items and describe in narrative) Subtotal 0 0 0 0 Administration Aggregate in one line item and describe in narrative ADM FEE 1,476 1,476 Subtotal 0 0 Total expenses 2.0 106,187 0 106,187 Estimated number of clients to be served 100 100 Estimated cost per client 1,060 1,060 * Full time equivalent - A measurement equal to one staff person working full-time for one year (2080 hours). Exhibit C Miscellaneous Provisions 1. CONTRACT TERM The term of this contract is 12 months. 2. PROVIDE SERVICES The contractor shall provide the services according to the plans submitted in the "Statement of Work", attached and, incorporated herein by this reference as Exhibit A. In all cases, the descriptions, plans, timetables, tasks, duties, and responsibilities of the Contractor as described in the Statement of Work, shall be adhered to in the performance of the requirements of this contract. 3. GOALS & OBJECTIVE The Contractor shall be responsible for the achievement of goals and objectives as specified within the "Statement of Work" (Exhibit A) of this contract. 4. QUARTERLY STATUS REPORTS The Contractor shall prepare and submit to the State, quarterly status reports, which shall include information relative to the progress in achievement of goals and objectives specified in Exhibit A. Reports shall be completed in the format provided by the State. Reports shall be delivered to the State or its designee, not later than last working day after the end of the month following September, December, March and June. 5. COPY OF PROPOSED SUBCONTRACT The Contractor shall provide to the State a copy of any proposed subcontract between the Contractor and any potential provider of services to fulfill any requirements of this contract. The State shall be notified of any changes to contractual agreements between Contractor and subcontractors. 6. REPORTING SYSTEMS The Contractor, or its subcontractor shall be responsible for participating in any reporting systems (DACODS) on the management and evaluation of the program as may be required by the State. 7. PAYMENT In consideration of the provision of services and reporting as set forth herein and subject to all payment and price provisions herein and further subject to verification by the State of full and satisfactory compliance with the terms of this contract, the State shall cause to be paid to the Contractor an amount not to exceed the amount specified in the "Budget", Exhibit B, of this contract, in the following manner. a) To receive reimbursement for expenditures, the Contractor shall submit accurate monthly requests for payment that include date, check number (if applicable), name of payee, description of expenditure, total cost, amount to Page 1 of 3 Pages Exhibit C be reimbursed by DBH, and amount to be reimbursed from other sources, on forms prescribed by the State, by the 20th of the second month following the month in which expenses occur. b) By the 20th of each month during the term hereof; the Contractor shall submit monthly requests for payment on forms prescribed by the State. c) Payment will be made in arrears for services rendered. Advances will not be approved except in documented situations of cash flow emergency, for a specified term, with the prior written approval of the State, and in accordance with State fiscal rules and procedures. d) Contractor is eligible for any increases as appropriated by the Colorado General Assembly and approved by the Department of Human Services. 8. OPTION LETTER The State may require continued performance for a period of 3 one-year terms for any services at the rates and terms specified in the contract. The State may exercise the option by written notice to the Contractor with 30 days prior to the end of the current contract term in a form substantially equivalent to Exhibit D (Option Letter). If the State exercises this option, the extended contract will be considered to include this option provision. The total duration of this contract, including the exercise of any options under this clause, shall not exceed June 30, 2016. The State may increase or decrease the quantity of goods/services described in Exhibit A based upon the per -client rates established in the Contract. If the State exercises the option, it will provide written notice to Contractor at least 30 days prior to the end of the current contract term in a form substantially equivalent to Exhibit D. Delivery/performance of the goods/service shall continue at the same rates and terms. If exercised, the provisions of the Option Letter shall become part of and be incorporated into the original contract. 9. PARTICIPATION The Contractor is expected to participate in DBH sponsored meetings, which shall occur at a minimum quarterly. 10. REQUIREMENTS AS SPECIFIED IN THE "REQUEST FOR APPLICATION" The contractor and subcontractors in providing services as specified herein shall: a) Partnership with DBH-licensed substance use disorder treatment providers, b) Provider culturally competent and appropriate services, c) Meet the needs of individuals who are physically challenged, deaf or hearing impaired, or blind, d) Provider services in a manor that respects and protects client's rights, e) Have support by local probation departments, 11. NOT SUPPLANT Payments made to the Contractor under this contract will supplement and not supplant state or local expenditures for substance use disorder or co-occurring Page 2 of 3 Pages Exhibit C substance use and mental health disorder treatment that would have been made in the absence of such payments. 12. NOT ASSIGNABLE This contract is not assignable without prior written consent of the State. 13. BUDGET CHANGES Any changes/line-item adjustments within the budget total amount, Exhibit B of this contract, shall be made only with the prior written approval of the State and shall not exceed 10% of the total amount of the contract for the then current fiscal year as described on page one of the contract. 14. HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT of 1996 ("HIPAA") Federal law and regulations governing the privacy of certain health information requires a "Business Associate Contract" between the State and the Contractor. 45 C.F.R. Section 164.504(e). Exhibit J (HIPAA Business Associate Addendum) attached and incorporated herein by reference and agreed to by the parties is a HIPAA Business Associate Addendum for HIPAA compliance. Terms of the Addendum shall be considered binding upon execution of this contract and shall remain in effect during the term of the contract including any extensions. Contractor and its applicable subcontractors hereunder shall obtain and maintain during the term of this Contract liability insurance covering all loss of Protected Health Information data and claims based upon alleged violations of privacy rights through improper use or disclosure of Protected Health Information with minimum annual limits as follows: 1. Contractors with 10 or less clients and revenues of $250,000 or less shall maintain limits on Privacy Liability Insurance of not less than $50,000. 2. Contractors with 25 or less clients and revenues of $500,000 or less shall maintain limits on Privacy Liability Insurance of not less than $100,000. 3. Contractors with more than 25 clients and revenues of more than $500,000 shall maintain limits on Privacy Liability Insurance of not less than $1,000,000. This provision modifies and takes precedence over any conflicting requirements in the Contract General Provisions relative to privacy insurance coverage by Contractor. Page 3 of 3 Pages Exhibit D SAMPLE OPTION LETTER Date: State Fiscal Year: Option Letter No. CMS Routing # 1) OPTIONS: Choose all applicable options listed in §1 and in §2 and delete the rest [also delete all yellow highlighted text]. a. Option to renew only (for an additional term) b. Change in the amount of goods within current term c. Change in amount of goods in conjunction with renewal for additional term d. Level of service change within current term e. Level of service change in conjunction with renewal for additional term f Option to initiate next phase of a contract 2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below: a. For use with Options 1(a -e): In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Department of Human Services, and Contractor's Name, the State hereby exercises its option for an additional term beginning Insert start date and ending on Insert ending date at a cost/price specified in Section , AND/OR an increase/decrease in the amount of goods/services at the same rate(s) as specified in Identify the Section, Schedule, Attachment, Exhibit etc. b. For use with Option 1(f), please use the following: In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Department of Human Services, and Contractor's Name, the State hereby exercises its option to initiate Phase indicate which Phase: 2, 3, 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price specified in Section c. For use with all Options: The amount of the current Fiscal Year contract value is increased/decreased by $ amount of change to a new contract value of Insert New $ Amt to as consideration for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first sentence in Section is hereby modified accordingly. The total contract value including all previous amendments, option letters, etc. is Insert New $ Amt. 3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or , whichever is later. STATE OF COLORADO John W. Hickenlooper, GOVERNOR Department of Human Services Reggie Bicha, Executive Director By: Insert Name & Title of Person Signing for Agency or IHE Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: Date: Effective Date: 1/6/09 -Rev 8/25/09 Exhibit E Jail Based Behavioral Health Services Performance Measures The Contractor shall on an annual basis: Measure and report to the Division its performance, using standard measures required by the Division. Submit to the Division, the following data that enables the Division to measure the entity's performance. These measures shall be submitted along with the 4th Quarter Status Report no later than July 30th of each year. 1. Total number of clients served. Reporting shall include a breakdown of total number of clients screened and total number of clients receiving behavioral health services under JBBS. 2. Clients successfully engaged (this means the client engages in treatment as recommended by the jail based transition plan) into treatment in the community after release from jail. Reporting shall track: i. Actual numbers clients engaged in treatment ii. Percentage to be calculated as follows: # of clients successfully engaged in treatment in the community Total # of clients served in jail 3. Data Reporting: Provide the Division screening outcomes. The following data should be reported: a. Total number of screens completed; Total number of positive screens for: b. Mental Health Disorders, c. Substance Use Disorders, d. Trauma and; e. Traumatic Brain Injury Submit DACODs for all jail based treatment provided. The Division shall randomly check these by requesting a client roster or during a site visit. Exhibit F HIPAA BUSINESS ASSOCIATE ADDENDUM For purposes of this Addendum, the State is referred to as "Covered Entity" or "CE" and the Contractor is referred to as "Associate". Unless the context clearly requires a distinction between the Contract document and this Addendum, all references herein to "the Contract" or "this Contract" include this Addendum. RECITALS A. CE wishes to disclose certain information to Associate pursuant to the terms of the Contract, some of which may constitute Protected Health Information ("PHI") (defined below). B. CE and Associate intend to protect the privacy and provide for the security of PHI disclosed to Associate pursuant to this Contract in compliance with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d — 1320d-8 ("HIPAA") as amended by the American Recovery and Reinvestment Act of 2009 ("ARRA")/HITECH Act (P.L. 111-005), and its implementing regulations promulgated by the U.S. Department of Health and Human Services, 45 C.F.R. Parts 160, 162 and 164 (the "HIPAA Rules") and other applicable laws, as amended. C. As part of the HIPAA Rules, the CE is required to enter into a written contract containing specific requirements with Associate prior to the disclosure of PHI, as set forth in, but not limited to, Title 45, Sections 160.103, 164.502(e) and 164.504(e) of the Code of Federal Regulations ("C.F.R.") and contained in this Addendum. The parties agree as follows: 1. Definitions. a. Except as otherwise defined herein, capitalized terms in this Addendum shall have the definitions set forth in the HIPAA Rules at 45 C.F.R. Parts 160, 162 and 164, as amended. In the event of any conflict between the mandatory provisions of the HIPAA Rules and the provisions of this Contract, the HIPAA Rules shall control. Where the provisions of this Contract differ from those mandated by the HIPAA Rules, but are nonetheless permitted by the HIPAA Rules, the provisions of this Contract shall control. b. "Protected Health Information" or "PHI" means any information, whether oral or recorded in any form or medium: (i) that relates to the past, present or future physical or mental condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (ii) that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual, and shall have the meaning given to such term under the HIPAA Rules, including, but not limited to, 45 C.F.R. Section 164.501. Page 1 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F c. "Protected Information" shall mean PHI provided by CE to Associate or created received, maintained or transmitted by Associate on CE's behalf. To the extent Associate is a covered entity under HIPAA and creates or obtains its own PHI for treatment, payment and health care operations, Protected Information under this Contract does not include any PHI created or obtained by Associate as a covered entity and Associate shall follow its own policies and procedures for accounting, access and amendment of Associate's PHI. d. "Subcontractor" shall mean a third party to whom Associate delegates a function, activity, or service that involves CE's Protected Information, in order to carry out the responsibilities of this Agreement. 2. Obligations of Associate. a. Permitted Uses. Associate shall not use Protected Information except for the purpose of performing Associate's obligations under this Contract and as permitted under this Addendum. Further, Associate shall not use Protected Information in any manner that would constitute a violation of the HIPAA Rules if so used by CE, except that Associate may use Protected Information: (i) for the proper management and administration of Associate; (ii) to carry out the legal responsibilities of Associate; or (iii) for Data Aggregation purposes for the Health Care Operations of CE. Additional provisions, if any, governing peituitted uses of Protected Information are set forth in Attachment A to this Addendum. Associate accepts full responsibility for any penalties incurred as a result of Associate's breach of the HIPAA Rules. b. Permitted Disclosures. Associate shall not disclose Protected Information in any manner that would constitute a violation of the HIPAA Rules if disclosed by CE, except that Associate may disclose Protected Information: (i) in a manner permitted pursuant to this Contract; (ii) for the proper management and administration of Associate; (iii) as required by law; (iv) for Data Aggregation purposes for the Health Care Operations of CE; or (v) to report violations of law to appropriate federal or state authorities, consistent with 45 C.F.R. Section 164.502(j)(1). To the extent that Associate discloses Protected Information to a third party Subcontractor, Associate must obtain, prior to making any such disclosure: (i) reasonable assurances through execution of a written agreement with such third party that such Protected Information will be held confidential as provided pursuant to this Addendum and only disclosed as required by law or for the purposes for which it was disclosed to such third party; and that such third party will notify Associate within two (2) business days of any breaches of confidentiality of the Protected Information, to the extent it has obtained knowledge of such breach. Additional provisions, if any, governing permitted disclosures of Protected Information are set forth in Attachment A. c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are necessary to prevent the use or disclosure of Protected Information other than as permitted by this Contract. Associate shall comply with the requirements of the IIIPAA Security Rule at 45 C.F.R. Sections 164.308, 164.310, 164.312, and 164.316. Associate shall maintain a comprehensive written information privacy and security program that includes administrative, technical and physical safeguards appropriate to the size and complexity of the Associate's operations and the nature and scope of its activities. Associate shall review, modify, and update Page 2 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F documentation of, its safeguards as needed to ensure continued provision of reasonable and appropriate protection of Protected Information. d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing any use or disclosure of Protected Information other than as provided for by this Contract within five (5) business days of becoming aware of such use or disclosure. e. Associate's Agents. If Associate uses one or more Subcontractors or agents to provide services under the Contract, and such Subcontractors or agents receive or have access to Protected Information, each Subcontractor or agent shall sign an agreement with Associate containing the same provisions as this Addendum and further identifying CE as a third party beneficiary with rights of enforcement and indemnification from such Subcontractors or agents in the event of any violation of such Subcontractor or agent agreement. The Agreement between the Associate and Subcontractor or agent shall ensure that the Subcontractor or agent agrees to at least the same restrictions and conditions that apply to Associate with respect to such Protected Information. Associate shall implement and maintain sanctions against agents and Subcontractors that violate such restrictions and conditions and shall mitigate the effects of any such violation. f. Access to Protected Information. If Associate maintains Protected Information contained within CE's Designated Record Set, Associate shall make Protected Information maintained by Associate or its agents or Subcontractors in such Designated Record Sets available to CE for inspection and copying within ten (10) business days of a request by CE to enable CE to fulfill its obligations to permit individual access to PHI under the HIPAA Rules, including, but not limited to, 45 C.F.R. Section 164.524. If such Protected Information is maintained by Associate in an electronic foul' or format, Associate must make such Protected Information available to CE in a mutually agreed upon electronic form or format. g. Amendment of PHI. If Associate maintains Protected Information contained within CE's Designated Record Set, Associate or its agents or Subcontractors shall make such Protected Information available to CE for amendment within ten (10) business days of receipt of a request from CE for an amendment of Protected Information or a record about an individual contained in a Designated Record Set, and shall incorporate any such amendment to enable CE to fulfill its obligations with respect to requests by individuals to amend their PHI under the HIPAA Rules, including, but not limited to, 45 C.F.R. Section 164.526. If any individual requests an amendment of Protected Information directly from Associate or its agents or Subcontractors, Associate must notify CE in writing within five (5) business days of receipt of the request. Any denial of amendment of Protected Information maintained by Associate or its agents or Subcontractors shall be the responsibility of CE. h. Accounting Rights. If Associate maintains Protected Information contained within CE's Designated Record Set, Associate and its agents or Subcontractors shall make available to CE within ten (10) business days of notice by CE, the information required to provide an accounting of disclosures to enable CE to fulfill its obligations under the HIPAA Rules, including, but not limited to, 45 C.F.R. Section 164.528. In the event that the request for an accounting is delivered directly to Associate or its agents or Subcontractors, Associate shall Page 3 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F within five (5) business days of the receipt of the request forward it to CE in writing. It shall be CE's responsibility to prepare and deliver any such accounting requested. Associate shall not disclose any Protected Information except as set forth in Section 2(b) of this Addendum. i. Governmental Access to Records. Associate shall keep records and make its internal practices, books and records relating to the use and disclosure of Protected Information available to the Secretary of the U.S. Department of Health and Human Services (the "Secretary"), in a time and manner designated by the Secretary, for purposes of determining CE's or Associate's compliance with the HIPAA Rules. Associate shall provide to CE a copy of any Protected Information that Associate provides to the Secretary concurrently with providing such Protected Information to the Secretary when the Secretary is investigating CE. Associate shall cooperate with the Secretary if the Secretary undertakes an investigation or compliance review of Associate's policies, procedures or practices to determine whether Associate is complying with the HIPAA Rules, and permit access by the Secretary during normal business hours to its facilities, books, records, accounts, and other sources of information, including Protected Information, that are pertinent to ascertaining compliance. j. Minimum Necessary. Associate (and its agents or subcontractors) shall only request, use and disclose the minimum amount of Protected Information necessary to accomplish the purpose of the request, use or disclosure, in accordance with the Minimum Necessary requirements of the HIPAA Rules including, but not limited to 45 C.F.R. Sections 164.502(b) and 164.514(d). k. Data Ownership. Associate acknowledges that Associate has no ownership rights with respect to the Protected Information. 1. Retention of Protected Information. Except upon termination of the Contract as provided in Section 4(d) of this Addendum, Associate and its Subcontractors or agents shall retain all Protected Information throughout the term of this Contract and shall continue to maintain the information required under Section 2(h) of this Addendum for a period of six (6) years. m. Associate's Insurance. Associate shall maintain insurance to cover loss of PHI data and claims based upon alleged violations of privacy rights through improper use or disclosure of PHI. All such policies shall meet or exceed the minimum insurance requirements of the Contract (e.g., occurrence basis, combined single dollar limits, annual aggregate dollar limits, additional insured status and notice of cancellation). n. Notice of Privacy Practices. Associate shall be responsible for reviewing CE's Notice of Privacy Practices, available on CE's external website, to determine any requirements applicable to Associate per this Contract. o. Notification of Breach. During the term of this Contract, Associate shall notify CE within two (2) business days of any suspected or actual breach of security, intrusion or unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in violation of any applicable federal or state laws or regulations. Associate shall not initiate Page 4 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F notification to affected individuals per the HIPAA Rules without prior notification and approval of CE. Infonnation provided to CE shall include the identification of each individual whose unsecured PHI has been, or is reasonably believed to have been accessed, acquired or disclosed during the breach. Associate shall take (i) prompt corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable federal and state laws and regulations. p. Audits, Inspection and Enforcement. Within ten (10) business days of a written request by CE, Associate and its agents or subcontractors shall allow CE to conduct a reasonable inspection of the facilities, systems, books, records, agreements, policies and procedures relating to the use or disclosure of Protected Infonnation pursuant to this Addendum for the purpose of determining whether Associate has complied with this Addendum; provided, however, that: (i) Associate and CE shall mutually agree in advance upon the scope, timing and location of such an inspection; and (ii) CE shall protect the confidentiality of all confidential and proprietary information of Associate to which CE has access during the course of such inspection. The fact that CE inspects, or fails to inspect, or has the right to inspect, Associate's facilities, systems, books, records, agreements, policies and procedures does not relieve Associate of its responsibility to comply with this Addendum, nor does CE's (i) failure to detect or (ii) detection, but failure to notify Associate or require Associate's remediation of any unsatisfactory practices, constitute acceptance of such practice or a waiver of CE's enforcement rights under the Contract. q. Safeguards During Transmission. Associate shall be responsible for using appropriate safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and security of Protected Information transmitted pursuant to the Contract, in accordance with the standards and requirements of the HIPAA Rules. r. Restrictions and Confidential Communications. Within ten (10) business days of notice by CE of a restriction upon uses or disclosures or request for confidential communications pursuant to 45 C.F.R. Section 164.522, Associate will restrict the use or disclosure of an individual's Protected Information. Associate will not respond directly to an individual's requests to restrict the use or disclosure of Protected Information or to send all communication of Protect Information to an alternate address. Associate will refer such requests to the CE so that the CE can coordinate and prepare a timely response to the requesting individual and provide direction to Associate. 3. Obligations of CE. a. Safeguards During Transmission. CE shall be responsible for using appropriate safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and security of Protected Information transmitted pursuant to the Contract, in accordance with the standards and requirements of the HIPAA Rules. b. Notice of Changes. CE maintains a copy of its Notice of Privacy Practices on its website. CE shall provide Associate with any changes in, or revocation of; permission to use or disclose Protected Information, to the extent that it may affect Associate's permitted or required uses or disclosures. To the extent that it may affect Associate's permitted use or disclosure of Page 5 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F PHI, CE shall notify Associate of any restriction on the use or disclosure of Protected Information that CE has agreed to in accordance with 45 C.F.R. Section 164.522. 4. Termination. a. Material Breach. In addition to any other provisions in the Contract regarding breach, a breach by Associate of any provision of this Addendum, as determined by CE, shall constitute a material breach of this Contract and shall provide grounds for immediate termination of this Contract by CE pursuant to the provisions of the Contract covering termination for cause, if any. If the Contract contains no express provisions regarding termination for cause, the following terms and conditions shall apply: (1) Default. If Associate refuses or fails to timely perform any of the provisions of this Contract, CE may notify Associate in writing of the non-performance, and if not promptly corrected within the time specified, CE may terminate this Contract. Associate shall continue performance of this Contract to the extent it is not terminated and shall be liable for excess costs incurred in procuring similar goods or services elsewhere. (2) Associate's Duties. Notwithstanding termination of this Contract, and subject to any directions from CE, Associate shall take timely, reasonable and necessary action to protect and preserve property in the possession of Associate in which CE has an interest. (3) Compensation. Payment for completed supplies delivered and accepted by CE shall be at the Contract price. In the event of a material breach under paragraph 4a, CE may withhold amounts due Associate as CE deems necessary to protect CE against loss from third party claims of improper use or disclosure and to reimburse CE for the excess costs incurred in procuring similar goods and services elsewhere. (4) Erroneous Termination for Default. If after such termination it is determined, for any reason, that Associate was not in default, or that Associate's action/inaction was excusable, such termination shall be treated as a termination for convenience, and the rights and obligations of the parties shall be the same as if this Contract had been terminated for convenience, as described in this Contract. b. Reasonable Steps to Cure Breach. If CE knows of a pattern of activity or practice of Associate that constitutes a material breach or violation of the Associate's obligations under the provisions of this Addendum or another arrangement and does not terminate this Contract pursuant to Section 4(a), then CE shall take reasonable steps to cure such breach or end such violation.. If CE's efforts to cure such breach or end such violation are unsuccessful, CE shall either (i) terminate the Contract, if feasible or (ii) if termination of this Contract is not feasible, CE shall report Associate's breach or violation to the Secretary of the Department of Health and Human Services. If Associate knows of a pattern of activity or practice of a Subcontractor or agent that constitutes a material breach or violation of the Subcontractor's or agent's obligations under the written agreement between Associate and the Subcontractor or agent, Associate shall take reasonable steps to cure such breach or end such violation, if feasible. Page 6 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F c. Judicial or Administrative Proceedings. Either party may terminate the Contract, effective immediately, if (i) the other party is named as a defendant in a criminal proceeding for a violation of the HIPAA Rules or other security or privacy laws or (ii) a finding or stipulation that the other party has violated any standard or requirement of the HIPAA Rules or other security or privacy laws is made in any administrative or civil proceeding in which the party has been joined. d. Effect of Termination. (1) Except as provided in paragraph (2) of this subsection, upon termination of this Contract, for any reason, Associate shall return or destroy all Protected Information that Associate or its agents or Subcontractors still maintain in any form, and shall retain no copies of such Protected Information. If Associate elects to destroy the PHI, Associate shall certify in writing to CE that such PHI has been destroyed. (2) If Associate believes that returning or destroying the Protected Information is not feasible, Associate shall promptly provide CE notice of the conditions making return or destruction infeasible. Associate shall continue to extend the protections of Sections 2(a), 2(b), 2(c), 2(d) and 2(e) of this Addendum to such Protected Information, and shall limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. 5. Injunctive Relief. CE shall have the right to injunctive and other equitable and legal relief against Associate or any of its Subcontractors or agents in the event of any use or disclosure of Protected Information in violation of this Contract or applicable law. 6. No Waiver of Immunity. No term or condition of this Contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection, or other provisions of the Colorado Governmental Immunity Act, CRS 24-10-101 et seq. or the Federal Tort Claims Act, 28 U.S.C. 2671 et seq. as applicable, as now in effect or hereafter amended. 7. Limitation of Liability. Any limitation of Associate's liability in the Contract shall be inapplicable to the terns and conditions of this Addendum. 8. Disclaimer. CE makes no warranty or representation that compliance by Associate with this Contractor the HIPAA Rules will be adequate or satisfactory for Associate's own purposes. Associate is solely responsible for all decisions made by Associate regarding the safeguarding of PHI. 9. Certification. To the extent that CE determines an examination is necessary in order to comply with CE's legal obligations pursuant to the HIPAA Rules relating to certification of its security practices, CE or its authorized agents or contractors, may, at CE's expense, examine Associate's facilities, systems, procedures and records as may be necessary for such agents or contractors to certify to CE the extent to which Associate's security safeguards comply with the HIPAA Rules or this Addendum. Page 7 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F 10. Amendment. a. Amendment to Comply with Law. The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of this Addendum may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of the HIPAA Rules and other applicable laws relating to the confidentiality, integrity, availability and security of PHI. The parties understand and agree that CE must receive satisfactory written assurance from Associate that Associate will adequately safeguard all Protected Information and that it is Associate's responsibility to receive satisfactory written assurances from Associate's Subcontractors and agents. Upon the request of either party, the other party agrees to promptly enter into negotiations concerning the terms of an amendment to this Addendum embodying written assurances consistent with the standards and requirements of the HIPAA Rules or other applicable laws. CE may terminate this Contract upon thirty (30) days written notice in the event (i) Associate does not promptly enter into negotiations to amend this Contract when requested by CE pursuant to this Section, or (ii) Associate does not enter into an amendment to this Contract providing assurances regarding the safeguarding of PHI that CE, in its sole discretion, deems sufficient to satisfy the standards and requirements of the HIPAA Rules. b. Amendment of Attachment A. Attachment A may be modified or amended by mutual agreement of the parties in writing from time to time without formal amendment of this Addendum. 11. Assistance in Litigation or Administrative Proceedings. Associate shall make itself; and any Subcontractors, employees or agents assisting Associate in the performance of its obligations under the Cunlracl, available to CE, at no cost to CE up to a maximum of 30 hours, to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against CE, its directors, officers or employees based upon a claimed violation of the HIPAA Rules or other laws relating to security and privacy or PHI, except where Associate or its Subcontractor, employee or agent is a named adverse party. 12. No Third Party Beneficiaries. Nothing express or implied in this Contract is intended to confer, nor shall anything herein confer, upon any person other than CE, Associate and their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever. 13. Interpretation and Order of Precedence. The provisions of this Addendum shall prevail over any provisions in the Contract that may conflict or appear inconsistent with any provision in this Addendum. Together, the Contract and this Addendum shall be interpreted as broadly as necessary to implement and comply with the HIPAA Rules. The parties agree that any ambiguity in this Contract shall be resolved in favor of a meaning that complies and is consistent with the HIPAA Rules. This Contract supercedes and replaces any previous separately executed HIPAA addendum between the parties. Page 8 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit F 14. Survival of Certain Contract Terms. Notwithstanding anything herein to the contrary, Associate's obligations under Section 4(d) ("Effect of Termination") and Section 12 ("No Third Party Beneficiaries") shall survive termination of this Contract and shall be enforceable by CE as provided herein in the event of such failure to perform or comply by the Associate. This Addendum shall remain in effect during the term of the Contract including any extensions. 15. Representatives and Notice. a. Representatives. For the purpose of the Contract, the individuals identified elsewhere in this Contract shall be the representatives of the respective parties. If no representatives are identified in the Contract, the individuals listed below are hereby designated as the parties' respective representatives for purposes of this Contract. Either party may from time to time designate in writing new or substitute representatives. b. Notices. All required notices shall be in writing and shall be hand delivered or given by certified or registered mail to the representatives at the addresses set forth below. State/Covered Entity Representative: Name: _as named in contract _ Title: Department and Division: Address: Contractor/Business Associate Representative: Name: as named in contract _ Title: Department and Division: Address: Page 9 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 ATTACHMENT A to Exhibit F This Attachment may be amended from time to time as provided in Section 10(b) of the Addendum. 1. Additional Permitted Uses. In addition to those purposes set forth in Section 2(a) of the Addendum, Associate may use Protected Information as follows: None except as otherwise directed in writing by the State 2. Additional Permitted Disclosures. In addition to those purposes set forth in Section 2(b) of the Addendum, Associate may disclose Protected Information as follows: None except as otherwise directed in writing by the State 3. Subcontractor(s). The parties acknowledge that the following subcontractors or agents of Associate shall receive Protected Information in the course of assisting Associate in the performance of its obligations under this Contract: None except as otherwise directed in writing by the State 4. Receipt. Associate's receipt of Protected Information pursuant to this Contract shall be deemed to occur as follows, and Associate's obligations under the Addendum shall commence with respect to such PHI upon such receipt: Upon the effective date of the contract 5. Additional Restrictions on Use of Data. CE is a Business Associate of certain other Covered Entities and, pursuant to such obligations of CE, Associate shall comply with the following restrictions on the use and disclosure of Protected Information: As may be directed in writing by the State 6. Additional Terms. [This section may include specifications for disclosure format, method of transmission, use of an intermediary, use of digital signatures or PKI authentication, additional security ofprivacy specifications, de -identification or re -identification of data and other additional terms.] None Page 1 of 1 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 STATE OF COLORADO Colorado Department of Human Services people who help people OFFICE OF BEHAVIORAL HEALTH Lisa M. Clements, Ph.D., Director OFFICE OF BEHAVIORAL HEALTH Lori Banks, LCSW, Interim Deputy Director Community Programs 3824 West Princeton Circle Denver, Colorado 80236 Phone 303-866-7400 Fax 303-866-7481,303-866-7428 July 12, 2013 Nancy Kroll Weld County Sheriffs Office 1950 O Street Greeley, Colorado 80631 John W. Hickenlooper Governor Reggie Bicha Executive Director Re: Jail Based Behavioral Health Services Executed Contract, # 14 IID 55060 Dear Ms. Kroll, Enclosed please find one fully executed copy of the contract with the Office of Behavioral Health for fiscal year 2013-14. Please note the July 2, 2013 effective date. It is understood the Weld County Sheriffs Office will abide by all terms and conditions outlined in the contract documents. Please place a copy of this correspondence in the contract file. If you have any questions regarding this project, please do not hesitate to contact me at (303) 866-7511. Sincerely, ecca Lembke Manager, Contracts and Finance Enclosure 01.17 Our Mission is to Design and Deliver Quality Human Services that Improve the Safety and Independence of the People of Colorado Hello