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HomeMy WebLinkAbout20121381.tiff RESOLUTION RE: APPROVE SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT FOR CHILD WELFARE CLIENTS AND AUTHORIZE CHAIR TO SIGN - SIGNAL BEHAVIORAL HEALTH NETWORK 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 Substance Abuse Treatment Service Agreement for Child Welfare Clients between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services,and Signal Behavioral Health Network,commencing June 1,2012,and ending June 30,2013,with further terms and conditions being as stated in said agreement,and WHEREAS,after review,the Board deems it advisable to approve said agreement,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 Substance Abuse Treatment Service Agreement for Child Welfare Clients between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Signal Behavioral Health Network be,and hereby is,approved. BE IT FURTHER RESOLVED by the Board that the Chair be,and hereby is,authorized to sign said agreement. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 4th day of June,A.D.,2012,nunc pro tunc June 1,2012. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, ATTEST: Gk..�dr c •)---- Sean P on Chair Weld County Clerk to the Board ' IEZA, / �J X r� iain F.Garcia,I,Yo-Tem i BY: 61 Deputy CI'rk to the Boar. %r. j' rbara Kirkmeyer Meg APP AS TI• %' ` EXCUSED vid E.Long u ty Attorney U • Dougl Rademac er Date of signature: 6 c/"/ I 0 vice -6 S�so,A7• k-k,7)D 2012-1381 lA, i-t L4 I°1-I.a HR0083 MEMORANDUM 1861 DATE: May 31, 2012 TO: ::.zz:::: at: unty Com ise • FROM: rvi ep tit RE: Agreement between the Weld County Department of Human Services and Signal Behavioral Health Network Enclosed for Board approval is an Agreement between the Department and Signal Behavioral Health Network. This Agreement was reviewed at the Board's May 30, 2012, Work Session. The Department agrees to contract with Signal for a maximum of$300,000.00 from their Core Service Funding. Signal, as the managed care entity, would contract with North Range Behavioral Health to provide the substance abuse monitoring and treatment services. Signal agrees to contribute a maximum of$115,126.04 annually from designated Alcohol, Drug Abuse Division (ADAD) Additional Family Service (AFS) funds to serve eligible clients as described in the Attachment. Signal's administration fee shall be calculated as five percent of the service fees, salaries, and other authorized costs that are actually incurred in the delivery of treatment services. Other requested services or reports may be considered outside the scope of this agreement and, therefore, subject to an additional fee. Funding this year is at the same level as last year; however, minor changes were made to this year's Contract as follows: 1. All monitoring beyond standard urinalysis or breathalyzer tests must be approved by the County prior to administration. 2. Added Exhibit S to allow us to utilize SCRAMx (Secure, Continuous, Remote, Alcohol Monitoring) as another testing procedure that may benefit some of our clients. Due to different State funding cycles, the period of performance under this Agreement will overlap. For the County Core Services the period of performance shall be June 1, 2012 through May 31, 2013. The Signal Additional Family Service(AFS) period of performance shall be July 1, 2012 through June 30, 2013. If you have any questions, give me a call at extension 6510. 2012-1381 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS This Agreement is between the Weld County Department of Human Services, hereinafter referred to as "WCDHS" and Signal Behavioral Health Network, and hereinafter referred to as "Signal." WHEREAS, the Colorado Department of Human Services has provided Colorado Core Services substance abuse treatment funding to Human Services for outpatient and residential core services for families, children, and adolescents; and WHEREAS, WCDHS requires the services of a substance abuse treatment provider to assist the County in delivering substance abuse treatment services to child welfare clients, and Signal is willing and able to coordinate and manage such services; and WHEREAS, Signal is a Colorado not-for-profit corporation organized for the purpose of managing and coordinating high quality, cost efficient, integrated chemical dependency and related behavioral health care services in the State of Colorado. NOW, THEREFORE, it is mutually agreed as follows: SERVICES: A. Responsibilities of Signal 1. Signal agrees and desires to participate as the service provider coordinator for WCDHS qualified child welfare clients under the definition set forth in the Child Welfare Lawsuit Settlement Agreement (David Littman vs. State of Colorado). 2. Signal will ensure the delivery of a high quality of clinical care to clients in a delivery system of limited resources and public funding. The full continuum of care (Outpatient, Intensive Outpatient, Transitional Residential, Intensive Residential, Therapeutic Community, or comparable alternatives as mutually agreed upon) will be available to clients. The client's clinical needs will determine the level of care Signal is to provide and Signal will meet those needs regardless of "modality." 3. Signal will assure that all eligible child welfare clients referred by WCDHS in need of treatment will receive such in accordance with ASAM PPC-II R level of care, as reimbursed by the State of Colorado, Division of Behavioral Health. 4. Signal will give priority service to child welfare clients (parents and children) who comply with the following criteria as WCDHS refers: a. Case is active on TRAILS, and b. Case meets the State DHS program category criteria 4, 5, or 6, and c. Case meets the definition of "imminent risk for out-of-home placement/reunification" set forth by the State of Colorado. Signal will 1 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS secondarily evaluate and treat Colorado Works/TANF/Employment First clients as referred by WCDHS. 5. Signal will include the following provisions in all subcontracts with providers: a. The Provider shall submit a treatment plan to WCDHS within 30 days b. The Provider shall enter monthly progress reports into the Signal system no later than the 10`" calendar day of the month following the month during in which the service was rendered. Services submitted without monthly progress reports will be pended for official billing and utilization against AFS funds until such reports are submitted. c. Signal, or their designee, agrees to provide Human Services monitoring results (UA, BA, patch, tox trap) by faxing said results to Human Services at (970) 346-7667 or via access to online system no later than 72 hours after the day of service. d. Signal agrees to make available Core and AFS Utilization Reports to WCDHS each month by the 3`d Wednesday of each month. e. Signal agrees to cooperate with WCDHS to resolve any duplicated fees and/or errors identified by the WCDHS billing review process. 6. Signal will also make monthly progress reports available on its website for each WCDHS client in treatment. 7. Signal will provide training and technical support, as necessary, for WCDHS staff in accessing data reports and on the use of the child welfare referral system. 9. Signal shall reconcile all treatment providers' claims to AFS funds within 90 days from the date of service delivery. Claims not properly submitted to Signal within this time line will be denied. 10. Signal will assure that the providers in its network give timely notice of cancelled appointments to the clients and will reschedule such appointments as soon as practical. 11. At all times from the effective date of this Contract until completion of this Contract, Signal shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under the Child Welfare Services and Family and Children's Program funding must conform to the Single Audit Act of 1984 and OMB Circular A-133. 2 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS B. Responsibilities of WCDHS: 1. WCDHS will work cooperatively with Signal and its Providers to deliver quality, efficient and cost-effective substance abuse treatment services to WCDHS qualified clients. 2. WCDHS will make every effort to inform Signal and its Providers in a timely manner of system issues, developments, and complications so that Signal and the Provider can make informed choices in its role as the managed service organization and treatment agency respectively. 3. WCDHS will assure that all referrals under this contract meet the eligibility criteria expressed in Section I(A)(5) above. 4. WCDHS agrees to provide Signal with the name of a primary contact person who will be responsible for interacting with Signal's accounting and information systems departments. 5. WCDHS, or its authorized designee(s), will be responsible for electronically authorizing services to various providers. 6. WCDHS will review monthly AFS actual reports and determine any duplicate charges pursuant to Core or other previously paid services. WCDHS will report monthly any discrepancies in duplication and/or errors to Signal, and in cooperation with Signal, work with Signal to resolve any conflicts of billed services or fees. 7. WCDHS will complete the Signal remittance advice and return to Signal within 5 business days of completion of each month's TRAILS payroll date. Each remittance advice shall detail reasons for denial of any and all services. WCDHS shall work with Signal and other counties to develop standard claims denial criteria. WCDHS shall reimburse Signal for all complete services invoiced within 45 calendar days from the date of receipt of Signal's invoice. 8. WCDHS shall inform Signal of the county primary contacts along with contact information. WCDHS shall provide such contact information for all contract, data and billing related matters. II. PERIOD OF PERFORMANCE Due to different State funding cycles, the period of performance under this Agreement will overlap. For the County Core Services the period of performance shall be for the 12-month period beginning, June 1, 2012 through May 31, 2013, unless sooner terminated. The Signal Additional Family Service (AFS) period of performance under this Agreement shall be for the 12-month period beginning July 1, 2012 through June 30, 2013, unless sooner terminated. Either party hereto may terminate this Agreement at any time by giving not less than 45 days advance written notice to the other party. 3 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS As a condition of continuing to render services under this Agreement, it is understood that Signal will report any limitation or restriction of their license or insurance or the ability to perform the services covered by this Agreement under any condition of impairment. In the absence of any formal agreement beyond the term of this agreement, Signal agrees to continue providing treatment, under the terms of this agreement, for clients that are in treatment or referred by WCDHS for treatment. This is with the further understanding that service delivery and payment are subject to the termination terms mentioned above. Signal reserves the right to suspend services to clients if funding is no longer available. WCDHS acknowledges financial responsibility for all services authorized and performed before the effective date of termination. III. COMPENSATION See Exhibit A. IV. CLIENT FEES OR CO-PAYS Neither Signal nor their network Providers shall assess a client fee or co-pay to child welfare clients served under this contract, unless the client is required to pay for any positive urine screen as a condition of their Family Service Plan or through court order for monitored sobriety and/or treatment as a condition of their treatment plan. Any such client fees or co-pays shall be outside the scope of this contract, and Signal shall have no responsibility for accounting for such fees and co-pays. V. ATTACHMENTS Signal and WCDHS agree to adopt herein Exhibit A, - Memorandum of Understanding, Exhibit B — Signal Remittance Advice, Exhibit C — Qualified Service Organization Agreement, Exhibit D — Scope of Services, Exhibit E — Assurances, and Exhibit F — Standards of Responsibility for Core Services. VI. INDEPENDENT CONTRACTOR Signal and its providers shall be providing services hereunder as an independent contractor and the relationship of employer and employee does not exist between WCDHS and Signal. None of the provisions of this Agreement are intended to create, nor shall they be deemed or construed to create, any relationship among Signal, Providers, or WCDHS other than that of independent entities contracting solely for the purpose of effecting the provisions of this Agreement. Signal and Providers shall pay when due all required employment taxes and income withholding taxes, shall provide and keep in force worker's compensation (and show proof of such insurance as requested) and unemployment compensation insurance in the amounts required by law, and shall be solely responsible for the acts for Signal, its employees and agents. 4 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS VII. ASSURANCES Signal shall abide by all assurances as set forth in the attached Exhibit E, which is attached hereto and incorporated herein by reference. VIII. COMPLIANCE WITH APPLICABLE LAWS At all times during the performance of this contract, Signal shall strictly adhere to all applicable federal and state laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Contract. Signal acknowledges that the following laws are included: Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d —1 et seq. and its implementing regulation, 45 C.F.R. Part 80 et seq.; and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et seq. and its implementation regulations, 45 C.F.R. Part 91; and Title VII of the Civil Rights Act of 1964; and the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603; 42 C.F.R. Part 2 All regulations applicable to these laws prohibiting discrimination because of race, color, national origin, and sex, religion and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Signal and Human Services will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2. Human Services and Signal shall sign a Qualified Service Organization Agreement in compliance with 42 CFR Part 2, and attached hereto as Exhibit F. Included is 45 C.F.R. Part 74 Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all federal and/or state financial assistance. 5 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS Any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. EMPLOYMENT OR CONTRACTING WITH ILLEGAL ALIENS UNDER COLORADO LAW Contractor certifies that it shall comply with the provisions of Section 8-17.5-101, et seq., C.R.S., 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 represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise comply with the requirements of Section 81-.5-102(2)(b),C.R.S. Contractor shall comply with all reasonable requests made in the course of an investigation under Section 8-17,5-102,C.R.S., by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirements of this provision or Section 8-17.5-101. et seq.,C.R.S., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. Except where exempted by federal law and except as provided in Section 24- 76/5-103(3), C.R.S, if Contractor receives federal or state funds under this Contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to Section 24-76.5-103(4), C.R.S., if such individual applies for public benefits provided under this Contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States, or is otherwise lawfully present in the United States pursuant to federal law, (b) shall product one of the forms of identification required by Section 24-76/5-101. et seq., C.R.S., and (c) shall produce one of the forms of identification required by Section 24-76.5-103, C.R.S., prior to the effective date of this Contract. IX. CERTIFICATIONS Signal certifies that, at the time of entering into this Contract, it has currently in effect all necessary licenses, approvals, insurance, etc. required to properly provide the services and/or supplies covered by this contract. X. MONITORING AND EVALUATION 6 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS Signal and Human Services agree that monitoring and evaluation of the performance of this Agreement shall be conducted by Signal and Human Services. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners and Signal. Signal shall permit Human Services, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Signal pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on-site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with agreement work. XI. MODIFICATION OF AGREEMENT All modifications to this agreement shall be in writing and signed by both parties. XII. REMEDIES A. Signal and Human Services shall exhaust all remedies as provided in Exhibit F, "Standards of Responsibility for Core Services", prior to the remedy provided in Item XII, B, of this Agreement. B. The Director of Human Services or designee may exercise the following remedial actions should s/he find Signal substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Signal. These remedial actions are as follows: 1. Provide reasonable advance written notice of perceived failure to satisfy the scope of work. After Signal receives such notice and a reasonable opportunity to cure WCDHS may withhold payment of Signal until the necessary services or corrections in performance are satisfactorily completed; and 2. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by Signal cannot be performed or if performed would be of no value to the Human Services. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to Human Services; and 3. Incorrect payment to Signal due to omission, error, fraud, and/or defalcation shall be recovered from Signal by deduction from subsequent payments under this Agreement or other agreements between Human Services and Signal, or by Human Services as a debt due to Human Services or otherwise as provided by law. 7 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS C. Signal may appeal the decision of the Director of Human Services or designee, as provided in Item XII, B, of the Agreement, by submitting, within thirty (30) calendar days of the Director's action, and basis of such appeal to the Board of County Commissioners. XIII. NON-DISCRIMINATION It is the policy of Signal to provide equal opportunity without discrimination based on race, color, sex, religion, age, sexual orientation, national origin, veteran status, or individual handicap in any aspect of employment, training or services offered. All Signal programs, activities, and services are administered on a non- discriminatory basis subject to the provisions of: Title VI and VII of the Civil Rights Act of 1964 Executive Order 11246, as amended Title VII and VIII of the Public Health Services Act Rehabilitation Act of 1973 (Section 503 and 504) Equal Pay Act of 1963, as amended Title IX of the Education Amendments of 1972 Vietnam Era Veteran's Readjustment Assistance Act of 1974 Age Discrimination in Employment Act of 1967 Age Discrimination Act of 1975 Non-Discrimination Laws of the State of Colorado. XIV. ACCESS TO RECORDS Signal, its Providers and WCDHS agree to make available in a timely manner, all books, documents, and records pertinent to this contract for the purpose of billing for services, audit, and compliance with requirements and regulations of federal and state agencies and commercial insurance carriers. Signal acknowledges that in reviewing, storing, processing, or otherwise dealing with any client records dealing with any client seen by a Signal provider or the on-site substance abuse counselor is bound by the confidentiality provisions of 42 CFR Part 2. If necessary, Signal shall resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2. WCDHS and Signal shall sign a Qualified Service Organization Agreement in compliance with 42 CFR, Part 2. XV. OBLIGATIONS Obligations of WCDHS and Signal are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. XVI. PROVISIONS This Agreement may be amended only by written agreement signed by each of 8 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS the parties hereto. This Agreement shall be binding upon, and shall inure to the benefit of the respective parties hereto and shall not be assigned without the consent of all parties hereto. XVII. NOTICES: Any notice required to be given pursuant to the terms and provisions hereof shall be in writing and shall be sent by certified mail, return receipt requested; To Signal at: Michael Jenet CEO Signal Behavioral Health Network 455 Sherman St. Suite 455 Denver, CO 80203 To WCDHS at: Judy A. Griego Director Weld County Department of Human Services P.O. Box A Greeley, CO 80632 XVIII. LITIGATION Signal shall promptly notify Human Services in the event that Signal learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Signal, 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, shall deliver copies of such document(s) to the Human Services Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganization and/or foreclosure. XIX. TERMINATION This Agreement may be terminated at any time by either party given thirty (30) days written notice and is subject to the availability of funding, subject to the provisions of Item XI and Item XIX. Signal reserves the right to suspend services to clients if funding is no longer available. Human Services acknowledges financial responsibility for clients authorized under the terms of the Agreement. XX. DISPUTE RESOLUTION It is the desire of all parties to resolve conflicts at the Signal/County level through cooperation. Internally, the County Directors and the Signal provider shall 9 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS attempt to resolve all conflicts and disputes. If the issue cannot be resolved, either party may request that Signal intervene and mediate the situation. If the county, Signal and the provider are unable to resolve the dispute, the State may be requested by any party to intervene (DHS Child Welfare and ADAD). Any further unresolved issues may be submitted to the Director of the Office of Health and Rehabilitation Services or their designee(s) for case presentation and review. Should the above efforts fail, Signal, its provider(s) and WCDHS hereby agree to submit all unresolved controversies, claims, and disputes arising out of this Agreement to mediation in Denver, Colorado, according to the commercial rules and practices of the American Arbitration Association then in force, or pursuant to other rules or procedures as to which the parties may agree. Regardless of the outcome, each party agrees to fund their own litigation expenses. This Agreement shall be governed by and construed in accordance with the laws of the State of Colorado. XXI. MISCELLANEOUS PROVISIONS A. Headings. The headings of the sections and subsections of this Agreement are inserted solely for ease of reference and shall not in any way affect the meaning or interpretation of this Agreement. B. Non-Assignment. None of the parties shall have the right to assign the benefits or delegate the obligations in this Agreement without prior written consent of the other parties. Subject to the foregoing, this Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, successors, legal or personal representatives and permitted assigns. C. Waiver of Breach. The waiver of any party of a breach or violation of any provision of this Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of the same or any other provision thereof. D. Gender and Number. Whenever the context of this Agreement requires, the gender of all words shall include the masculine, feminine and neuter, and the number of all words shall include singular and plural. E. Severability. If any provision of this Agreement is held to be unenforceable for any reason, the unenforceability thereof shall not affect the remainder of this Agreement, which shall remain in full force and effect and be enforceable in accordance with its terms. F. Counterparts. This Agreement may be executed in duplicate originals, each of which shall be an original instrument but both of which taken together shall constitute one and the same instrument. G. Entire Agreement. This Agreement constitutes the entire understanding and agreement between the parties with respect to its subject matter and 10 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS supersedes all prior agreements or understandings, whether written or unwritten, with respect to the same subject matter. H. Non-Exclusivity. Participation in this Agreement shall be non-exclusive in nature and either party may enter into other Agreements other then through Signal or WCDHS. The only restriction is on the amount of funding included in this Agreement. Either party may not enter into other Agreements that may dilute the funding base in this Agreement. Hold Harmless. To the extent authorized by law each party agrees to defend, hold harmless, and indemnify the other party and its affiliates, directors, trustees, officers, and employees from and against all claims, demands, suits, judgments, expenses, and costs of any and all kinds arising as a result of damages or injuries arising out of, or incident to, the performance or failure of performance of this Agreement by such indemnifying party or its agents of its duties, obligations, or rights hereunder. J. Negligence/Malpractice. In the event that negligence or malpractice of Signal or an employee of Signal shall subject County to potential or actual liability, Signal shall hold the Weld County Department of Human Services harmless from all monetary loss resulting from such liability. This obligation to hold harmless shall, in addition to any other obligations commonly associated with it, would obligate Signal to pay all reasonable attorney fees, costs, expenses, and damages incurred as a result of such liability. Signal acknowledges that the Weld County Department of Human Services is a department of Weld County and, thus, to the extent authorized by law, Signal agrees to indemnify, save, and hold harmless the Board of County Commissioners of Weld County, or Weld County, or both, against any and all claims, damages, liability, and the like as above set forth. The indemnities and assumptions of liabilities and obligations herein provided for shall continue in full force and effect notwithstanding the expiration or termination of this Agreement. K. Third Party Beneficiary Enforcement. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of actions relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 11 of 12 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS APPROVED B SIXAL- Michael Jenet CEO Date SIGNAL BEHAVIORAL HEALTH NETWORK JUN 0 4 2012 Sean P. Conway, Chair WELD COUNTY BOARD OF COUNTY COMMISSIONERS Date .J / L ? Judy P(Oriego, Vector WELD COUN DEPA MENT OF HUMAN SERVICES ate *****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK***** 12 of 12 0/02-/3g(- EXHIBIT A SIGNAL BEHAVIORAL HEALTH NETWORK and WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE RATES MEMORANDUM OF UNDERSTANDING This Memorandum of Understanding (MOU) shall act as an attachment to the contract between Signal Behavioral Health Network (Signal) and Weld County Department of Human Services (WCDHS). The term of the contract and this MOU is from June 1, 2012 to June 30, 2013, unless terminated otherwise. Compensation WCDHS agrees to contract with Signal for a maximum of $300,000.00 from their Core Service Funding. Signal agrees to contribute a maximum of $115,126.04 annually from designated DBH Additional Family Service (AFS) funds to serve eligible clients in accordance with the terms herein. Signal's administration fee shall be calculated as five percent of the service fees, salaries, and other authorized costs that are actually incurred in the delivery of treatment services. Signal's administration fee shall obligate Signal to perform, or deliver, the responsibilities, services, and reports specifically mentioned in this agreement. Other requested services or reports may be considered outside the scope of this agreement and, therefore, subject to an additional fee. Payment A. Responsibilities 1. Signal shall submit an itemized monthly bill to Human Services for all costs incurred and services provided in accordance with criteria established by Human Services and Signal. Requests to modify criteria must be provided with 30 days advance notice. Signal shall submit all itemized monthly billings to Human Services no later than the 3rd Wednesday of the month following the current month plus the previous 60 days for the month the cost was incurred in accordance with the Trails payroll calendar. 2. Signal shall make available, on its web site, monthly billing reports in accordance with the billing criteria established by Human Services no later than the 3rd Wednesday of the month following the month of service. Monthly client progress reports must be made available to the Core Services Caseworker, in the format provided by the Department (see attached Exhibit B). In the alternative, the information contained on Exhibit B will be available to the Core Services Caseworker for download from the Signal database by the 3rd Wednesday of the month following the date of service. Arapahoe House, North Range Behavioral Health and Larimer Center for Mental Health will be required by Signal to input the monthly progress information into the Signal database prior to their ability to bill service charges for that client. Any incomplete progress report will be deemed incomplete and all such associated services will be pended. 3. Failure to submit monthly billings and/or monthly client reports in accordance with the terms of this agreement may result in Signal's forfeiture of all rights 1 of 6 EXHIBIT A SIGNAL BEHAVIORAL HEALTH NETWORK and WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE RATES MEMORANDUM OF UNDERSTANDING to be reimbursed for such expenses. In the event of a forfeiture of reimbursement, Signal may appeal such circumstance to the Director of Human Services, after all remedies described in Item XII, A of the Agreement are exhausted. The Director of Human Services shall render a decision. The decision of the Director of Human Services may be appealed to the Board of County Commissioners according to the provisions of Item XII of the Agreement. 4. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of Colorado Core Services substance abuse treatment funding to Human Services. WCDHS shall be liable for all services authorized and provided up to the date of receipt by Signal of revocation of such authorization. 5. Human Services shall not be billed for, and reimbursement shall not be made for, time involved in activities outside of those defined in Exhibit D, "Scope of Services" and Exhibit A, "Weld County 12/13 AFS and Core Fee Schedule." Work performed prior to the execution of this Contract shall not be reimbursed or considered part of this Agreement. 6. Signal shall provide training and technical support, as necessary and as resources allow, for Human Services staff in accessing Signal's data and billing reports and on the use of the child welfare referral system. B. Unless otherwise provided in the Scope of Services and Payment Schedule: 1. Signal shall provide proper monthly invoices, make available monthly progress reports for each client incurring charges, and verification of services performed for costs incurred in the performance of the agreement. 2. Human Services may withhold any payment if Signal has failed to comply materially with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the event of a withhold of reimbursements, Signal may appeal such circumstance to the Director of Human Services, after all remedies described in Item XII, A of the Agreement are exhausted. The Director of Human Services shall render a decision. The decision of the Director of Human Services may be appealed to the Board of County Commissioners according to the provisions of Item XII of the Agreement. 3. WCDHS will complete the Signal remittance advice and return to Signal within 5 business days of completion of each month's TRAILS payroll date. Each remittance advice shall detail reasons for denial of any and all services. WCDHS shall work with Signal and other counties to develop standard claims denial criteria. WCDHS shall reimburse Signal for all complete services invoiced within 45 calendar days from the date of receipt of Signal's invoice. 4. WCDHS shall identify the individuals Signal should communicate with for clinical, data and billing needs. 2 of 6 EXHIBIT A SIGNAL BEHAVIORAL HEALTH NETWORK and WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE RATES MEMORANDUM OF UNDERSTANDING AFS and Core Services Reimbursement Funding Sources AFS Core Total On-Site Salaries and Benefits 0 0 0 Supplies, Supervision and Travel 0 0 0 Subtotal-Onsite Costs 0 0 0 Adm Fee 0 0 0 Total Onsite Costs 0 0 0 Fee-for-service funding 109,370 285,000 394,370 Signal Fee 5,756 15,000 20,756 Total fee-for-service 115,126 300,000 415,126 Total Contract Costs 115,126 300,000 415,126 Fee-For-Service Reimbursement County Core Services and Signal AFS funding will be responsible for purchasing services in accordance with the schedule below (to a maximum funding specified in the contract language). Weld County 12113 AFS and Core Fee Schedule Service Code Service Description Units Measured Payer Rate 80100:HF UA- Ethyl Glucuronide (EtG) each 31.50 80101 UA—5 panel each 12.60 80101:HF UA-7 Panel each 15.75 80102 UA Confirmation each 0.00 81002 UA- Dip Stick each 12.60 81099 UA- Soma each 0.00 82055 UA-Oral Swab each 15.75 82055: SC UA- Synthetic Cannabinoids (Spice) each 36.75 82055: OS Oral Swab—Synthetic Cannabinoids (Spice) each 36.75 82075 Breathalyzer each 5.25 82541 UA-GC/MS -Qualitative each 36.75 82542 UA-GC/MS -Quantitative each 36.75 83000:P80 Expanded Designer Stimulants-14 Panel each 52.50 3 of 6 EXHIBIT A SIGNAL BEHAVIORAL HEALTH NETWORK and WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE RATES MEMORANDUM OF UNDERSTANDING Service Code Service Description Units Measured Payer Rate 83000:P81 MDPV, Mephedrone, & Methylone-3 Panel each 36.75 84999 Hair Testing each 105.00 86586 SCRAM Skin Monitor day(s) 0.00 90801 Psychiatric Diagnostic Interview Exam 15 min. session(s) 0.00 94664 Vapor inhalations evaluation each 63.00 99075 Medical testimony 15 min. session(s) 18.38 99199 Court Case Consultation 15 min. session(s) 7.88 H0001:I1 Evaluation: II each 151.20 H0001: HH Evaluation: Ill each 262.50 H0002:TN Evaluation: Rural 15 min. session(s) 17.50 H0003:HF UA w/TX each 0.00 H0004 Individual Counseling 15 min. session(s) 18.38 H0004:TN Individual Counseling: Rural 15 min. session(s) 0.00 H0005 Group Counseling 15 min. session(s) 6.57 H0005:TN Group Counseling: Rural 15 min. session(s) 15.75 H0005: HR Group counseling: Family/couple with client present 15 min. session(s) 6.56 H0005: HS Group counseling: Family/couple without client present 15 min. session(s) 6.56 H0006 Case Management 15 min. session(s) 0.00 H0011 Detox day(s) 157.50 H0018:HA Intensive Short-Term Residential: Adolescent day(s) 239.40 H0018:HB Intensive Short-Term Residential: Adult day(s) 178.50 H0019 Transitional Long-Term Residential day(s) 101.85 H0019:HA Transitional Long-Term Residential: Adolescent day(s) 0.00 H0019:HD Transitional Long-Term Residential: Preg/Parent(NDF) day(s) 183.75 H0020 Opiod Replacement(Methadone) month(s) 435.75 H0048 Drug Patch Confirmation each 0.00 H0048:HF Drug Patch Monitoring each 52.50 H2012:HA Day Treatment: Adolescent hour(s) 10.36 H2012:HB Day Treatment: Adult hour(s) 7.25 H2020:HA Therapeutic Behavioral Srvcs: Adolescent day(s) 131.25 H2020:HB Therapeutic Behavioral Srvcs: Adult w/o Infant day(s) 61.95 4 of 6 EXHIBIT A SIGNAL BEHAVIORAL HEALTH NETWORK and WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE RATES MEMORANDUM OF UNDERSTANDING Service Code Service Description Units Measured Payer Rate H2020:HD Therapeutic Behavioral Srvcs: Preg/Parent day(s) 104.48 H2033 MST for juveniles 15 min. session(s) 0.00 H2033:M Multi-systemic Therapy (MST) day(s) 60.38 H2033: F Functional Family Therapy (FFT) day(s) 21.00 T1006 Family Counseling 15 min. session(s) 21.00 T1006:TN Family Counseling: Rural 15 min. session(s) 0.00 T2010 Intake each 0.00 The County and Signal acknowledge that all UA services MUST be physically monitored/observed by an individual in order for payment to be considered. The County and Signal further acknowledge that any and all monitoring beyond standard urinalysis or breathalyzer tests must be approved by the County prior to administration. Signal, in accordance with Federal HIPAA regulations, adopted a standard transaction code set for all treatment services on October 16, 2003, which are subject to change throughout each contract year. Even though this compliance changed the service labels and groupings (shown above), the net amount of the fees associated with those services has not changed. The following services are available exclusively through AFS funds and must be purchased in conjunction with the residential treatment services described in the fee-for-service schedule above: Weld County 12/13 AFS Fee Schedule Service Units Payer Code Service Description Measured Rate T2048:HA Room and Board: Adolescent: ARTS Daily 40.03 Room and Board: Adolescent: Arapahoe House Daily 38.12 Room and Board: Adolescent: Crossroads Daily 0.00 Room and Board: Adolescent: North Range Behavioral Health Daily 36.75 Room and Board: Adolescent: Sobriety House Daily 0.00 T2048:HB Room and Board: Adult: ARTS Daily 17.72 Room and Board: Adult: Arapahoe House Daily 47.49 Room and Board: Adult: Crossroads Daily 52.50 Room and Board: Adult: North Range Behavioral Health Daily 36.75 Room and Board: Adult: Sobriety House Daily 23.10 T2048:HD Room and Board: Preg/Parent: ARTS Daily 17.72 Room and Board: Preg/Parent: Arapahoe House Daily _ 52.68 5 of 6 EXHIBIT A SIGNAL BEHAVIORAL HEALTH NETWORK and WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE RATES MEMORANDUM OF UNDERSTANDING Service Units Payer Code Service Description Measured Rate Room and Board: Preg/Parent: Crossroads Daily 78.75 Room and Board: Preg/Parent: North Range Behavioral Health Daily 0.00 Room and Board: Preg/Parent: Sobriety House Daily 0.00 APPROVEQ B : s/y/„ Michael Jenet CEO Date SIGNAL BEHAVIORAL HEALTH NETWORK JUN 0 4 2012 Sean P. Conway, Chair CD WELD COUNTY BOARD OF COUNTY COMMISSIONERS Date Judy iditT recto �� WELD OUN DEPA TMENT\QF HUMAN SERVICES Date *****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK***** 6 of 6 0 0 to a co o c $ [D cE 'mLL I— a o y w m ry o °i "y' nj 0 V c X am C oo '.. X - 0- a a W L C A N a o 3ci o aC li c o Li N O O .t-. n E N a c is a f. a L ,p C - I .S n V N a 0 N 'a E ..-• >" LL a'. a a o a) $ a E 0 OI I c $ ¢ -5 �' 11 E d m a'I O in d iv 0 C.C V 0) C) C CE a a O C O Ins ''I 2 r co Z V E I I m E C v ''.I II `mm E v a) >.co Et ito ! n E C 3' o `lY _- - c- . 0 7 1.... o in C 0 0 T Z I'. x o a) a O O x •j o G' e E w 'O 3 o iM . r• y d w• — V C = l No « ° F- Q —Alto O E Ell 0.10 2 q u N _W a I— .c C C u 0 u 0 M w LT co .c ay.?.I co Ii I a E F- c• a C1) CI R U ' in' 0) N O A rn C'QIca O -p a t u na T 2 e7) V Q of C o 5 0 c O .. N ! 0 - O aa) 'm' I !. C I O m E " EI 0 u II u u Wy co o y. 0) C <n O' E. It t m 0 �' 0 U —. m -r-- iii cn co o 0 a) m C a E o u E C 0 z — a o R a C W U N 0 U N CPS C C N m - I C C O L: 0 O I I- 01 a) 0 u , p u O O0 C C ' a > u) V- E I QO Z •-• I C ,, w co a) 7 0 a • O o E , C O.. Q (0 1 — p I T C C 9 - p O I 0• ot C „_ 0 O uH 0 EXHIBIT C SIGNAL BEHAVIORAL HEALTH NETWORK QUALIFIED SERVICE ORGANIZATION AGREEMENT Signal Behavioral Health Network (MSO) and Weld County (County or Counties) Department of Human Services hereby enter into a Qualified Service Organization Agreement whereby the MSO agrees to accept and serve Counties' clients substance abuse treatment needs. In light of the relationship between County and the MSO, County requires client identifying information and data and information related to the services furnished to the clients. County and MSO will have this relationship from June 1, 2012 - June 30, 2013, thus the QSOA will be in effect during this period of time. Furthermore, the County: 1. acknowledges that in receiving, storing, processing, or otherwise dealing with any information from the MSO about the clients in the MSO's program, it is fully bound by the provisions of the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2; and 2. undertakes to resist in judicial proceedings any effort to obtain access to information pertaining to clients otherwise than as expressly provided for in the federal confidentiality regulations, 42 CFR Part 2. Executed this P1 day of /mil , 2012. Michael Jen u A. Gr go CEO ector Signal Behavioral Health Network Weld County Department of Human Services 1 of 1 EXHIBIT D SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT D - SCOPE OF SERVICES - FY 2012/2013 SCOPE OF SERVICES A. ASSESSMENTS 1. Alcohol and Drug Differential Assessment (3-Hours) Assessment will evaluate alcohol/drug involvement as well as mental health status, history of mental health issues, sexual history, legal history, and certain standard tests (ASAP, ASAM PPC-2, ASI, SOCRATE, AODUI, Drinking History Questionnaire, Family Environment Scale) may be given. Signal will provide two collateral contacts as part of the Assessment. 2. Co-Occurring Alcohol and Drug with Domestic Violence Assessment (3-Hours) Summary of assessment with recommendations sent to referring agency. The following areas will be assessed: Criminal History Profile of Client's Violent Behaviors Potential for Violence Mental Health Status Client's Medical History Substance Abuse History Suicidal/Psychological/Cultural Milton Test, if needed History 3. Substance Abuse Forensic Evaluation (3 hours, as staff expertise permits) A forensic evaluation is specifically geared toward the substance-abusing offender. It involves additional testing to determine the crimogenic aspect of the person to be taken into consideration when developing treatment recommendations. Testing will be comprised of CVI, ASUS, SASSI, Milton Clinical Multiaxial Inventory (MCMI-III), a clinical interview, and a behavioral profile. The testing is cross-referenced with the clinical interview, and in relation to collateral data. B. TREATMENT OPTIONS 1. Co-Occurring Alcohol and Drug with Domestic Violence Group Therapy (average length of treatment, 24 to 36 weeks): Groups for both men and women are offered. The group addresses anger management, healthy relationships, male and female roles, and boundaries. As needed, a Milton Test may be given, a standardized psychological test which 1 of 5 EXHIBIT D SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT D - SCOPE OF SERVICES - FY 2012/2013 measures functioning level in 22 personality disorders and clinical syndromes for adults (8th grade reading level: > 18; available in Spanish). 2. Family Therapy (average length of treatment, 8 to 16 sessions): Involves two or more family members and provides therapeutic intervention to improve family communications, functioning, and relationships. Length of participation is dependent on client goals and progress toward meeting goals. 3. Individual Counseling (average length of treatment, 6 to 12 sessions): Primary client is seen on an individual basis. Length of participation is dependent on client goals and progress toward goals. 4. Substance Abuse Therapy (average length of treatment, 12 to 20 sessions): A group to enhance positive coping skills by focusing on their lifestyle dealing with use and abuse of chemicals. 5. Adult Intensive Outpatient (average length of treatment, 4 to 12 weeks): An intensive outpatient group therapy track that offers groups every evening, Monday through Friday, with a family program component. This program will include medical aspects of addiction and adult relapse education components focusing on understanding the relapse process as well as group process (focuses on individual issues relating to their abuse of alcohol). The program length and participation level will be individualized based on the presenting issues and other factors. 6. Women's Group (average length of treatment, 12-20 sessions): A gender-specific group addressing issues affecting women and their relationships, such as family violence, co-dependency, self-esteem and stress management. 7. Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users (MET/CBT5 average length of treatment 5-8 weeks): The MET/CBT5 is a brief treatment approach for cannabis abusing adolescents. Treatment consists of two individual motivational enhancement therapy sessions (MET) Sessions, followed by participation in three group cognitive behavioral therapy (CBT) sessions. The assessment includes a psychosocial history and data from the Global Assessment of Individual Needs (GAIN), and a personalized feedback report. 8. Adolescent Intensive Outpatient (length of treatment - 3 to 12 weeks): This intensive outpatient track offers therapy and education groups utilizing the Matrix Model for Youth and Young adults curriculum. Groups are offered Monday through Friday. This program also provides individual 2 of 5 EXHIBIT D SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT D - SCOPE OF SERVICES - FY 2012/2013 and family therapy as well as family group therapy. Topics addressed include the medical aspects of addiction and relapse-prevention education focusing on understanding the relapse process. The program length and participation level will be individualized based on the presenting issues and other factors. C. SPECIAL PROGRAM OPTION 1. Special Connections (through pregnancy and up to one year postpartum): A gender-specific program that focuses on healthy babies, appropriate child care, prenatal care, birth control, developmental stages of the baby, parenting skills, relationship issues, and other issues as identified by the counselor. Services include group and individual therapy, case management and family health education. D. MISCELLANEOUS SERVICE OPTIONS 1. Extended Detoxify Stay: This is an option when case management goals require that the person be in a stable environment until they can be referred to the next level of care. 2. Enhanced Services: Enhanced services as approved services that are requested by Human Services for specific cases, which fall outside of the definitions, listed above in the description of the DBH menu of services. Enhanced services may be services not described on the menu, services not included in the definition or due to lack of economy of scale, or rural location, or result in additional costs to Signal. In order for Signal to provide enhanced service, the cost would be outside of the approved rates. Any additional fees would be negotiated on a case-by-case basis. Signal can arrange for services outside of the approved definitions, but Human Services will be charged an additional fee that would be negotiated on a case-by-case basis by the designated representative listed in the contract. E. MEASURABLE OUTCOMES AND OBJECTIVES Signal shall abide by Human Services outcome indicators of Safety, Permanency and Child and Family Well-Being, which are provided under Adoption and Safe Families Act (ASFA), 1997; Colorado Child and Family Services Plan 2000 — 2004; and ACF Reviews (Reference: Federal Register, Volume 65, Number 16: 45 CRF Parts 1355, 1356, and 1357), March 25, 2000. 3 of 5 EXHIBIT D SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT D - SCOPE OF SERVICES - FY 2012/2013 1. Outcome Reports as Prescribed by Human Services 2. Outcome reports will be developed and provided as mutually agreed upon by the parties. 3. Client Objectives The Human Services caseworker will identify a maximum of three child welfare objectives to be addressed within each client's treatment plan. Signal shall develop action steps to reach the identified child welfare objectives. Signal shall report monthly on each client's progress in meeting the three identified objectives while the client is receiving treatment services 4. Overall Program Objectives Signal and Human Services agree to monitor the ability of the substance abuse program offered by Signal to achieve objectives as follows: a. Demonstrate Abstinence with the use of UA/Patch Monitoring Only. b. Improve parental capabilities currently impaired by substance abuse. c. Develop the capacity to ask for help and assistance without resorting back to substance abuse d. Develop or increase the ability to recognize, prioritize and meet child(ren)'s needs e. Parent will identify how their substance use has affected their parenting f. Parent will identify how their substance use got them involved with Human Services g. Parent will identify how their substance use helped them parent h. Parent will identify relapse triggers and develop a safety plan for their children Parent will identify whom they consider to be a support in their recovery j. Parent will identify who will care for their children should they relapse k. Parent will identify what they enjoy about parenting sober Improve parent-child functioning to lower the risk of out of home placement m. Parent will support their children in speaking about how living in a substance-effected family has impacted them n. Parents will demonstrate increased verbal skills, empathy and accountability with child(ren) o. Parent will identify their parenting strengths 4 of 5 EXHIBIT D SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT D - SCOPE OF SERVICES - FY 2012/2013 p. Family members including significant other, children and extended family will increase ability to communicate more effectively q. Family members will identify how they can support the identified client in their recovery r. Family members will identify the positive parenting changes the substance-effected person is making s. Family members will identify who will care for the children in the event of a relapse t. Family members will identify relapse systems of the identified client u. Family members will identify how they can reach out for help if a relapse occurs v. Increase level of functioning currently impaired by living in a substance affected family w. Identify how living in substance affected family has impacted their life x. Improve level of functioning currently impaired by substance abuse issues y. Decrease aggressive behaviors at home and/or school and in the community z. Learn how to socialize without the use of substances aa. Identify relapse triggers bb. Create a sober support network F. STAFF QUALIFICATIONS Signal staff members who will provide services to Human Services clients will have credentials and/or certifications as required by the Colorado Department of Human Services, Colorado Board of Education, Division of Behavioral Health, and the Colorado Board of Medical Examiners. 5 of 5 EXHIBIT E SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT E - ASSURANCES - FY 2012/2013 1. Signal agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 2. Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of Signal or its employees, volunteers, or agents while performing duties as described in this Agreement. Signal shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers, and agents. Signal shall provide adequate liability and worker's compensation insurance for all its employees, volunteers, and agents engaged in the performance of the Agreement upon request, Signal shall provide Human Services with the acceptable evidence that such coverage is in effect. 3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their officers or employees may possess, not shall any portion of this Agreement be deemed to have created a duty of care with respect to any persons not a party of this Agreement. 4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year. 5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Contract and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 6. No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. 7. Signal assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the 1 of 4 EXHIBIT E SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT E -ASSURANCES - FY 2012/2013 benefits of, or be otherwise subjected to discrimination under this approved Contract. 8. Signal assures that sufficient, auditable, and otherwise adequate records that will provide accurate, current, separate, and complete disclosure of the status of the funds received under the Contract are maintained for three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow authorized local, Federal, and State auditors, and representatives to audit and monitor Signal. 9. All such records, documents, communications, and other materials shall be the property of Human Services and shall be maintained by Signal, in a central location and custodian, in behalf of Human Services, for a period of four (4) years from the date of final payment under this Contract, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: 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 four (4) year period, or if audit findings have not been resolved after a four (4) year period, the materials shall be retained until the resolution of the audit finding. 10. Signal assures that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect any copy records, and shall be allowed to monitor and review through on-site visits, all contract activities, supported with funds under this Contract to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. 11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. Signal or Human Services may not assign any of its rights nor obligations hereunder without the prior written consent of both parties. 12. Signal certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of Signal, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, 2 of 4 EXHIBIT E SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT E -ASSURANCES - FY 2012/2013 the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 13. Signal assures that it will fully comply with all other applicable federal and state laws. Signal understands that the source of funds to be used under this Contract is: Colorado Core Services substance abuse treatment funds. 14, Signal assures and certifies that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department of agency. B. Have not, within a three-year period of preceding this Agreement, been convicted of, or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; C. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 11(b) of this certification; and D. Have not within a three-year period preceding this Contract, had one or more public transactions (federal, state, and local) terminated for cause or default. 15. The Appearance of Conflict of Interest applies to the relationship of Signal with Human Services when Signal also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for Signal to gain from knowledge of these opposing interests. It is only necessary that Signal know that the two relationships are in opposition. During the term of the Contract, Signal shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Signal shall submit to Human Services, a full disclosure statement setting forth the details that 3 of 4 EXHIBIT E SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES EXHIBIT E - ASSURANCES - FY 2012/2013 create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for Human Services' termination, for cause, of its contract with Signal. 16. Signal shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Contract. Except for purposes directly connected to the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of Signal shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with Signal written policies governing access to, duplication and dissemination of, all such information. Signal shall advise its employees, agents, and sub-providers of Signal, if any, that they are subject to these confidentiality requirements. Signal shall provide its employees, agents, and sub-providers of Signal, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 17. Proprietary information for the purposes 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 (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that 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 Signal in the course of providing services under this Contract will be accorded at least the same precautions as are employed by Signal for similar information in the course of its own business. 18. Signal certifies it will abide by Colorado Revised Statue (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors, and sub-contractors. *****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK***** 4 of 4 EXHIBIT F SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT STANDARDS OF RESPONSIBILITY FOR CORE SERVICES FISCAL YEAR 2012/2013 1. Signal and Human Services agree to develop a case management plan (aka substance abuse treatment plan) on each referred family within 30 days of the date the Signal received the referral. The case management plan will be monitored and modified monthly to measure progress toward goals. Copies of the case management plan must be sent to the caseworker, program area supervisor, and Core and Service Contract Coordinator at Weld County Department of Human Services, P. O. Box A, 315 B N 11 Avenue, Greeley, Colorado 80632. The case management plan will include, at a minimum, goals, timelines, and measurement of success. 2. Signal and Human Services agree to resolve level of care conflicts at the Signal/County level through cooperation. Human Services and Signal shall attempt to resolve all levels of care conflicts and disputes at the lowest level possible within each organization. Should Human Services and/or Signal fail to agree upon the level of care offered by Signal, they may appeal the case directly to the County Director, or designee, and the Signal Chief Operating Officer. Both Signal and Human Services will have an opportunity to provide consultation and documentation regarding the appeal. Appeals are to be resolved within 72 working hours, unless good cause justifies an extension. 3. Signal agrees that payments for levels of care are not authorized for reimbursement by Human Services until a referral from Human Services is provided to Signal prior to services rendered by Signal. Furthermore, Signal and its providers agree that any monitoring in conjunction with treatment beyond standard urinalysis and breathalyzer tests, as well as changes in level of care are not authorized for reimbursement by Human Services until staffed with designated Human Services staff. Human Services agrees to identify designated staff that may provide this authorization. 4. Signal agrees not to accept any referral from Human Services unless the referral contains all information required on the form and necessary for reimbursement by Human Services and authorized for reimbursement. If Signal accepts the referral without all data fields required on the referral form or authorization, Signal may assume fiscal responsibility for the services provided under the incomplete referral. Inaccurate information listed on the referral form by Human Services will be excluded as a fiscal responsibility for Signal. 1 of 4 EXHIBIT F SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT STANDARDS OF RESPONSIBILITY FOR CORE SERVICES FISCAL YEAR 2012/2013 5. Signal agrees to provide access to all monthly client progress reports for clients with treatment charges by the 3rd Wednesday after the month of service, via the Signal website. The monthly progress report for each client must be entered into the Signal Service Management website by the provider previous to the monthly billing claims in order for payment to be honored. Failure to submit such monthly reports will result in delays or forfeiture of payment. It is expected, at a minimum, that these reports will reflect all information requested on the Monthly Progress Report 6. Signal agrees to submit a final discharge summary of client outcomes to Human Services within thirty (30) calendar days after the completion date. 7. Signal agrees to report expenditures and case disbursement at agreed upon times. 8. Signal agrees to assume fiscal responsibility for expenses incurred by Signal that do not meet the requirements of Exhibit F of this Agreement. Those expenses incurred by Signal outside of the scope of Exhibit F requirements are not eligible Human Services expenditures and shall not be reimbursed by Human Services. 9. Signal agrees to the definition of a complete and timely billing form for purposes of submitting an original bill under Exhibit F, 8. A complete and timely billing form must include the following elements. A. The billing must include all forms designed for Core Services reimbursement and approved by Human Services; Core Services Authorization of Funds, Project Report, Update Report, and original signed client verification forms for therapy and group services. Additionally, Signal agrees to provide Human Services monitoring results (UA, BA, patch, tox trap swab) by faxing said results to Human Services at 970.346-7667 or via access to online system no later than 72 hours after the day of service. B. The Department will determine billed services not eligible for payment by identifying conflicts in the following: 1. Details provided in client referrals and renewals, including approved hours of service, begin and end dates of service, client name, and Case ID. 2 of 4 EXHIBIT F SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT STANDARDS OF RESPONSIBILITY FOR CORE SERVICES FISCAL YEAR 2012/2013 2. Details in supporting documentation provided by the Provider and submitted with the original bill, including, but not limited to, original signed client verifications, receipt of monitoring results, time of service and units or hours of service provided, and names of clients receiving the services, and monthly progress reports with all the information specified on the Monthly Progress Report. 3. Details provided in the current approved contract and Notification of Financial Assistance, including, but not limited to unit of service, cost per unit of service, and special conditions and/or revisions to said contract. The above items, 9 C, 1, 2, and 3, will supersede all requests from Signal for review of billing errors. Items submitted for billing will be processed according to the criteria established by the above documentation. The Department will make obvious corrections to minor errors in the bill in order to expedite processing the claims for payment. Minor errors include missing or transposed digits in Household Numbers, TRAILS Case ID, or other Department-generated information. D. An Administrative fee will be assessed to all fees reimbursed through County only funding. Such fees include, but are not limited to, those service fees previously billed and determined by the Department to be not eligible for payment. 10. Signal will develop and utilize evaluation tools (pre- and post-assessment test instruments) to collect necessary data in cooperation with Human Services staff to monitor effectiveness of program. 11. Signal will meet with the Human Services designated supervisor quarterly and/or the Core Services Coordinator (more if needed) to review program usage and effectiveness to discuss necessary improvements to better serve families or increase referrals. 12. Signal will be available to meet with Human Services staff to explain program, time lines of response to referrals and answer questions to enhance program. 3 of 4 EXHIBIT F SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT STANDARDS OF RESPONSIBILITY FOR CORE SERVICES FISCAL YEAR 2012/2013 13. Signal, or their authorized designee, will be available for the Families, Youth and Children (FYC) Commission review and attendance at the FYC meetings. 14. Regarding all forms referenced herein in the Agreement, Signal shall replicate these forms in format, content and according to the specifications of Human Services or as mutually agreed upon by Signal and Human Services. Signal agrees to modify these treatment authorization forms according to Human Services specifications and requirements. 15. Human Services will be responsible for electronically authorizing services to various Signal providers and initially designating if Core funds shall be used for payment. Human Services shall assure that the authorization will have all information required for reimbursement from the county. 16. Human Services agrees to provide Signal with the name of a primary contact who will be responsible for interacting with Signal's data system. 17. Human Services agrees to provide TRAILS Remittance Advice and a Signal Remittance Summary (Exhibit B) to Signal within five (5) business days of the monthly TRAILS Core Main Payroll date. 18. Human Services agrees to render payment for one full billing invoice at a time, as billed monthly by Signal, and not to submit payment for a mixture of separate invoices within one payment. *****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK***** 4 of 4 EXHIBIT S SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS Weld County SCRAMx Use Case Project. Signal Behavioral Health Network(Signal) is convinced that SCRAMx can be used to benefit clients in their quest to achieve real world abstinence and help stake holders achieve financial and clinical efficiencies not before realized. Signal wishes to initiate a use case project with the help of Weld County and North Range Behavioral Health. The FY 2012-2013 contract will be amended. The exhibit will be for one additional service. The amendment will be effective June 1, 2012 through May 31, 2013. Exhibit S will state: A rate is added for the service that will be titled SCRAMx; the rate is$13.00 per day with the Service Code 86586 and will carry an additional administrative fee of 5%or$.65. Resulting in the total rate of$13.65 per day. Signal and MSI have qualified SCRAMx (Secure, Continuous, Remote, Alcohol Monitoring) from Alcohol Monitoring Systems(AMS) as an affirmative technology option. From the successful trial that Signal and MSI implemented in 2011, use case illuminates clinical and financial benefits to be shared with other treatment providers and payer systems in an effort to build clinical field adoption of remote alcohol monitoring. I. General duties of MSI. -MSI will be responsible for providing SCRAMx equipment, installing the equipment, adjusting the equipment as needed, and training all involved in the project in the operations of the equipment and hardware. For purposes of this amendment, MSI and Signal will be available to place equipment on an identified client within 24-hours of the initial request. -MSI will manage the inventory of hardware allocated to this program. -MSI will invoice Signal on the first day of each month for the prior month utilization charges. -MSI will provide the identified treatment team a list of SCRAMx clients, along with compliance reports on all clients. Compliance reports will be customized to meet the treatment teams reporting requirements. -MSI will report any evidence of non-compliance to North Range Behavioral Health (NRBH) and/or designated Case Worker immediately. -MSI will notify the NRBH and Case Worker of all confirmed events. -MSI staff will troubleshoot all potential drinking and tamper events per AMS advisement prior to notifying the Case Worker or the provider. IV. General duties of Signal Behavioral Health Network. -Signal Behavioral Health Network will provide general duties as the fiscal agent for the SCRAMx project. -Signal Behavioral Health Network will provide contract management duties to facilitate the execution of the contract between parties. 1 EXHIBIT S SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS -Signal Behavioral Health Network will provide subject matter expertise in the areas of substance use disorder treatment, compliance and quality improvement. -Signal Behavioral Health Network will coordinate efforts to inform the partners of the the evolution, project development and outcomes of the SCRAMx program. Signal will foster a robust follow up of information to and from all stake holders. V. Client enrollment and process. SCRAMx is a technology to be used with alcohol involved clients and will not monitor the use of illicit drug abuse. When an alcohol involved client is identified and deemed appropriate for the SCRAMx technology, the Case Worker should contact Jason Botticelli, or other MSI representative at 818.264.6152 to begin the enrollment process. Enrollment Process • The phone-based, risk assessment screening, using ADRS, will be completed to confirm the client is a match for the SCRAMx project; • MSI will arrange a meeting with the client and Case Worker/Clinical Team, and orient the client to the SCRAMx bracelet and SCRAMx will be placed on the client's ankle; • MSI will coordinate with the team to determine the desired process of results reporting; • SCRAMx will be made active and monitoring will commence. As the client evolves through SCRAMx project, representatives from MSI and Signal will be available to the clinical team to assess the client's clinical progress using a combination of Motivational Interviewing interventions along with SCRAMx. A key focus will be working with the client to internalize behavior changes to improve long-term abstinence from alcohol. Additionally, project representatives will be assessing the client's satisfaction using SCRAMx and elicit feedback to further inform the client portion of the project. Secondly, representatives from MSI and Signal will ask the clinical team to report their experience with the SCRAMx intervention. This information will be used to manage project processes moving forward. Also important to the project is the opportunity to work with Department Administration to determine cost-savings and/or cost-offset when applying SCRAMx to this clinical population. Project Goals Achieve Patient Satisfaction Improve Health Outcomes Create Cost Savings 2 EXHIBIT S SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2012/2013 CHILD WELFARE CLIENTS When the SCRAMx use case project completes Signal and MSI will evaluate the project to determine the project's ability to achieve the identified project goals. All findings will be reported back to the clinical team, case worker and Department. APPROVED BY. Michael CEO Date SIGNAL BEHAVIORAL HEALTH NETWORK ) JUN 0 4 2012 Sean P. Conway, Chair WELD COUNTY BOARD OF COUNThOlIMISSIONERS Date CY 'Lk D Judy A. 'ego, ector WELD C UNTY EPART ENT 4 HUMAN SERVICES ate 3 Hello