HomeMy WebLinkAbout20091019RESOLUTION
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, 2009, and ending
June 30, 2010, 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 29th day of April, A.D., 2009.
BOARD OF COUNTY COMMISSIONERS
WEB D�COUI , COLORADO
ATTEST:
Weld County Clerk to th
BY.
Deputy Cler to the Board
IO D AS RM:
ounty Attorney
Date of signature /2711
William F. Garcia, Chair
Douglas,tRademach
Se n P. Conway
vn411N�1
, Pro-Tem
e6: I4SC(u iS)
2009-1019
HR0080
OS// 5/0q
MEMORANDUM
tett
Wig
DATE: April 27, 2009
TO: William F. Garcia, Chair, Board of County Comm issioruers
FROM: Judy A. Griego, Director, Human Sery
•
COLORADO RE: Memorandum of Understanding betwe'n the Weld County
Department of Human Services and Signal Behavioral Health
for Substance Abuse Treatment Service Compensation and
Service Rates
Enclosed for Board Approval is the Memorandum of Understanding between the Department
and Signal Behavioral Health for Substance Abuse Treatment Service Compensation and
Service Rates. This was presented at the Board's April 27, 2009, 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 ADAD
Additional Family Service (AFS) funds to serve eligible clients in 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.
If you have any questions, give me a call at extension 6510.
2009-1019
SIGNAL BEHAVIORAL HEALTH NETWORK TU(4931)
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
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:
I. 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, Alcohol and Drug
Abuse Division.
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
1 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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
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 10th 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) 346-7698 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 3rd 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
120 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
2 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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.
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 l(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.
3 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09 10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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, 2009 through May 31, 2010,
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, 2009 through June 30, 2010, 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.
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 —
4 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10WA/ELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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, it's employees and agents.
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 at 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;
5 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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.
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
6 of 13
G:\Department of Social Services \Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
(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
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:
7 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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.
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
8 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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
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:
William Wendt
Chief Executive Officer and General Counsel
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
9 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09 10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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
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
10 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09 10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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
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.
11 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
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.
12 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09 10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2009/2010
CHILD WELFARE CLIENTS
APPROVED BY:
Jll A) e//
MannW. vvendt, ief Executive Officer and General Counsel
SIGNAL BEHAVIORAL HEALTH NETWORK
William F. Garcia, Chair
WELD COUNTY BOARD OF COUNTY COMMISSIONERS
L (n
Jud . . Grieg d Director
WE COU DEPA TMEN F HUMAN SERVICES
/Z y&ocJ
Date
APR 2 9 2009
Date
9
Date
*****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK*****
13 of 13
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 v3 Contract Body
04152009_FINAL.doc
c QOO 9-. /C),
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, 2009 to June 30, 2010,
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 ADAD
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 3r° Wednesday of the month following the date of service. Island Grove
Regional Treatment Center 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 7
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
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 08/09 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 7
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
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).
-
jIL
80100:HF
UA- Eth I Glucuronide EtG
each
35.00
1.75
36.75
80101
UA — 5 panel
each
12.00
0.60
12.60
80101:HF
UA - 7 Panel
each
15.00
0.75
15.75
80102
UA Confirmation
each
0.00
0.00
0.00
81002
UA - Di. Stick
each
12.00
0.60
12.60
81099
UA - Soma
each
0.00
0.00
0.00
82055
UA - Oral Swab
each
15.00
0.75
15.75
3 of 7
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
nay 0911
ore Fee Schedule
rvic
C-
sa i fz�
'Sery ptionl
Breathalyzer
each
mate
5.00
Adm a
- - e
0.25
F`aYer
tee'
5.25
82075
82541
UA - GC/MS - Qualitative
each
35.00
1.75
36.75
82542
UA - GC/MS - Quantitative
each
35.00
1.75
36.75
84999
Hair Testing
each
100.00
5.00
105.00
86586
SCRAM Skin Monitor
day(s)
0.00
0.00
0.00
90801
Psychiatric Diagnostic Interview Exam
15 min.
session(s)
0.00
0.00
0.00
94664
Vapor inhalations evaluation
each
40.00
2.00
42.00
99075
Medical testimony
15 min.
session(s)
17.50
0.88
18.38
99199
Court Case Consultation
15 min.
session(s)
7.50
0.38
7.88
H0001
Evaluation
each
144.00
7.20
151.20
H0002:TN
Evaluation: Rural
15 min.
session(s)
16.67
0.83
17.50
H0003:HF
UA w/ TX
each
0.00
0.00
0.00
H0004
Individual Counseling
15 min.
session(s)
17.50
0.88
18.38
H0004:TN
Individual Counseling: Rural
15 min.
session(s)
0.00
0.00
0.00
H0005
Group Counseling
15 min.
session(s)
6.25
0.32
6.57
H0005:TN
Group Counseling: Rural
15 min.
session(s)
15.00
0.75
15.75
H0006
Case Management
15 min.
session(s)
0.00
0.00
0.00
H0011
Detox
day(s)
150.00
7.50
157.50
H0018:HA
Intensive Short -Term
Residential:Adolescent
day(s)
228.00
11.40
239.40
H0018:HB
Intensive Short -Term Residential:Adult
day(s)
170.00
8.50
178.50
H0019
Transitional Long -Term Residential
day(s)
96.00
4.80
100.80
H0019:HA
Transitional Long -Term
Residential:Adolescent
day(s)
0.00
0.00
0.00
H0019:HD
Transitional Long -Term
Residential:Preg/Parent (NDF)
day(s)
175.00
8.75
183.75
H0020
Opiod Replacement (Methadone)
month(s)
415.00
20.75
435.75
H0048
Drug Patch Confirmation
each
0.00
0.00
0.00
H0048:HF
Drug Patch Monitoring
each
50.00
2.50
52.50
H2012:HA
Day Treatment:Adolescent
hour(s)
9.87
0.49
10.36
H2012:HB
Day Treatment:Adult
hour(s)
6.90
0.35
7.25
4 of 7
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
. 9 • du 9I1#1 1FS dnd'Core Fee°
.'
>a ,
H2020:HA
cDs-
Therapeutic Behavioral Srvcs:
Adolescent
Una
easured.,,v,
day(s)
131.25
125.00
6.25
H2020:HB
Therapeutic Behavioral Srvcs: Adult
w/o Infant
day(s)
59.00
2.95
61.95
H2020:HD
Therapeutic Behavioral Srvc:
Preg/Parent
day(s)
99.50
4.98
104.48
H2033
MST for juveniles
15 min.
session(s)
0.00
0.00
0.00
T1006
Family Counseling
15 min.
session(s)
20.00
1.00
21.00
J2315
Therapeutic Injection (Vivotrol)
month(s)
957.60
47.88
1,005.48
T1006:TN
Family Counseling: Rural
15 min.
session(s)
0.00
0.00
0.00
T2010
Intake
each
40.00
2.00
42.00
Signal and WCDHS acknowledge that the therapeutic injection (Vivotrol) with service code
J2315 MUST be pre -authorized by WCDHS before any provider is allowed utilization of this
service. There will be no exceptions to this rule, due to the cost of providing this service.
Signal, in accordance with federal HIPAA regulations, adopted the standard transaction code
set for all treatment services on October 16, 2003. Even though this compliance changed the
service labels and groupings shown above, the fees associated with those services have 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:
IC
C
T2048:HA
Room and Board: Adolescent: ARTS
Dail
38.12
1.91
40.03
Room and Board: Adolescent:
Ara.ahoe House
Dail
36.30
1.82
38.12
Room and Board: Adolescent:
Crossroads
Dail
0.00
0.00
0.00
Room and Board: Adolescent: North
Ran.e Behavioral Health
Dail
35.00
1.75
36.75
Room and Board: Adolescent: Sobriety
House
Dail
0.00
0.00
0.00
5 of 7
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
Vf etd County Q
' cheduie
$sN�.�
Code $
�r.x
rviDescription ,
Room and Board: Adult: ARTS
f _ ��,
Daily
16.88
0.84
17.72
T2048:HB
Room and Board: Adult: Arapahoe
House
Daily
45.23
2.26
47.49
Room and Board: Adult: Crossroads
Daily
50.00
2.50
52.50
Room and Board: Adult: North Range
Behavioral Health
Daily
36.00
1.80
37.80
Room and Board: Adult: Sobriety
House
Daily
22.00
1.10
23.10
T2048:HD
Room and Board: Preg/Parent: ARTS
Daily
16.88
0.84
17.72
Room and Board: Preg/Parent:
Arapahoe House
Daily
50.17
2.51
52.68
Room and Board: Preg/Parent:
Crossroads
Daily
75.00
3.75
78.75
Room and Board: Preg/Parent: North
Range Behavioral Health
Daily
0.00
0.00
0.00
Room and Board: Preg/Parent:
Sobriety House
Daily
0.00
0.00
0.00
*****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK*****
6 of 7
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
APPROVED BY:
William W. Wendt, Chief Executive Officer and General Counsel
SIGNAL BEHAVI AL HEALTH NETWORK
William F Garcia, Chair
WELD COUNTY BOARD OF COUNTY COMMISSIONERS
Judy 4 Griego Director
WEL n COUN DEPAR
Date
APR 2 9 2009
Date
tip 7/O
MENDOF HUMAN SERVICES Date
*****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK*****
7 of 7
G:\Department of Social Services \Contracts\Weld\Fiscal 09_10\WCDSS Exhibt A FY0910 v5
040142009_FINAL.doc
?oo 9 /O/
m
X
W
lE
C
a)
U)
a
cc
O
2
CC
O
0
C.
co
O
it
a
a
0
E
a
0
0
O
T
Y
C
O
E
L
co
a
C
01
3
a
0
0
w_
E
2
N
N
co
0
C
O
co
C
C
ra
a' a
d
O
O C
co a
L
g
O
V
Ca
C
ca
N
0
E
2
C
m
0 0
O
IC.)'5
O C
Ii•
i
a
u 'II
m _ EE
z c a d
T
= O -0 C
j m C :01
'C
0 p LL O
Reason Denied:
w
q • LL
0 W
• w
w c90 C
0 O
= w
N w
C E.
O • O
E
w • o
= E
- w
Amount Paid
Amount Billed
Denied/Additional Services Report**:
a
a
w
t
0)
0
F
Dates of Service
0
'Total Amount Denied Services:
I -
b
00
CD
N
N
A
L
0.
.
iz
A
C
1
Sponsor Name
rn
}
LL
8
m
U
E
0
2
m
w
0
0 O
9
N
O
To
0
co
`0
a)
r
N
9
CD
EXHIBIT C
William W. Wendt,
CEO/General Counsel, Director
Signal Behavioral Health Network
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, 2009 - June 30, 2010, 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 af)" day of tr; l , 2009.
tbi thr +It C
Judy AJGriegov
Director
Weld County Department of Human
Services
1 of 1
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\Weld QSOA Exhibit C v1 FY0910 03192009.doc
EXHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2009/2010
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
History
Milton Test, if needed
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
1 of 6
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 Exhibit D Scope of Services v3
04152009_FINAL.doc
EXHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2009/2010
relationships, male and female roles, and boundaries. As needed, a
Milton Test may be given, a standardized psychological test which
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.
2 of 6
G:\Department of Social Services\Contracts\Weld\Fiscal 09 10\WELD FY0910 Exhibit D Scope of Services v3
04152009_FINAL.doc
EXHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2009/2010
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. Fast Track Adolescent Program: The Fast Track Adolescent Program
is an Intensive Outpatient Program with supportive housing services if
clinically necessary. The targeted population ranges from 13 to 17 years
of age who demonstrate substance abuse problems. The goal is to have
these adolescents discover positive alternatives to their current use
behavior. The program consists of a comprehensive differential
assessment compiling personal and collateral information as well as data
obtained from the Addiction Severity Index (ASI), Substance Abuse Subtle
Screening Inventory (SASSI) and the Adolescent Self -Assessment Profile
(ASAP) instruments. This data is utilized to develop an individualized
treatment plan. Clients receive a minimum of three individual sessions
with the focus on achieving their treatment goals and attend three groups
per week and three per day if in residential with the primary focus on
education and motivational topics. Family therapy is encouraged as a part
of the client's treatment. A discharge planning session will be
implemented focusing on appropriate referrals addressing the needs and
motivation of the adolescent and family. To refer to the Fast Track
Program, Human Services will contact Program Manager of Youth
Services at (970) 356-6664, extension 16. If she/he is not on duty, inform
the staff person that Human Services is referring a Fast Track adolescent
and give the youth's caseworker's name so that the Fast Track staff can
contact the caseworker when they return to duty.
2. 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.
3. 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 ADAD menu of services.
Enhanced services may be services not described on the menu, services
3 of 6
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 Exhibit D Scope of Services v3
04152009 FINAL.doc
EXHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2009/2010
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.
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
(Code #100).
b. Improve parental capabilities currently impaired by substance
abuse (Code #101).
c. Develop the capacity to ask for help and assistance without
resorting back to substance abuse (Code #102).
d. Develop or increase the ability to recognize, prioritize and meet
child(ren)'s needs (Code #103).
4 of 6
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 Exhibit ID Scope of Services v3
04152009_FINAL.doc
EXHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2009/2010
e. Parent will identify how their substance use has affected their
parenting (Code #104).
f. Parent will identify how their substance use got them involved with
Human Services (Code #105).
g. Parent will identify how their substance use helped them parent
(Code #106).
h. Parent will identify relapse triggers and develop a safety plan for
their children (Code #107).
Parent will identify whom they consider to be a support in their
recovery (Code #108).
j. Parent will identify who will care for their children should they
relapse (Code #109).
k. Parent will identify what they enjoy about parenting sober (Code
#110).
Improve parent -child functioning to lower the risk of out of home
placement (Code #201).
m. Parent will support their children in speaking about how living in a
substance -effected family has impacted them (Code #202).
n. Parents will demonstrate increased verbal skills, empathy and
accountability with child(ren) (Code #203).
o. Parent will identify their parenting strengths (Code #204).
p. Family members including significant other, children and extended
family will increase ability to communicate more effectively (Code
#301).
q. Family members will identify how they can support the identified
client in their recovery (Code #302).
r. Family members will identify the positive parenting changes the
substance -effected person is making (Code #303).
s. Family members will identify who will care for the children in the
event of a relapse (Code #304).
t. Family members will identify relapse systems of the identified client
(Code #305).
u. Family members will identify how they can reach out for help if a
relapse occurs (Code #306).
v. Increase level of functioning currently impaired by living in a
substance affected family (Code #401).
w. Identify how living in substance effected family has impacted their
life (Code #402).
x. Improve level of functioning currently impaired by substance abuse
issues (Code #403).
y. Decrease aggressive behaviors at home and/or school and in the
community (Code #404).
z. Learn how to socialize without the use of substances (Code #405).
aa. Identify relapse triggers (Code #406).
bb. Create a sober support network (Code #407).
5 of 6
G:\Department of Social Services\Contracts\Weld\Fiscal 09 10\WELD FY0910 Exhibit D Scope of Services v3
04152009_FINAL.doc
EXHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2009/2010
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, Alcohol and Drug Abuse
Division, and the Colorado Board of Medical Examiners.
*****THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK*****
6 of 6
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WELD FY0910 Exhibit D Scope of Services v3
04152009_FINAL.doc
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2009/2010
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
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WeLd FY0910 Exhibit E v3
04152009 FINAL.doc
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2009/2010
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
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WeLd FY0910 Exhibit E v3
04152009 FINAL.doc
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2009/2010
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
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\WeLd FY0910 Exhibit E v3
04152009 FINAL.doc
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2009/2010
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
G:\Department of Social Services \Contracts\Weld\Fiscal 09_10\WeLd FY0910 Exhibit E v3
04152009 FINAL.doc
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 2009/2010
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.
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.
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
1 of 4
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\Weld FY0910 Exh F v3
04152009_FINALdoc
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 2009/2010
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 Exhibit G, 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 970.346.7698 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. 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
2 of 4
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\Weld FY0910 Exh F v3
04152009_FINAL.doc
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 2009/2010
names of clients receiving the services, and monthly progress
reports with all the information specified on Exhibit G.
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 Caseworker (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.
13. Signal, or their authorized designee, will be available for the Families,
Youth and Children (FYC) Commission review and attendance at the FYC
meetings.
3 of 4
G:\Department of Social Services\Contracts\Weld\Fiscal 09_10\Weld FY0910 Exh F v3
04152009_FINAL.doc
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 2009/2010
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
G:\Department of Social Services \Contracts\Weld\Fiscal 09_10\Weld FY0910 Exh F v3
04152009_FINAL.doc
Hello