HomeMy WebLinkAbout20062387 RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES 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 Child Protection Agreement for Services
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 Social Services, and Signal
Behavioral Health Network,commencing June 1,2006,and ending May 31,2007,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, ex-officio Board of Social Services, that the Child Protection Agreement for
Services 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 Social 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 30th day of August, A.D., 2006, nunc pro tunc June 1, 2006.
BOARD OF C NTY COMMISSIONERS
WELD COU , COLORADO
i� `•
ATTEST: 72%`kK
M. . ile, CI-air
Weld County Clerk to the � a ` cc r
David E. Long, Pro-Tem
BY: tE (410— _
Dep Clerk the Board
William Jerk-\ ��p
APP AS TO • �� �
Robert D. Masden
oar orney EXCUSED
Glenn Vaad
Date of signature: 112/0(0
2006-2387
SS0033
09-19-0�
arill"*".N\Thie,
DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
WI ID O Fax(970)346-7663
•
COLORADO
MEMORANDUM
TO: M.J. Geile, Chair Date: August 28, 2006
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services.) ( . L-
RE: Child Protection Agreement for Services between Signal Behavioral Health
Network and the Weld County Department of Social Services
Enclosed for Board approval is a Child Protection Agreement for Services between Signal
Behavioral Health Network(Signal) and the Weld County Department of Social Services
(Department). This Agreement was reviewed at the Board's Work Session held on August 28,
2006.
The major provisions of the Agreement are as follows:
1. The term of the Agreement is June 1,2006 through May 31, 2007.
2. The Department agrees to reimburse Signal, on behalf of Island Grove Regional
Treatment Center a maximum total of$300,000 including an administrative fee of
$15,000 and according to a fee schedule.
3. Signal will provide assessments,monitored sobriety services, and treatment according to
Signal's fee schedule and through their provider, Island Grove Regional Treatment
Center.
4. The source of funding is Core Services.
If you have any questions,please telephone me at extension 6510.
2006-2387
06-07-CORE-73
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND SIGNAL BEHAVIORAL HEALTH NETWORK
This Agreement,made and entered into the 1s`day of June 2006,by and between the Board of
Weld County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services,hereinafter referred to as"Social Services,"and Signal Behavioral Health
Network,referred to as"Signal".
WITNESSETH
WHEREAS,required approval,clearance, and coordination have been accomplished from and
with appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Colorado Core Services
substance abuse treatment funding to Social Services for outpatient and residential core services for
families,children,and adolescents;and
WHEREAS, Social Services requires the services of a substance abuse treatment provider to assist
Social Services to deliver substance abuse treatment services to child welfare clients, and Signal is willing
and able to provide such services; and
WHEREAS, Signal is a Colorado non-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, in consideration of the premises,the parties hereto covenant and agree as
follows:
1. Term
This Agreement shall become effective on June 1,2006,upon proper execution of this Agreement
and shall expire May 31,2007.
2. Scope of Services
Signal network providers shall provide services to any person(s)eligible for child protection
services in compliance with Exhibit A,"Scope of Services,"a copy of which is attached hereto
and incorporated herein by reference.
3. Payment
A. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"Exhibit C,"Core
Services Fee Schedule,"and Exhibit E,"Standards of Responsibility for Core Services",
copies of which are attached hereto and incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement, which will be paid
from Colorado Core Services substance abuse treatment funding during the duration of
this Agreement. Signal,in accordance with federal HIPPA regulations,has adopted the
standard transaction code set for all treatment services on or before October 16,2003.
B. Signal shall submit an itemized monthly bill to Social Services for all costs incurred and
services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by Social Services and Signal. Requests to modify criteria must be provided
with 30 days advance notice. Signal shall submit all itemized monthly billings to Social
Services no later than the 3`d Wednesday of the month following the current month forthe
monthly invoice the cost was incurred in accordance with the Trails payroll calendar. For
rebills for services previously denied due to lack of documentation,those charges can be
submitted for payment up to 60 day in arrears of the service date.
1
06-07-CORE-73
C. Signal shall make available,on its web site,monthly billing reports in accordance with
the billing criteria established by Social Services no later than the 3`d Wednesday of the
month following the month of service. Monthly client progress reports shall be made
available by providing access to Social Services to download the reports from the Signal
database. Monthly progress reports shall include the information contained in Exhibit G.
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 enter service charges
for that client. Any incomplete progress report will be deemed incomplete and all such
associated services will not be paid.
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 to be reimbursed for
such expenses. In the event of a forfeiture of reimbursement, Signal may appeal such
circumstance to the Director of Social Services,after all remedies described in Item 11,A
of the Agreement are exhausted. The Director of Social Services shall render a decision.
The decision of the Director of Social Services may be appealed to the Board of County
Commissioners according to the provisions of Item 11 of the Agreement.
D. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the
availability of Colorado Core Services substance abuse treatment funding to Social
Services. WCDSS shall be liable for all services authorized and provided up to the date
of receipt by Signal of revocation of such authorization.
E. Social Services shall not be billed for, and reimbursement shall not be made for,time
involved in activities outside of those defined in Exhibit A, "Scope of Services"and
Exhibit C,"Core Services Fee Schedule." Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
F. Signal shall provide up to 4 hours of training, if requested by WCDSS,for Social
Services staff in accessing Signal's data and billing reports and on the use of the child
welfare referral system.
G. Signal shall provide technical support,as necessary, for Social Services staff in accessing
Signal's data and billing reports and on the use of the child welfare referral system.
4. Financial Management
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.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
A. Signal shall provide proper monthly invoices,make available by accessibility to download
off the Signal database monthly progress reports for each client incurring charges,and
verification of services performed for costs incurred in the performance of the agreement.
B. Social 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 reimbursement is withheld, Signal may appeal such
circumstance to the Director of Social Services,after all remedies described in Item 11,A
of the Agreement are exhausted. The Director of Social Services shall render a decision.
2
06-07-CORE-73
The decision of the Director of Social Services may be appealed to the Board of County
Commissioners according to the provisions of Item 11 of the Agreement.
C. WCDSS will complete the Signal remittance advice and return to Signal within 15
business days of completion of the applicable month's TRAILS payroll date. Each
remittance advice shall detail reasons for denial of any and all services. WCDSS shall
reimburse Signal for all complete services invoiced with all necessary and accurate
information included within 45 calendar days from the date of receipt of the Signal
invoice.
D. The Core Services Caseworker shall be the primary contact for receipt of Signal invoices
and the Core Payroll Clerk shall be responsible for generating the Signal remittance
advice.
6. Assurances
Signal shall abide by all assurances as set forth in the attached Exhibit D,which is attached hereto and
incorporated herein by reference.
7. 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 a seq.and its
implementing regulation,45 C.F.R.Part 80 a 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
and 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 Social Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Social 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.
3
06-07-CORE-73
8. 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. Signal shall maintain such necessary licenses, approvals,
insurance,etc.,required to properly provide the services covered by this Contract during the term
of the Contract. Any lapse in these requirements shall be reported to Social Services in writing
immediately.
9. Monitoring and Evaluation
Signal and Social Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by Signal and Social Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and Signal.
Signal shall permit Social 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
A. Signal and Social Services shall exhaust all remedies as provided in Exhibit E,"Standards of
Responsibility for Core Services",prior to the remedy provided in Item 11,B,of this
Agreement.
B. The Director of Social 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. This remittance shall be submitted to Accounting Department, 1391 Speer
Blvd., Suite 300,Denver,CO 80204,and phone number(303)639-9320. After
Signal receives such notice,Signal is given a 30 day period to cure,WCDSS may
withhold payment to Signal;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 Social
Services. Denial of the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Social 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 Social Services and Signal,or by Social
Services as a debt due to Social Services or otherwise as provided by law.
4
06-07-CORE-73
C. Signal may appeal the decision of the Director of Social Services or designee,as provided in
Item 11,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.
12. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated
representatives of the respective parties. Either party may from time to time designate in writing a
new or substitute representative(s):
For Social Services:
Gloria Romansik Social Services Administrator
Name Title
For Signal:
Bill Wendt Chief Executive Officer, Signal
Name Title
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered
mail to the individuals at the addresses set forth below. Either party may from time to time
designate in writing a substitute person(s)or address to whom such notices shall be sent:
To: Social Services To: Signal
Judy A.Griego,Director Bill Wendt,CEO
P.O.Box A 1391 Speer Blvd.,Suite 300
Greeley,CO 80632 Denver,CO 80204
14. Litigation
Signal shall promptly notify Social 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 Social Services Director. The term"litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy,reorganization and/or
foreclosure.
15. 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 10 and Item 15. Signal
reserves the right to suspend services to clients if funding is no longer available. Social Services
acknowledges financial responsibility for clients authorized under the terms of the Agreement.
5
06-07-CORE-73
16. Entire Agreement
This Agreement,together with all attachments hereto, constitutes the entire understanding between
the parties with respect to the subject matter hereof, and may not be changed or modified except as
stated in Paragraph 10 herein.
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,
and ye trst a 'tt
ATTEST: �
Weld County Clerk to the Board ,\ E L�1J �� TY OF WELD COLORADO,BY AND
S UGH THE BOARD OF COUNTY
,��� ♦e".t ISSIONERS,SITTING AS THE BOARD OF
` tb6t
SERVICES FOR THE WELD COUNTY
` TMENT OF SOC AL SERVICES
By: 1 t c 1
��.ury Cle to the Boar. 64 • ---` ,il\�
¶iC
" iivvll J. eile,Char AUG 3 0 2006
APP AS TO F
a ./ -
ty Ara ey
APPROVED AS TO SUBSTANCE SIGNAL AUTHORIZED REPRESENTATIVE:
By: / �� By \11\ i; ♦ tio
Ju A.Gri go,Dirk tor,W Id County :J'bhn T.Brewster:Bparcjyresident
e artme t of Soci Servic s Signal Behavioral Health Network
6
CCE - a?i-97
06-07-CORE-73
EXHIBIT A
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.
Baseline Urinalysis Testing(7-Panel)is included. Summary of assessment with
recommendations sent to referral agency. Tests determine what drugs, if any,are present in
client.
The 7-Panel baseline urinalysis test for alcohol and drugs screens for the following:
THC Cutoff Level: 50 ng/ml
Amphetamines Cutoff Level: 1000 bg/ml
Cocaine Cutoff Level: 300 ng/ml
Barbiturates Cutoff Level:200 ng/ml
Benzodiazepines Cutoff Level:200 ng/ml
Opiates Cutoff Level: 200 ng/ml
Creatinine >20 mgDL is normal
The 3-Panel baseline urinalysis test screens for: Amphetamines,THC,and Cocaine,with
the same cutoff levels set forth above.
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 Millon 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,Millon 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 Millon 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).
7
06-07-CORE-73
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(CAIN),and a personalized feedback report.
C. Special Program Option
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 if in
outpatient treatment and three per day if in residential treatment 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.
8
06-07-CORE-73
To refer to the Fast Track Program, Social 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 Social 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 are approved services that are requested by
Social 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 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 may 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 Social Services
may 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 Social 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.
F. Staff Qualifications
Signal staff members who will provide services to Social 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.
Signal staff members will provide a copy of their resume or curriculum vitae,which shall include
their credentials and/or certifications,upon request by Social Services.
9
06-07-CORE-73
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Social Services agrees to reimburse to Signal in consideration for the work and services
performed, a total amount not to exceed Three Hundred Thousand Dollars($300,000.00)under
Core Services Funding. Of this total amount, Social Services agrees to pay an administrative fee
not to exceed Fifteen Thousand($15,000.00)or five percent of the service fees,salaries, and other
authorized costs that are actually incurred in the delivery of the treatment services authorized in
this Agreement.
Expenses incurred by Signal, in association with said project prior to the term of this agreement,
are not eligible Social Services expenditures and shall not be reimbursed by Social Services.
Payment pursuant to this Contract,if Colorado Core Services substance abuse treatment funding,
whether in whole or in part, is subject to and contingent upon the continuing availability of
Colorado Core Services substance abuse treatment funding for the purposes hereof. In the event
that said funds,or any part thereof,become unavailable as determined by Social Services, Social
Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services
Social Services agrees to pay for services according to Exhibit A,"Scope of Services", and
according to the fees described in Exhibit C,"Core Services Fee Schedule".
Social Services referrals will not be sent to collections by Signal for default of co-pay/fees.
Services will be performed regardless of client's refusal or inability to pay co-pay.
The Sliding Fee Schedule will only be applied to those services as noted in Exhibit C,"Core
Services Fee Schedule",all other fees will be charged directly to Social Services.
If a client is deemed to be Medicaid eligible,and Island Grove Regional Treatment Center is
authorized and prepared to accept Medicaid clients,Social Services will be notified and all eligible
substance abuse treatment and monitoring services will immediately begin to be billed to
Medicaid and not to Social Services. If Social Services becomes aware of Medicaid eligibility for
a client,they will immediately notify Island Grove Regional Treatment Center, in writing. At that
time, Medicaid billing will begin for any services the client receives at Island Grove Regional
Treatment Center.
3. Submittal of Vouchers
Signal shall prepare and submit monthly the itemized voucher according to the criteria listed under
Exhibit E,"Standards of Responsibility for Core Services",and certify that the services authorized
were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A,"Scope of Services", and Exhibit C,"Core Services Fee Schedule".
10
06-07-CORE-73
EXHIBIT C
CORE SERVICES FEE SCHEDULE
1. General Core Services Fee Schedule
HIPAA HIPAA Base Admin Payer
Service Code Unit Rate Fee Rate
Antabuse Monitoring H0033 Each $2.00 $0.10 $2.10
Antabuse Physical -
Existing Client 99214 Each $60.00 $3.00 $63.00
Antabuse Physical- New
Client 99203 Each $60.00 $3.00 $63.00
Breathalyzer 82075 Each $2.00 $0.10 $2.10
15 minute
Case Management H0006 session(s) N/A N/A N/A
Day
Treatment:Adolescent H2012:HA hour(s) $9.87 $0.49 $10.36
Day Treatment:Adult H2012:HB hour(s) $6.90 $0.35 $7.25
Detox—OP H0012 day(s) N/A N/A N/A
Detoxification H0011 day(s) $185.00 $9.25 $194.25
Drug Patch Confirmation H0048 Each N/A N/A N/A
Drug Patch Monitoring H0048:HF Each $35.00 $1.75 $36.75
15 minute
Evaluation H0002 session(s) $11.67 $0.58 $12.25
15 minute
Evaluation:Out of Area H0002:TN session(s) $16.67 $0.83 $17.50
15 minute
Family Counseling T1006 session(s) $25.00 $1.25 $26.25
15 minute
Group Counseling H0005 session(s) $6.75 $0.34 $7.09
Hair Testing 84999 Each N/A N/A N/A
15 minute
Individual Counseling H0004 session(s) $15.00 $0.75 $15.75
Intake T2010 Each N/A N/A N/A
Intensive Short-Term
Residential:Adolescent H0018:HA day(s) $228.00 $11.40 $239.40
Intensive Short-Term
Residential:Adult H0018:HB day(s) $170.00 $8.50 $178.50
15 minute
Medical testimony 99075 session(s) $18.75 $0.94 $19.69
Multisystemic therapy for 15 minute
juveniles H2033 session(s) N/A N/A N/A
Opiod Replacement
(Buprenorphine) J0592 Month(s) N/A N/A N/A
Opiod Replacement
(Methadone) H0020 Month(s) $415.00 $20.75 $435.75
Prevention Information 15 minute
Dissemination H0024 session(s) N/A N/A N/A
Psychiatric Diagnostic 15 minute
Interview Exam 90801 session(s) N/A N/A N/A
Skills Training and 15 minute
Development H2014 session(s) N/A N/A N/A
Therapeutic Behavioral
Srvc:Preg/Parent H2020:HD day(s) $99.50 $4.98 $104.48
11
06-07-CORE-73
Therapeutic Behavioral
Srvcs:Adolescent H2020:HA day(s) $125.00 $6.25 $131.25
Therapeutic Behavioral
Srvcs:Adult w/o I H2020:HB day(s) $59.00 $2.95 $61.95
Transitional Long-Term
Residential H0019 day(s) $93.00 $4.65 $97.65
Transitional Long-Term
Residential:Preg/Parent
(NDF) H0019:HD day(s) $175.00 $8.75 $183.75
UA-Oral Swab 82055 Each $15.00 $0.75 $15.75
UA-GCMS per drug 80101 per drug $18.00 $0.90 $18.90
UA-Soma 81099 Each N/A N/A N/A
UA w/TX H0003:HF Each $12.00 $0.60 $12.60
UA w/o TX H0003 Each $12.00 $0.60 $12.60
Vapor inhalations
evaluation 94664 Each $40.00 $2.00 $42.00
UA- Dip Stick 81002 Each N/A N/A N/A
A GC/MS will automatically be completed without additional WCDSS authorization for all substances that
test positive at initial urine drug screening.
2. Special Core Services Fee Schedule
Assessments All assessments shall include documentation of at least two collateral contacts
to confirm/refute client self-reported information
Residential Youth residential services may be billed to core,as negotiated on a case-by-
case basis.
Adult Treatment Adult treatment,case management and after care(45-60 days).
Services
Ongoing Treatment Ongoing treatment services will be assigned to funding streams according to
usage,as negotiated on a case-by-case basis.
Youth Services Youth in Conflict(YIC)cases maybe eligible for services through Core
Service dollars,as negotiated on a case-by-case basis.
12
06-07-CORE-73
EXHIBIT D
ASSURANCES
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 Social
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,nor 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 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 maintained by Signal,
in a central location and custodian, 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
13
06-07-CORE-73
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 Social 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,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 Social 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 Social Services,
a full disclosure statement setting forth the details that create the appearance of a conflict of
interest. Failure to promptly submit a disclosure statement required by this paragraph shall
constitute grounds for Social 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,
14
06-07-CORE-73
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.
15
06-07-CORE-73
EXHIBIT E
STANDARDS OF RESPONSIBILITY FOR CORE SERVICES
1. Signal and Social 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 and Ms.Andrea Shay,
Core Services Caseworker,at Weld County Department of Social Services,P. O. Box A, 315 B N
11 Avenue, Greeley,Colorado 80632,or available in its entirety to be downloaded from the Signal
database. The case management plan will include, at a minimum,goals,timelines, and
measurement of success.
2. Signal and Social Services agree to resolve level of care conflicts at the Signal/County level
through cooperation. Social Services and Signal shall attempt to resolve all levels of care conflicts
and disputes at the lowest level possible within each organization. Should Social 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 Executive Officer. Both Signal and Social
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 Social
Services until a referral from Social Services is provided to Signal prior to services rendered by
Signal.
4. Signal agrees not to accept any referral from Social Services unless the referral contains all
information required on the form and necessary for reimbursement by Social Services and
authorized for reimbursement according to Exhibit E, Item 20. 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 Social Services will be excluded as a fiscal responsibility for Signal.
5. Signal agrees to provide access to all monthly client progress reports ten(10)days 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 Exhibit G,Monthly Progress Report
6. Signal agrees to submit a final discharge summary of client outcomes to Social 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 E of this Agreement.Those expenses incurred by Signal outside of the
scope of Exhibit E requirements are not eligible Social Services expenditures and shall not be
reimbursed by Social Services.
9. Signal agrees to the definition of a complete and timely billing form for purposes of submitting an
original bill under Exhibit E, 8.A complete and timely billing form must include the following
elements.
16
06-07-CORE-73
10.
A. The billing must contain an original signature cover page.
B. The billing must include all forms designed for Core Services reimbursement and approved
by Social 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 Social Services monitoring results(UA,BA,patch,tox trap swab)by faxing
said results to Social Services at 970.346.7698 no later than 72 hours after the day of service.
C. The Department will determine billed services not eligible for payment by identifying
conflicts in the following:
I. 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 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, 11 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.
11. Signal will develop and utilize evaluation tools(pre-and post-assessment test instruments)to
collect necessary data in cooperation with Social Services staff to monitor effectiveness of
program.
12. Signal will meet with the Social 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.
13. Signal will be available to meet with Social Services staff to explain program,time lines of
response to referrals and answer questions to enhance program up to 4 hours per contract year,at
Social Services request.
14. Signal, or their authorized designee,will be available for the Families,Youth and Children(FYC)
Commission review and attendance at the FYC meetings, if requested,biannually.
15. Regarding all forms referenced herein in the Agreement, Signal shall replicate these forms in
format, content and according to the specifications of Social Services or as mutually agreed upon
by Signal and Social Services. Signal agrees to modify these treatment authorization forms
according to Social Services specifications and requirements.
17
06-07-CORE-73
16. Social Services will be responsible for electronically authorizing services to various Signal
providers and initially designating if Core funds shall be used for payment. Social Services shall
assure that the authorization will have all information required for reimbursement from the county.
Failure of the County to provide accurate information will not harm provider's ability to receive
reimbursement.
17. Social Services agrees to provide Signal with the name of a primary contact who will be
responsible for interacting with Signal's data system.
18. Social Services agrees to provide TRAILS Remittance Advice and a Signal Remittance Summary
(Exhibit G)to Signal within five(5)business days of the monthly TRAILS Core Main Payroll
date.
19. Social 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.
18
06-07-CORE-73
WELD COUNTY
AUTHORIZATION FOR CONTRACTUAL SERVICES
Date:
Provider: Billing Contact:
Phone #:
Address:
Description of Services:
Service Month / Year Charges: $
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE
INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE
CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF SOCIAL
SERVICES.
/
Printed Name of Signer Provider Signature Date
(Original signature required— no faxes)
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
Approvals:
/ /
Core Caseworker Date Director Date
AMOUNT PAYABLE: $
ANY CHANGES LISTED BELOW:
Client/ID/HEI# Billed Amt Denied Paid Reason
19
06-07-CORE-73
EXHIBIT F
SIGNAL BEHAVIORAL HEALTH NETWORK
QUALIFIED SERVICE ORGANIZATION AGREEMENT
Signal Behavioral Health Network(MSO)and Weld County Department of Social Services(Social 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 1,2006-June 30,2007,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. Agrees to undertake in resisting judicial proceedings in 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 day of ,2006.
William W. Wendt, CEO Judy Griego,Director
Signal Behavioral Health Network Weld County Department of Social Services
20
06-07-CORE-73
EXHIBIT G
MONTHLY PROGRESS REPORT FORMAT
Island Grove Regional Treatment Center, Inc.
[address]
Phone: Fax:
WELD COUNTY DSS AFS/CORE SERVICES MONTHLY REPORT FORM
To: DSS FAX: (970) 353-5215
(Caseworker's Name)
From: Telephone: (970) 313-
(Therapist's Name)
Date: Fax: (970)
Provider Name: Island Grove Regional Treatment Center Modality:
Client Name: HH#:
Month of: Year: Treatment Type:
Attitude: 1 2 3 4 5 (1 =very poor; 5=excellent)
Progress: 1 2 3 4 5
Participation: 1 2 3 4 5
Narration:
Groups Attended:
Date: Topic: Date: Topic:
Date: Topic: Date: Topic:
Date: Topic: Date: Topic:
Date: Topic: Date: Topic:
Date: Topic: Date: Topic:
Date: Topic: Date: Topic:
Date: Topic: Date: Topic:
Monitored Sobriety:
Date: Type/Result: Date: Type/Result:
Date: _ Type/Result: Date: Type/Result:
Date: Type/Result: Date: Type/Result:
Date: _ Type/Result: Date: Type/Result:
Date: _ Type/Result: Date: Type/Result:
Date: Type/Result: Date: Type/Result:
Date: Type/Result: Date: Type/Result:
Authorization for services valid: through ; requesting renewal? Yes
**Therapist affirms that the above information is true and correct:
(original signature)
21
Hello