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Home My WebLink About20051785.tiff 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, 2005, and ending May 31, 2006, 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 22nd day of June, A.D., 2005, nunc pro tunc June 1, 2005. BOARD OF COUNTY COMMISSIONERS r WELD COUNTY, COLORADO w ��MtL 861 ('..`:'L�.,. `�, William H. J: e, hair :i Vty :'Th1 Is, Clerk to the Board equip ,tr. PIPIT . J. ''l I:- em alle1Spil Deputy Clerk to the Board A S. Dav7. Long APPRO D AS TO Robert D. Mas n ounty Attorney Glenn Vaad Date of signature: 7-.57-0,5- 2005-1785 SS0032 (e ; s 5 ( !a u1� D'7 d� n s— 4 t L. DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website: www.co.weld.ca.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 WIIDO MEMORANDUM • COLORADO William H. Jerke, Chair Date: June 17, 2005 Board of County Commissioners FR: Judy A. Griego, Director, Social Services a RE: Child Protection Agreement for Services between the Weld County Department of Social Services and Signal Behavioral Health Network Enclosed for Board approval is a Child Protection Agreement for Services between the Weld County Department of Social Services (Department) and Signal Behavioral Health Network (Signal). This Agreement was reviewed at the Board's Work Session of May 31, 2005. The major provisions of the Agreement are as follows: 1. The term of the Agreement is from June 1, 2005 through May 31, 2006. 2. The source of funding is Core Services and Child Welfare Administration funding. 3. Signal is agrees to provide drug and alcohol testing and treatment services for child welfare clients through its provider, Island Grove Regional Treatment Center, according to fee charges set by Signal. 4. The Department agrees to reimburse Signal for drug and alcohol treatment services at maximum funding level of$300,000 including a 5% administrative fee of$15,000. If you have any questions, please telephone me at extension 6510. 2005-1785 Contract Number. PY 05-06-CPS-49 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 day of June 2005,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 1,2005,upon proper execution of this Agreement and shall expire May 31,2006. 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 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 3rd Wednesday of the month following the month the cost was incurred in accordance to the Trails payroll calendar. Page 1 of24 Contract Number.PY 05-06-CPS-49 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. 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 II of the Agreement. D. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability of Colorado Core Services substance abuse treatment funding to Social Services. 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 training and 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 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 with the Financial Management Requirements,program objectives,contractual terms,or reporting requirements. In the event of a forfeiture of reimbursements, 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. 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, Page 2 of 24 Contract Number. PY 05-06-CPS-49 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 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. 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. 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. Page 3 of 24 Contract Number. PY 05-06-CPS-49 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) 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 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. 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 Page 4 of 24 Contract Number.PY 05-06-CPS-49 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. 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. es`IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year �. ' ! 'tC a.. e wri e 6 Adri 01004. ^";. .. >A k to the Board COUNTY OF WELD COLORADO,BY AND THROUGH �, THE BOARD OF COUNTY COMMISSIONERS,SITTING art ,'`'� AS THE BOARD OF SOCIAL SERVICES FOR THE `r2')� WELD COUNTY DEPARTMENT OF SOCIAL SERVICES Na( Diet Clerk to the Board By William H.Jerke,Chair 'JUN 2 2 2005 APA9V1 D S TIJ�J�Ig• unty A y �. PROVED AS TO SUBST SIGNAL AUTHO' By. By ��,t'�/� • J y neg ,Direct , eld C ty Scott oemke,Board President ent ocial S ices Signal Behavioral Health Network Page 5 of 24 &e es -/25 Contract Number. PY 05-06-CPS-49 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 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. 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(8'h grade reading level: > 18;available in Spanish). Page 6 of 24 Contract Number. PY 05-06-CPS-49 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 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, Social Services will contact Program Manager of Youth Services at(970)356- 6664,extension 16. If she/he is not on duty, Page 7 of 24 Contract Number. PY 05-06-CPS-49 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 as 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 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 Social 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 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. 1) Outcome Reports as Prescribed by Social Services Quarterly Outcome reports will be provided to Social Services and will include the following: a) Number of clients served; b) Number of clients currently in each level of care; c) Number of clients that have successfully completed their treatment.This will be broken down into each level of care primary; d) Number of clients that no showed,were unsuccessfully discharged or moved to a higher level of care. This will be broken down by level of care primary; e) Number of clients served whose primary addiction is to methamphetamine; t) Number of clients served with a dual diagnosis,including the client's primary mental health diagnosis; g) Percentage of client progress delineated by each outcome objective as described under Item 5,C of the Agreement. 2) Client Objectives The Social 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. Each objective will be measured via a percentage Liken Scale to determine progress. 3) Overall Program Objectives Signal and Social 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#I00). b) Improve parental capabilities currently impaired by substance abuse(Code#101). Page 8 of 24 Contract Number.PY 05-06-CPS-49 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). 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 social 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). i) 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#I10). I) 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) Leam how to socialize without the use of substances(Code#405). aa) Identify relapse triggers(Code#406). bb) Create a sober support network(Code#407). 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. Page 9 of 24 Contract Number.PY 05-06-CPS-49 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. Signal will collect any applicable sliding scale co-pays and credit Social Services for any payments received on the monthly billing statements. 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". Page 10 of 24 Contract Number. PY 05-06-CPS-49 EXHIBIT C CORE SERVICES FEE SCHEDULE 1. General Core Services Fee Schedule Description Service Weld County Code Trails Service Provide 5.0% AFS/Core Units Description r Rate Rate Alcohol(ethanol),breath 82075 Treatment $2.00 $0.10 $2.10 Each Pkg-Low Alcohol and/or drug H0003 Treatment $12.00 $0.60 $12.60 Each screening; laboratory Pkg-Intensive analysis of specimens for presences of alcohol and/or drugs(UA) Alcohol and/or drug H0011 Detoxification $152.00 $7.60 $159.60 Day(s) services; acute Services detoxification(residential addiction program inpatient) (Detox) Alcohol and/or drug 110005 Group $6.75 $0.34 $7.09 15 services;group counseling Therapy Minutes by a clinician Alcohol and or other drug H0048:HF Patch Reading/ $50.00 $2.50 $52.50 Each testing,collection and Monitoring handling only,specimens other than blood: Substance abuse program(Drug Patch Monitoring) Alcohol and/or substance T1006 Family $25.00 $1.25 $26.25 15 abuse services: family/couple Counseling Minutes counseling Behavioral health screening H0002 Intake Fee $140.00 $7.00 $147.00 Each to determine eligibility for admission to treatment program(Evaluation) Behavioral health screening H0002:tn Substance $200.00 $10.00 $210.00 Each to determine eligibility for Abuse admission to treatment Evaluation program: Rural/out of service area(Off-Site Evaluation) Behavioral health; long term 110019 Transitional $93.00 $4.65 $97.65 Day(s) residential(non-medical, Residential non-acute care in a Treatment residential treatment program where stay is typically longer than 30 day(s),without room and board,per diem(Transitional Residential) Drug confirmation,each 80102 GCMS UA $35.00 $1.75 $36.75 Each procedure Confirmation Individual behavioral health 110004 Individual $15.00 $0.75 $15.75 15 Page 11 of 24 ...... ...._. Contract Number. PY 05-06-CPS-49 counseling and therapy Counseling Minutes Medical testimony 99075 Court $18.75 $0.94 $19.69 15 Testimony Minutes Office or other outpatient 99214 Antabuse $60.00 $3.00 $63.00 Each visit for the evaluation and Physical management of a new patient,which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity. (Antabuse Physical,new patient) Office or other outpatient 99203 Antabuse $60.00 $3.00 $63.00 Each visits for the evaluation and Physical management of an established patient,which requires at least two of these three key components: a detailed history;a detailed examination;medical decision making of moderate complexity. (Antabuse Physical, established patient) Oral medication H0033 Antabuse $2.00 $0.10 $2.10 Each administration,direct observation(Antabuse Monitoring) Vapor inhalations 94664 Other Services $40.00 $2.00 $42.00 Each evaluation Out of Region One Services Alcohol and/or drug H0020 Methadone $415.00 $20.75 $435.75 Month services; methadone administration and/or services(provision of the drug by a licensed program) Behavioral health day H2012:HB Day Treatment $6.90 $0.35 $7.25 Hour(s) treatment,per hour: Adult on behalf of program non-geriatric(Day Child Tx—Adult) Behavioral health day H2012:HA Intensive $9.87 $0.49 $10.36 Hour(s) treatment,per hour: Outpatient Child/adolescent program Services (Day Tx—Adolescent) Behavioral health: long term H0019:HD New $175.00 $8.75 $183.75 Day(s) residential(non-medical, Directions non-acute care in a Treatment residential treatment program where stay is typically longer than 30 days),without room and board,per diem; Pregnant/parenting women's program(New Page 12 of 24 Contract Number. PY 05-06-CPS-49 Directions for Family) Behavioral health;short- H0018:HB Treatment $170.00 $8.50 $178.50 Day(s) term residential(non- Services only hospital residential for treatment program)without Residential- room and board,per diem: Adult Adult program,non- geriatric(Intensive Residential—Adult) Behavioral health;short- H0018:HA Treatment $228.00 $11.40 $239.40 Day(s) term residential(non- Services only hospital residential for treatment program)without Residential- room and board,per diem: Adolescent Child-adolescent program (Intensive Residential— Adolescent) Therapeutic behavioral H2020:HB Therapeutic $59.00 $2.95 $61.95 Day(s) services;per diem: Adult Community on program,non-geriatric behalf of Child (Therapeutic Community— Adult w/out Infant) Therapeutic behavioral H2020:HA Therapeutic $125.00 $6.25 $131.25 Day(s) services,per diem: Staffing Child/adolescent program (Therapeutic Community— Adolescent) Therapeutic behavioral H2020:HD Women's $99.50 $4.98 $104.48 Day(s) services,per diem: Therapeutic Pregnant/parenting Community women's program with Infant (Therapeutic Community— Adult w/Infant) SWAB Treatment $15.00 $1.05 $15.75 Each Pkg-Moderate SWAB Treatment $45.00 $2.25 $47.25 Each Pkg-High 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 may be eligible for services through Core Service dollars,as negotiated on a case-by-case basis. Page 13 of 24 Contract Number.PY 05-06-CPS-49 EXHIBIT D ASSURANCES 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 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,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 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 Social Services and shall be maintained by Signal,in a central location and custodian, in behalf of Social 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. Page 14 of 24 Contract Number. PY 05-06-CPS-49 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, 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. Page 15 of24 Contract Number. PY 05-06-CPS-49 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. Page 16 of 24 Contract Number.PY 05-06-CPS-49 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,program area supervisor,and Ms. Elaine Furister, CPS/CAP,Core Services Specialist,at Weld County Department of Social 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 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 Operating 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. 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 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: A. Presenting problem(s)of the client/family;and B. Specific services provided;and C. Extent of client(s)participation and commitment to program;and D. Client(s)progress to date; and E. Anticipated discharge date. 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 provide completed billing forms or reports monthly to Ms.Elaine Furister,CPS/CAP,Core Services Specialist,that are consistent with Trails,and county,administration and reporting requirements, by the 3`d Wednesday of the month following service in order to receive payment. 9. 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. Page 17 of 24 Contract Number. PY 05-06-CPS-49 10. 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. A. The billing must be an original billing signed by the provider and/or designee. 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: 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 names of clients receiving the services. 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 may 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. 12. 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. 13. Signal will meet with the Social Services designated supervisor quarterly(more if needed)to review program usage and effectiveness to discuss necessary improvements to better serve families or increase referrals. 14. 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. 15. Signal,or their authorized designee,will be available for the Families,Youth and Children(FYC) Commission review and attendance at the FYC meetings. 16. 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. Page 18 of 24 Contract Number.PY 05-06-CPS-49 17. 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. 18. Social Services agrees to provide Signal with the name of a primary contact who will be responsible for interacting with Signal's data system. 19. 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. 20. 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. Page 19 of 24 Contract Number.PY 05-06-CPS-49 5310.213 (2/79) COLORADO STATE DEPARTMENT OF SOCIAL SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES 1. WELD COUNTY DATE: 2. Name of Provider 3. Address 4. City, State, Zip THE DESCRIBED SERVICE IS AUTHORIZED FOR THE CLIENT INDICATED: 5. Name of Client Household# Cat. Cat.Grp. 6. Description Sv. Code 7.APPROVAL: Caseworker Date Co.Director or Supervisor 8.TO BE COMPLETED BY PROVIDER DATE OF SERVICE 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 COUNTY DEPARTMENT OF SOCIAL SERVICES INDICATED. Provider Signature Date Prepare in Triplicate,Original and One copy to Provider,One Copy for Pending File. Completed Provider's Forms-Original to County Finance Office-Copy to Case Record. 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