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Home My WebLink About20221656.tiffCuhkvccd-tp4Coll q PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: February 28, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Amendment #2 with Signal Behavioral Health Network Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Amendment #2 with Signal Behavioral Health Network. On June 15, 2022, the Department entered into Agreement with Signal Behavioral Health, referenced as Tyler ID 2022-1656, to ensure high -quality substance abuse evaluation and treatment services to clients. This Agreement was amended on November 9, 2022, to add an Outpatient Program. The Department is now requesting to amend the Agreement a second time, to correct the funding source for the .5 FTE Substance Abuse and Mental Health (SAMH) Therapist who will be provided by North Range Behavioral Health (NRBH), and to clarify that this position will work with Weld County Department of Human Services (WCDHS) Clients and be co -locate at WCDHS, NRBH and in the community. I do not recommend a Work Session. I recommend approval of Amendment #2 and authorize the Chair to sign. Perry L. Buck, Pro-Tem Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; February28, 2023 5 j Page 1 Conk' �I- � Cit"-a\ 3/Z,/.2 2072- °559 031 c o 23 V -00g4 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SIGNAL BEHAVIORAL HEALTH NETWORK This Agreement Amendment, made and entered into (D'Uth day of M Q,.'ch 2023 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Signal Behavioral Health Network, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Substance Abuse Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1656, approved on July 20, 2021. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: Due to different State funding cycles, the period of performance under this Agreement will overlap. • The Original Agreement for Core Services will end on May 31, 2023. • The Original Agreement for Additional Family Service (AFS) will end on June 30, 2023. • The Original Agreement was amended on: • November 9, 2022, to amend Exhibit A, Compensation, and Exhibit C, Scope of Services. • The Amendment is identified by the Weld County Clerk to the Board of County Commissioners as document number 2022-3578. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of February 1, 2023: 1. Exhibit A — Compensation, is hereby amended as attached. 2. Exhibit C — Scope of Services, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: ""'�� v• '16" erk to the Board BY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair MAR 0 6 2323 CONTRACTOR: Signal Behavioral Health Network 6130 Greenwood Plaza Boulevard, Suite 150 Greenwood Village, Colorado 80111 By: j Daniel Darting, Chief Operating Officer Date: "b26'2°23 01Oaa SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT A - COMPENSATION Compensation WCDHS agrees to contract with Signal for a maximum of $272,180.25 from their Core Service Funding. Signal agrees to contribute a maximum of $177,819.75 annually from designated OBH Additional Family Service (AFS) funds to serve eligible clients in accordance with the terms herein. Signal's administration fee shall be calculated as five percent of the service fees, salaries, and other authorized costs that are actually incurred in the delivery of treatment services. Signal's administration fee shall obligate Signal to perform, or deliver, the responsibilities, services, and reports specifically mentioned in this agreement. Other requested services or reports may be considered outside the scope of this agreement and, therefore, subject to an additional fee. Core Service funds may be used to pay for counselor services and will be dedicated to pay for drug tests and other authorized services. AFS funds will be used to pay for a .5 FTE co -located and dedicated WCDHS Substance Abuse and Mental Health (SAMH) Therapist who will be provided by North Range Behavioral Health (NRBH). This position will work with WCDHS clients and co - locate at WCDHS, NRBH and in the community. AFS funds may be used to pay for counselor services and will be dedicated to paying for withdrawal management, outpatient, residential treatment (TRT or IRT) at AFS funded providers in the Signal network and/or for other authorized treatment services. Medicaid will be billed first when available to pay for the services. Signal will utilize Core and/or AFS monies to pay for services in cooperation with the Core Services Coordinator. The WCDHS Core Services Coordinator will initially place all clients under either Core or AFS funding source for off -site services. Any changes that switch clients to another funding source will be mutually decided by the Core Services Coordinator and Signal prior to switching the funding source. If the parties fail to agree, the procedures contained in Exhibit E, shall be followed. All services for clients that have been designated as approved for services as of 6/1/2022 for Core, or 7/1/2022 for AFS, will be billed to either funding source according to the designation in effect on 6/1/2022. WCDHS will share a list of these clients and compare with a list that Signal produces to make sure that the lists from both entities are in agreement. 1 of 8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Payment A. Responsibilities 1. Signal shall submit an itemized monthly bill to WCDHS for all costs incurred and services provided in accordance with criteria established by WCDHS and Signal. Requests to modify criteria must be provided with 30 days advance notice. Signal shall submit all itemized monthly billings to WCDHS no later than the 7th of the month following the current month the cost was incurred in accordance with the Trails payroll calendar. Monthly billings received after 60 days from the date of services my result in delay or forfeiture of payment. 2. Signal shall make available, on its web site, monthly billing reports in accordance with the billing criteria established by WCDHS no later than the 7th of the month following the month of service. Monthly client progress reports must be made available to the Core Services Caseworker, in the format provided by the Department, for download from the Signal database by the 7th of the month following the date of service. Signal's contracted providers will be required by Signal to input the monthly progress information into the Signal database prior to their ability to bill service charges for that client. Any incomplete progress report will be deemed incomplete and all such associated services will be pended. 3. Failure to submit monthly billings and/or monthly client reports in accordance with the terms of this agreement or to comply with the Financial Management Requirements, program objective or other contractual terms or program objectives 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 in accordance with the Remedies Section of this Agreement. 4. WCDHS shall not be billed for, and reimbursement shall not be made for, time involved in activities outside of those defined in Exhibit C, "Scope of Services" and this Exhibit's Fee for Reimbursement Schedule. Work performed prior to the execution of this Contract shall not be reimbursed or considered part of this Agreement. 5. Signal shall provide proper monthly invoices, make available monthly progress reports for each client incurring charges, and verification of services performed for costs incurred in the performance of the agreement. 2 of8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS AFS and Core Services Reimbursement Funding Sources AFS Core Total WCDHS dedicated provider salary and benefits $ 27,000.00 -- $27,000.00 Supplies, Supervision and Travel $2,440.00 -- $2,440.00 Subtotal-Onsite Costs $29,440.00 -- $29,440.00 Provider In -direct costs $4,710.00 -- $4,710.00 Signal administrative fee (5%) $1,707,50 -- $1,707.50 Total Onsite Costs $35,857.50 -- $35,857.50 Fee -for -service funding $135,202.14 $259,219.29 $394,421.00 Signal Fee $6,760.11 $12,960.96 $21,429.00 Total fee -for -service $141,962.25 $272,180.25 $415,850.00 Total Contract Costs $177,819.75 $272,180.25 $450,000.00 Fee -For -Service Reimbursement County Core Services and Signal AFS funding will be responsible for purchasing services in accordance with the schedule below (to a maximum funding specified in the contract language). The County and Signal acknowledge that all UA services MUST be physically monitored/observed by an individual in order for payment to be considered. The County and Signal further acknowledge that any and all monitoring beyond standard urinalysis or breathalyzer tests must be approved by the County prior to administration. 3 of 8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Service Code Value Service Code Description Unit of Measure Description Pay or Rate 80100:HF UA - Ethyl Glucuronide (EtG) Each $ 31.50 80101:AC UA - 5 Panel w/Auto-Confirmation Each $ 15.75 80101:AO UA - Optional Add -On Panel Each $ 2.10 81002 UA - Multi -panel instant Each $ 15.75 82055 Oral Swab - Lab or instant Each $ 15.75 82055:OF Oral Fluid Panel Each $ 17.85 82055:OS Oral Swab - Synthetic Cannabinoids (Spice) Each $ 36.75 82055:SC UA - Synthetic Cannabinoids (Spice) Each $ 36.75 82075 Breathalyzer Each $ 5.25 82541 GC/MS - Qualitative Each $ 36.75 82542 GC/MS - Quantitative Each $ 36.75 83000:80 Expanded Designer Stimulants - 14 panel Each $ 52.50 83000:81 MDPV & Mephedrone (Bath Salts) Each $ 36.75 84999 Hair Testing Each $105.00 94664 SUD Inhalant Drug Screen (Vapor inhalations evaluation) Each $ 63.00 99075 DEPRECATED: Medical testimony (travel, wait, prep time) 15 Minute Session(s) $ 21.00 99199 DEPRECATED: Court Case Consultation 15 Minute Session(s) $ 10.50 B0020 Beacon - Opioid Replacement (Methadone), per month Month(s) $435.75 H0001:HH Evaluation: Ill Each $262.50 H0001:II Evaluation: II Each $183.75 H0004 Individual Counseling 15 Minute Session(s) $ 31.50 H0004:HE:GT Individual Counseling w/HE:GT modifier 15 Minute Session(s) $ 31.50 H0004:HE:HF:GT Individual Counseling w/HE:HF:GT modifier 15 Minute Session(s) $ 31.50 H0005 Group Counseling Hour(s) $ 26.29 H0005:HE:GT Group Counseling Hour(s) $ 26.29 H0005:HR Group counseling: Family/Couple with client present 15 Minute Session(s) $ 26.29 H0005:HS Group counseling: Family/couple without client present 15 Minute Session(s) $ 26.25 H0006 Case Management 15 Minute Session(s) $ - 4 of 8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS H0006:HE:GT Case Management w/HE:GT modifier 15 Minute Session(s) $ - H0006:HE:HF:GT Case Management w/HE:HF:GT modifier 15 Minute Session(s) $ H0011 Detox Day(s) $315.00 H0018:HA H2036:HF:U5 H2036:HF:U7 Intensive Short -Term Residential: Adolescent Day(s) $239.40 H0018: H B H2036:HF:U5 H2036:HF:U7 Intensive Short -Term Residential: Adult Day(s) $204.75 H0019 H2036:HF:U1 Transitional Long -Term Residential Day(s) $183.75 H0019:HA Therapeutic Behavioral Srvcs: Adolescent, per diem Day(s) $131.25 H0019:HB Therapeutic Behavioral Srvcs: Adult w/o Infant, per diem Day(s) $ 61.95 H0019:HD Therapeutic Behavioral Srvcs: Preg/Parent, per diem Day(s) $104.48 H0019:HD H2036:HF:U1 Transitional Long -Term Residential: Preg/Parent (NDF) Day(s) $204.75 H0020 Opioid Replacement (Methadone), per encounter Each $ 14.52 H0038 Self-Help/Peer Services, per 15 minutes 15 Minute Session(s) $ 7.49 H0038:CG Peer Services Recovery Groups 15 Minute Session(s) $ 15.75 H0038:HE:GT Self-Help/Peer Services, per 15 minutes w/HE:GT modifier 15 Minute Session(s) $ 7.49 H0038:HE:HF:GT Self-Help/Peer Services, per 15 minutes w/HE:HF:GT modifier 15 Minute Session(s) $ 7.49 H0048:HF Drug Screen Collection w/HF Modifier (Drug Patch Monitoring) Each $ 52.50 H2012:HA Day Treatment: Adolescent Hour(s) $ 10.36 H2012:HB Day Treatment: Adult Hour(s) $ 7.25 H2033:F FFT Daily Day(s) $ 36.75 H2033:M MST Daily Day(s) $ 68.25 H3000 In -Home Addictions Treatment — Turning Point Day(s) $105.00 S9480 Intensive Outpatient Program — Turning Point Day(s) $367.50 T1006 Family Counseling Hour(s) $ 88.20 80100:HF UA - Ethyl Glucuronide (EtG) Each $ 31.50 80101:AC UA - 5 Panel w/Auto-Confirmation Each $ 15.75 80101:AO UA - Optional Add -On Panel Each $ 2.10 81002 UA - Multi -panel instant Each $ 15.75 5 of8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 82055 Oral Swab - Lab or instant Each $ 15.75 82055:OF Oral Fluid Panel Each $ 17.85 82055:OS Oral Swab - Synthetic Cannabinoids (Spice) Each $ 36.75 82055:SC UA - Synthetic Cannabinoids (Spice) Each $ 36.75 82075 Breathalyzer Each $ 5.25 82541 GC/MS - Qualitative Each $ 36.75 82542 GC/MS - Quantitative Each $ 36.75 83000:80 Expanded Designer Stimulants - 14 panel Each $ 52.50 83000:81 MDPV & Mephedrone (Bath Salts) Each $ 36.75 84999 Hair Testing Each $105.00 94664 SUD Inhalant Drug Screen (Vapor inhalations evaluation) Each $ 63.00 99075 DEPRECATED: Medical testimony (travel, wait, prep time) 15 Minute Session(s) $ 21.00 99199 DEPRECATED: Court Case Consultation 15 Minute Session(s) $ 10.50 B0020 Beacon - Opioid Replacement (Methadone), per month Month(s) $435.75 H0001:HH Evaluation: Ill Each $262.50 H0001:lI Evaluation: II Each $183.75 H0004 Individual Counseling 15 Minute Session(s) $ 31.50 H0004:HE:GT Individual Counseling w/HE:GT modifier 15 Minute Session(s) $ 31.50 H0004:HE:HF:GT Individual Counseling w/HE:HF:GT modifier 15 Minute Session(s) $ 31.50 H0005 Group Counseling Hour(s) $ 26.29 H0005:HE:GT Group Counseling Hour(s) $ 26.29 H0005:HR Group counseling: Family/Couple with client present 15 Minute Session(s) $ 26.29 H0005:HS Group counseling: Family/couple without client present 15 Minute Session(s) $ 26.25 H0006 Case Management 15 Minute Session(s) $ H0006:HE:GT Case Management w/HE:GT modifier 15 Minute Session(s) $ H0006:HE:HF:GT Case Management w/HE:HF:GT modifier 15 Minute Session(s) $ H0011 Detox Day(s) $315.00 H0018:HA Intensive Short -Term Residential: Adolescent Day(s) $239.40 H0018:HB Intensive Short -Term Residential: Adult Day(s) $204.75 6 of8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS H0019 Transitional Long -Term Residential Day(s) $183.75 H0019:HA Therapeutic Behavioral Srvcs: Adolescent, per diem Day(s) $131.25 H0019:HB Therapeutic Behavioral Srvcs: Adult w/o Infant, per diem Day(s) $ 61.95 H0019:HD Therapeutic Behavioral Srvcs: Preg/Parent, per diem Day(s) $104.48 H0019:HD Transitional Long -Term Residential: Preg/Parent (NDF) Day(s) $204.75 H0020 Opioid Replacement (Methadone), per encounter Each $ 14.52 H0038 Self-Help/Peer Services, per 15 minutes 15 Minute Session(s) $ 7.49 H0038:CG Peer Services Recovery Groups 15 Minute Session(s) $ 15.75 H0038:HE:GT Self-Help/Peer Services, per 15 minutes w/HE:GT modifier 15 Minute Session(s) $ 7.49 H0038:HE:HF:GT Self-Help/Peer Services, per 15 minutes w/HE:HF:GT modifier 15 Minute Session(s) $ 7.49 H0048:HF Drug Screen Collection w/HF Modifier (Drug Patch Monitoring) Each $ 52.50 H2012:HA Day Treatment: Adolescent Hour(s) $ 10.36 H2012:HB Day Treatment: Adult Hour(s) $ 7.25 H2033:F FFT Daily Day(s) $ 36.75 H2033:M MST Daily Day(s) $ 68.25 H3000:HL In -home Addictions Treatment: High Level Day(s) $ 56.00 H3000:LL In -home Addictions Treatment: Low Level Day(s) $ 28.00 T1006 Family Counseling Hour(s) $ 88.20 Signal, in accordance with Federal HIPAA regulations, adopted a standard transaction code set for all treatment services on October 16, 2003, which are subject to change throughout each contract year. Even though this compliance changed the service labels and groupings (shown above), the net amount of the fees associated with those services has not changed. 7of8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS The following services are available exclusively through AFS funds and must be purchased in conjunction with the residential treatment services described in the fee -for - service schedule above: Service Code Service Code Description Units Measured Payer Rate S9976:HB Room & Board: Adult: Daily $94.50 S9976:HD Room & Board: Preg/Parent: RESADA Daily $94.50 8 of 8 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT C - SCOPE OF SERVICES A. IN -HOME ADDICTION TREATMENT PROGRAM Turning Point Substance Abuse Treatment Scope of Services for State Fiscal Year 2022- 2023 The In -Home Addictions Treatment Program (IHAT) is an intensive in -home therapy program designed to serve at -risk families that have come to the attention of the Department due to drug/alcohol concerns. Clients referred to the IHAT program typically have a mental health and/or substance abuse disorder and are continuing to struggle despite having been treated at lower levels of care such as outpatient therapy. Families served in the program often have a history that may include inpatient substance abuse treatment, trauma, criminal and/or delinquent behaviors, verbal or physical aggression, or attachment difficulties. Features of the program include: Intensive short-term treatment, averaging 4 to 5 months in duration. Two sessions per week in -home (or 1 session and phone consultation, dependent on client need). Availability of on —call services 24 hours a day 7 days a week. Case consultation with collaterals such as treatment providers (SA and MH), school personnel, probation, DHS, etc. Therapist flexibility in terms of drawing from a variety of evidence -informed treatment models including: Seeking Safety, Dialectical Behavioral Therapy, Trauma Informed Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, Solution Focused Therapy, and behavior management techniques. Drug testing of clients as therapeutically necessary. Therapist flexibility in terms of modality of treatment used (parents -only sessions, family therapy, occasional individual therapy, or some of each). Focus of treatment that is highly parent/family oriented and interventions designed to be sustainable for the family. Support in linking to other therapeutic services as appropriate including coaching, medication evaluation and management, substance abuse treatment, DBT programming, trauma focused services, etc. Integrating social supports into family treatment planning. Establishing positive daily life routines. Develop family stable patterns: Rules, Roles, Rituals, Routines, Relationships (Barnes, 1995). Additional interventions for parents of delinquent adolescents around monitoring/supervision, holding youth accountable for behavior and choices, and therapists will collaborate closely with the juvenile justice system. 1 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Rate of Payment (to Turning Point) and Service Description: (Associated with H3000 in attached Exhibit A - Compensation) Service Rate I HAT $105/day B. CO -LOCATED AND DEDICATED WCDHS SUBSTANCE ABUSE AND MENTAL HEALTH (SAMH) THERAPIST North Range Behavioral Health (NRBH) will provide a .5 FTE CAS Certified, Master's Level Substance Abuse and Mental Health (SAMH) Therapist to work with WCDHS clients. The SAMH Therapist will be co -located at WCDHS, NRBH and in the community. The SAMH Therapist will provide case consultation, integrated assessments, therapy and case management services for clients within the WCDHS Child Welfare Division, to include: Maintaining a caseload of 6-10 adults and juvenile clients to include service planning and follow up. Completing substance abuse evaluations on adults and juveniles using the ASAM assessment tool. Conducting short term safety plans for both adults and juveniles. Participate in the discharge and relapse prevention planning with the client, caseworker, and service team. Completing monthly data that will be provided to WCDHS and Signal. Attending agency specific meetings when requested meetings include (TDM's, FTM's, Group Supervision, etc.) Providing consultation and services to caseworkers, supervisors, and Weld County staff. Attending WCDHS staffings with the caseworker and report on progress on the adult and/or juvenile. 2of10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Goals of service: Immediate access to casework staff for case consultation and/or meeting with clients. • Same week access to integrated assessments. • Same week referral to NRBH for other services. • Problem -solving systems issues, including delayed appointments, lack of client engagement, miscommunication between caseworkers and clinical staff. Outcome of Services: • Reduced length of time from referral to intake and assessment. • Increased communication between caseworkers and clinical staff. • Thorough assessments to include recommendations necessary for parents to safely maintain children at home or to engage in treatment so that children can safely return home. C. ASSESSMENTS 1. Alcohol and Drug Differential Assessment (3 -Hours) Assessment will evaluate alcohol/drug involvement as well as mental health status, history of mental health issues, sexual history, legal history, and certain standard tests (ASAP, ASAM PPC-2, ASI, SOCRATE, AODUI, Drinking History Questionnaire, Family Environment Scale) may be given. Signal will provide two collateral contacts as part of the Assessment. 2. Co -Occurring Alcohol and Drug with Domestic Violence Assessment (3 - Hours) Summary of assessment with recommendations sent to referring agency. The following areas will be assessed: Criminal History Profile of Client's Violent Behaviors Potential for Violence Mental Health Status Client's Medical History Substance Abuse History Suicidal/Psychological/Cultural History Millon Test, if needed 3. Substance Abuse Forensic Evaluation (3 hours, as staff expertise permits) A forensic evaluation is specifically geared toward the substance -abusing offender. It involves additional testing to determine the criminogenic aspect of the person to be taken into consideration when developing treatment 3 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS recommendations. Testing will be comprised of CVI, ASUS, SASS', Milton Clinical Multiaxial Inventory (MCMI-III), a clinical interview, and a behavioral profile. The testing is cross-referenced with the clinical interview, and in relation to collateral data. 4. Evaluation: II - Level II Assessment A Level II Assessment is the initial diagnostic interview enrolling a client in services. It is conducted by a Master's Level Therapist (OR AT THE MINIMUM A CAC II OR III). A Level II is typically completed in 1-1.5 hours. Areas addressed: Referral information and Chief Complaint / Precipitating Event(s) Presenting Problem Psychosocial History Legal History Abuse and/or Victimization History Strengths, Resources and Needs Prior Treatment History Drug and Alcohol History and Assessment Medical History Mental Status DSM Diagnosis and Rationale Risk Assessment Level of Care Assessment Disposition and Recommendations for treatment 5. Evaluation: Ill - Level III Assessment In addition to all areas identified in the Level II assessment, a Level III may include the use of assessment tools and/or include extensive history review and collateral input as appropriate. A Level III Assessment is always completed by a dually trained and credentialed (license and certification) Behavioral Health Therapist so that, if necessary, he or she can act as an expert witness. A Level III is typically completed over the course of 2-3 hours. All Co -Occurring Alcohol or Drug with Domestic Violence or Anger Management assessments will be billed at the Evaluation: III rate. The primary difference between a Level II and Level III assessment is the amount of time involved (2-3 hours for a Level III versus 1-2 hours for a Level II). A Level III assessment requires more time and is more in-depth than a Level II assessment. A Level III assessment also includes more lengthy documentation, typically will involve more collateral contacts, and is suitable for court purposes. Both assessments assess substance abuse and mental health issues/concerns. However, we do not dictate which tools are used for each Level of assessment. As indicated in the contract, a Level III 4 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS assessment is always conducted by a duly trained and certified/licensed individual who can act as an expert witness if necessary. Level III assessments are typically requested by outside agencies for the purposes of obtaining clear information on treatment recommendations and prognoses (e.g., likelihood of continued risky behaviors). Collateral information/contacts are required (not just typical) in order to better understand the reason for the referring parties request for an evaluation, and a more formal written report is provided (e.g., no abbreviations or jargon, more comprehensive psychosocial history) so the referral source better understands the issues, and treatment recommendations and prognoses (e.g., likelihood of continued risky behaviors) are more formally addressed, as they pertain to the reason for the referral. Formal psychological testing is not administered for a Level Ill assessment. D. TREATMENT OPTIONS 1. Co -Occurring Alcohol and Drug with Domestic Violence Group Therapy (average length of treatment, 24 to 36 weeks): Groups for both men and women are offered. The group addresses anger management, healthy relationships, male and female roles, and boundaries. As needed, a Milton Test may be given, a standardized psychological test which measures functioning level in 22 personality disorders and clinical syndromes for adults (810 grade reading level: > 18; available in Spanish). 2. Family Therapy (average length of treatment, 8 to 16 sessions): Involves two or more family members and provides therapeutic intervention to improve family communications, functioning, and relationships. Length of participation is dependent on client goals and progress toward meeting goals. 3. Individual Counseling (average length of treatment, 6 to 12 sessions): Primary client is seen on an individual basis. Length of participation is dependent on client goals and progress toward goals. 4. Substance Abuse Therapy (average length of treatment, 12 to 20 sessions): A group to enhance positive coping skills by focusing on their lifestyle dealing with use and abuse of chemicals. 5. Adult Intensive Outpatient (average length of treatment, 4 to 12 weeks): An intensive outpatient group therapy track that offers groups every evening, Monday through Friday, with a family program component. This program will include medical aspects of addiction and adult relapse education components focusing on understanding the relapse process as well as group process (focuses on individual issues relating to their abuse 5 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS of alcohol). The program length and participation level will be individualized based on the presenting issues and other factors. 6. Women's Group (average length of treatment, 12-20 sessions): A gender -specific group addressing issues affecting women and their relationships, such as family violence, co-dependency, self-esteem, and stress management. 7. Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users (MET/CBT5 average length of treatment 5-8 weeks): The MET/CBT5 is a brief treatment approach for cannabis abusing adolescents. Treatment consists of two individual motivational enhancement therapy sessions (MET) Sessions, followed by participation in three group cognitive behavioral therapy (CBT) sessions. The assessment includes a psychosocial history and data from the Global Assessment of Individual Needs (GAIN), and a personalized feedback report. 8. Adolescent Intensive Outpatient (length of treatment - 3 to 12 weeks): This intensive outpatient track offers therapy and education groups utilizing the Matrix Model for Youth and Young adults' curriculum. Groups are offered Monday through Friday. This program also provides individual and family therapy as well as family group therapy. Topics addressed include the medical aspects of addiction and relapse -prevention education focusing on understanding the relapse process. The program length and participation level will be individualized based on the presenting issues and other factors. E. SPECIAL PROGRAM OPTION 1. Special Connections (through pregnancy and up to one year postpartum): A gender -specific program that focuses on healthy babies, appropriate childcare, 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. F. MISCELLANEOUS SERVICE OPTIONS 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. 6 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 2. Enhanced Services: Enhanced services, as approved services that are requested by WCDHS for specific cases, which fall outside of the definitions, listed above in the description of the DBH menu of services. Enhanced services may be services not described on the menu, services not included in the definition or due to lack of economy of scale, or rural location, or result in additional costs to Signal. In order for Signal to provide enhanced service, the cost would be outside of the approved rates. Any additional fees would be negotiated on a case -by -case basis. Signal can arrange for services outside of the approved definitions, but WCDHS will be charged an additional fee that would be negotiated on a case -by -case basis by the designated representative listed in the contract. G. MEASURABLE OUTCOMES AND OBJECTIVES Signal shall abide by WCDHS outcome indicators of Safety, Permanency and Child and Family Well -Being, which are provided under Adoption and Safe Families Act (ASFA), 1997; Colorado Child and Family Services Plan 2000 —2004; and ACF Reviews (Reference: Federal Register, Volume 65, Number 16: 45 CRF Parts 1355, 1356, and 1357), March 25, 2000. 1. Outcome Reports as Prescribed by Human Services 2. Outcome reports will be developed and provided as mutually agreed upon by the parties. 3. Client Objectives The WCDHS caseworker will identify a maximum of three child welfare objectives to be addressed within each client's treatment plan. Signal shall develop action steps to reach the identified child welfare objectives. Signal shall report monthly on each client's progress in meeting the three identified objectives while the client is receiving treatment services. 4. Overall Program Objectives Signal and WCDHS 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 monitoring only. b. Improve parental capabilities currently impaired by substance abuse. c. Develop the capacity to ask for help and assistance without resorting back to substance abuse. d. Develop or increase the ability to recognize, prioritize and meet child(ren)'s needs. e. Parent will identify how their substance use has affected their parenting. 7 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS f. Parent will identify how their substance use got them involved with Human Services. g. Parent will identify how their substance use helped them parent. h. Parent will identify relapse triggers and develop a safety plan for their children. i. Parent will identify whom they consider to be a support in their recovery. j. Parent will identify who will care for their children should they relapse. k. Parent will identify what they enjoy about parenting sober. I. Improve parent -child functioning to lower the risk of out of home placement. m. Parent will support their children in speaking about how living in a substance -effected family has impacted them. n. Parents will demonstrate increased verbal skills, empathy and accountability with child(ren). o. Parent will identify their parenting strengths. p. Family members, including significant other, children and extended family will increase ability to communicate more effectively. q. Family members will identify how they can support the identified client in their recovery. r. Family members will identify the positive parenting changes the substance -effected person is making. s. Family members will identify who will care for the children in the event of a relapse. t. Family members will identify relapse systems of the identified client. u. Family members will identify how they can reach out for help if a relapse occurs. v. Increase level of functioning currently impaired by living in a substance affected family. w. Identify how living in substance affected family has impacted their life. x. Improve level of functioning currently impaired by substance abuse issues. y. Decrease aggressive behaviors at home and/or school and in the community. z. Learn how to socialize without the use of substances. aa. Identify relapse triggers. bb. Create a sober support network. H. STAFF QUALIFICATIONS Signal staff members who will provide services to WCDHS clients will have credentials and/or certifications as required by the Colorado Department of Human 8 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Services, Colorado Board of Education, Division of Behavioral Health, and the Colorado Board of Medical Examiners. I. Intensive Outpatient Program Turning Point's Intensive Outpatient Program (IOP) is designed to provide a high level of treatment intervention to support youth in their home and community. Trauma -informed care is provided in group, individual, and family/caregiver settings. The program includes treatment for substance use and mental health needs for youth 12-17 years of age. The youth/family referred will have opportunities to engage in: Individual therapy individualized to each youth's needs. This can be Trauma Focused Cognitive Behavioral Therapy, or they will be paired with an Addiction Specialist for substance use treatment. Group Therapy focusing on building skills, understanding symptoms, emotional intelligence, resiliency, relapse prevention, and other relevant TF-CBT or Addiction topics. Family Therapy to strengthen bonds, improve communication, and develop resiliency within the family and caregiver system Related case management services to link any necessary providers or services for parents and youth. Intake Assessment and bi-weekly treatment plan reviews. Ability to continue with the same therapist after successful completion of the Intensive Outpatient Program. Youth will receive 9 contact hours of service per week. This will include 1.5 hours of individual therapy, 1.5 hours of family therapy, and 6 hours of group therapy per week along with case management. The expected length of the program is approximately 6 weeks, however, can be adjusted to meet family, department, or team goals. The program goals are to: • Provide stability and support to youth and family/caregivers. • Provide a more intensive place for youth to learn and develop skills while remaining in the community. • Help youth decrease substance use. • Entry into Turning Point's continuum of care. • Strengthen family and caregiver relationships. 9of10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Program outcomes include: • Decrease the need of out of home placements through stabilizing the youth's behaviors. • Improve family and caregiver stability. • Decrease substance use. • Healing from traumatic experiences. • Continuation of care within Turning Point. Service Rates: (Associated with S9480 in attached Exhibit A - Compensation) Service Rate lOP $367.50/day 10 of 10 SIGNATURE REQUESTED: Weld/Signal 2023-24 Amendment Final Audit Report 2023-02-26 Created: By: Status: Transaction ID: 2023-02-23 Windy Luna (wluna@co.weld.co.us) Signed CBJCH BCAABAAIxoM2203YTbdVm_DRMP-NnhnWCFZC7k6 "SIGNATURE REQUESTED: Weld/Signal 2023-24 Amendment" History ,5 Document created by Windy Luna (wluna@co.weld.co.us) 2023-02-23 - 5:46:29 PM GMT El Document emailed to DANIEL DARTING (ddarting@signalbhn.org) for signature 2023-02-23 - 5:47:16 PM GMT ,5 Email viewed by DANIEL DARTING (ddarting@signalbhn.org) 2023-02-26 - 10:44:49 PM GMT 654 Document e -signed by DANIEL DARTING (ddarting@signalbhn.org) Signature Date: 2023-02-26 - 10:52:23 PM GMT - Time Source: server Agreement completed. 2023-02-26 - 10:52:23 PM GMT Powered by Adobe Acrobat Sign Contract Form New Contract Request ❑ New Entity? Entity Name* SIGNAL BEHAVIORAL HEALTH Entity ID. @00033360 Contract Name. SIGNAL BEHAVIORAL HEALTH (AMENDMENT #2) Contract Status CTB REVIEW Contract ID 6719 Contract Lead* WLIJNA Contract Lead Email wiuna`0weldgov.com;cobbx xlk@weldgov.com Parent Contract ID Requires Board Approval YES Department Project Contract Description" (CONSENT) AMENDING TO CORRECT THE FUNDING SOURCE FOR THE .5 FTE SUBSTANCE ABUSE AND MENTAL HEALTH THERAPITS, TERM: 02/01,2023 THROUGH 05, 3112023. Contract Description 2 PA ROUTING THROUGH NORMAL PROCESS AS A COURTESY. ETA TO CTB: 03+02,2023. Contract Type. AMENDMENT Amount. $0.00 Renewable. NO Automatic Renewal IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov.co Department Head Email CM-HumanServices- DeptHeadti@weidgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO RN EY OIWELDG OV.COM Requested BOCC Agenda Date* 03/082023 Due Date 03!04{2023 Will a work session with BOCC be required_?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MA enter NSA Contract ID Note; the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Base Effective Date Review Date 03;31)2023 Renewal Date Termination Notice Period Contact Information Committed Delivery Date Contact Info Contact Name Contact Type Contact Email Purchasing Purchasing Approver CONSENT Approval Process Department Head Finance Approver JAMIE ULRICH CONSENT Expiration Date* 05131/2023 Contact Phone 1 Contact Phone 2 Purchasing Approved Date 02,27/2023 Legal Counsel CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 02 27/2023 02/27,'2023 02,,27,=2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 03;06/2023 Originator WLUNA Tyler Ref # AG 030623 r1+ate + CD #C,0,1 `D.-7 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: November 1, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Amendment with Signal Behavioral Health Network Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Amendment with Signal Behavioral Health Network. The Department has an Agreement with Signal Behavioral Health to ensure the provision of high -quality substance abuse evaluation and treatment services to clients. This Agreement is known to the Board as Tyler ID 2022-1656. We are now requesting to Amend the Agreement to add an Intensive Outpatient Program, which is designed to provide a high level of treatment intervention to support youth in their home and community. Additionally, the Amendment will make updates to the In -home Addiction Treatment Program by eliminating high -end versus low -end services to only provide one level of service. Rates: Intensive Outpatient Program: $350.00 per day. In -home Addiction Treatment Program: $100.00 per day. I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair to sign. Approve Recommendation Perry L. Buck Mike Freeman, Pro-Tem Scott K. James, Chair Steve Moreno Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; November 1, 2022 — CMS ID 6427 c__1ne-r14 A�06, (I(Gd a'D 11/01/-'-2 Page 1 (Doan- lcosca HROC39c-1 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SIGNAL BEHAVIORAL HEALTH NETWORK This Agreement Amendment, made and entered into q 4-h day of neve m bet, 2022 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Signal Behavioral Health Network, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Substance Abuse Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1656, approved on June 15, 2022. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • Due to different State funding cycles, the period of performance under this Agreement will overlap. • The Original Agreement for Core Services will end on May 31, 2023. • The Original Agreement for Additional Family Service (AFS) will end on June 30, 2023. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Exhibit A — Compensation, is hereby amended as attached. 2. Exhibit C — Scope of Services is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. detateu • /m%4. COUNTY: / BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Sco . James, Chair NOV 0 0 2023 CONTRACTOR: Signal Behavioral Health Network 6130 Greenwood Plaza Boulevard, Suite 150 Greenwood Village, Colorado 80111 By: Daniel Darting, Chief Operating Officer Date: oct 2J, 2022 .2oo2a - /6 5Z SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT A - COMPENSATION Compensation WCDHS agrees to contract with Signal for a maximum of $300,000 from their Core Service Funding. Signal agrees to contribute a maximum of $150,000 annually from designated OBH Additional Family Service (AFS) funds to serve eligible clients in accordance with the terms herein. Signal's administration fee shall be calculated as five percent of the service fees, salaries, and other authorized costs that are actually incurred in the delivery of treatment services. Signal's administration fee shall obligate Signal to perform, or deliver, the responsibilities, services, and reports specifically mentioned in this agreement. Other requested services or reports may be considered outside the scope of this agreement and, therefore, subject to an additional fee. Core Service funds may be used to pay for some counselor services and some Core funds will be dedicated to pay for drug tests and other authorized services. In addition, both Core and AFS funds will be used to pay for a .5 FTE therapist who will be co - located at the WCDHS. Some AFS funds may be used to pay for some counselor services and some AFS funds will be dedicated to paying for withdrawal management, outpatient, residential treatment (TRT or IRT) at AFS funded providers in the Signal network and/or for other authorized treatment services. Medicaid will be billed first when available to pay for the services. Signal will utilize Core and/or AFS monies to pay for services in cooperation with the Core Services Coordinator. The WCDHS Core Services Coordinator will initially place all clients under either Core or AFS funding source for off -site services. Any changes that switch clients to another funding source will be mutually decided by the Core Services Coordinator and Signal prior to switching the funding source. If the parties fail to agree, the procedures contained in Exhibit E, shall be followed. All services for clients that have been designated as approved for services as of 6/1/2021 for Core or 7/1/2021 for AFS will be billed to either funding source according to the designation in effect on 6/1/2021. WCDHS will share a list of these clients and compare with a list that Signal produces to make sure that the lists from both entities are in agreement. Payment A. Responsibilities 1. Signal shall submit an itemized monthly bill to WCDHS for all costs incurred and services provided in accordance with criteria established by WCDHS and Signal. Requests to modify criteria must be provided with 30 days advance notice. Signal shall submit all itemized monthly 1 of 7 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS billings to WCDHS no later than the 7th of the month following the current month the cost was incurred in accordance with the Trails payroll calendar. Monthly billings received after 60 days from the date of services my result in delay or forfeiture of payment. 2. Signal shall make available, on its web site, monthly billing reports in accordance with the billing criteria established by WCDHS no later than the 7th of the month following the month of service. Monthly client progress reports must be made available to the Core Services Caseworker, in the format provided by the Department, for download from the Signal database by the 7th of the month following the date of service. Signal's contracted providers will be required by Signal to input the monthly progress information into the Signal database prior to their ability to bill service charges for that client. Any incomplete progress report will be deemed incomplete and all such associated services will be pended. 3. Failure to submit monthly billings and/or monthly client reports in accordance with the terms of this agreement or to comply with the Financial Management Requirements, program objective or other contractual terms or program objectives 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 in accordance with the Remedies Section of this Agreement. 4. WCDHS shall not be billed for, and reimbursement shall not be made for, time involved in activities outside of those defined in Exhibit C, "Scope of Services" and this Exhibit's Fee for Reimbursement Schedule. Work performed prior to the execution of this Contract shall not be reimbursed or considered part of this Agreement. 5. Signal shall provide proper monthly invoices, make available monthly progress reports for each client incurring charges, and verification of services performed for costs incurred in the performance of the agreement. AFS and Core Services Reimbursement Funding Sources AFS Core Total On -Site Salaries and Benefits $13,500 $13,500 $27,000 Supplies, Supervision and Travel 1,220 1,220 2,440 2 of 7 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Subtotal-Onsite Costs 14,720 14,720 29,440 Admin Fee 2,355 2,355 4,710 Total Onsite Costs 17,075 17,075 34,150 Fee -for -service funding $125,782 $ 268,639 $ 394,421 Signal Fee $ 7,143 $ 14,286 $ 21,429 Total fee -for -service $ 132,925 $ 282,925 $ 415,850 Total Contract Costs $ 150,000 $ 300,000 $ 450,000 Fee -For -Service Reimbursement County Core Services and Signal AFS funding will be responsible for purchasing services in accordance with the schedule below (to a maximum funding specified in the contract language). The County and Signal acknowledge that all UA services MUST be physically monitored/observed by an individual in order for payment to be considered. The County and Signal further acknowledge that any and all monitoring beyond standard urinalysis or breathalyzer tests must be approved by the County prior to administration. Service Code Value Service Code Description Unit of Measure Description Payor Rate 80100:HF UA - Ethyl Glucuronide (EtG) Each $ 31.50 80101:AC UA - 5 Panel w/Auto-Confirmation Each $ 15.75 80101:AO UA - Optional Add -On Panel Each $ 2.10 81002 UA - Multi -panel instant Each $ 15.75 82055 Oral Swab - Lab or instant Each $ 15.75 82055:OF Oral Fluid Panel Each $ 17.85 82055:OS Oral Swab - Synthetic Cannabinoids (Spice) Each $ 36.75 82055:SC UA - Synthetic Cannabinoids (Spice) Each $ 36.75 3 of 7 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 82075 Breathalyzer Each $ 5.25 82541 GC/MS - Qualitative Each $ 36.75 82542 GC/MS - Quantitative Each $ 36.75 83000:80 Expanded Designer Stimulants - 14 panel Each $ 52.50 83000:81 MDPV & Mephedrone (Bath Salts) Each $ 36.75 84999 Hair Testing Each $105.00 94664 SUD Inhalant Drug Screen (Vapor inhalations evaluation) Each $ 63.00 99075 DEPRECATED: Medical testimony (travel, wait, prep time) 15 Minute Session(s) $ 21.00 99199 DEPRECATED: Court Case Consultation 15 Minute Session(s) $ 10.50 B0020 Beacon - Opioid Replacement (Methadone), per month Month(s) $435.75 H0001:HH Evaluation: III Each $262.50 H0001:11 Evaluation: II Each $183.75 H0004 Individual Counseling 15 Minute Session(s) $ 31.50 H0004:HE:GT Individual Counseling w/HE:GT modifier 15 Minute Session(s) $ 31.50 H0004:HE:HF:GT Individual Counseling w/HE:HF:GT modifier 15 Minute Session(s) $ 31.50 H0005 Group Counseling Hour(s) $ 26.29 H0005:HE:GT Group Counseling Hour(s) $ 26.29 H0005:HR Group counseling: Family/Couple with client present 15 Minute Session(s) $ 26.29 H0005:HS Group counseling: Family/couple without client present 15 Minute Session(s) $ 26.25 H0006 Case Management 15 Minute Session(s) $ H0006:HE:GT Case Management w/HE:GT modifier 15 Minute Session(s) $ - H0006:HE:HF:GT Case Management w/HE:HF:GT modifier 15 Minute Session(s) $ - H0011 Detox Day(s) $315.00 H0018: HA H2036:HF:U5 H2036:HF:U7 Intensive Short -Term Residential: Adolescent Day(s) $239.40 H0018: H B H2036:HF:U5 H2036:HF:U7 Intensive Short -Term Residential: Adult Day(s) $204.75 H0019 H2036:HF:U1 Transitional Long -Term Residential Day(s) $183.75 H0019:HA Therapeutic Behavioral Srvcs: Adolescent, per diem Day(s) $131.25 4 of7 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS H0019:HB Therapeutic Behavioral Srvcs: Adult w/o Infant, per diem Day(s) $ 61.95 H0019:HD Therapeutic Behavioral Srvcs: Preg/Parent, per diem Day(s) $104.48 H0019:HD H2036:HF:U1 Transitional Long -Term Residential: Preg/Parent (NDF) Day(s) $204.75 H0020 Opioid Replacement (Methadone), per encounter Each $ 14.52 H0038 Self-Help/Peer Services, per 15 minutes 15 Minute Session(s) $ 7.49 H0038:CG Peer Services Recovery Groups 15 Minute Session(s) $ 15.75 H0038:HE:GT Self-Help/Peer Services, per 15 minutes w/HE:GT modifier 15 Minute Session(s) $ 7.49 H0038:HE:HF:GT Self-Help/Peer Services, per 15 minutes w/HE:HF:GT modifier 15 Minute Session(s) $ 7.49 H0048:HF Drug Screen Collection w/HF Modifier (Drug Patch Monitoring) Each $ 52.50 H2012:HA Day Treatment: Adolescent Hour(s) $ 10.36 H2012:HB Day Treatment: Adult Hour(s) $ 7.25 H2033:F FFT Daily Day(s) $ 36.75 H2033:M MST Daily Day(s) $ 68.25 H3000 In -Home Addictions Treatment — Turning Point Day(s) 105.00 S9480 Intensive Outpatient Program — Turning Point Day(s) 367.50 T1006 Family Counseling Hour(s) $ 88.20 80100:HF UA - Ethyl Glucuronide (EtG) Each $ 31.50 80101:AC UA - 5 Panel w/Auto-Confirmation Each $ 15.75 80101:AO UA - Optional Add -On Panel Each $ 2.10 81002 UA - Multi -panel instant Each $ 15.75 82055 Oral Swab - Lab or instant Each $ 15.75 82055:OF Oral Fluid Panel Each $ 17.85 82055:OS Oral Swab - Synthetic Cannabinoids (Spice) Each $ 36.75 82055:SC UA - Synthetic Cannabinoids (Spice) Each $ 36.75 82075 Breathalyzer Each $ 5.25 82541 GC/MS - Qualitative Each $ 36.75 82542 GC/MS - Quantitative Each $ 36.75 83000:80 Expanded Designer Stimulants - 14 panel Each $ 52.50 83000:81 MDPV & Mephedrone (Bath Salts) Each $ 36.75 84999 Hair Testing Each $105.00 5 of7 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 94664 SUD Inhalant Drug Screen (Vapor inhalations evaluation) Each $ 63.00 99075 DEPRECATED: Medical testimony (travel, wait, prep time) 15 Minute Session(s) $ 21.00 99199 DEPRECATED: Court Case Consultation 15 Minute Session(s) $ 10.50 B0020 Beacon - Opioid Replacement (Methadone), per month Month(s) $435.75 H0001:HH Evaluation: Ill Each $262.50 H0001:11 Evaluation: II Each $183.75 H0004 Individual Counseling 15 Minute Session(s) $ 31.50 H0004:HE:GT Individual Counseling w/HE:GT modifier 15 Minute Session(s) $ 31.50 H0004:HE:HF:GT Individual Counseling w/HE:HF:GT modifier 15 Minute Session(s) $ 31.50 H0005 Group Counseling Hour(s) $ 26.29 H0005:HE:GT Group Counseling Hour(s) $ 26.29 H0005:HR Group counseling: Family/Couple with client present 15 Minute Session(s) $ 26.29 H0005:HS Group counseling: Family/couple without client present 15 Minute Session(s) $ 26.25 H0006 Case Management 15 Minute Session(s) $ - H0006:HE:GT Case Management w/HE:GT modifier 15 Minute Session(s) $ H0006:HE:HF:GT Case Management vy/HE:HF:GT modifier 15 Minute Session(s) $ H0011 Detox Day(s) $315.00 H0018:HA Intensive Short -Term Residential: Adolescent Day(s) $239.40 H0018:HB Intensive Short -Term Residential: Adult Day(s) $204.75 H0019 Transitional Long -Term Residential Day(s) $183.75 H0019:HA Therapeutic Behavioral Srvcs: Adolescent, per diem Day(s) $131.25 H0019:HB Therapeutic Behavioral Srvcs: Adult w/o Infant, per diem Day(s) $ 61.95 H0019:HD Therapeutic Behavioral Srvcs: Preg/Parent, per diem Day(s) $104.48 H0019:HD Transitional Long -Term Residential: Preg/Parent (NDF) Day(s) $204.75 H0020 Opioid Replacement (Methadone), per encounter Each $ 14.52 H0038 Self-Help/Peer Services, per 15 minutes 15 Minute Session(s) $ 7.49 6 of7 SIGNAL BEHAVIORAL HEALTH. NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS H0038:CG Peer Services Recovery Groups 15 Minute Session(s) $ 15.75 H0038:HE:GT Self-Help/Peer Services, per 15 minutes w/HE:GT modifier 15 Minute Session(s) $ 7.49 H0038:HE:HF:GT Self-Help/Peer Services, per 15 minutes w/HE:HF:GT modifier 15 Minute Session(s) $ 7.49 H0048:HF Drug Screen Collection w/HF Modifier (Drug Patch Monitoring) Each $ 52.50 H2012:HA Day Treatment: Adolescent Hour(s) $ 10.36 H2012:HB Day Treatment: Adult Hour(s) $ 7.25 H2033:F FFT Daily Day(s) $ 36.75 H2033:M MST Daily Day(s) $ 68.25 H3000:HL In -home Addictions Treatment: High Level Day(s) $ 56.00 H3000:LL In -home Addictions Treatment: Low Level Day(s) $ 28.00 T1006 Family Counseling Hour(s) $ 88.20 Signal, in accordance with Federal HIPAA regulations, adopted a standard transaction code set for all treatment services on October 16, 2003, which are subject to change throughout each contract year. Even though this compliance changed the service labels and groupings (shown above), the net amount of the fees associated with those services has not changed. The following services are available exclusively through AFS funds and must be purchased in conjunction with the residential treatment services described in the fee -for - service schedule above: Service Code Service Code Description Units Measured Payer Rate S9976:HB Room & Board: Adult: Daily $94.50 S9976:HD Room & Board: Preg/Parent: RESADA Daily $94.50 7 of 7 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT C - SCOPE OF SERVICES A. IN -HOME ADDICTION TREATMENT PROGRAM Turning Point Substance Abuse Treatment Scope of Services for State Fiscal Year 2022- 2023 The In -Home Addictions Treatment Program (IHAT) is an intensive in -home therapy program designed to serve at -risk families that have come to the attention of the Department due to drug/alcohol concerns. Clients referred to the IHAT program typically have a mental health and/or substance abuse disorder, and are continuing to struggle despite having been treated at lower levels of care such as outpatient therapy. Families served in the program often have a history that may include inpatient substance abuse treatment, trauma, criminal and/or delinquent behaviors, verbal or physical aggression, or attachment difficulties. Features of the program include: Intensive short-term treatment, averaging 4 to 5 months in duration. Two sessions per week in -home (or 1 session and phone consultation, dependent on client need). Availability of on —call services 24 hours a day 7 days a week. Case consultation with collaterals such as treatment providers (SA and MH), school personnel, probation, DHS, etc. Therapist flexibility in terms of drawing from a variety of evidence -informed treatment models including: Seeking Safety, Dialectical Behavioral Therapy, Trauma Informed Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, Solution Focused Therapy, and behavior management techniques. Drug testing of clients as therapeutically necessary. Therapist flexibility in terms of modality of treatment used (parents -only sessions, family therapy, occasional individual therapy, or some of each). Focus of treatment that is highly parent/family oriented and interventions designed to be sustainable for the family. Support in linking to other therapeutic services as appropriate including coaching, medication evaluation and management, substance abuse treatment, DBT programming, trauma focused services, etc. 1 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Integrating social supports into family treatment planning. Establishing positive daily life routines. Develop family stable patterns: Rules, Roes, Rituals, Routines, Relationships (Barnes, 1995). Additional interventions for parents of delinquent adolescents around monitoring/supervision, holding youth accountable for behavior and choices, and therapists will collaborate closely with the juvenile justice system. Rate of Payment (to Turning Point) and Service Description: (Associated with H3000 in attached Exhibit A - Compensation) Service Rate I HAT $105/day B. CO -LOCATED SUBSTABCE ABUSE THERAPIST North Range Behavioral Health (NRBH) will provide a .5 FTE CAS Certified, Master's Leve Substance Abuse Therapist to be co -located at Department of Human Services, Child Welfare Division. The NRBH therapist will provide case consultation, integrated assessments, therapy and case management services for clients within the WCDHS Child Welfare Division, to include: Maintaining a caseload of 6-10 adults and juvenile clients to include service planning and follow up. Completing substance abuse evaluations on adults and juveniles using the ASAM assessment tool. Conducting short term safety plans for both adults and juveniles. Participate in the discharge and relapse prevention planning with the client, caseworker, and service team. Completing monthly data that will be provide to DHS and Signal. Attending agency specific meetings when requested meetings include (TDM's, FTM's, Group Supervision, etc.) Providing consultation and services to caseworkers, supervisors, and Weld County staff. Attending CORE staffings with the caseworker and report on progress on the adult and/or juvenile. 2 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Goals of service: • Immediate access to casework staff for case consultation and/or meeting with clients. • Same week access to integrated assessments. • Same week referral to NRBH for other services. • Problem -solving systems issues, including delayed appointments, lack of client engagement, miscommunication between caseworkers and clinical staff. Outcome of Services: • Reduced length of time from referral to intake and assessment. • Increased communication between caseworkers and clinical staff. • Thorough assessments to include recommendations necessary for parents to safely maintain children at home or to engage in treatment so that children can safely return home. C. ASSESSMENTS 1. Alcohol and Drug Differential Assessment (3 -Hours) Assessment will evaluate alcohol/drug involvement as well as mental health status, history of mental health issues, sexual history, legal history, and certain standard tests (ASAP, ASAM PPC-2, ASI, SOCRATE, AODUI, Drinking History Questionnaire, Family Environment Scale) may be given. Signal will provide two collateral contacts as part of the Assessment. 2. Co -Occurring Alcohol and Drug with Domestic Violence Assessment (3 - Hours) Summary of assessment with recommendations sent to referring agency. The following areas will be assessed: Criminal History Profile of Client's Violent Behaviors Potential for Violence Mental Health Status Client's Medical History Substance Abuse History Suicidal/Psychological/Cultural History Millon Test, if needed 3. Substance Abuse Forensic Evaluation (3 hours, as staff expertise permits) A forensic evaluation is specifically geared toward the substance -abusing offender. It involves additional testing to determine the crimogenic aspect of the person to be taken into consideration when developing treatment 3 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS recommendations. Testing will be comprised of CVI, ASUS, SASSI, Milton Clinical Multiaxial Inventory (MCMI-III), a clinical interview, and a behavioral profile. The testing is cross-referenced with the clinical interview, and in relation to collateral data. 4. Evaluation: II - Level II Assessment A Level II Assessment is the initial diagnostic interview enrolling a client in services. It is conducted by a Master's Level Therapist (OR AT THE MINIMUM A CAC II OR III). A Level II is typically completed in 1-1.5 hours. Areas addressed: Referral information and Chief Complaint / Precipitating Event(s) Presenting Problem Psychosocial History Legal History Abuse and/or Victimization History Strengths, Resources and Needs Prior Treatment History Drug and Alcohol History and Assessment Medical History Mental Status DSM Diagnosis and Rationale Risk Assessment Level of Care Assessment Disposition and Recommendations for treatment 5. Evaluation: Ill - Level III Assessment In addition to all areas identified in the Level II assessment, a Level III may include the use of assessment tools and/or include extensive history review and collateral input as appropriate. A Level III Assessment is always completed by a dually trained and credentialed (license and certification) Behavioral Health Therapist so that, if necessary, he or she can act as an expert witness. A Level III is typically completed over the course of 2-3 hours. All Co -Occurring Alcohol or Drug with Domestic Violence or Anger Management assessments will be billed at the Evaluation: III rate. The primary difference between a level II and level III assessment is the amount of time involved (2-3 hours for a level III versus 1-2 hours for a level II). A level III assessment requires more time and is more in-depth than a level II assessment. A level III assessment also includes more lengthy documentation, typically will involve more collateral contacts, and is suitable for court purposes. Both assessments assess substance abuse and mental health issues/concerns. However, we do not dictate which tools are used for each level of assessment. As indicated in the contract, a level III 4 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS assessment is always conducted by a duly trained and certified/licensed individual who can act as an expert witness if necessary. Level III assessments are typically requested by outside agencies for the purposes of obtaining clear information on treatment recommendations and prognoses (e.g., likelihood of continued risky behaviors). Collateral information/contacts are required (not just typical) in order to better understand the reason for the referring parties request for an evaluation, and a more formal written report is provided (e.g., no abbreviations or jargon, more comprehensive psychosocial history) so the referral source better understands the issues, and treatment recommendations and prognoses (e.g., likelihood of continued risky behaviors) are more formally addressed, as they pertain to the reason for the referral. Formal psychological testing is not administered for a Level III assessment. D. TREATMENT OPTIONS 1. Co -Occurring Alcohol and Drug with Domestic Violence Group Therapy (average length of treatment, 24 to 36 weeks): Groups for both men and women are offered. The group addresses anger management, healthy relationships, male and female roles, and boundaries. As needed, a Milton Test may be given, a standardized psychological test which measures functioning level in 22 personality disorders and clinical syndromes for adults (8t0 grade reading level: > 18; available in Spanish). 2. Family Therapy (average length of treatment, 8 to 16 sessions): Involves two or more family members and provides therapeutic intervention to improve family communications, functioning, and relationships. Length of participation is dependent on client goals and progress toward meeting goals. 3. Individual Counseling (average length of treatment, 6 to 12 sessions): Primary client is seen on an individual basis. Length of participation is dependent on client goals and progress toward goals. 4. Substance Abuse Therapy (average length of treatment, 12 to 20 sessions): A group to enhance positive coping skills by focusing on their lifestyle dealing with use and abuse of chemicals. 5. Adult Intensive Outpatient (average length of treatment, 4 to 12 weeks): An intensive outpatient group therapy track that offers groups every evening, Monday through Friday, with a family program component. This program will include medical aspects of addiction and adult relapse education components focusing on understanding the relapse process as well as group process (focuses on individual issues relating to their abuse 5 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS of alcohol). The program length and participation level will be individualized based on the presenting issues and other factors. 6. Women's Group (average length of treatment, 12-20 sessions): A gender -specific group addressing issues affecting women and their relationships, such as family violence, co-dependency, self-esteem and stress management. 7 Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users (MET/CBT5 average length of treatment 5-8 weeks): The MET/CBT5 is a brief treatment approach for cannabis abusing adolescents. Treatment consists of two individual motivational enhancement therapy sessions (MET) Sessions, followed by participation in three group cognitive behavioral therapy (CBT) sessions. The assessment includes a psychosocial history and data from the Global Assessment of Individual Needs (GAIN), and a personalized feedback report. 8. Adolescent Intensive Outpatient (length of treatment - 3 to 12 weeks): This intensive outpatient track offers therapy and education groups utilizing the Matrix Model for Youth and Young adults curriculum. Groups are offered Monday through Friday. This program also provides individual and family therapy as well as family group therapy. Topics addressed include the medical aspects of addiction and relapse -prevention education focusing on understanding the relapse process. The program length and participation level will be individualized based on the presenting issues and other factors. E. 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. F. MISCELLANEOUS SERVICE OPTIONS 1. Extended Detoxify Stay: This is an option when case management goals require that the person be in a stable environment until they can be referred to the next level of care. 6 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 2. Enhanced Services: Enhanced services as approved services that are requested by WCDHS for specific cases, which fall outside of the definitions, listed above in the description of the DBH menu of services. Enhanced services may be services not described on the menu, services not included in the definition or due to lack of economy of scale, or rural location, or result in additional costs to Signal. In order for Signal to provide enhanced service, the cost would be outside of the approved rates. Any additional fees would be negotiated on a case -by -case basis. Signal can arrange for services outside of the approved definitions, but WCDHS will be charged an additional fee that would be negotiated on a case -by -case basis by the designated representative listed in the contract. G. MEASURABLE OUTCOMES AND OBJECTIVES Signal shall abide by WCDHS outcome indicators of Safety, Permanency and Child and Family Well -Being, which are provided under Adoption and Safe Families Act (ASFA), 1997; Colorado Child and Family Services Plan 2000 -2004; and ACF Reviews (Reference: Federal Register, Volume 65, Number 16: 45 CRF Parts 1355, 1356, and 1357), March 25, 2000. 1. Outcome Reports as Prescribed by Human Services 2. Outcome reports will be developed and provided as mutually agreed upon by the parties. 3. Client Objectives The WCDHS caseworker will identify a maximum of three child welfare objectives to be addressed within each client's treatment plan. Signal shall develop action steps to reach the identified child welfare objectives. Signal shall report monthly on each client's progress in meeting the three identified objectives while the client is receiving treatment services. 4. Overall Program Objectives Signal and WCDHS agree to monitor the ability of the substance abuse program offered by Signal to achieve objectives as follows: a. Demonstrate Abstinence with the use of UA/Patch Monitoring Only. b. Improve parental capabilities currently impaired by substance abuse. c. Develop the capacity to ask for help and assistance without resorting back to substance abuse. d. Develop or increase the ability to recognize, prioritize and meet child(ren)'s needs. e. Parent will identify how their substance use has affected their parenting. 7 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS f. Parent will identify how their substance use got them involved with Human Services. g. Parent will identify how their substance use helped them parent. h. Parent will identify relapse triggers and develop a safety plan for their children. i. Parent will identify whom they consider to be a support in their recovery. j. Parent will identify who will care for their children should they relapse. k. Parent will identify what they enjoy about parenting sober. I. Improve parent -child functioning to lower the risk of out of home placement. m. Parent will support their children in speaking about how living in a substance -effected family has impacted them. n. Parents will demonstrate increased verbal skills, empathy and accountability with child(ren). o. Parent will identify their parenting strengths. p. Family members including significant other, children and extended family will increase ability to communicate more effectively. q. Family members will identify how they can support the identified client in their recovery. r. Family members will identify the positive parenting changes the substance -effected person is making. s. Family members will identify who will care for the children in the event of a relapse. t. Family members will identify relapse systems of the identified client. u. Family members will identify how they can reach out for help if a relapse occurs. v. Increase level of functioning currently impaired by living in a substance affected family. w. Identify how living in substance affected family has impacted their life x. Improve level of functioning currently impaired by substance abuse issues. y. Decrease aggressive behaviors at home and/or school and in the community. z. Learn how to socialize without the use of substances. aa. Identify relapse triggers. bb. Create a sober support network. H. STAFF QUALIFICATIONS Signal staff members who will provide services to WCDHS clients will have credentials and/or certifications as required by the Colorado Department of Human Services, Colorado Board of Education, Division of Behavioral Health, and the Colorado Board of Medical Examiners. 8of10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS I. Intensive Outpatient Program Turning Point's Intensive Outpatient Program (IOP) is designed to provide a high level of treatment intervention to support youth in their home and community. Trauma -informed care is provided in group, individual, and family/caregiver settings. The program includes treatment for substance use and mental health needs for youth 12-17 years of age. The youth/family referred will have opportunities to engage in: Individual therapy individualized to each youth's needs. This can be Trauma Focused Cognitive Behavioral Therapy or they will be paired with an Addiction Specialist for substance use treatment. Group Therapy focusing on building skills, understanding symptoms, emotional intelligence, resiliency, relapse prevention, and other relevant TF-CBT or Addiction topics. Family Therapy to strengthen bonds, improve communication, and develop resiliency within the family and caregiver system Related case management services to link any necessary providers or services for parents and youth Intake Assessment and bi-weekly treatment plan reviews Ability to continue with the same therapist after successful completion of the Intensive Outpatient Program. Youth will receive 9 contact hours of service per week. This will include 1.5 hours of individual therapy, 1.5 hours of family therapy, and 6 hours of group therapy per week along with case management. The expected length of the program is approximately 6 weeks, however, can be adjusted to meet family, department, or team goals. The program goals are to: Provide stability and support to youth and family/caregivers Provide a more intensive place for youth to learn and develop skills while remaining in the community • Help youth decrease substance use • Entry into Turning Point's continuum of care • Strengthen family and caregiver relationships Program outcomes include: • Decrease the need of out of home placements through stabilizing the youth's behaviors • Improve family and caregiver stability 9 of 10 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS • Decrease substance use • Healing from traumatic experiences • Continuation of care within Turning Point Service Rates: (Associated with S9480 in attached Exhibit A - Compensation) Service Rate l OP $367.50/day 10of 10 SIGNATURE REQUESTED: Weld/Signal 2022-23 Amendment (f) Final Audit Report 2022-10-27 Created: 2022-10-27 By: Alison Pegg (apegg@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAr614YYAvoUxcElylnjVZazrY9a1dGznb "SIGNATURE REQUESTED: Weld/Signal 2022-23 Amendment (f)" History 5 Document created by Alison Pegg (apegg@co.weld.co.us) 2022-10-27 - 4:22:35 PM GMT- IP address: 204.133.39.9 E 5 Document emailed to DANIEL DARTING (ddarting@signalbhn.org) for signature 2022-10-27 - 4:27:42 PM GMT 5 Email viewed by DANIEL DARTING (ddarting@signalbhn.org) 2022-10-27 - 5:04:35 PM GMT- IP address: 104.47.58.126 LI5 Document e -signed by DANIEL DARTING (ddarting@signalbhn.org) Signature Date: 2022-10-27 - 5:04:46 PM GMT - Time Source: server- IP address: 50.206.37.97 d Agreement completed. 2022-10-27 - 5:04:46 PM GMT Powered by Adobe Acrobat Sign Contract Form New Contract Request Entity Information Entity Name" SIGNAL BEHAVIORAL HEALTH Entity ID* OO003 3360 Contract Name* SIGNAL BEHAVIORAL HEALTH (AMENDMENT #1) Contract Status CTB REVIEW Contract Description" CONSENT AMENDING TO UPDATE EXHIBITS A AND C. ❑ New Entity? Contract ID 6427 Contract Lead" APEGG Contract Lead Email apegg @weldgov.com;cobbx xlkO'weldgov.com Contract Description 2 PA IS ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB 1 1 ,'3 22. Contract Type" AMENDMENT Amount $0.00 Renewable NO Automatic Renewal Department HUMAN SERVICES Department Email CM- HumanServices0weldgov.co rn Department Head Email CM-HumanServices- DeptHeadTweldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTORNEYrRWELDG OV, COM Requested 11OCC Agenda Date" 1110912022 Parent Contract ID '20221656 Requires Board Approval YES Department Project Due Date 11/05,2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Base Contras Dates Effective Date Review Date* 03131;2023 Renewal Date Termination Notice Period Contact Information Committed Delivery Date Contact Info Contact Name Contact Type Contact Email Purchasing Purchasing Approver CONSENT Approval Process Department Head Finance Approver JAMIE ULRICH CONSENT Expiration Date* 05/31/2023 Contact Phone 1 Contact Phone 2 Purchasing Approved Date 11 x03,'2022 Legal Counsel CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 11,'0312022 11,'0312022 11/03/2022 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 11/09;2022 Originator APEGG Tyler Ref # AG 110922 RESOLUTION RE: APPROVE AGREEMENT FOR SUBSTANCE ABUSE TREATMENT SERVICES AND AUTHORIZE CHAIR AND DIRECTOR OF DEPARTMENT OF HUMAN SERVICES 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 an Agreement for Substance Abuse Treatment 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 Human Services, and Signal Behavioral Health Network, commencing June 1, 2022, and ending June 30, 2023, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Agreement for Substance Abuse Treatment 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 Human Services, and Signal Behavioral Health Network, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair and the Director of the Department of Human Services, be, and hereby are, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 15th day of June, A.D., 2022, nunc pro tunc June 1, 2022. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: ddthio `e j ;,A, Weld County Clerk to the Board Deputy Clerk to the APPAS County Attorney Date of signature: CtIZO/ZCZZ' Scott K. James, Chair Lori S an, Pro-Tem cc.. S fl 7/21 /2.2 2022-1656 HR0094 Cor*iad- PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: June 6, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Substance Abuse Evaluation and Treatment Agreement - FY 2022/23 with Signal Behavioral Health Network Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Substance Abuse Evaluation and Treatment Agreement - FY 2022/23 with Signal Behavioral Health Network. Each year the Department enters into an Agreement with Signal Behavioral Health who ensures the provision of high -quality substance abuse evaluation and treatment services to clients in a delivery system of limited resources and public funding. For FY 2022-23 the rates will remain the same as outlined in the current Agreement, identified by the Weld County Clerk to the Board of County Commissioners as document No. 2021-3578. The new Agreement updates the term dates for the new fiscal year. Due to varying State funding cycles, the periods of performance within this agreement will overlap. For Core Services funding, the period of performance shall be June 1, 2022, through May 31, 2023, unless sooner terminated. For Additional Family Services (AFS) funding, the period of performance shall be July 1, 2022, through June 30, 2023, unless sooner terminated. The Department agrees to contract with Signal for a maximum of $300,000.00 in Core Services funding. Signal agrees to contribute a maximum of $150,000.00 in AFS funds, as designated by the Office of Behavioral Health (OBH), for the purpose of serving eligible clients in accordance with the terms of this agreement. I do not recommend a Work Session. I recommend approval of this Agreement and authorize the Chair to sign. Approve Schedule Recommendation Work Session Other/Comments: Perry L. Buck Mike Freeman, Pro -Tern Scott K. James, Chair Steve Moreno Lori Saine tittaaP Pass -Around Memorandum; June 6, 2022 — CMS ID 5865 P. 2022-1656 Ole/IS HOO94 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 O Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: Isaine@weld_gpv.com Website: www.co.weld.co.us In God We Trust Lori Saine Tuesday, June 7, 2022 1:40 PM Karla Ford RE: Please Reply - DHS 1 PA FOR ROUTING: CW Signal Agreement (CMS 5865) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weldgov.com> Sent: Tuesday, June 7, 2O22 9:OO AM To: Lori Saine <Isaine@weldgov.com> Subject: Please Reply - DHS 1 PA FOR ROUTING: CW Signal Agreement (CMS 5865) Importance: High Please advise if you approve recommendation. Thanks. Karla Ford ; Executive Assistant & Office Manager, Board of Weld County Commissioners 1150 0 Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford@weldgov.com:: www.weidgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-5:00p.m.** 1 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT- FY 2023 CHILD WELFARE CLIENTS This Agreement is between the Weld County Department of Human Services, hereinafter referred to as "WCDHS" and Signal Behavioral Health Network, and hereinafter referred to as "Signal." WHEREAS, the Colorado Department of Human Services has provided Colorado Core Services substance abuse treatment funding to WCDHS for outpatient and residential core services for families, children, and adolescents; and WHEREAS, WCDHS requires the services of substance abuse treatment providers to assist the County in delivering substance abuse treatment services to child welfare clients, and Signal is willing and able to coordinate and manage such services; and WHEREAS, Signal is a Colorado not -for-profit corporation organized for the purpose of managing and coordinating high quality, cost efficient, integrated chemical dependency and related behavioral health care services in the State of Colorado. NOW, THEREFORE, it is mutually agreed as follows: I. INTRODUCTION. The terms of this Agreement are contained in the terms recited in this document and in Exhibits A, B, C, D, and E, each of which forms an integral part of this Agreement. Exhibits A, B, C, D, and E are specifically incorporated herein by this reference. WCDHS and Signal acknowledge and agree that this Agreement, including specifically Exhibits A, B, C, D, and E define the performance obligations of WCDHS and Signal and the parties' willingness and ability to meet those requirements. II. SERVICES: A. Responsibilities of Signal 1. Signal agrees and desires to participate as the service provider coordinator for WCDHS qualified child welfare clients. This service is described in State CDHS Rules and Regulations Volume 7, Section 7, and the State approved Weld County Family Preservation Program/Core Service Plan. Section 7.303.1 of Volume 7 describes Core Substance Abuse Treatment Services as: diagnostic and/or therapeutic services to assist in the development of the family service plan, to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. 2. Signal will ensure the delivery of a high quality of clinical care to clients in a delivery system of limited resources and public funding. The full continuum of care (Outpatient, Intensive Outpatient, Transitional Residential, Intensive Residential, Therapeutic Community, or comparable alternatives as 1 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS mutually agreed upon) will be available to clients. The client's clinical needs will determine the level of care Signal is to provide and Signal will meet those needs regardless of "modality." 3. Signal will assure that all eligible child welfare clients referred by WCDHS in need of treatment will receive such in accordance with American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC) II R level of care, as reimbursed by the State of Colorado, Office of Behavioral Health. 4. It is the intention of WCDHS to utilize the substance abuse counselors/therapists furnished through Signal providers to provide substance abuse evaluation and treatment services for all of WCDHS qualified clients at agreed upon rates for specified services. Signal will ensure that provider therapists will provide all of the following services for Weld County clients: assessments, evaluations, standard out -patient services, enhanced out -patient services and intensive out -patient services. 5. Signal will evaluate priority service as follows: a. Signal will give priority service to child welfare clients (parents and children) who comply with the following criteria as WCDHS refers: i. Case is active on TRAILS, and ii. Case meets the State DHS program category criteria 4, 5, or 6, and, iii. Case meets the definition of "imminent risk for out -of -home placement/reunification" set forth by the State of Colorado. b. Signal will secondarily evaluate and treat ColoradoWorks, Temporary Assistance for Needy Families (TANF), and Employment First clients as referred by WCDHS. 6. Signal will include the following provisions in all subcontracts with providers: a. The Provider shall submit a treatment plan to WCDHS within 30 days. b. The Provider shall enter monthly progress reports into the Signal system no later than the 7th calendar day of the month following the month during in which the service was rendered. Services submitted without monthly progress reports will be pended for official billing and utilization against AFS funds until such reports are submitted. c. Providers will give timely notice of cancelled appointments to the clients and will reschedule such appointments as soon as practical. 2 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 7 Signal, or their designee, agrees to provide WCDHS monitoring results (UA, BA, patch, tox trap) by faxing said results to WCDHS at (970) 346-7667 or via access to online system no later than 72 hours after the day,of service 8 Signal agrees to make available Core and AFS Utilization Reports to WCDHS each month by the 7th of each month 9 Signal agrees to cooperate with WCDHS to resolve any duplicated fees and/or errors identified by the WCDHS billing review process 10 Signal will also make monthly progress reports available on its website for each WCDHS client in treatment by the 7th of the month following the date of service 11 Signal will provide training and technical support, as necessary, for WCDHS staff in accessing data and billing reports and on the use of the child welfare referral system 12 Signal shall reconcile all treatment providers' claims to AFS funds within 90 days from the date of service delivery Claims not properly submitted to Signal within this timeline will be denied 13 Signal will assure that the providers in its network give timely notice to cancelled appointments to the clients and will reschedule such appointments as soon as possible 14 Signal will collaborate with WCDHS and the providers in its network to provide quarterly reports to WCDHS which contain timelines from referral date to service start date, service length of stay, service no show rates, service completion rates and average number of outreach contacts to clients to engage them in treatment WCDHS will provide a template to the providers as requested 15 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 16 Signal agrees to comply with the Standard Procedures for Core Services as set forth in the attached Exhibit E, which iS attached hereto and incorporated herein by reference 3 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS B. Responsibilities of WCDHS. 1 WCDHS will work cooperatively with Signal and its Providers to deliver quality, efficient and cost-effective substance abuse treatment services to WCDHS qualified clients 2 WCDHS will make every effort to inform Signal and its Providers in a timely manner of system issues, developments, and complications so that Signal and the Provider can make informed choices in its role as the managed service organization and treatment agency respectively 3 WCDHS will assure that all referrals under this contract meet the eligibility criteria expressed in Section l(A)(5) above 4 WCDHS agrees to provide Signal with the name of a primary contact person who will be responsible for interacting with Signal's accounting and information systems departments 5 WCDHS, or its authorized designee(s), will be responsible for electronically authorizing services to vanous providers 6 WCDHS will review monthly AFS actual reports and determine any duplicate charges pursuant to Core or other previously paid services WCDHS will report monthly any discrepancies in duplication and/or errors to Signal, and in cooperation with Signal, work with Signal to resolve any conflicts of billed services or fees 7 WCDHS will send a remittance advice within 10 business days of completion of each month's TRAILS payroll date WCDHS shall work with Signal and other counties to develop standard claims denial cntena WCDHS shall reimburse Signal for all complete services invoiced within 45 calendar days from the date of receipt of Signal's invoice 8 WCDHS shall inform Signal of the county primary contacts along with contact information WCDHS shall provide such contact information for all contract, data and billing related matters III PERIOD OF PERFORMANCE Due to different State funding cycles, the period of performance under this Agreement will overlap For the County Core Services the period of performance shall be for the 12 -month period beginning, June 1, 2022 through May 31, 2023, unless sooner terminated The Signal Additional Family Service (AFS) period of performance under this Agreement shall be for the 12 -month period beginning July 1, 2022 through June 30, 2023, unless sooner terminated Either party hereto 4 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS may terminate this Agreement at any time by giving not less than 45 days advance written notice to the other party. As a condition of continuing to render services under this Agreement, it is understood that Signal will report any limitation or restriction of their license or insurance or the ability to perform the services covered by this Agreement under any condition of impairment. In the absence of any formal agreement beyond the term of this agreement, Signal agrees to continue providing treatment, under the terms of this agreement, for clients that are in treatment or referred by WCDHS for treatment. This is with the further understanding that service delivery and payment are subject to the termination terms mentioned above. Signal reserves the right to suspend services to clients if funding is no longer available. WCDHS acknowledges financial responsibility for all services authorized and performed before the effective date of termination. IV. COMPENSATION See Exhibit A for specific compensation which is attached hereto and incorporated by reference. V. CLIENT FEES OR CO -PAYS Neither Signal nor their network Providers shall assess a client fee or co -pay to child welfare clients served under this contract, unless the client is required to pay for any positive urine screen as a condition of their Family Service Plan or through court order for monitored sobriety and/or treatment as a condition of their treatment plan. Any such client fees or co -pays shall be outside the scope of this contract, and Signal shall have no responsibility for accounting for such fees and co -pays. VI. INDEPENDENT CONTRACTOR Signal and its providers shall be providing services hereunder as an independent contractor and the relationship of employer and employee does not exist between WCDHS and Signal. None of the provisions of this Agreement are intended to create, nor shall they be deemed or construed to create, any relationship among Signal, Providers, or WCDHS other than that of independent entities contracting solely for the purpose of effecting the provisions of this Agreement. Signal and Providers shall pay when due all required employment taxes and income withholding. taxes, shall provide and keep in force worker's compensation (and show proof of such insurance as requested) and unemployment compensation insurance in the amounts required by law, and shall be solely responsible for the 5 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS acts for Signal, its employees and agents. VII. ASSURANCES Signal shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and incorporated herein by reference. VIII. COMPLIANCE WITH APPLICABLE LAWS AND NON-DISCRIMINATION A. 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 and VII of the Civil Rights Act of 1964 and 1986 amendments, 42 U.S.C. Sections 2000d —1 et seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and Sections 503 and 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 the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963 as amended; and the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603; 42 C.F.R. Part 2 Executive Order 11246, as amended Title VII and VIII of the Public Health Services Act Vietnam Era Veteran's Readjustment Assistance Act of 1974 Non-discrimination laws of the State of Colorado. B. All regulations applicable to above referenced laws prohibiting discrimination because of race, color, national origin, and sex, religion, veteran status 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 WCDHS will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2. C. WCDHS and Signal shall sign a Qualified Service Organization Agreement in compliance with 42 CFR Part 2, and attached hereto and incorporated by reference as Exhibit B. D. Additionally, 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 6 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 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. E. 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. IX. EMPLOYMENT OR CONTRACTING WITH ILLEGAL ALIENS UNDER COLORADO LAW Signal certifies that it shall comply with the provisions of Section 8-17.5-101, et seq., C.R.S., Signal shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify to Signal that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Signal represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise comply with the requirements of Section 81- .5-102(2)(b), C.R.S. Signal shall comply with all reasonable requests made in the course of an investigation under Section 8-17,5-102, C.R.S., by the Colorado Department of Labor and Employment. If Signal fails to comply with any requirements of this provision or Section 8-17.5-101. et seq. C.R.S., Weld County may terminate this Agreement for breach and Signal shall be liable for actual and consequential damages to Contractor. Except where exempted by federal law and except as provided in Section 24-76/5- 103(3), C.R.S, if Signal receives federal or state funds under this Agreement, Signal must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to Section 24-76.5-103(4), C.R.S., if such individual applies for public benefits provided under this Agreement. If Signal operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States, or is otherwise lawfully present in the United States pursuant to federal law, (b) shall product one of the forms of identification required by Section 24-76/5-101. et seq., C.R.S., and (c) shall produce one of the forms of identification required by Section 24-76.5-103, C.R.S., prior to the effective date of this Agreement. 7 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS X. CERTIFICATIONS Signal certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc. required to properly provide the services and/or supplies covered by this contract. XI. MONITORING AND EVALUATION Signal and WCDHS agree that monitoring and evaluation of the performance of this Agreement shall be conducted by Signal and WCDHS. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners and Signal. Signal shall permit WCDHS, 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. XII. ACCESS TO RECORDS Signal, its Providers and WCDHS agree to make available in a timely manner, all books, documents, and records pertinent to this contract for the purpose of billing for services, audit, and compliance with requirements and regulations of federal and state agencies and commercial insurance carriers. Signal acknowledges that in reviewing, storing, processing, or otherwise dealing with any client records dealing with any client seen by a Signal provider or the on - site substance abuse counselor is bound by the confidentiality provisions of 42 CFR Part 2. If necessary, Signal shall resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2. XIII. MODIFICATION OF AGREEMENT All modifications to this agreement shall be in writing and signed by both parties. XIV. REMEDIES A. Signal and WCDHS shall exhaust all remedies as provided in Exhibit E, "Standards of Procedures for Core Services", if applicable, prior to pursuing any further remedies provided in this section of the Agreement. 8 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS B. The Director of WCDHS 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 that is not corrected through procedures set forth in Exhibit E. These remedial actions are as follows: Provide reasonable advance written notice of perceived failure to satisfy the scope of work. After Signal receives such notice and a reasonable opportunity to cure WCDHS may withhold payment of Signal until the necessary services or corrections in performance are satisfactorily completed; and ii. 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 WCDHS. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to WCDHS; and iii. 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 WCDHS and Signal, or by WCDHS as a debt due to WCDHS or otherwise as provided by law. C. Signal may appeal the decision of the Director of WCDHS or designee, as provided in this Section, by submitting, within thirty (30) calendar days of the Director's action, and basis of such appeal to the Board of County Commissioners. D. Should disputes remain, Signal and WCDHS hereby agree to submit all unresolved controversies, claims, and disputes arising out of this Agreement to mediation in Denver, Colorado, according to the commercial rules and practices of the American Arbitration Association then in force, or pursuant to other rules or procedures as to which the parties may agree. Mediation is not binding and regardless of the outcome, each party agrees to fund their own litigation expenses. XV. OBLIGATIONS Obligations of WCDHS and Signal are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. 9 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS XVI. PROVISIONS This Agreement may be amended only by written agreement signed by each of the parties hereto. This Agreement shall be binding upon and shall inure to the benefit of the respective parties hereto and shall not be assigned without the consent of all parties hereto. XVII. NOTICES: Any notice required to be given pursuant to the terms and provisions hereof shall be in writing and shall be sent by certified mail, return receipt requested; To Signal at: Daniel Darting CEO Signal Behavioral Health Network 6130 Greenwood Plaza Blvd., Suite 150 Greenwood Village, CO 80111 To WCDHS at: Jamie Ulrich Director Weld County Department of Human Services P.O. Box A Greeley, CO 80632 XVIII. LITIGATION Signal shall promptly notify WCDHS 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 WCDHS Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganization and/or foreclosure. XIX. MISCELLANEOUS PROVISIONS A. Headings. The headings of the sections and subsections of this Agreement are inserted solely for ease of reference and shall not in any way affect the meaning or interpretation of this Agreement. B. Non -Assignment. None of the parties shall have the right to assign the benefits or delegate the obligations in this Agreement without prior written 10 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS consent of the other parties. Subject to the foregoing, this Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, successors, legal or personal representatives and permitted assigns. C. Waiver of Breach. The waiver of any party of a breach or violation of any provision of this Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of the same or any other provision thereof. D. Gender and Number. Whenever the context of this Agreement requires, the gender of all words shall include the masculine, feminine and neuter, and the number of all words shall include singular and plural. E. Severability. If any provision of this Agreement is held to be unenforceable for any reason, the unenforceability thereof shall not affect the remainder of this Agreement, which shall remain in full force and effect and be enforceable in accordance with its terms. F. Counterparts. This Agreement may be executed in duplicate originals, each of which shall be an original instrument but both of which taken together shall constitute one and the same instrument. G. Entire Agreement. This Agreement constitutes the entire understanding and agreement between the parties with respect to its subject matter and supersedes all prior agreements or understandings, whether written or unwritten, with respect to the same subject matter. H. Non -Exclusivity. Participation in this Agreement shall be non-exclusive in nature and either party may enter into other Agreements other than through Signal or WCDHS. The only restriction is on the amount of funding included in this Agreement. Neither party may enter into other Agreements that may dilute the funding base in this Agreement. Hold Harmless. To the extent authorized by law each party agrees to defend, hold harmless, and indemnify the other party and its affiliates, directors, trustees, officers, and employees from and against all claims, demands, suits, judgments, expenses, and costs of any and all kinds arising as a result of damages or injuries arising out of, or incident to, the performance or failure of performance of this Agreement by such indemnifying party or its agents of its duties, obligations, or rights hereunder. J. Negligence/Malpractice. In the event that negligence or malpractice of Signal or an employee of Signal shall subject County to potential or actual liability, Signal shall hold the WCDHS harmless from all monetary loss resulting from such liability. This obligation to hold harmless shall, in addition to any other obligations commonly associated with it, would obligate Signal to pay all reasonable attorney fees, costs, expenses, and damages incurred as a result of such liability. Signal acknowledges that the WCDHS is a department of Weld County and, thus, to the extent authorized 11 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS by law, Signal agrees to indemnify, save, and hold harmless the Board of County Commissioners of Weld County, or Weld County, or both, against any and all claims, damages, liability, and the like as above set forth. The indemnities and assumptions of liabilities and obligations herein provided for shall continue in full force and effect notwithstanding the expiration or termination of this Agreement. K. Third Party Beneficiary Enforcement. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of actions relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. L. Choice of Law/Jurisdiction. Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Signal agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. M. Governmental Immunity. No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. APPROVED BY: May 23, 2022 Daniel Darting, Chief Executive Officer Date SIGNAL BEHAVIORAL HEALTH NETWORK Ja a Ulrich, Director W D COUNTY DEPARTMENT OF HUMAN SERVICES t K. James, Chair D COUNTY BOARD OF COUNTY COMMISSIONERS 12 of 35 JUN 15 2022 Date C,c�Sz Dte SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT A - COMPENSATION Compensation WCDHS agrees to contract with Signal for a maximum of $300,000 from their Core Service Funding. Signal agrees to contribute a maximum of $150,000 annually from designated OBH Additional Family Service (AFS) funds to serve eligible clients in accordance with the terms herein. Signal's administration fee shall be calculated as five percent of the service fees, salaries, and other authorized costs that are actually incurred in the delivery of treatment services. Signal's administration fee shall obligate Signal to perform, or deliver, the responsibilities, services, and reports specifically mentioned in this agreement. Other requested services or reports may be considered outside the scope of this agreement and, therefore, subject to an additional fee. Core Service funds may be used to pay for some counselor services and some Core funds will be dedicated to pay for drug tests and other authorized services. In addition, both Core and AFS funds will be used to pay for a .5 FTE therapist who will be co - located at the WCDHS. Some AFS funds may be used to pay for some counselor services and some AFS funds will be dedicated to paying for withdrawal management, outpatient, residential treatment (TRT or IRT) at AFS funded providers in the Signal network and/or for other authorized treatment services. Medicaid will be billed first when available to pay for the services. Signal will utilize Core and/or AFS monies to pay for services in cooperation with the Core Services Coordinator. The WCDHS Core Services Coordinator will initially place all clients under either Core or AFS funding source for off -site services. Any changes that switch clients to another funding source will be mutually decided by the Core Services Coordinator and Signal prior to switching the funding source. If the parties fail to agree, the procedures contained in Exhibit E, shall be followed. All services for clients that have been designated as approved for services as of 6/1/2021 for Core or 7/1/2021 for AFS will be billed to either funding source according to the designation in effect on 6/1/2021. WCDHS will share a list of these clients and compare with a list that Signal produces to make sure that the lists from both entities are in agreement. Payment A. Responsibilities 1. Signal shall submit an itemized monthly bill to WCDHS for all costs incurred and services provided in accordance with criteria established by WCDHS and Signal. Requests to modify criteria must be provided with 30 days advance notice. Signal shall submit all itemized monthly 13 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS billings to WCDHS no later than the 7th of the month following the current month the cost was incurred in accordance with the Trails payroll calendar. Monthly billings received after 60 days from the date of services my result in delay or forfeiture of payment. 2. Signal shall make available, on its web site, monthly billing reports in accordance with the billing criteria established by WCDHS no later than the 791 of the month following the month of service. Monthly client progress reports must be made available to the Core Services Caseworker, in the format provided by the Department, for download from the Signal database by the 7th of the month following the date of service. Signal's contracted providers will be required by Signal to input the monthly progress information into the Signal database prior to their ability to bill service charges for that client. Any incomplete progress report will be deemed incomplete and all such associated services will be pended. 3. Failure to submit monthly billings and/or monthly client reports in accordance with the terms of this agreement or to comply with the Financial Management Requirements, program objective or other contractual terms or program objectives 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 in accordance with the Remedies Section of this Agreement. 4. WCDHS shall not be billed for, and reimbursement shall not be made for, time involved in activities outside of those defined in Exhibit C, "Scope of Services" and this Exhibit's Fee for Reimbursement Schedule. Work performed prior to the execution of this Contract shall not be reimbursed or considered part of this Agreement. 5. Signal shall provide proper monthly invoices, make available monthly progress reports for each client incurring charges, and verification of services performed for costs incurred in the performance of the agreement. AFS and Core Services Reimbursement Funding Sources AFS Core Total On -Site Salaries and Benefits $13,500 $13,500 $27,000 Supplies, Supervision and Travel 1,220 1,220 2,440 14 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Subtotal-Onsite Costs 14,720 14,720 29,440 Admin Fee 2,355 2,355 4,710 Total Onsite Costs 17,075 17,075 34,150 Fee -for -service funding $125,782 $ 268,639 $ 394,421 Signal Fee $ 7,143 $ 14,286 $ 21,429 Total fee -for -service $ 132,925 $ 282,925 $ 415,850 Total Contract Costs $ 150,000 $ 300,000 $ 450,000 Fee -For -Service Reimbursement County Core Services and Signal AFS funding will be responsible for purchasing services in accordance with the schedule below (to a maximum funding specified in the contract language). The County and Signal acknowledge that all UA services MUST be physically monitored/observed by an individual in order for payment to be considered. The County and Signal further acknowledge that any and all monitoring beyond standard urinalysis or breathalyzer tests must be approved by the County prior to administration. Service Code Value Service Code Description Unit of Measure Description Payor Rate 80100:HF UA - Ethyl Glucuronide (EtG) Each $ 31.50 80101:AC UA - 5 Panel w/Auto-Confirmation Each $ 15.75 80101:AO UA - Optional Add -On Panel Each $ 2.10 81002 UA - Multi -panel instant Each $ 15.75 82055 Oral Swab - Lab or instant Each $ 15.75 82055:OF Oral Fluid Panel Each $ 17.85 82055:OS Oral Swab - Synthetic Cannabinoids (Spice) Each $ 36.75 82055:SC UA - Synthetic Cannabinoids (Spice) Each $ 36.75 15 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 82075 Breathalyzer Each $ 5.25 82541 GC/MS - Qualitative Each $ 36.75 82542 GC/MS - Quantitative Each $ 36.75 83000:80 Expanded Designer Stimulants - 14 panel Each $ 52.50 83000:81 MDPV & Mephedrone (Bath Salts) Each $ 36.75 84999 Hair Testing Each $105.00 94664 SUD Inhalant Drug Screen (Vapor inhalations evaluation) Each $ 63.00 99075 DEPRECATED: Medical testimony (travel, wait, prep time) 15 Minute Session(s) $ 21.00 99199 DEPRECATED: Court Case Consultation 15 Minute Session(s) $ 10.50 B0020 Beacon - Opioid Replacement (Methadone), per month Month(s) $435.75 H0001:HH Evaluation: Ill Each $262.50 H0001:II Evaluation: II Each $183.75 H0004 Individual Counseling 15 Minute Session(s) $ 31.50 H0004:HE:GT Individual Counseling w/HE:GT modifier 15 Minute Session(s) $ 31.50 H0004:HE:HF:GT Individual Counseling w/HE:HF:GT modifier 15 Minute Session(s) $ 31.50 H0005 Group Counseling Hour(s) $ 26.29 H0005:HE:GT Group Counseling Hour(s) $ 26.29 H0005:HR Group counseling: Family/Couple with client present 15 Minute Session(s) $ 26.29 H0005:HS Group counseling: Family/couple without client present 15 Minute Session(s) $ 26.25 H0006 Case Management 15 Minute Session(s) $ - H0006:HE:GT Case Management w/HE:GT modifier 15 Minute Session(s) $ - H0006:HE:HF:GT Case Management w/HE:HF:GT modifier 15 Minute Session(s) $ - H0011 Detox Day(s) $315.00 H0018:HA H2036:HF:U5 H2036:HF:U7 Intensive Short -Term Residential: Adolescent Day(s) $239.40 H0018:HB H2036:HF:U5 H2036:HF:U7 Intensive Short -Term Residential: Adult Day(s) $204.75 H0019 H2036:HF:U1 Transitional Long -Term Residential Day(s) $183.75 H0019:HA Therapeutic Behavioral Srvcs: Adolescent, per diem Day(s) $131.25 16 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS H0019:HB Therapeutic Behavioral Srvcs: Adult w/o Infant, per diem Day(s) $ 61.95 H0019:HD Therapeutic Behavioral Srvcs: Preg/Parent, per diem Day(s) $104.48 H0019:HD H2036:HF:U1 Transitional Long -Term Residential: Preg/Parent (NDF) Day(s) $204.75 H0020 Opioid Replacement (Methadone), per encounter Each $ 14.52 H0038 Self-Help/Peer Services, per 15 minutes 15 Minute Session(s) $ 7.49 H0038:CG Peer Services Recovery Groups 15 Minute Session(s) $ 15.75 H0038:HE:GT Self-Help/Peer Services, per 15 minutes w/HE:GT modifier 15 Minute Session(s) $ 7.49 H0038:HE:HF:GT Self-Help/Peer Services, per 15 minutes w/HE:HF:GT modifier 15 Minute Session(s) $ 7.49 H0048:HF Drug Screen Collection w/HF Modifier (Drug Patch Monitoring) Each $ 52.50 H2012:HA Day Treatment: Adolescent Hour(s) $ 10.36 H2012:HB Day Treatment: Adult Hour(s) $ 7.25 H2033:F FFT Daily Day(s) $ 36.75 H2033:M MST Daily Day(s) $ 68.25 H3000:HL In -home Addictions Treatment: High Level Day(s) $ 56.00 H3000:LL In -home Addictions Treatment: Low Level Day(s) $ 28.00 T1006 Family Counseling Hour(s) $ 88.20 80100:HF UA - Ethyl Glucuronide (EtG) Each $ 31.50 80101:AC UA - 5 Panel w/Auto-Confirmation Each $ 15.75 80101:AO UA - Optional Add -On Panel Each $ 2.10 81002 UA - Multi -panel instant Each $ 15.75 82055 Oral Swab - Lab or instant Each $ 15.75 82055:OF Oral Fluid Panel Each $ 17.85 82055:OS Oral Swab - Synthetic Cannabinoids (Spice) Each $ 36.75 82055:SC UA - Synthetic Cannabinoids (Spice) Each $ 36.75 82075 Breathalyzer Each $ 5.25 82541 GC/MS - Qualitative Each $ 36.75 82542 GC/MS - Quantitative Each $ 36.75 83000:80 Expanded Designer Stimulants - 14 panel Each $ 52.50 83000:81 MDPV & Mephedrone (Bath Salts) Each $ 36.75 84999 Hair Testing Each $105.00 17 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 94664 SUD Inhalant Drug Screen (Vapor inhalations evaluation) Each $ 63.00 99075 DEPRECATED: Medical testimony (travel, wait, prep time) 15 Minute Session(s) $ 21.00 99199 DEPRECATED: Court Case Consultation 15 Minute Session(s) $ 10.50 B0020 Beacon - Opioid Replacement (Methadone), per month Month(s) $435.75 H0001:HH Evaluation: III Each $262.50 H0001:II Evaluation: II Each $183.75 H0004 Individual Counseling 15 Minute Session(s) $ 31.50 H0004:HE:GT Individual Counseling w/HE:GT modifier 15 Minute Session(s) $ 31.50 H0004:HE:HF:GT Individual Counseling w/HE:HF:GT modifier 15 Minute Session(s) $ 31.50 H0005 Group Counseling Hour(s) $ 26.29 H0005:HE:GT Group Counseling Hour(s) $ 26.29 H0005:HR Group counseling: Family/Couple with client present 15 Minute Session(s) $ 26.29 H0005:HS Group counseling: Family/couple without client present 15 Minute Session(s) $ 26.25 H0006 Case Management 15 Minute Session(s) $ - H0006:HE:GT Case Management w/HE:GT modifier 15 Minute Session(s) $ - H0006:HE:HF:GT Case Management w/HE:HF:GT modifier 15 Minute Session(s) $ - H0011 Detox Day(s) $315.00 H0018:HA Intensive Short -Term Residential: Adolescent Day(s) $239.40 H0018:HB Intensive Short -Term Residential: Adult Day(s) $204.75 H0019 Transitional Long -Term Residential Day(s) $183.75 H0019:HA Therapeutic Behavioral Srvcs: Adolescent, per diem Day(s) $131.25 H0019:HB Therapeutic Behavioral Srvcs: Adult w/o Infant, per diem Day(s) $ 61.95 H0019:HD Therapeutic Behavioral Srvcs: Preg/Parent, per diem Day(s) $104.48 H0019:HD Transitional Long -Term Residential: Preg/Parent (NDF) Day(s) $204.75 H0020 Opioid Replacement (Methadone), per encounter Each $ 14.52 H0038 Self-Help/Peer Services, per 15 minutes 15 Minute Session(s) $ 7.49 18 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS H0038:CG Peer Services Recovery Groups 15 Minute Session(s) $ 15.75 H0038:HE:GT Self-Help/Peer Services, per 15 minutes w/HE:GT modifier 15 Minute Session(s) $ 7.49 H0038:HE:HF:GT Self-Help/Peer Services, per 15 minutes w/HE:HF:GT modifier 15 Minute Session(s) $ 7.49 H0048:HF Drug Screen Collection w/HF Modifier (Drug Patch Monitoring) Each $ 52.50 H2O12:HA Day Treatment: Adolescent Hour(s) $ 10.36 H2O12:HB Day Treatment: Adult Hour(s) $ 7.25 H2O33:F FFT Daily Day(s) $ 36.75 H2033:M MST Daily Day(s) $ 68.25 H3000:HL In -home Addictions Treatment: High Level Day(s) $ 56.00 H3000:LL In -home Addictions Treatment: Low Level Day(s) $ 28.00 T1006 Family Counseling Hour(s) $ 88.20 Signal, in accordance with Federal HIPAA regulations, adopted a standard transaction code set for all treatment services on October 16, 2003, which are subject to change throughout each contract year. Even though this compliance changed the service labels and groupings (shown above), the net amount of the fees associated with those services has not changed. The following services are available exclusively through AFS funds and must be purchased in conjunction with the residential treatment services described in the fee -for - service schedule above: Service Code Service Code Description Units Measured Payer Rate S9976:HB Room & Board: Adult: Daily $94.50 S9976:HD Room & Board: Preg/Parent: RESADA Daily $94.50 19 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT B SIGNAL BEHAVIORAL HEALTH NETWORK QUALIFIED SERVICE ORGANIZATION AGREEMENT Signal Behavioral Health Network (MSO) and Weld County Department of Human Services (WCDHS) hereby enter into a Qualified Service Organization Agreement (QSOA) whereby the MSO agrees to accept and serve WCDHS clients' substance abuse treatment needs. In light of the relationship between WCDHS and the MSO, WCDHS requires client identifying information and data and information related to the services furnished to the clients. WCDHS and MSO will have this relationship from June 1, 2021 - November 30, 2021, thus the QSOA will be in effect during this period. Furthermore, WCDHS: 1. acknowledges that in receiving, storing, processing, or otherwise dealing with any information from the MSO about the clients in the MSO's program, it is fully bound by the provisions of the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2; and 2. undertakes to resist in judicial proceedings any effort to obtain access to information pertaining to clients otherwise than as expressly provided for in the federal confidentiality regulations, 42 CFR Part 2. Executed this day of , 2022. Daniel Darting Chief Executive Officer Signal Behavioral Health Network 20 of 35 Jamie Ulrich Director Weld County Department of Human Services SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT C - SCOPE OF SERVICES (Associated with H3000:HL and H3000:LL in attached rate sheet) A. IN -HOME ADDICTION TREATMENT PROGRAM Turning Point Substance Abuse Treatment Scope of Services for State Fiscal Year 2022- 2023 The In -Home Addictions Treatment Program (IHAT) is an intensive in -home therapy program designed to serve at -risk families that have come to the attention of the Department due to drug/alcohol concerns. Clients referred to the IHAT program typically have a mental health and/or substance abuse disorder, and are continuing to struggle despite having been treated at lower levels of care such as outpatient therapy. Families served in the program often have a history that may include inpatient substance abuse treatment, trauma, criminal and/or delinquent behaviors, verbal or physical aggression, or attachment difficulties. Features of the program include: • Intensive short-term treatment, averaging 4 to 5 months in duration. • Two sessions per week in -home (or 1 session and phone consultation, dependent on client need). • Availability of on —call services 24 hours a day 7 days a week. • Case consultation with collaterals such as treatment providers (SA and MH), school personnel, probation, DHS, etc. • Therapist flexibility in terms of drawing from a variety of evidence -informed treatment models including: Seeking Safety, Dialectical Behavioral Therapy, Trauma Informed Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, Solution Focused Therapy, and behavior management techniques. • Drug testing of clients as therapeutically necessary. • Therapist flexibility in terms of modality of treatment used (parents -only sessions, family therapy, occasional individual therapy, or some of each). • Focus of treatment that is highly parent/family oriented and interventions designed to be sustainable for the family. • Support in linking to other therapeutic services as appropriate including coaching, medication evaluation and management, substance abuse treatment, DBT programming, trauma focused services, etc. • Integrating social supports into family treatment planning. Establishing positive daily life routines. Develop family stable patterns: Rules, Roes, Rituals, Routines, Relationships (Barnes, 1995). 21 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS • Additional interventions for parents of delinquent adolescents around monitoring/supervision, holding youth accountable for behavior and choices, and therapists will collaborate closely with the juvenile justice system. Rate of Payment (to Turning Point) and Service Description: High -end Service 4-6 hours a week of Therapist intervention 2-3 hours a week of Case Manager $1600/month per family OR $53.33/day per family Low -end Service 2-3 hours a week of Therapist Intervention 1-2 hours a week of Case Manager $800/month per family OR $26.67/day per family B. CO -LOCATED SUBSTABCE ABUSE THERAPIST North Range Behavioral Health (NRBH) will provide a .5 FTE CAS Certified, Master's Leve Substance Abuse Therapist to be co -located at Department of Human Services, Child Welfare Division. The NRBH therapist will provide case consultation, integrated assessments, therapy and case management services for clients within the WCDHS Child Welfare Division, to include: • Maintaining a caseload of 6-10 adults and juvenile clients to include service planning and follow up. • Completing substance abuse evaluations on adults and juveniles using the ASAM assessment tool. • Conducting short term safety plans for both adults and juveniles. • Participate in the discharge and relapse prevention planning with the client, caseworker, and service team. • Completing monthly data that will be provide to DHS and Signal. • Attending agency specific meetings when requested meetings include (TDM's, FTM's, Group Supervision, etc.) • Providing consultation and services to caseworkers, supervisors, and Weld County staff. • Attending CORE staffings with the caseworker and report on progress on the adult and/or juvenile. 22 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS Goals of service: • Immediate access to casework staff for case consultation and/or meeting with clients. • Same week access to integrated assessments. • Same week referral to NRBH for other services. • Problem -solving systems issues, including delayed appointments, lack of client engagement, miscommunication between caseworkers and clinical staff. Outcome of Services: • Reduced length of time from referral to intake and assessment. • Increased communication between caseworkers and clinical staff. • Thorough assessments to include recommendations necessary for parents to safely maintain children at home or to engage in treatment so that children can safely return home. C. ASSESSMENTS 1. Alcohol and Drug Differential Assessment (3 -Hours) Assessment will evaluate alcohol/drug involvement as well as mental health status, history of mental health issues, sexual history, legal history, and certain standard tests (ASAP, ASAM PPC-2, ASI, SOCRATE, AODUI, Drinking History Questionnaire, Family Environment Scale) may be given. Signal will provide two collateral contacts as part of the Assessment. 2. Co -Occurring Alcohol and Drug with Domestic Violence Assessment (3 - Hours) Summary of assessment with recommendations sent to referring agency. The following areas will be assessed: Criminal History Profile of Client's Violent Behaviors Potential for Violence Mental Health Status Client's Medical History Substance Abuse History Suicidal/Psychological/Cultural History Milton Test, if needed 3. Substance Abuse Forensic Evaluation (3 hours, as staff expertise permits) A forensic evaluation is specifically geared toward the substance -abusing offender. It involves additional testing to determine the crimogenic aspect of the person to be taken into consideration when developing treatment 23 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS recommendations. Testing will be comprised of CVI, ASUS, SASSI, Milton Clinical Multiaxial Inventory (MCMI-III), a clinical interview, and a behavioral profile. The testing is cross-referenced with the clinical interview, and in relation to collateral data. 4. Evaluation: II - Level II Assessment A Level II Assessment is the initial diagnostic interview enrolling a client in services. It is conducted by a Master's Level Therapist (OR AT THE MINIMUM A CAC II OR III). A Level II is typically completed in 1-1.5 hours. Areas addressed: Referral information and Chief Complaint / Precipitating Event(s) Presenting Problem Psychosocial History Legal History Abuse and/or Victimization History Strengths, Resources and Needs Prior Treatment History Drug and Alcohol History and Assessment Medical History Mental Status DSM Diagnosis and Rationale Risk Assessment Level of Care Assessment Disposition and Recommendations for treatment 5. Evaluation: Ill - Level III Assessment In addition to all areas identified in the Level II assessment, a Level III may include the use of assessment tools and/or include extensive history review and collateral input as appropriate. A Level III Assessment is always completed by a dually trained and credentialed (license and certification) Behavioral Health Therapist so that, if necessary, he or she can act as an expert witness. A Level III is typically completed over the course of 2-3 hours. All Co -Occurring Alcohol or Drug with Domestic Violence or Anger Management assessments will be billed at the Evaluation: Ill rate. The primary difference between a level II and level III assessment is the amount of time involved (2-3 hours for a level III versus 1-2 hours for a level II). A level III assessment requires more time and is more in-depth than a level II assessment. A level III assessment also includes more lengthy documentation, typically will involve more collateral contacts, and is suitable for court purposes. Both assessments assess substance abuse and mental health issues/concerns. However, we do not dictate which tools are used for each level of assessment. As indicated in the contract, a level III 24 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS assessment is always conducted by a duly trained and certified/licensed individual who can act as an expert witness if necessary. Level III assessments are typically requested by outside agencies for the purposes of obtaining clear information on treatment recommendations and prognoses (e.g., likelihood of continued risky behaviors). Collateral information/contacts are required (not just typical) in order to better understand the reason for the referring parties request for an evaluation, and a more formal written report is provided (e.g., no abbreviations or jargon, more comprehensive psychosocial history) so the referral source better understands the issues, and treatment recommendations and prognoses (e.g., likelihood of continued risky behaviors) are more formally addressed, as they pertain to the reason for the referral. Formal psychological testing is not administered for a Level III assessment. D. TREATMENT OPTIONS 1. Co -Occurring Alcohol and Drug with Domestic Violence Group Therapy (average length of treatment, 24 to 36 weeks): Groups for both men and women are offered. The group addresses anger management, healthy relationships, male and female roles, and boundaries. As needed, a Milton Test may be given, a standardized psychological test which measures functioning level in 22 personality disorders and clinical syndromes for adults (8th grade reading level: > 18; available in Spanish). 2. Family Therapy (average length of treatment, 8 to 16 sessions): Involves two or more family members and provides therapeutic intervention to improve family communications, functioning, and relationships. Length of participation is dependent on client goals and progress toward meeting goals. 3. Individual Counseling (average length of treatment, 6 to 12 sessions): Primary client is seen on an individual basis. Length of participation is dependent on client goals and progress toward goals. 4. Substance Abuse Therapy (average length of treatment, 12 to 20 sessions): A group to enhance positive coping skills by focusing on their lifestyle dealing with use and abuse of chemicals. 5. Adult Intensive Outpatient (average length of treatment, 4 to 12 weeks): An intensive outpatient group therapy track that offers groups every evening, Monday through Friday, with a family program component. This program will include medical aspects of addiction and adult relapse education components focusing on understanding the relapse process as well as group process (focuses on individual issues relating to their abuse 25 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS of alcohol). The program length and participation level will be individualized based on the presenting issues and other factors. 6. Women's Group (average length of treatment, 12-20 sessions): A gender -specific group addressing issues affecting women and their relationships, such as family violence, co-dependency, self-esteem and stress management. 7. Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users (MET/CBT5 average length of treatment 5-8 weeks): The MET/CBT5 is a brief treatment approach for cannabis abusing adolescents. Treatment consists of two individual motivational enhancement therapy sessions (MET) Sessions, followed by participation in three group cognitive behavioral therapy (CBT) sessions. The assessment includes a psychosocial history and data from the Global Assessment of Individual Needs (GAIN), and a personalized feedback report. 8. Adolescent Intensive Outpatient (length of treatment - 3 to 12 weeks): This intensive outpatient track offers therapy and education groups utilizing the Matrix Model for Youth and Young adults curriculum. Groups are offered Monday through Friday. This program also provides individual and family therapy as well as family group therapy. Topics addressed include the medical aspects of addiction and relapse -prevention education focusing on understanding the relapse process. The program length and participation level will be individualized based on the presenting issues and other factors. E. 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. F. MISCELLANEOUS SERVICE OPTIONS 1. Extended Detoxify Stay: This is an option when case management goals require that the person be in a stable environment until they can be referred to the next level of care. 26 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 2. Enhanced Services: Enhanced services as approved services that are requested by WCDHS for specific cases, which fall outside of the definitions, listed above in the description of the DBH menu of services. Enhanced services may be services not described on the menu, services not included in the definition or due to lack of economy of scale, or rural location, or result in additional costs to Signal. In order for Signal to provide enhanced service, the cost would be outside of the approved rates. Any additional fees would be negotiated on a case -by -case basis. Signal can arrange for services outside of the approved definitions, but WCDHS will be charged an additional fee that would be negotiated on a case -by -case basis by the designated representative listed in the contract. G. MEASURABLE OUTCOMES AND OBJECTIVES Signal shall abide by WCDHS outcome indicators of Safety, Permanency and Child and Family Well -Being, which are provided under Adoption and Safe Families Act (ASFA), 1997; Colorado Child and Family Services Plan 2000 -2004; and ACF Reviews (Reference: Federal Register, Volume 65, Number 16: 45 CRF Parts 1355, 1356, and 1357), March 25, 2000. 1. Outcome Reports as Prescribed by Human Services 2. Outcome reports will be developed and provided as mutually agreed upon by the parties. 3. Client Objectives The WCDHS caseworker will identify a maximum of three child welfare objectives to be addressed within each client's treatment plan. Signal shall develop action steps to reach the identified child welfare objectives. Signal shall report monthly on each client's progress in meeting the three identified objectives while the client is receiving treatment services. 4. Overall Program Objectives Signal and WCDHS agree to monitor the ability of the substance abuse program offered by Signal to achieve objectives as follows: a. Demonstrate Abstinence with the use of UA/Patch Monitoring Only. b. Improve parental capabilities currently impaired by substance abuse. c. Develop the capacity to ask for help and assistance without resorting back to substance abuse. d. Develop or increase the ability to recognize, prioritize and meet child(ren)'s needs. e. Parent will identify how their substance use has affected their parenting. 27 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS f. Parent will identify how their substance use got them involved with Human Services. g. Parent will identify how their substance use helped them parent. h. Parent will identify relapse triggers and develop a safety plan for their children. Parent will identify whom they consider to be a support in their recovery. j. Parent will identify who will care for their children should they relapse. k. Parent will identify what they enjoy about parenting sober. Improve parent -child functioning to lower the risk of out of home placement. m. Parent will support their children in speaking about how living in a substance -effected family has impacted them. n. Parents will demonstrate increased verbal skills, empathy and accountability with child(ren). o. Parent will identify their parenting strengths. p. Family members including significant other, children and extended family will increase ability to communicate more effectively. q. Family members will identify how they can support the identified client in their recovery. r. Family members will identify the positive parenting changes the substance -effected person is making. s. Family members will identify who will care for the children in the event of a relapse. t. Family members will identify relapse systems of the identified client. u. Family members will identify how they can reach out for help if a relapse occurs. v. Increase level of functioning currently impaired by living in a substance affected family. w. Identify how living in substance affected family has impacted their life x. Improve level of functioning currently impaired by substance abuse issues. Y. Decrease aggressive behaviors at home and/or school and in the community. z. Learn how to socialize without the use of substances. aa. Identify relapse triggers. bb. Create a sober support network. H. STAFF QUALIFICATIONS Signal staff members who will provide services to WCDHS clients will have credentials and/or certifications as required by the Colorado Department of Human Services, Colorado Board of Education, Division of Behavioral Health, and the Colorado Board of Medical Examiners. 28 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT D - ASSURANCES 1. 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. 2. 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. 3. 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. 4. 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 four (4) years or the until the completion and resolution of an audit, whichever is later. Such records shall be sufficient to allow authorized local, Federal, and State auditors, and representatives to audit and monitor Signal. 5. All such records, documents, communications, and other materials shall be the property of WCDHS and shall be maintained by Signal, in a central location and as custodian, on behalf of WCDHS, 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. 6. 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. 29 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 7. 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. 8. 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. 9. 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 9(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. 10. The Appearance of Conflict of Interest applies to the relationship of Signal with WCDHS 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 30 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS submit to WCDHS, 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 WCDHS' termination, for cause, of its contract with Signal. 11. 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. 12. 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. 13. 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. 31 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS EXHIBIT E- STANDARDS OF PROCEDURES FOR CORE SERVICES 1. Signal and WCDHS agree to develop a case management plan (aka substance abuse treatment plan) on each referred family within 30 days of the date the Signal received the referral. The case management plan will be monitored and modified monthly to measure progress toward goals. Copies of the case management plan must be sent to the caseworker, program area supervisor, and Core and Service Contract Coordinator at Weld County Department of Human Services, P. O. Box A, 822 7th Street, Suite 150, Greeley, Colorado 80632. The case management plan will include, at a minimum, goals, timelines, and measurement of success. 2. Signal agrees that payments for levels of care are not authorized for reimbursement by WCDHS until a referral from WCDHS is provided to Signal. A referral must be received prior to services rendered by Signal. Furthermore, Signal and its providers agree that any monitoring in conjunction with treatment beyond standard urinalysis and breathalyzer tests, as well as changes in level of care are not authorized for reimbursement by WCDHS until staffed with designated WCDHS staff. WCDHS agrees to identify designated staff that may provide this authorization. 3. Signal agrees not to accept any referral from WCDHS unless the referral contains all information required on the form and necessary for reimbursement by WCDHS and authorized for reimbursement. If Signal accepts the referral without all data fields required on the referral form or authorization, Signal may assume fiscal responsibility for the services provided under the incomplete referral. Inaccurate information listed on the referral form by WCDHS will be excluded as a fiscal responsibility for Signal. 4. Signal agrees to provide access to all monthly client progress reports for clients with treatment charges by the 7th day after the month of service, via the Signal website. The monthly progress report for each client must be entered into the Signal Service Management website by the provider previous to the monthly billing claims in order for payment to be honored. Failure to submit such monthly reports will result in delays or forfeiture of payment. It is expected, at a minimum, that these reports will reflect all information requested on the Monthly Progress Report. 5. Signal agrees to submit a final discharge summary of client outcomes to Human Services within thirty (30) calendar days after the completion date. 6. Signal agrees to report expenditures and case disbursement at agreed upon times. 32 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 7. Signal agrees to assume fiscal responsibility for expenses incurred by Signal that do not meet the requirements of this Exhibit and Agreement. Those expenses incurred by Signal outside of the requirements of this Agreement are not eligible WCDHS expenditures and shall not be reimbursed by WCDHS. 8. Signal agrees to the definition of a complete and timely billing form for purposes of submitting an original bill under as described in this Exhibit. A complete and timely billing form must include the following elements. A. The billing must include all forms designed for Core Services reimbursement and approved by WCDHS; 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 WCDHS monitoring results (UA, BA, patch, tox trap swab) by faxing said results to WCDHS at 970.346-7667 or via access to online system no later than 72 hours after the day of service. B. The Department will determine billed services not eligible for payment by identifying conflicts in the following: 1. Details provided in client referrals and renewals, including approved hours of service, begin and end dates of service, client name, and Case ID. 2. Details in supporting documentation provided by the Provider and submitted with the original bill, including, but not limited to, original signed client verifications, receipt of monitoring results, time of service and units or hours of service provided, and names of clients receiving the services, and monthly progress reports with all the information specified on the Monthly Progress Report. 3. Details provided in the current approved contract and Notification of Financial Assistance, including, but not limited to unit of service, cost per unit of service, and special conditions and/or revisions to said contract. C. The above items, 8 B,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. 33 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS 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. 9. Signal will develop and utilize evaluation tools (pre- and post -assessment test instruments) to collect necessary data in cooperation with WCDHS staff to monitor effectiveness of program. 10. Signal will meet with the WCDHS designated supervisor quarterly and/or the Core Services Coordinator (more if needed) to review program usage and effectiveness to discuss necessary improvements to better serve families or increase referrals. 11. Signal will be available to meet with WCDHS staff to explain program, timelines of response to referrals and answer questions to enhance program. 12. Signal, or their authorized designee, will be available for the Families, Youth and Children (FYC) Commission review and attendance at the FYC meetings. 13. Regarding all forms referenced herein in the Agreement, Signal shall replicate these forms in format, content and according to the specifications of WCDHS or as mutually agreed upon by Signal and WCDHS. Signal agrees to modify these treatment authorization forms according to WCDHS specifications and requirements. 14. WCDHS will be responsible for electronically authorizing services to various Signal providers and initially designating if Core funds shall be used for payment. WCDHS shall assure that the authorization will have all information required for reimbursement from the county. 15. WCDHS agrees to provide Signal with the name of a primary contact who will be responsible for interacting with Signal's data system. 16. WCDHS agrees to provide the TRAILS Remittance Advice to Signal within ten (10) business days of the monthly TRAILS Core Main Payroll date. 17. WCDHS 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. Signal and WCDHS agree to resolve level of care conflicts at the Signal/County level through cooperation. WCDHS and Signal shall attempt to resolve all levels of care conflicts and disputes at the lowest level possible within each organization. Should WCDHS and/or Signal fail to agree upon the level of care offered by Signal, 34 of 35 SIGNAL BEHAVIORAL HEALTH NETWORK WELD COUNTY DEPARTMENT OF HUMAN SERVICES SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2023 CHILD WELFARE CLIENTS they may appeal the case directly to the WCDHS Director, or designee, and the Signal Chief Operating Officer. Both Signal and WCDHS 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. 19. If the WCDHS and Signal are unable to resolve the dispute, either party may request that the State intervene. Any further unresolved issues may be submitted to the Colorado Department of Human Services, Office of Behavioral Health or their designee(s) for case presentation and review. 35 of 35 New Contract Reque s Entity Name* SIGNAL BEHAVIORAL HEALTH 1.1 New Entity? Entity ID* 00033360 Contract Name* SIGNAL BEHAVIORAL HEALTH (AGREEMENT) Contract Status CTB REVIEW Contract ID 5865 Contract Lead* APEGG Contract Lead Email a.pe ggwe l d gov. com ; co bbx xlk •welclgov.com Contract Description* NEW SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2022-23 TERM: CORE SERVICES JUNE 1, 2022 - MAY 31, 2023 & AFS JULY 1, 2022 - JUNE 30, .2023. Contract Description 2 PA IS BEING ROUTED THROUGH THE NORMAL PROCESS. ETA TO CTB: 6/9/22 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices3 weldgov.co m. Department Head Email CM-HumanServices- DeptHead weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYA r r ORNEYsgWELDG OV.COM Requested MCC Agenda Date* 06 22/202.2 Parent Contract ID Requires Board Approval YES Department Project # Due Date 06/18/202.2 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID if this is part of a MSA enter MSA. Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Co tract dates Effective Date Review Date* 03/3112023 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Contact Type. Contact Email Expiration Date* 05!'31 202 3 Contact Phone I Contact Phone 2 Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH DH Approved Date 05,25;2022 Anal Approval ROCC Approved 8OCC Signed Date BOCC Agenda. Date 06; 15,E 2022 Originator APEGG Finance Approver CHERYL PATTELLI Legal Counsel BRUCE BARKER Finance Approved Date Legal Counsel Approved Date 05 26 2022 05 i 26, 2022 Tyler Ref # AG 061522 Hello