HomeMy WebLinkAbout20152169.tiff RESOLUTION
RE: APPROVE SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT FOR CHILD
WELFARE CLIENTS AND AUTHORIZE CHAIR TO SIGN - SIGNAL BEHAVIORAL
HEALTH NETWORK
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Substance Abuse Treatment Service
Agreement for Child Welfare Clients between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Human Services, and Signal Behavioral Health Network, the periods of performance shall be
commencing June 1, 2015, and ending May 31, 2016, for the Core Services, and commencing
July 1, 2015, and ending June 30, 2016, for The Signal Additional Family Service(AFS),with further
terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Substance Abuse Treatment Service Agreement for Child Welfare
Clients between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and Signal
Behavioral Health Network be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 20th day of July, A.D., 2015, nunc pro tunc June 1, 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ditite/ti � 'Lo� frk. ,(4i ,.,( 172' c:�
Barbara Kirkmeyer, hair I
Weld County Clerk to the Board
`` I / Mike Freeman, Pro-Tem
BY: (dL(�Q,.) �h
De utO Clerk to the Bo. rd ��■■� /
Lz Sean P. Conway
APP DAS •• S - 'l f .,�,►. �1 / i
361 I =�', = 'lie . ozad
ounty Attorney
Ai
®�NI Steve Moreno
Date of signature:
CC. SY 2015-2169 H00 8006
86
c6ytactn 77
MEMORANDUM
peassanar
DATE : June 15 , 2015
ter` 1861
TO : Board of County Commissioners — Pass-Around
IlD.74.44N FR : Judy A . Griego, Director, Human Services
RE: Weld County Department of Human Services ' FY 2015/2016
Substance Abuse Treatment Service Agreement 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 for the Departments ' FY2015/2016 Substance Abuse Treatment
Service Agreement with Signal Behavioral Health Network. Signal agrees and desires to
participate as the service provider coordinator for WCDHS qualified child welfare clients.
Signal will ensure the delivery of high quality clinical care to clients in a delivery system of
limited resources and public funding.
Due to different State funding cycles, the period of performance under this Agreement will
overlap. For the County CORE Services the period of performance shall be June 1 , 2015
through May 31 , 2016, unless sooner terminated. The Signal Additional Family Service (AES )
period of performance shall be July 1 , 2015 through June 30, 2016, unless sooner terminated.
WCDHS agrees to contract with Signal for a maximum of $300,000.00 from their Core Service
funding. Signal agrees to contribute up to a maximum of $ 116,259. 88 annually from designated
Office of Behavioral Health AFS funds to service eligible clients in accordance with the terms
of the Agreement.
I do not recommend a Work Session . I recommend approval of this Agreement.
Approve Request
BOCC Agenda Work Session
Sean Conway
ry
Steve Moreno
Barbara Kirkmeyer
Mike Freeman
Julie Cozad
Pass -Around Memorandum ; June 15, 2015 Page 1
2015-2169
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/20,.
CHILD WELFARE CLIENTS
This Agreement is between the Weld County Department of Human Services.
hereinafter referred to as "WCDHS" and Signal Behavioral Health Network, and
hereinafter referred to as "Signal."
WHEREAS, the Colorado Department of Human Services has provided Colorado
Core Services substance abuse treatment funding to Human Services for outpatient and
residential core services for families, children, and adolescents: and
WHEREAS, WCDHS requires the services of a substance abuse treatment
provider to assist the County in delivering substance abuse treatment services to child;(';
welfare clients, and Signal is willing and able to coordinate and manage such services;'
and
WHEREAS, Signal is a Colorado not-for-profit corporation organized for the
purpose of managing and coordinating high quality, cost efficient. integrated chemical
dependency and related behavioral health care services in the State of Colorado.
a"y
NOW. THEREFORE, it is mutually agreed as follows:
I. SERVICES: .
A. Responsibilities of Signal .
1. Signal agrees and desires to participate as the service provider
coordinator for WCDHS qualified child welfare clients under the definition '
set forth in the Child Welfare Lawsuit Settlement Agreement (David
Littman vs. State of Colorado).
2. Signal will ensure the delivery of a high quality of clinical care to clients in ',. .
a delivery system of limited resources and public funding. The full
continuum of care (Outpatient, Intensive Outpatient, Transitional '
Residential, Intensive Residential, Therapeutic Community. or comparable
alternatives as mutually agreed upon) will be available to clients. The
client's clinical needs will determine the level of care Signal is to provide
and Signal will meet those needs regardless of "modality."
3. Signal will assure that all eligible child welfare clients referred by WCDHS
in need of treatment will receive such in accordance with ASAM PPC-II R
level of care, as reimbursed by the State of Colorado, Office of Behavioral
Health.
4. Signal will give priority service to child welfare clients (parents and .,
children) who comply with the following criteria as WCDHS refers:
a. Case is active on TRAILS. and
b. Case meets the State DHS program category criteria 4 5, or 6, and
c. Case meets the definition of "imminent risk for out-of-home
placement/reunification" set forth by the State of Colorado. Signal will
1of12
°3w
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
".$ CHILD WELFARE CLIENTS
secondarily evaluate and treat Colorado Works/TANF/Employment=M&"
First clients as referred by WCDHS.
5. Signal will include the following provisions in all subcontracts with`.
providers:
yy aA.
a. The Provider shall submit a treatment plan to WCDHS within 30 days
b. The Provider shall enter monthly progress reports into the Sign'
,,.,...►' system no later than the 10th calendar day of the month following the t�
month during in which the service was rendered. Services submitted
without monthly progress reports will be pended for official billing and
th utilization against AFS funds until such reports are submitted.
c. Signal, or their designee. agrees to provide Human Services
monitoring results (UA, BA, patch. tox trap) by faxing said results to,:—.
Human Services at (970) 346-7667 or via access to online system no
later than 72 hours after the day of service
d. Signal agrees to make available Core and AFS Utilization Reports tf.
WCDHS each month by the 3`a Wednesday of each month.
e Signal agrees to cooperate with WCDHS to resolve any duplicated
fees and/or errors identified by the WCDHS billing review process.
6 Signal will also make monthly progress reports available on its website for
each WCDHS client in treatment.
7. Signal will provide training and technical support, as necessary, or
WCDHS staff in accessing data reports and on the use of the child welfare ' '~u
referral system. y`
9. Signal shall reconcile all treatment providers' claims to AFS funds within
90 days from the date of service delivery. Claims not properly submitted to
Signal within this time line will be denied.
10. Signal will assure that the providers in its network give timely notice of
cancelled appointments to the clients and will reschedule such ,
appointments as soon as practical.
11. At all times from the effective date of this Contract until completion of this
Contract, Signal shall comply with the administrative requirements, cost
principles and other requirements set forth in the Financial Management
Manual adopted by the State of Colorado. The required annual audit of all
funds expended under the Child Welfare Services and Family and
Children's Program funding must conform to the Single Audit Act of 1984
and OMB Circular A-133.
2 of 12
�pr , .„,, , ,. ., ,,, _
' SIGNAL BEHAVIORAL HEALTH NETWORK „, .,. .
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
is
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
f CHILD WELFARE CLIENTS (x,
B. Responsibilities of WCDHS:
1 WCDHS will work cooperatively with Signal and its Providers to delive'
quality. efficient and cost-effective substance abuse treatment services to E.
WCDHS qualified clients. " " " `""m
2. WCDHS will make every effort to inform Signal and its Providers in :,
timely manner of system issues, developments, and complications so tha,
.gig Signal and the Provider can make informed choices in its role as thee' ' '`{
managed service organization and treatment agency respectively.
` 3. WCDHS will assure that all referrals under this contract meet the eligibilit1mm
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 -ffi
electronically authorizing services to various providers.
''f
6. WCDHS will review monthly AFS actual reports and determine any' w
duplicate charges pursuant to Core or other previously paid services. --
WCDHS will report monthly any discrepancies in duplication and/or errors
f to Signal, and in cooperation with Signal. work with Signal to resolve any
rg conflicts of billed services or fees. ®u ,.
7. WCDHS will complete the Signal remittance advice and return to Signal
within 5 business days of completion of each month's TRAILS payroll
date. Each remittance advice shall detail reasons for denial of any and all ,' ` `
services. WCDHS shall work with Signal and other counties to develop '• -
standard claims denial criteria. WCDHS shall reimburse Signal for all
complete services invoiced within 45 calendar days from the date of
receipt of Signal's invoice.
ka
8. WCDHS shall inform Signal of the county primary contacts along with
contact information. WCDHS shall provide such contact information for all
i contract, data and billing related matters. w.
`R• 11. PERIOD OF PERFORMANCE
„x 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, 2015 through May 31, 2016.
m 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, 2015 through June 30, 2016, unless sooner terminated. Either party
hereto may terminate this Agreement at any time by giving not less than 45 days
advance written notice to the other party •
3 of 12
.
.bwma e .` rx MPSd.b G-.,,,o ,b. .;✓a. a. n Y r#,° .„ µp
SIGNAL BEHAVIORAL H ,LTH NE CORK
i WELD COUNTY DEPARTMENT OF HUMAN SERVICES
'i SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
As'-` '° onditio -• continuing to render services under this Agreement, .. i ''
understood that Signal will report any limitation or restriction of their license or ,w
insurance or the ability to perform the services covered by this Agreement under
any condition of impairment. .w ,. ..
».
jn In the absence of any formal agreement beyond the term of this ag .4
Signal agrees to continue providing treatment, under the terms of this agreement'~x
for clients that are in treatment or referred by WCDHS for treatment. This is with t
the further understanding that service delivery and payment are subje ...11.. r
termination terms mentioned above.
.,
Signal reserves the right to suspend services to clients if funding is no longej`
available. WCDHS acknowledges financial responsibility for all ,7,0,......=-`'
' authorized and performed before the effective date of termination.
III. COMPENSATION :
See Exhibit A.
IV. CLIENT FEES OR CO-PAYS
it
j. Neither Signal nor their network Providers shall assess a client fee or co-pay to
t' 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 fe ,W .nd
co-pays.
V. ATTACHMENTS .
Signal and WCDHS agree to adopt herein Exhibit A. - Memorandu-- ":-`m
Understanding, Exhibit B — Signal Remittance Advice, Exhibit C — Qualified,
Service Organization Agreement, Exhibit D — Scope of Services. Exhibit E —
Assurances, Exhibit F — Standards of Responsibility for Core Services. and .r. ,A
. Exhibit S - SCRAMx Use Case Project.VI. INDEPENDENT CONTRACTOR AW
Signal and its providers shall be providing services hereunder as an independent,'
contractor and the relationship of employer and employee does not exist w
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 x' '''
»' compensation insurance in the amounts required by law. and shall be solely ..
responsible for the acts for Signal, its employees and agents.
4of12
SIGNAL BEHAVIORAL HEAL H NE `CORK
Wr WELD COUNTY DEPARTMENT OF HUMAN SERVICE
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
VIIw w. ASSURANCES
Signal shall abide by all assurances as set forth in the attached Exhibit E. which i''•
attached hereto and incorporated herein by reference. .m@...
VIII. COMPLIANCE WITH APPLICABLE LAWS
i{ At all times during the performance of this contract, Signal shall st is i a. ere
all applicable federal and state laws, orders, and all applicable standards
( regulations, interpretations or guidelines issued pursuant thereto. This include
the protection of the confidentiality of all applicant/recipient records, papers,
documents. tapes and any other materials that have been or may hereafter b:
established which relate to the Contract. Signal acknowledges that the f.11•. m,e,Rµ
laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d
implementing regulation. 45 C.F.R. Part 80 et seq.; and
fl Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its
mr implementing regulations, 45 C.F.R. Part 84; and
the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq and it
implementation regulations, 45 C.F.R. Part 91; and
Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967; and
the Equal Pay Act of 1963; and
the Education Amendments of 1972: and
Immigration Reform and Control Act of 1986, P.L. 99-603; Po
42 C.F.R. Part 2
All regulations applicable to these laws prohibiting discrimination because of
race, color. national origin. and sex, religion and handicap. including Acquired
Immune Deficiency Syndrome (AIDS) or AIDS related conditions, covered under
Section 504 of the Rehabilitation Act of 1973, as amended. cited above. If
necessary, Signal and Human Services will resist in judicial proceedings any
efforts to obtain access to client records except as permitted by 42 CFR Part 2.
u+bd aC r< "Human Services and Signal shall sign a Qualified Serviceµ Organization=
Agreement in compliance with 42 CFR Part 2, and attached hereto as Exhibit F
i� SFr
Included is 45 C.F.R. Part 74 Appendix G 9, which requires that affirmative steps +W
be taken to assure that small and minority businesses are utilized, when
possible, as sources of supplies. equipment, construction and services. This
assurance is given in consideration of and for the purpose of obtaining any and
all federal and/or state financial assistance.
.a.,...m _.4, _ ..,,, „" .. <��, ,: ,: , ._. •.arm,m , -° o... ,,. .",., _ ,. ,".
SIGNAL BEHAVIORAL HEALTH NETWORK !'
WELD COUNTY DEPARTMENT OF HUMAN SERVICE ,w
SE TREATMENT SERVICE AGREEMENT - FY 2015/2016 �
CHILD WELFARE CLIENTS
Any person who feels that s/he has been discriminated against has the right to "
file a complaint either with the Colorado Department of Human Services or with °"
the U.S. Department of Health and Human Services, Office for Civil Rights
EMPLOYMENT OR CONTRACTING WITH ILLEGAL ALIENS UNDE'j
COLORADO LAW
tt Contractor certifies that it shall comply with the provisions of Secti.`"'":
et seq.; C.R.S., Contractor shall not knowingly employ or contract with an illegal° M£
alien to perform work under this Contract or enter into a contract with a
subcontractor that fails to certify to Contractor that the subcontractor shall no
knowingly employ or contract with an illegal alien to perform work under thi.
Contract. Contractor represents. warrants. and agrees that it (a) has verified tha
it does not employ any illegal aliens, through participation in the Basic Pilo
Employment Verification Program administered by the Social Securit
Administration and Department of
Homeland Security, and (b) otherwise comply with the requirements of Sectio
81-.5-102(2)(b),C.R.S. Contractor shall comply with all reasonable requests,,
made in the course of an investigation under Section 8-17,5-102.C.R.S., by the.x ,.„..r'
Colorado Department of Labor and Employment. If Contractor fails to compl
with any requirements of this provision or Section 8-17.5-101. et seq..C.R.S.
Weld County may terminate this Contract for breach and Contractor shall bed
liable for actual and consequential damages to Contractor
Except where exempted by federal law and except as provided in Section 24_W
76/5-103(3), C.R.S, if Contractor receives federal or state funds under this,,
Contract, Contractor must confirm that any individual natural person eighteen,
(18) years of age or older is lawfully present in the United States pursuant to')
Section 24-76.5-103(4), C.R.S., if such individual applies for public benefits
provided under this Contract. If Contractor operates as a sole proprietor, 'i°j€
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 w„ yk"
24-76/5-101. et seq., C.R.S., and (c) shall produce one of the forms on
identification required by Section 24-76.5-103, C.R.S.. prior to the effective date',
of this Contract.
-- IX. CERTIFICATIONS
Signal certifies that, at the time of entering into this Contract, it has currently in
effect all necessary licenses, approvals. insurance. etc. required to properly''
provide the services and/or supplies covered by this contract.
Wu
o-"r;1. Y°""'7" •"iti3P aa,. a..b w.»5:m: « t.,:ab3ra "' -.b .x,,u iad
y3
k1'
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES " ` ''' ' W
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
X. MONITORING AND EVALUATION
Signal and Human Services agree that monitoring and evaluation of the:
performance of this Agreement shall be conducted by Signal and Human:.'
Services. The results of the monitoring and evaluation shall be provided to the
Board of Weld County Commissioners and Signal.
Signal shall permit Human Services, and any other duly authorized agent or.]
governmental agency, to monitor all activities conducted by Signal pursuant to`
the terms of this Agreement. As the monitoring agency may in its sole discretion,
deem necessary or appropriate, such program data, special analyses. on-site'
checking, formal audit examinations, or any other reasonable procedures. All
such monitoring shall be performed in a manner that will not unduly interfere with,
agreement work. �� r +r= ff5.
XI. MODIFICATION OF AGREEMENT
All modifications to this agreement shall be in writing and signed by both parties
` XII. REMEDIES
A. Signal and Human Services shall exhaust all remedies as provided in Exhibit,
F, "Standards of Responsibility for Core Services", prior to the �. •_,,
provided in Item XII, B, of this Agreement.
B. The Director of Human Services or designee may exercise the following"
remedial actions should s/he find Signal substantially failed to satisfy the M ` f,
scope of work found in this Agreement. Substantial failure to satisfy the
scope of work shall be defined to mean incorrect or improper activities or.„
inaction by Signal. These remedial actions are as follows:
1. Provide reasonable advance written notice of perceived failure to satisfy the 'gin
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 s :. •, ..���.�m sir°
2. Deny payment or recover reimbursement for those services or
deliverables. which have not been performed and which due to
circumstances caused by Signal cannot be performed or if performed b,
would be of no value to the Human Services. Denial of the amount of
payment shall be reasonably related to the amount of work or deliverables
lost to Human Services; and
3. Incorrect payment to Signal due to omission, error, fraud, and/or defalcation
shall be recovered from Signal by deduction from subsequent payments
under this Agreement or other agreements between Human Services and
r
tjr
..
SIGNAL BEHAVIORAL HEALTH NETWORKS
WELD COUNTY DEPARTMENT OF HUMAN SERVICES "`""`°""' `°"T''''' ° ''''
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/201 .. , `"<<.
CHILD WELFARE CLIENTS "'
Signal, or by Human Services as a debt due to Human Services or 'r
' otherwise as provided by law.
j`
C. Signal may appeal the decision of the Director of Human Services or
designee, as provided in Item XII, B, of the Agreement, by submitting, within ,
thirty (30) calendar days of the Director's action, and basis of such appeal to'!,
the Board of County Commissioners.
XIII. NON-DISCRIMINATION
l,
It is the policy of Signal to provide equal opportunity without discrimination based :.
on race, color, sex, religion, age, sexual orientation, national origin, veteran
status, or individual handicap in any aspect of employment, training or services
offered. All Signal programs, activities, and services are administered on a non
discriminatory basis subject to the provisions of:
Title VI and VII of the Civil Rights Act of 1964 ,
Executive Order 11246, as amended ,
Title VII and VIII of the Public Health Services Act
I Rehabilitation Act of 1973 (Section 503 and 504)
Equal Pay Act of 1963, as amended
Title IX of the Education Amendments of 1972
Vietnam Era Veteran's Readjustment Assistance Act of 1974
Age Discrimination in Employment Act of 1967
Age Discrimination Act of 1975
Non-Discrimination Laws of the State of Colorado.
XIV. ACCESS TO RECORDS
Signal. its Providers and WCDHS agree to make available in a timely manner, all
books, documents. and records pertinent to this contract for the purpose of billing
for services, audit, and compliance with requirements and regulations of federal
and state agencies and commercial insurance carriers. Yr.
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 A.
x:
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 ' x = =,wa =, µ=,
WCDHS and Signal shall sign a Qualified Service Organization Agreement in j
compliance with 42 CFR, Part 2.
XV. OBLIGATIONS
Obligations of WCDHS and Signal are contingent upon funds for that purpose ,
being appropriated, budgeted and otherwise made available.
• .,...a „ tea .. ., ,„.. ..w _ ,,., .... .„ ,w, :..,.,. wP a .' yt aw u�:mwaee ww �wva ureaw ww'..W .p
M .:-ss.ra• .,n.....r r.. ,-s .rr ..r aex,tiwawrYJ' ' 'y mY .^ wre,
•
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
:.... CE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016,.
CHILD WELFARE CLIENTS
XV SIONS
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 th:'
consent of all parties hereto.
XVII. NOTICES:
Any notice required to be given pursuant to the terms and provisions hereof I
be in writing and shall be sent by certified mail, return receipt re•uested
To Signal at:
Susan Williamson
CEO
Signal Behavioral Health Network
6130 Greenwood Plaza Blvd., Suite 150
Greenwood Village, CO 80111
To WCDHS at:
Judy A. Griego
Director
Weld County Department of Human Services
P.O. Box A
Greeley, CO 80632
XVIII. LITIGATION
Signal shall promptly notify Human Services in the event that Signal learns of any ;
actual litigation in which it is a party defendant in a case that involves services
provided under this Agreement. Signal, within five (5) calendar days after being'.
served with a summons, complaint, or other pleading which has been filed in any,.
federal or state court or administrative agency, shall deliver copies of such':
document(s) to the Human Services Director. The term "litigation" includes an-,
assignment for the benefit of creditors, and filings in bankruptcy, reorganiz- i•
and/or foreclosure,
T,ERMINATIO
om..e t„,,, '�h 2.(tge va . 'Pa,
This Agreement may be terminated at any time by either party given thirty (30) days
written notice and is subject to the availability of funding. subject to the provisions of
Item XI and Item XIX. Signal reserves the right to suspend services to clients if s=
funding is no longer available. Human Services acknowledges financial
responsibility for clients authorized under the terms of the Agreement.
,r
w ,.
SIG ' .," : ` ORAL EALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
1
XX. DISPUTE RESOLUTION
It is the desire of all parties to resolve conflicts at the Signal/County level throug :j
cooperation. Internally, the County Directors and the Signal provider shale
attempt to resolve all conflicts and disputes. If the issue cannot be resolved,,
j either party may request that Signal intervene and mediate the situation. If the
.2 county, Signal and the provider are unable to resolve the dispute, the State may
be requested by any party to intervene (DHS Child Welfare and ADAD). Any
further unresolved issues may be submitted to the Director of the Office of Health
µ and Rehabilitation Services or their designee(s) for case presentation an*;"
review. �.
, Should the above efforts fail, Signal, its provider(s) and WCDHS hereby agree to ,,_,, . ::.
' submit all unresolved controversies, claims, and disputes arising out of this,
, Agreement to mediation in Denver. Colorado. according to the commercial rules
and practices of the American Arbitration Association then in force, or pursuant to
other rules or procedures as to which the parties may agree. Regardless of they
outcome. each party agrees to fund their own litigation expenses. f
This Agreement shall be governed by and construed in accordance with the laws
of the State of Colorado. .w' =. "
w XXI. MISCELLANEOUS PROVISIONS
A. Headings. The headings of the sections and subsections of this;
Agreement are inserted solely for ease of reference and shall not in any', .
' way affect the meaning or interpretation of this Agreement.
B. Non-Assignment. None of the parties shall have the right to assign these
benefits or delegate the obligations in this Agreement without prior written
consent of the other parties. Subject to the foregoing, this Agreement ,'jq
shall be binding upon and inure to the benefit of the parties and their r 'x
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 ,. : :y '
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 ,.,t•,+
neuter, and the number of all words shall include singular and plural. ''®, ,m
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 =, mm , ,,
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
SIGNAL BEHAVIORAL HEALTH NETWORK '" ° ""' ''.- -"
WELD COUNTY DEPARTMENT OF HUMAN SERVICE .. .
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
tai"n 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 mM
unwritten, with respect to the same subject matter
. ti
H. Non-Exclusivity. Participation in this Agreement shall be non-exc use's
is in nature and either party may enter into other Agreements other then'.'°
through Signal or WCDHS. The only restriction is on the amount or'
funding included in this Agreement. Either party may not enter into othe
Agreements that may dilute the funding base in this Agreement.
G I. Hold Harmless. To the extent authorized by law each party agrees toM
defend, hold harmless. and indemnify the other party and its affiliates n.,
jz directors. trustees, officers, and employees from and against all claims,
demands, suits, judgments. expenses. and costs of any and all kind-
arising as a result of damages or injuries arising out of. or incident to.
m
the
`' performance or failure of performance of this Agreement by suc ,
indemnifying party or its agents of its duties, obligations, or right-,
jq hereunder. '
J. Negligence/Malpractice. In the event that negligence or Ma'practice o'.
Signal or an employee of Signal shall subject County to potential or actual
liability. Signal shall hold the Weld County Department of Human Services,,
harmless from all monetary loss resulting from such liability. This;
obligation to hold harmless shall, in addition to any other obligations,;
commonly associated with it, would obligate Signal to pay all reasonable
j' attorney fees. costs, expenses, and damages incurred as a result of such
liability. Signal acknowledges that the Weld County Department of Human;'
Services is a department of Weld County and, thus, to the extent'1
authorized by law, Signal agrees to indemnify. save, and hold harmless -
the Board of County Commissioners of Weld County. or Weld County. or
both, against any and all claims. damages, liability, and the like as above
set forth.
,s
The indemnities and assumptions of liabilities and obligations herein
provided for shall continue in full force and effect notwithstandin. the
m'
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 as
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
iiit
undersigned parties that any entity other than the undersigned parties
receiving services or benefits under this Agreement shall be an incidental
beneficiary only.
11 of 12
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
APPROVED BY.
3c.62- 6/30/15
Susan Williamson, Chief Executive Officer Date
SIGNAL BEHAVIORAL HEALTH NETWORK
!jUL2e2015
` `
arbara Kirkmeyer, hair X Date
WELD COUNTY BOARD OF COUNTY COMMISSIONERS
.r 7 ;t
Jud, Grie o, Dire Di �/`
Diet
WEL COU TY DEP -TMEN 'OF HUMAN SERVICES
•
0.20/5 02/6�!
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding (MOU) shall act as an attachment to the contract between
Signal Behavioral Health Network (Signal) and Weld County Department of Human Services
(WCDHS). The term of the contract and this MOU is from June 1, 2015 to June 30, 2016,
unless terminated otherwise.
Compensation
WCDHS agrees to contract with Signal for a maximum of $300,000.00 from their Core Service
Funding.
Signal agrees to contribute a maximum of $116,259.88 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.
Payment
A. Responsibilities
1. Signal shall submit an itemized monthly bill to Human Services for all costs
incurred and services provided in accordance with criteria established by
Human Services and Signal. Requests to modify criteria must be provided
with 30 days advance notice. Signal shall submit all itemized monthly
billings to Human Services no later than the 3rd Wednesday of the month
following the current month plus the previous 60 days for the month the cost
was incurred in accordance with the Trails payroll calendar.
2. Signal shall make available, on its web site, monthly billing reports in
accordance with the billing criteria established by Human Services no later
than the 3rd Wednesday of the month following the month of service. Monthly
client progress reports must be made available to the Core Services
Caseworker, in the format provided by the Department (see attached Exhibit
B). In the alternative, the information contained on Exhibit B will be available
to the Core Services Caseworker for download from the Signal database by
the 3rd Wednesday of the month following the date of service. Arapahoe
House, North Range Behavioral Health and Larimer Center for Mental Health
will be required by Signal to input the monthly progress information into the
Signal database prior to their ability to bill service charges for that client. Any
incomplete progress report will be deemed incomplete and all such
associated services will be pended.
3. Failure to submit monthly billings and/or monthly client reports in accordance
with the terms of this agreement may result in Signal's forfeiture of all rights
1 of7 0200-02/6. 7
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
to be reimbursed for such expenses. In the event of a forfeiture of
reimbursement, Signal may appeal such circumstance to the Director of
Human Services, after all remedies described in Item XII, A of the Agreement
are exhausted. The Director of Human Services shall render a decision. The
decision of the Director of Human Services may be appealed to the Board of
County Commissioners according to the provisions of Item XII of the
Agreement.
4. Payments of costs incurred pursuant to this Agreement are expressly
contingent upon the availability of Colorado Core Services substance abuse
treatment funding to Human Services. WCDHS shall be liable for all services
authorized and provided up to the date of receipt by Signal of revocation of
such authorization.
5. Human Services shall not be billed for, and reimbursement shall not be made
for, time involved in activities outside of those defined in Exhibit D, "Scope of
Services" and Exhibit A, "Weld County 13/14 AFS and Core Fee Schedule."
Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
6. Signal shall provide training and technical support, as necessary and as
resources allow, for Human Services staff in accessing Signal's data and
billing reports and on the use of the child welfare referral system.
B. Unless otherwise provided in the Scope of Services and Payment
Schedule:
1. Signal shall provide proper monthly invoices, make available monthly
progress reports for each client incurring charges, and verification of services
performed for costs incurred in the performance of the agreement.
2. Human Services may withhold any payment if Signal has failed to comply
materially with the Financial Management Requirements, program objectives,
contractual terms, or reporting requirements. In the event of a withhold of
reimbursements, Signal may appeal such circumstance to the Director of
Human Services, after all remedies described in Item XII, A of the Agreement
are exhausted. The Director of Human Services shall render a decision. The
decision of the Director of Human Services may be appealed to the Board of
County Commissioners according to the provisions of Item XII of the
Agreement.
3. WCDHS will complete the Signal remittance advice and return to Signal
within 5 business days of completion of each month's TRAILS payroll date.
Each remittance advice shall detail reasons for denial of any and all services.
WCDHS shall work with Signal and other counties to develop standard claims
denial criteria. WCDHS shall reimburse Signal for all complete services
invoiced within 45 calendar days from the date of receipt of Signal's invoice.
4. WCDHS shall identify the individuals Signal should communicate with for
clinical, data and billing needs.
2 of 7
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
AFS and Core Services Reimbursement
Funding Sources
AFS Core Total
On-Site Salaries and Benefits 0 0 0
Supplies, Supervision and Travel 0 0 0
Subtotal-Onsite Costs 0 0 0
Admin Fee 0 0 0
Total Onsite Costs 0 0 0
Fee-for-service funding 110,447 285,000 395,447
Signal Fee 5,813 15,000 20,813
Total fee-for-service 116,260 300,000 416,260
Total Contract Costs 116,260 300,000 416,260
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).
Rate
Schedule
FY15-16 Weld
Provider Adm Payer
Service Code Service Code Description Units Meas. Rate Fee Rate
UA - 5 panel w/auto
80101:AC confirmation each 15.00 0.75 15.75
81002 UA - Multi-panel Instant each 12.00 0.60 12.60
82055 Oral Swab Instant each 15.00 0.75 15.75
82075 Breathalyzer each 5.00 0.25 5.25
82541 UA - GC/MS - Qualitative each 35.00 1.75 36.75
82542 UA - GC/MS - Quantitative each 35.00 1.75 36.75
84999 Hair Testing each
3 of 7
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
100.00 5.00 105.00
94664 Vapor Inhalations Evaluation each 60.00 3.00 63.00
Medical Testimony (Inc.
99075 travel, wait & prep time) per 15 min. 17.50 0.88 18.38
per 15 min.
99199 Court Case Consultation session(s) 7.50 0.38 7.88
UA - Ethyl Glucuronide
80100:HF (EtG) each 30.00 1.50 31.50
UA - Optional Add-on Panel
(Oxycodone or
80101:AO Buprehorphine) each 2.00 0.10 2.10
UA - 7 Panel w/Auto-
80101:CF confirmation each 20.00 1.00 21.00
UA - Single Panel EtG Add-
80101:TG on Test each 2.00 0.10 2.10
82055:OF Oral Fluid - 6 Drug Panel each ' 17.00 0.85 17.85
Oral Swab - Synthetic
82055:OS Cannabinoids (Spice) each 35.00 1.75 36.75
UA - Synthetic
82055:SC Cannabinoids (Spice) each 35.00 1.75 36.75
MDPV, Mephedrone, &
83000:81 Methylone - 3 panel each 35.00 1.75 36.75
Expanded Designer
83000:80 Stimulants - 14 panel each 50.00 2.50 52.50
H0001:HH Evaluation: Ill each 250.00 12.50 262.50
H0001:ll Evaluation: II each 144.00 7.20 151.20
H0004 Individual Counseling per 15 min. 17.50 0.88 18.38
H0005 Group Counseling hour(s) 25.04 1.25 26.29
Group counseling:
Family/couple with client
H0005:HR present per 15 min. 6.25 0.31 6.56
Group counseling:
Family/couple without client
H0005:HS present per 15 min. 6.25 0.31 6.56
H0006 Case Management each - - -
H0011 Detox day(s) 270.00 13.50 283.50
Intensive Short-Term
H0018:HA Residential:Adolescent day(s) 228.00 11.40 239.40
4 of 7
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
Intensive Short-Term
H0018:HB Residential:Adult day(s) 170.00 8.50 178.50
Transitional Long-Term
H0019 Residential day(s) 132.00 6.60 138.60
Transitional Long-Term
Residential:Preg/Parent
H0019:HD (NDF) day(s) 175.00 8.75 183.75
Opioid Replacement
H0020 (Methadone) month(s) 415.00 20.75 435.75
Peer Services Recovery
H0038:CG Groups per 15 min. 6.25 0.31 6.56
H0048:HF Drug Patch Monitoring each 50.00 2.50 52.50
H2012: HB Day Treatment:Adult hour(s) 6.90 0.35 7.25
H2012:HA Day Treatment:Adolescent hour(s) 9.87 0.49 10.36
Therapeutic Behavioral
H2020:HA Srvcs:Adolescent day(s) 125.00 6.25 131.25
Therapeutic Behavioral
H2020:HB Srvcs:Adult w/o Infant day(s) 59.00 2.95 61.95
Therapeutic Behavioral
H2020:HD Srvc:Preg/Parent day(s) 99.50 4.98 104.48
Functional Family Therapy
H2033:F (FFT) day(s) 20.00 1.00 21.00
Multisystemic Therapy
H2033:M (MST) day(s) 57.50 2.88 60.38
T1006 Family Counseling hour(s) 84.00 4.20 88.20
The County and Signal acknowledge that all UA services MUST be physically
monitored/observed
by an individual in order for payment to be considered.
The County and Signal further acknowledge that any and all monitoring beyond standard
urinalysis or breathalyzer tests must be approved by the County prior to administration.
Signal, in accordance with Federal HIPAA regulations, adopted a standard transaction code set
for all treatment services on October 16, 2003, which are subject to change throughout each
contract year. Even though this compliance changed the service labels and groupings (shown
above), the net amount of the fees associated with those services has not changed.
5 of 7
EXHIBIT A
SIGNAL BEHAVIORAL HEALTH NETWORK and
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE COMPENSATION AND SERVICE
RATES
MEMORANDUM OF UNDERSTANDING
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:
AFS Only
Service Units Provider Admin Payer
Code Service Code Description Measured Rate Fee Rate
Room & Board: Adolescent:
T2048:HA ARTS Daily 38.50 2.03 40.53
Room & Board: Adolescent:
T2048:HA Arapahoe House Daily 36.30 1.91 38.21
Room & Board: Adolescent: North
T2048:HA Range Beh. Health Daily 35.00 1.84 36.84
T2048:HB Room & Board: Adult: ARTS Daily 16.88 0.89 17.77
Room & Board: Adult: Arapahoe
T2048:HB House Daily 45.23 2.38 47.61
T2048:HB Room & Board: Adult: Crossroads Daily 50.00 2.63 52.63
Room & Board: Adult: North
T2048:HB Range Beh. Health Daily 30.00 1.58 31.58
Room & Board: Adult: Sobriety
T2048:HB House Daily 22.00 1.16 23.16
Room & Board: Preg/Parent:
T2048:HD ARTS Daily 16.88 0.89 17.77
Room & Board: Preg/Parent:
T2048:HD Arapahoe House Daily 50.17 2.64 52.81
Room & Board: Preg/Parent:
T2048:HD Crossroads Daily 75.00 3.95 78.95
J2315:OR Oral Naltrexone monthly supply each 85.00 4.25 89.25
J0593 Suboxone Oral monthly supply each 445.00 22.25 467.25
Physician time medication per 15 min.
99205 beginning/induction session(s) 50.00 2.50 52.50
Physician time medication per 15 min.
99215 maintenance session(s) 50.00 2.50 52.50
86586 SCRAM Skin monitor day(s) 13.00 0.68 13.68
6 of 7
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
APPROVED BY
azz Gt9e n 6/30/15
Susan Williamson, Chief Executive Officer Date
SIGNAL BEHAVIORAL HEALTH NETWORK
2 0 2C
arbara Kirkmey r, Chair Date
WELD COUNTY BOARD OF COUNTY COMMISSIONERS 6Judy A. r go, Directo # ;;15:-
WELD O NTY DEPARTMEN OF H AN SERVICES
18 of 34
0.26� aZ/60 g
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
EXHIBIT C
SIGNAL BEHAVIORAL HEALTH NETWORK
QUALIFIED SERVICE ORGANIZATION AGREEMENT
Signal Behavioral Health Network (MSO) and Weld County (County or Counties) Department of
Human Services hereby enter into a Qualified Service Organization Agreement whereby the MSO
agrees to accept and serve Counties' clients substance abuse treatment needs. In light of the
relationship between County and the MSO, County requires client identifying information and data
and information related to the services furnished to the clients. County and MSO will have this
relationship from June 1, 2015- June 30, 2016, thus the QSOA will be in effect during this period
of time.
Furthermore, the County:
1. acknowledges that in receiving, storing, processing, or otherwise dealing with any
information from the MSO about the clients in the MSO's program, it is fully bound by the
provisions of the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient
Records, 42 CFR Part 2; and
2. undertakes to resist in judicial proceedings any effort to obtain access to information
pertaining to clients otherwise than as expressly provided for in the federal confidentiality
regulations, 42 CFR Part 2.
Executed this_30_day of June , 2015.
ciz2
• Susan Williamson Ju . Grie9 (V�t
Chief Executive Officer Dire or
Signal Behavioral Health Network Weki County Department of Human
Services
20 of 34
c>20/5'02/4' /
$ .. _ atimredmem •Ord x"?dm
dr wrtc-"rsbv >F
N
XHIBIT D
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2015/2016
SCOPE OF SERVICES
A. ASSESSMENTS
1. Alcohol and Drug Differential Assessment (3-Hours)
( Assessment will evaluate alcohol/drug involvement as well as mental health
status, history of mental health issues, sexual history. legal history. anc
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 Assess,•. .F
, (3-Hours)
Summary of assessment with recommendations sent to re'-'' ' _•- " v
The following areas will be assessed: =,
Criminal History Profile of Client's Violent
Behaviors
Potential for Violence Mental Health Status
Client's Medical History Substance Abuse History
Suicidal/Psychological/Cultural Millon Test, if needed
History .:.
3. Substance Abuse Forensic Evaluation (3 hours, as staff expertise"' %-
p6 permits) .,
i.
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 ,n
recommendations. Testing will be comprised of CVI, ASUS, SASSI, Millon "
Clinical Multiaxial Inventory (MCMI-III), a clinical interview, and a behavioral
i' profile. The testing is cross-referenced with the clinical interview and"Win,'
relation to collateral data.
r
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.
,. ,,.
EXHI.
SIGNAL BEHAVIORAL HEALTH NETWORK a,
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2015/2016
Areas addressed: `'
Referral information and Chief Complaint / Precipitating Event(s) .ry
• Presenting Problem
• Psychosocial History
• Legal History
{ Abuse and/or Victimization History
• Strengths. Resources and Needs
xE • 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: III - Level III Assessment . ;.,.., ,
} In addition to all areas identified in the Level II assessment. a Level III mays
include the use of assessment tools and/or include extensive history,
review and collateral input as appropriate. A Level III Assessment isi.
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's
Violence or Anger Management assessments will be bill-. -
Evaluation: Ill rate.
,,; ,
B. TREATMENT OPTIONS
I.
1. Co-Occurring Alcohol and Drug with Domestic Violence Group Therapy
(average length of treatment. 24 to 36 weeks) Groups for both men and
women are offered. The group addresses anger management. healthy '
relationships, male and female roles, and boundaries. As needed. a "
Millon Test may be given, a standardized psychological test which ;£
measures functioning level in 22 personality disorders and clinical `?,
syndromes for adults (81h grade reading level: > 18: available in Spanish) m
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 i-0
relationships. Length of participation is dependent on client goals and
progress toward meeting goals. w`�
I
XHIBIT D .. :.
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2015/2016
3. Individual Counseling (average length of treatment, 6 to 1 `*Wtl6
sessions): Primary client is seen on an individual basis. Length o)
participation is dependent on client goals and progress toward goals.,.. ...''
4. Substance Abuse Therapy (average length of treatment, 12 to2a
sessions): A group to enhance positive coping skills by focusing on them
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 relaps:
education components focusing on understanding the relapse process ash
well as group process (focuses on individual issues relating to their abuse
of alcohol). The program length and participation level will be
individualized based on the presenting issues and other factors.
6. Women's Group (average length of treatment, 12-20 sessions): A
gender-specific group addressing issues affecting women and thei
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.
EXHIBI �A_
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2015/2016 '
C. SPECIAL PROGRAM OPTION
I` Conecial 1. Special p nections (through pregnancy and up to one yea
postpartum): A gender-specific program that focuses on healthy babie--
appropriate child care, prenatal care, birth control. developmental stages r „
of the baby. parenting skills, relationship issues. and other issues as °'
identified by the counselor. Services include group and individual therap
I" case management and family health education. *`z. '`.
.. . •.e,,. ®.NS
F 3'+'+mfi• ..Y•"""*"'* m ,. .... ,`".""�*d.. ^t,y,p,„ .. gym?.
Vin' 1. Extended Detoxify Stay: This is an option when case managemeri
goals require that the person be in a stable environment until they can b
1*
} referred to the next level of care.
a
2. Enhanced Services: Enhanced services as approved services that ar;-
requested by Human Services for specific cases. which fall outside of th:'
definitions, listed above in the description of the DBH menu of services!.
Enhanced services may be services not described on the menu, service-
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' a ,_,
Human Services will be charged an additional fee that would be
negotiated on a case-by-case basis by the designated representative •
listed in the contract. ,,
E. MEASURABLE OUTCOMES AND OBJECTIVES
-f
Signal shall abide by Human Services outcome indicators of Safety, Permanency!,,
and Child and Family Well-Being, which are provided under Adoption and Safe
Families Act (ASFA). 1997, Colorado Child and Family Services Plan 2000 —
2004; and ACF Reviews (Reference: Federal Register. Volume 65. Number 16:''
45 CRF Parts 1355, 1356, and 1357), March 25, 2000. ;►
1. Outcome Reports as Prescribed by Human Service,.','
2. Outcome reports will be developed and provided as mutually agreed'
upon by the parties.
,3. Client Objectives "` a "'
4 of 6
#{t
E ,_ = L
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2015/2016
The Human Services caseworker will identify a maximum o "" a.„ ,
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 i
meeting the three identified objectives while the client is receivinel
treatment services
4. Overall Program Objectives
Signal and Human Services agree to monitor the ability of the°su.s"an`c
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 su. tanc-,
abuse.
c. Develop the capacity to ask for help and assistance withou`
resorting back to substance abuse
d. Develop or increase the ability to recognize.
g prioritize and meet::
child(ren)'s needs
e. Parent will identify how their substance use has affected their:''
parenting
f. Parent will identify how their substance use got them involved with
, Human Services "�"°`"`
g. Parent will identify how their substance use helped em paren . ''
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 , p:..,,w
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
w q. Family members will identify how they can support the identified t
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
5 of 6
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT D - SCOPE OF SERVICES - FY 2015/2016
t. Family members will identify relapse systems of the identifi .
u. Family members will identify how they can reach out for help if k.
relapse occurs
v. Increase level of functioning currently impaired by living in
substance affected family
w , Identify how living in substance affected family has impacted,the.''
life
x. Improve level of functioning currently impaired by substanc= au
issues
y. Decrease aggressive behaviors at home and/or school and in th
community
z. Learn how to socialize without the use of substances
aa. Identify relapse triggers
bb. Create a sober support network
F. STAFF QUALIFICATIONS
Signal staff members who will provide services to Human Services clients will)!
havehave 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.
rt
xa
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2015/2016
1. Signal agrees it is an independent contractor and that its officers and
employees do not become employees of Weld County, nor are they
entitled to any employee benefits as Weld County employees, as the
result of the execution of this Agreement.
2. Weld County, the Board of County Commissioners of Weld County, its
officers and employees, shall not be held liable for injuries or damages
caused by any negligent acts or omissions of Signal or its employees,
volunteers, or agents while performing duties as described in this
Agreement. Signal shall indemnify, defend, and hold harmless Weld
County, the Board of County Commissioners of Weld County, its
employees, volunteers, and agents. Signal shall provide adequate liability
and worker's compensation insurance for all its employees, volunteers,
and agents engaged in the performance of the Agreement upon request,
Signal shall provide Human Services with the acceptable evidence that
such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any
immunities the parties or their officers or employees may possess, not
shall any portion of this Agreement be deemed to have created a duty of
care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the
part of the County of Weld, State of Colorado, to expend funds not
otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this
Contract is for any reason held or decided to be unconstitutional, such
decision shall not affect the validity of the remaining portions. The parties
hereto declare that they would have entered into this Contract and each
and every section, subsection, paragraph, sentence, clause, and phrase
thereof irrespective of the fact that any one or more sections, subsections,
paragraphs, sentences, clauses, or phrases might be declared to be
unconstitutional or invalid.
6. No officer, member or employee of Weld County and no member of their
governing bodies shall have any pecuniary interest, direct or indirect, in
the approved Agreement or the proceeds thereof.
7. Signal assures that they will comply with the Title VI of the Civil Rights Act
of 1986 and that no person shall, on the grounds of race, creed, color,
sex, or national origin, be excluded from participation in, be denied the
1 of 4
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2015/2016
benefits of, or be otherwise subjected to discrimination under this
approved Contract.
8. Signal assures that sufficient, auditable, and otherwise adequate records
that will provide accurate, current, separate, and complete disclosure of
the status of the funds received under the Contract are maintained for
three (3) years or the completion and resolution of an audit. Such records
shall be sufficient to allow authorized local, Federal, and State auditors,
and representatives to audit and monitor Signal.
9. All such records, documents, communications, and other materials shall
be the property of Human Services and shall be maintained by Signal, in a
central location and custodian, in behalf of Human Services, for a period
of four (4) years from the date of final payment under this Contract, or for
such further period as may be necessary to resolve any matters which
may be pending, or until an audit has been completed with the following
qualifications: If an audit by or on behalf of the federal and/or state
government has begun but is not completed at the end of the four (4) year
period, or if audit findings have not been resolved after a four (4) year
period, the materials shall be retained until the resolution of the audit
finding.
10. Signal assures that authorized local, federal, and state auditors and
representatives shall, during business hours, have access to inspect any
copy records, and shall be allowed to monitor and review through on-site
visits, all contract activities, supported with funds under this Contract to
ensure compliance with the terms of this Agreement. Contracting parties
agree that monitoring and evaluation of the performance of the Agreement
shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate
and interested parties.
11. This Contract shall be binding upon the parties hereto, their successors,
heirs, legal representatives, and assigns. Signal or Human Services may
not assign any of its rights nor obligations hereunder without the prior
written consent of both parties.
12. Signal certifies that federal appropriated funds have not been paid or will
be paid, by or on behalf of Signal, to any person for influencing or
attempting to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any federal grant, the making of any federal loan,
2 of 4
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2015/2016
the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal
contract, loan, grant, or cooperative agreement.
13. Signal assures that it will fully comply with all other applicable federal and
state laws. Signal understands that the source of funds to be used under
this Contract is: Colorado Core Services substance abuse treatment
funds.
14. Signal assures and certifies that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transaction
by a federal department of agency.
B. Have not, within a three-year period of preceding this Agreement,
been convicted of, or had a civil judgment rendered against them
for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (federal,
state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly
charged by a government entity (federal, state, or local) with
commission of any of the offenses enumerated in paragraph 11(b)
of this certification; and
D. Have not within a three-year period preceding this Contract, had
one or more public transactions (federal, state, and local)
terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of Signal
with Human Services when Signal also maintains a relationship with a
third party and the two relationships are in opposition. In order to create
the appearance of a conflict of interest, it is not necessary for Signal to
gain from knowledge of these opposing interests. It is only necessary that
Signal know that the two relationships are in opposition. During the term of
the Contract, Signal shall not enter any third party relationship that gives
the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation, Signal shall submit to
Human Services, a full disclosure statement setting forth the details that
3 of 4
EXHIBIT E
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
EXHIBIT E - ASSURANCES - FY 2015/2016
create the appearance of a conflict of interest. Failure to promptly submit
a disclosure statement required by this paragraph shall constitute grounds
for Human Services' termination, for cause, of its contract with Signal.
16. Signal shall protect the confidentiality of all applicant records and other
materials that are maintained in accordance with this Contract. Except for
purposes directly connected to the administration of Child Protection, no
information about or obtained from any applicant/recipient in possession of
Signal shall be disclosed in a form identifiable with the applicant/recipient
or a minor's parent or guardian unless in accordance with Signal written
policies governing access to, duplication and dissemination of, all such
information. Signal shall advise its employees, agents, and sub-providers
of Signal, if any, that they are subject to these confidentiality requirements.
Signal shall provide its employees, agents, and sub-providers of Signal, if
any, with a copy or written explanation of these confidentiality
requirements before access to confidential data is permitted.
17. Proprietary information for the purposes of this contract is information
relating to a party's research, development, trade secrets, business
affairs, internal operations and management procedures and those of its
customers, clients or affiliates, but does not include information (1) lawfully
obtained from third parties, (2) that which is in the public domain, or (3)
that which is developed independently. Neither party shall use or disclose
directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this
Contract. Any proprietary information removed from the State's site by
Signal in the course of providing services under this Contract will be
accorded at least the same precautions as are employed by Signal for
similar information in the course of its own business.
18. Signal certifies it will abide by Colorado Revised Statue (C.R.S.) 26-6-104,
requiring criminal background record checks for all employees,
contractors, and sub-contractors.
4 of 4
EXHIBIT F
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT
STANDARDS OF RESPONSIBILITY FOR CORE SERVICES
FISCAL YEAR 2015/2016
1. Signal and Human Services agree to develop a case management plan
(aka substance abuse treatment plan) on each referred family within 30
days of the date the Signal received the referral. The case management
plan will be monitored and modified monthly to measure progress toward
goals. Copies of the case management plan must be sent to the
caseworker, program area supervisor, and Core and Service Contract
Coordinator at Weld County Department of Human Services, P. O. Box A,
315 B N 11 Avenue, Greeley, Colorado 80632. The case management
plan will include, at a minimum, goals, timelines, and measurement of
success.
2. Signal and Human Services agree to resolve level of care conflicts at the
Signal/County level through cooperation. Human Services and Signal
shall attempt to resolve all levels of care conflicts and disputes at the
lowest level possible within each organization. Should Human Services
and/or Signal fail to agree upon the level of care offered by Signal, they
may appeal the case directly to the County Director, or designee, and the
Signal Chief Operating Officer. Both Signal and Human Services will have
an opportunity to provide consultation and documentation regarding the
appeal. Appeals are to be resolved within 72 working hours, unless good
cause justifies an extension.
3. Signal agrees that payments for levels of care are not authorized for
reimbursement by Human Services until a referral from Human Services is
provided to Signal prior to services rendered by Signal. Furthermore,
Signal and its providers agree that any monitoring in conjunction with
treatment beyond standard urinalysis and breathalyzer tests, as well as
changes in level of care are not authorized for reimbursement by Human
Services until staffed with designated Human Services staff. Human
Services agrees to identify designated staff that may provide this
authorization.
4. Signal agrees not to accept any referral from Human Services unless the
referral contains all information required on the form and necessary for
reimbursement by Human Services and authorized for reimbursement. If
Signal accepts the referral without all data fields required on the referral
form or authorization, Signal may assume fiscal responsibility for the
services provided under the incomplete referral. Inaccurate information
listed on the referral form by Human Services will be excluded as a fiscal
responsibility for Signal.
1 of 4
EXHIBIT F
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT
STANDARDS OF RESPONSIBILITY FOR CORE SERVICES
FISCAL YEAR 2015/2016
5. Signal agrees to provide access to all monthly client progress reports for
clients with treatment charges by the 3rd Wednesday after the month of
service, via the Signal website. The monthly progress report for each
client must be entered into the Signal Service Management website by the
provider previous to the monthly billing claims in order for payment to be
honored. Failure to submit such monthly reports will result in delays or
forfeiture of payment. It is expected, at a minimum, that these reports will
reflect all information requested on the Monthly Progress Report
6. Signal agrees to submit a final discharge summary of client outcomes to
Human Services within thirty (30) calendar days after the completion date.
7. Signal agrees to report expenditures and case disbursement at agreed
upon times.
8. Signal agrees to assume fiscal responsibility for expenses incurred by
Signal that do not meet the requirements of Exhibit F of this Agreement.
Those expenses incurred by Signal outside of the scope of Exhibit F
requirements are not eligible Human Services expenditures and shall not
be reimbursed by Human Services.
9. Signal agrees to the definition of a complete and timely billing form for
purposes of submitting an original bill under Exhibit F, 8. A complete and
timely billing form must include the following elements.
A. The billing must include all forms designed for Core Services
reimbursement and approved by Human Services; Core Services
Authorization of Funds, Project Report, Update Report, and original
signed client verification forms for therapy and group services.
Additionally, Signal agrees to provide Human Services monitoring
results (UA, BA, patch, tox trap swab) by faxing said results to
Human Services at 970.346-7667 or via access to online system no
later than 72 hours after the day of service.
B. The Department will determine billed services not eligible for
payment by identifying conflicts in the following:
1. Details provided in client referrals and renewals, including
approved hours of service, begin and end dates of service,
client name, and Case ID.
2 of 4
EXHIBIT F
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT
STANDARDS OF RESPONSIBILITY FOR CORE SERVICES
FISCAL YEAR 2015/2016
2. Details in supporting documentation provided by the Provider
and submitted with the original bill, including, but not limited to,
original signed client verifications, receipt of monitoring results,
time of service and units or hours of service provided, and
names of clients receiving the services, and monthly progress
reports with all the information specified on the Monthly
Progress Report.
3. Details provided in the current approved contract and
Notification of Financial Assistance, including, but not limited
to unit of service, cost per unit of service, and special
conditions and/or revisions to said contract.
The above items, 9 C, 1, 2, and 3, will supersede all requests from
Signal for review of billing errors. Items submitted for billing will be
processed according to the criteria established by the above
documentation.
The Department will make obvious corrections to minor errors in the
bill in order to expedite processing the claims for payment. Minor
errors include missing or transposed digits in Household Numbers,
TRAILS Case ID, or other Department-generated information.
D. An Administrative fee will be assessed to all fees reimbursed through
County only funding. Such fees include, but are not limited to, those
service fees previously billed and determined by the Department to
be not eligible for payment.
10. Signal will develop and utilize evaluation tools (pre- and post-assessment
test instruments) to collect necessary data in cooperation with Human
Services staff to monitor effectiveness of program.
11. Signal will meet with the Human Services designated supervisor quarterly
and/or the Core Services Coordinator (more if needed) to review program
usage and effectiveness to discuss necessary improvements to better
serve families or increase referrals.
12. Signal will be available to meet with Human Services staff to explain
program, time lines of response to referrals and answer questions to
enhance program.
3 of 4
EXHIBIT F
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT
STANDARDS OF RESPONSIBILITY FOR CORE SERVICES
FISCAL YEAR 2015/2016
13. Signal, or their authorized designee, will be available for the Families,
Youth and Children (FYC) Commission review and attendance at the FYC
meetings.
14. Regarding all forms referenced herein in the Agreement, Signal shall
replicate these forms in format, content and according to the specifications
of Human Services or as mutually agreed upon by Signal and Human
Services. Signal agrees to modify these treatment authorization forms
according to Human Services specifications and requirements.
15. Human Services will be responsible for electronically authorizing services
to various Signal providers and initially designating if Core funds shall be
used for payment. Human Services shall assure that the authorization will
have all information required for reimbursement from the county.
16. Human Services agrees to provide Signal with the name of a primary
contact who will be responsible for interacting with Signal's data system.
17. Human Services agrees to provide TRAILS Remittance Advice and a
Signal Remittance Summary (Exhibit B) to Signal within five (5) business
days of the monthly TRAILS Core Main Payroll date.
18. Human Services agrees to render payment for one full billing invoice at a
time, as billed monthly by Signal, and not to submit payment for a mixture
of separate invoices within one payment.
4 of 4
EXHIBIT S
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
Weld County SCRAMx Use Case Project.
Signal Behavioral Health Network (Signal) is convinced that SCRAMx can be used to benefit
clients in their quest to achieve real world abstinence and help stake holders achieve financial
and clinical efficiencies not before realized. Signal wishes to initiate a use case project with the
help of Weld County and North Range Behavioral Health.
Signal and MSI have qualified SCRAMx (Secure, Continuous, Remote, Alcohol Monitoring) from
Alcohol Monitoring Systems (AMS) as an affirmative technology option. From the successful
trial that Signal and MSI implemented in 2011, use case illuminates clinical and financial
benefits to be shared with other treatment providers and payer systems in an effort to build
clinical field adoption of remote alcohol monitoring.
I. General duties of MSI.
-MSI will be responsible for providing SCRAMx equipment, installing the equipment,
adjusting the equipment as needed, and training all involved in the project in the
operations of the equipment and hardware. For purposes of this amendment, MSI and
Signal will be available to place equipment on an identified client within 24-hours of the
initial request.
-MSI will manage the inventory of hardware allocated to this program.
-MSI will invoice Signal on the first day of each month for the prior month utilization
charges.
-MSI will provide the identified treatment team a list of SCRAMx clients, along with
compliance reports on all clients. Compliance reports will be customized to meet the
treatment teams reporting requirements.
-MSI will report any evidence of non-compliance to North Range Behavioral Health
(NRBH) and/or designated Case Worker immediately.
-MSI will notify the NRBH and Case Worker of all confirmed events.
-MSI staff will troubleshoot all potential drinking and tamper events per AMS
advisement prior to notifying the Case Worker or the provider.
IV. General duties of Signal Behavioral Health Network.
-Signal Behavioral Health Network will provide general duties as the fiscal agent for the
SCRAMx
project.
-Signal Behavioral Health Network will provide contract management duties to facilitate
the
execution of the contract between parties.
-Signal Behavioral Health Network will provide subject matter expertise in the areas of
substance use disorder treatment, compliance and quality improvement.
-Signal Behavioral Health Network will coordinate efforts to inform the partners of the
the evolution, project development and outcomes of the SCRAMx program. Signal will
foster a robust follow up of information to and from all stake holders.
1
EXHIBIT S
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
V. Client enrollment and process.
SCRAMx is a technology to be used with alcohol involved clients and will not monitor the use of
illicit drug abuse. When an alcohol involved client is identified and deemed appropriate for the
SCRAMx technology, the Case Worker should contact Jason Botticelli, or other MSI
representative at 818.264.6152 to begin the enrollment process.
Enrollment Process
• The phone-based, risk assessment screening, using ADRS, will be completed to
confirm the client is a match for the SCRAMx project;
• MSI will arrange a meeting with the client and Case Worker/ Clinical Team. and
orient the client to the SCRAMx bracelet and SCRAMx will be placed on the
client's ankle;
• MSI will coordinate with the team to determine the desired process of results
reporting;
• SCRAMx will be made active and monitoring will commence.
As the client evolves through SCRAMx project, representatives from MSI and Signal will be
available to the clinical team to assess the client's clinical progress using a combination of
Motivational Interviewing interventions along with SCRAMx. A key focus will be working with
the client to internalize behavior changes to improve long-term abstinence from alcohol.
Additionally, project representatives will be assessing the client's satisfaction using SCRAMx
and elicit feedback to further inform the client portion of the project.
Secondly, representatives from MSI and Signal will ask the clinical team to report their
experience with the SCRAMx intervention. This information will be used to manage project
processes moving forward.
Also important to the project is the opportunity to work with Department Administration to
determine cost-savings and/ or cost-offset when applying SCRAMx to this clinical population.
Project Goals
Achieve Patient Satisfaction
Improve Health Outcomes
Create Cost Savings
When the SCRAMx use case project completes Signal and MSI will evaluate the project to
determine the project's ability to achieve the identified project goals. All findings will be reported
back to the clinical team, case worker and Department.
2
SIGNAL BEHAVIORAL HEALTH NETWORK
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE TREATMENT SERVICE AGREEMENT - FY 2015/2016
CHILD WELFARE CLIENTS
APPROVED BY:
W 1C`112.4.- T. 6/30/15
Sue Williamson, CEO
SIGNAL BEHAVIORAL HEALTH NETWORK Date
rjUL 2 0 2015
arbara Kirkmeyer, C air
WELD COUNTY BOARD OF CO NTY COMMISSIONERS Date
`____71142LLS
Judy AA< sego, rector
WELD COUNTY EPARTM NT OF UMAN SERVICES Date
34 of 34
o20/5. O216. 7
Hello