HomeMy WebLinkAboutResolution - 2021-R0373 - Amendment No. 1 to Contrct HHS000780500002 with HHSC 9.28.21Resolution No. 2021-R0373
Item No. 7.14
September 28, 2021
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the acts of the Mayor of the City of Lubbock in executing, on behalf of the City of
Lubbock, Amendment No. 1 to the Health and Human Services Commission (HHSC) Contract
No. HHS000779500002, under the Substance Use Disorder Community Health Worker program,
by and between the City of Lubbock and the State of Texas acting by and through HHSC, and
related documents are hereby ratified in full. Said Amendment is attached hereto and
incorporated in this resolution as if fully set forth herein and shall be included in the minutes of
the City Council.
Passed by the City Council on September 28, 2021
DANIEL M. POPE, MAYOR
ATTEST:
Rebe ca Garza, City Secre
APPROVED AS TO CONTENT:
Bill How n, Deputy City pager
APPROVED AS TO FORM:
RyA,�(e, ssistant City Attorney
RES.HHSC Contract No. H14S000779500002 Amendment 1 Ratification
9.10.21
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
Resolution No. 2021-R0373
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS000780500002
AMENDMENT No. 1
EXTENSION
The HEALTH AND HUMAN SERVICES COMMISSION ("System Agency" or "HHSC") and CITY OF
LUBBOCK ("Performing Agency," "Grantee," or "Contractor"), who are collectively referred to
herein as the "Parties" to that certain Community Health Workers ("CHW") Contract effective
July 1, 2020 and denominated HHSC Contract No. HHS000780500002 ("Contract"), now desire
to amend the Contract.
WHEREAS, the Parties desire to revise Attachment A, Statement of Work, Attachment A-1,
Statement of Work Supplemental, Attachment B, Budget, Attachment E, Special Conditions, and
to extend the term of the Contract to allow for successful completion of the Project;
Whereas, the Parties desire to maintain an up to date Attachment I, Federal Funding
Accountability and Transparency Act (FFATA) Certification;
Whereas, the Parties desire to revise Section IV. Budget and increase the not -to -exceed Total
Contract Value; and
Whereas, the System Agency has chosen to exercise its option to extend the Contract in
accordance with Section III. Duration.
Now, THEREFORE, the Parties hereby amend the Contract as follows:
1. SECTION III of the Contract, DURATION, is hereby amended to reflect a revised
termination date of August 31, 2024.
2. SECTION IV of the Contract, BUDGET, is hereby amended to revise the following language
to in order to add ONE MILLION THREE HUNDRED NINETY-TWO THOUSAND DOLLARS
($1,392,000.00) to the System Agency Share total reimbursements, revise Performing
Agency match funding, and revise the Total Contract Value:
A. The total amount of this Contract, including applicable match, will not exceed Two
MILLION ONE HUNDRED NINETY -Two THOUSAND FOUR HUNDRED DOLLARS
($2,192,400.00).
B. System Agency Share total reimbursements will not exceed $2,088,000.00 for the
period from July 1, 2020 through August 31, 2024, allocated by State Fiscal Year (FY)
as follows:
1. FY 2020, July 1, 2020 through August 31, 2020: $232,000.00.
2. FY 2021, September 1, 2020 through August 31, 2021: $464,000.00.
3. FY 2022, September 1, 2021 through August 31, 2022: $464,000.00.
4. FY 2023, September 1, 2022 through August 31, 2023: $464,000.00.
5. FY 2024, September 1, 2023 through August 31, 2024: $464,000.00.
System Agency Contract No. HHS000780500002
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
C. For each State Fiscal Year (FY), Performing Agency is required to provide a five
percent (5%) match. In accordance with ATTACHMENT B, Performing Agency's
budgeted match requirements are as follows:
1. FY2020, July 1, 2020 through August 31, 2020 $11,600.00.
2. FY 2021, September 1, 2020 through August 31, 2021: $23,200.00.
3. FY 2022, September 1, 2021 through August 31, 2022: $23,200.00.
4. FY 2023, September 1, 2022 through August 31, 2023: $23,200.00.
5. FY 2024, September 1, 2023 through August 31, 2024: $23,200.00.
D. Total Contract Values will not exceed $2,192,400.00 for the period from July 1, 2020
through August 31, 2024, as follows:
1. FY2020, July 1, 2020 through August 31, 2020: $243,600.00.
2. FY 2021, September 1, 2020 through August 31, 2021: $487,200.
3. FY 2022, September 1, 2021 through August 31, 2022: $487,200.
4. FY 2023, September 1, 2022 through August 31, 2023: $487,200.
5. FY 2024, September 1, 2023 through August 31, 2024: $487,200.
3. ATTACHMENT A of the Contract, STATEMENT OF WORK, is hereby deleted and replaced
in its entirety with ATTACHMENT A, STATEMENT OF WORK (REVISED SEPTEMBER 2021).
4. ATTACHMENT A-1 of the Contract, STATEMENT OF WORK SUPPLEMENTAL, is hereby
deleted and replaced in its entirety with ATTACHMENT A-1, STATEMENT OF WORK
SUPPLEMENTAL (REVISED SEPTEMBER 2021).
5. ATTACHMENT B of the Contract, BUDGET is hereby deleted and replaced in its entirety
with ATTACHMENT B, BUDGET (REVISED SEPTEMBER 2021).
ATTACHMENT E of the Contract, SPECIAL CONDITIONS, Version 1.1, is hereby deleted and
replaced in its entirety with ATTACHMENT E, SPECIAL CONDITIONS, Version 1.3 (REVISED
SEPTEMBER 2021).
7. ATTACHMENT I of the Contract, FEDERAL FUNDING ACCOUNTABILITY AND
TRANSPARENCY ACT (FFATA) CERTIFICATION, will be resubmitted by Performing
Agency for the extended Contract term.
8. All references to the Contract termination date of August 31, 2021 are hereby replaced with
the revised Contract termination date of August 31, 2024.
9. This Amendment No. 1 shall be effective as of September 1, 2021.
10. Except as amended and modified by this Amendment No. 1, all terms and conditions of
the Contract shall remain in full force and effect.
System Agency Contract No. HHS000780500002
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
11. Any further revisions to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS.
System Agency Contract No. HHS000780500002
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
SIGNATURE PAGE FOR AMENDMENT No.1
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS000780500002
HEALTH AND HUMAN SERVICES CITY OF LUBBOCK
COMMISSION
Date of Signature:
[bm Signed by:
tea piyt.
3F037B8315554OF
Daniel Pope
Mayor
Date of Signature: September 1, 2021
THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE
CONTRACT:
ATTACHMENT A STATEMENT OF WORK (REVISED SEPTEMBER 2021)
ATTACHMENT A-1 STATEMENT OF WORK SUPPLEMENTAL (REVISED SEPTEMBER
2021)
ATTACHMENT B BUDGET (REVISED SEPTEMBER 2021)
ATTACHMENT E SPECIAL CONDITIONS VERSION 1.3 (REVISED SEPTEMBER 2021)
ATTACHMENT I FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT
(FFATA) CERTIFICATION
System Agency Contract No. HHS000780500002
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT A
STATEMENT OF WORK (SOW)
(REVISED SEPTEMBER 2021)
I. PURPOSE:
The Substance Use Disorder Community Health Worker (CHW) program allows Community
Health Workers and Promotoras to increase linkage and retention in substance use, mental health,
and medical services for Texas residents living with substance use disorders (SUD).
A. GOALS:
1. Address behavioral health disparities in the program service area.
2. Increase opportunities for substance users, including opioid users, to reduce harms
related to substance use.
3. Increase retention in substance use and mental health services.
4. Help individuals address medical needs.
5. Help individuals who desire change to build a foundation for their recovery.
B. ELIGIBLE POPULATION:
Any individual who uses substances. This population may include, but is not limited to, adults
and youth, populations who are marginalized or stigmatized, experiencing housing instability or
homelessness, inject substances, live with or at risk of Hepatitis C Virus (HCV) or Human
Immunodeficiency Virus (HIV), in need of medical and or mental health services, experience
greater barriers to entering treatment or recovery services, and those seeking to enhance their
recovery capital and maintain their recovery from substance use disorders.
II. SERVICE REQUIREMENTS:
A. Administrative and Organizational Requirements
Performing Agency shall:
Hire a minimum of 6 Community Health Workers (CHW) within 45 business days of
contract execution. The Performing Agency shall maintain and employ a minimum of
six (6) CHW staff for the duration of the contract.
a. Performing Agency shall notify System Agency within 10 business days when
any staff changes including separation occur.
b. CHW will work in teams of two (2) at all times, while in the community; and
c. Designate one (1) of the six (6) CHWs as the CHW Program Director,
whose role will be to provide oversight authority.
2. Ensure that the Program Director:
a. Spends, at minimum, fifty percent (50%) of work time delivering direct
participant services which meet this Contract performance measures.
b. b. Participates on all programmatic conference calls as scheduled by System
Agency. Performing Agency's executive management and any other staff may
be included in the conference calls, but it is required that the Program Director
attend the call, unless otherwise agreed to in writing by System Agency. If
Performing Agency is unavailable for a scheduled conference call, they are to
contact the SITP (Substance Intervention Treatment Programs)
Page 1 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
directly to provide them with the reason they cannot attend, and a date of when
they can reschedule the call.
3. Ensure Performing Agency will provide CHWs with an insured vehicle(s) to conduct
activities. All vehicle purchases, and/or leases, must be approved by System Agency.
A cost analysis report must be submitted in order to determine if a lease or purchase is
the best value.
4. Provide all services and activities with individuals in a respectful, non -threatening, non-
judgmental, and confidential manner.
5. Ensure program, policies and procedures do not discriminate against any participant,
family member, or supportive ally based on gender, race, religion, age, national origin,
disability, sexual orientation, medical condition, HIV Status, or length of time in
recovery, including those who have returned to use or are currently using substances.
6. Provide all services in a culturally, linguistically, and developmentally appropriate
manner for individuals, families and significant others as evidenced by:
a. Building a diverse team that may include the use of CHWs who are indigenous to
the communities and populations served, people who speak the language of the
community, reflect similar cultural background to those served, have lived
experience with mental health and substance use including injection drug use,
people who speak openly about their recovery and identify as a peer, people who
are living with HIV (Human Immunodeficiency Virus) or HCV (Hepatitis C
Virus), people who can speak openly about gender and sexual diversity, and
people who have lived experience with housing instability and homelessness, and
other people who reflect and identify with the priority population.
b. Pamphlets and other materials for education and health are written at appropriate
literacy levels of the eligible population;
c. Literature and signage in languages of the eligible populations;
d. Use of interpreters as appropriate; and
e. Lobby and office environment welcoming to the eligible population.
7. Establish and maintain working linkages through Memorandums of Understanding
(MOUs) with a network of community and social service agencies serving or having an
interest in the eligible population. MOUs will be executed within ninety (90) calendar
days after contract execution and shall encourage networking, coordination, and referrals
to help address the needs of the priority population, their families, and supportive allies.
8. Maintain copies of the signed MOUs on file for System Agency review upon request.
Performing Agency shall review and update all executed MOUs annually. All MOUs
shall include at a minimum:
a. Collaborative vision;
b. Purpose and concept;
c. Collaborative goals and desired outcomes;
d. Description of participating organizations;
e. Methods of Collaborative roles and responsibilities;
f. Provisions to address the non -duplication of services;
g. Signatures of both parties; and
h. Beginning and end dates.
Page 2 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
9. Develop, implement, and enforce a written policy that includes at a minimum the System
Agency's Recovery Oriented Values and Principles, delivery of person centered services,
standards for CHW, Philosophy and Standards for Harm Reduction services,
documenting and reporting policy and train all staff on data collection reporting
requirements related to contract performance measures. Performing Agency shall develop
this policy within 90 calendar days of contract execution, for System Agency approval,
this report shall be labeled as the Oriented Values and Principles written policy.
a. Develop, submit to System Agency, implement and ensure the following
Recovery Oriented Values and Principles are stated in policy and adhered to
within the Performing Agency's organization:
i. Choice and Self Determination:
1) provide individuals the opportunity to select supports and services that
correspond with their personal preferences and goals;
2) ensure services are self -directed, participant -driven, and reflect goals in
multiple life domains;
3) acknowledge an individual's choice for their own pathway to
wellness; and
4) be supportive and explore options for the priority population.
b. Community Integration:
i. provide individuals the opportunity to be involved in community activities and
receive support related to community integration that is associated with
recovery, health, and wellness;
ii. work with the eligible population to identify and connect with a broad
spectrum of community -based resources and supports that
will assist in achieving their goals and rebuilding their lives within their
community;
iii. align organizational policies to ensure CHW have access to transportation and
other resources to work with individuals outside of the organizational setting
and in the local communities;
iv. ensure CHW engage in assertive outreach in locations and times where t h e
eligible populations are likely to be found; and
v. utilize community or social services agency linkages to ensure CHW provide
warm hand-offs when transferring or referring individuals to community
resources.
10. Opioid Overdose Reversal Kits:
a. Are to be distributed to:
i. Individuals eligible for program services who use opioids;
ii. Support systems which may be able to reverse the individuals overdoses; or
iii. Eligible individuals who may be in the position to reverse an opioid overdose.
b. Performing Agency will ensure any health kits provided foreligible population
are individually packaged for CHWs to distribute.
c. Will be documented in a Monthly Work Log, which will be provided by System
Agency. Performing Agency shall Document the count of Opioid Reversal kits
dispersed to include reports of successful reversals in the work log. Performing Agency
shall provide this information to System Agency upon request.
d. Will not be distributed to individuals outside the eligible population without
prior written approval from System Agency.
e. Performing Agency shall not be placed under, restrict access, or put undue
burden on CHW staff ability to distribute lifesaving overdose reversal kits.
Page 3 of 18
DocuSlgn Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
11. Provide unrestricted internet access to CHWs to find resources and educational
materials for eligible individuals.
12. Develop and submit a behavioral health disparities impact statement no later than 60
calendar days of contract execution. Performing Agency shall submit any revisions to
the behavioral health disparities impact statement within 60 calendar days after each
new fiscal year begins. At a minimum the impact statement(s) should address how
the program has identified the subpopulation and will provide service to those
populations, including who are marginalized or stigmatized in the service area which
may experience greater barriers to behavioral health services.
13. Purchase and provide a professional messenger bags or side bags for CHWs to carry
supplies, one per staff member. Purchase of the messenger bag must be approved by
System Agency.
B. Community Health Services
Performing Agency shall:
Develop, submit, and maintain written policies and procedures that require all CHW
activities to be conducted in pairs or teams (a minimum of two CHW) which are
funded by this contract, while in the community or streets. Performing Agency shall
submit the written policies and procedures to System Agency within 60 calendar days
of contract execution, this report shall be labeled as the policies and procedures.
2. Develop, submit, and maintain a quarterly report. At minimum the quarterly
report will document and or include: Monthly work logs, self-care/and or
teambuilding activities, and financial assistance. The quarterly report is due
within 15 calendar days after each quarter.
3. Utilize the System Agency provided Monthly work logs to account for CHW efforts.
Work logs will:
a. reflect efforts by the CHWs without providing personal identifying
information of individuals receiving services;
b. be retained and provided at System Agency request; and
c. be summarized in the System Agency provided Quarterly Report.
4. Ensure CHW, group facilitation, communication, and events with eligible individuals
occur without undue interference from indirect staff or other agency staff not funded
by this Contract.
5. Ensure appropriate harm and risk -reduction information, methods, and tools are used
by CHWs in their work with the eligible populations.
6. Promote and encourage entry into substance use disorder and/or mental health
services including, intervention, treatment, or recovery by providing referrals,
community linkage, and support to eligible individuals.
7. Refer eligible individuals to other System Agency -funded programs as appropriate.
Page 4 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
Use Motivational Interviewing techniques and skills when appropriate to help
individuals enhance their confidence and motivation for change.
9. Promote and encourage entry into medical services, including Hepatitis C Virus
(HCV), Hepatitis B Virus (HCV), Human Immunodeficiency Virus (HIV),
Tuberculosis (TB), and Sexually Transmitted Infections (STI) testing or treatment
by providing referrals, community linkage, and support to individuals in the eligible
population.
10. Provide information, referrals, community linkage, and support to other
services and community resources to help individuals in the eligible
population improve their lives.
11. Ensure appropriate training on all information, methods, and tools used and
distributed by CHWs. Information, methods, and tools shall be based on the latest
scientific research and best practices for reducing harms related to substance use.
Methods and tools must include, but are not limited to:
a. substance use harm reduction tools including syringe cleaning kits with bleach;
b. Pre -Exposure Prophylactic treatments (PrEP) education and information;
c. overdose reversal kits including Naloxone;
d. condoms, lubricants, and safer sex tools;
e. wound care kits; and
f. hygiene kits.
Performing Agency shall ensure that Community Health Workers have these tools
and materials available for demonstration and distribution to eligible individuals and
their support system when appropriate.
12. Use the following guidelines for CHW:
a. Outreach Competencies: Minimum Standards for Conducting Street Outreach
with Hard To Reach Populations; Addiction Technology Transfer Center
(ATTC)_
http:/lattcnetwork.oriVresourcesiresource.aspx?prodID=438&rcID=2®ional
center=2.
b. The National Institute on Drug Abuse (NIDA) Community -Based Outreach
Model: A Manual To Reduce the Risk of HIV and Other Blood -Borne
Infections in Drug Users httl2s://archives.dru ag buse.gov/publications nida-
community-based-outreach-model-manual- to-reduce-risk-hiv-other-blood-
borne-infections-in-drug;
c. Ethical Guidelines for the Delivery of Peer -based Recovery Support
Services; https:/1www.naadac.org/assetsi'2416,lwhitew2007 the pro -
act ethics workgroup.pdf;
d. Substance Abuse and Mental Health Services Administration
(SAMHSA) Recovery Community Services Program: Peer Support and
Social Inclusion https://www.samhsa.gov/recovery/peer-support-social-
inclusion: and
e. Center for Disease Control (CDC) Social
Determinants of Health-
https://www.cdc.gov/socialdeterminants./.
III. STAFF COMPETENCIES:
Page 5 of 18
DocuSign Envelope ID: 5087415C-4FA34167-AC52-089F4329EC4B
A. Performing Agency shall:
1. Ensure all CHW staff and Program Director who provide services:
a. are knowledgeable and competent in discussing HIV, HCV, and other
communicable diseases associated with substance use and be able to
demonstrate ability to discuss sexuality openly and comfortably; and
b. are knowledgeable and competent in discussing opioid overdose and be able to
demonstrate ability to train individuals to use overdose reversal medications
and harm reduction materials.
2. To build a diverse team, Performing Agency may hire CHW who are licensed or
certified in other domains such as, Recovery Coaches, Peer Support, Licensed
Chemical Dependency Counselors (LCDC), Licensed Nurses or medical staff, Social
Workers, or other substance use related fields.
3. Require CHW to obtain Texas Department of State Health Services (DSHS) CHW
certification: https://www.dshs.texas.gov/mch/chw.shtm within 6 months from date of
contract execution or start date of employment, whichever is later. Performing
Agency shall provide a valid DSHS CHW certification for each CHW upon System
Agency request.
4. Ensure Program Director meets the following requirements:
a. Meet the competencies to become a DSHS Certified Community Health Worker;
b. Have a minimum of two (2) years of experience in one or more of the following:
i. substance use outreach;
ii. substance use intervention; or
iii. substance use treatment.
c. Have a minimum of one (1) year of experience in at least two (2) of the following:
i. working with prison populations;
ii. working with individuals experiencing housing instability;
iii. working with individuals with Substance Use Disorders (SUD),
HIV/STDs, and/or behavioral health issues;
iv. community health work; or
v. supervisory experience.
5. Ensure Program Director provides each staff member they supervise (CHW) with
documented field observations and feedback at least once every six months using the
supervision document that has been approved and provided by System Agency. The
documented field observations and feedback will be provided to System Agency
upon request.
6. Ensure all CHW maintain their certification, and be in good standing, for the duration
of employment under this Contract. All certifications shall be kept in the employee
file for review by System Agency upon request.
7. Ensure there are self -care and/or team building activities provided to CHW, that
will be held during work hours, and at least once per quarter. The self -care and or
team building activities shall be documented in the quarterly report, for review by
System Agency. At minimum the documentation must include: activities and
budget details.
IV. FINANCIAL ASSISTANCE:
Page 6 of 18
DocuSign Envelope ID: 5087415C4FA34167-AC52-089F4329EC4B
A. Financial assistance is allowable under this Contract to help eligible individuals when
coordinating service linkage and retention activities to and from substance use, mental
health, and medical services.
a. Financial assistance may include:
i. transportation needs to appointments;
ii. prescriptions or medicines needed;
iii. vision or hearing needs;
iv. clothing or personal hygiene items;
v. assistance for sober housing;
vi. employment or educational needs;
vii. other needs not listed that improve the individual's quality of life or ability to
successfully engage in services with System Agency written approval.
b. Financial assistance will not be used for, the following:
i. Direct cash payment to individuals;
ii. Meals;
iii. Payments to attend treatment; or
iv. Hypodermic needles or syringes for injection drug use.
This is not an exhaustive list of unallowable expenditures.
1. Performing Agency shall maintain and document all financial assistance, and it will be
summarized in the quarterly report, at minimum documentation shall include:
a. Date provided;
b. Dollar amount;
c. Item purchased; and
d. Client identifier (examples: driver's license, Clinical Management for Behavioral
Health Services (CMBHS) client number, first name and last initial).
2. Performing Agency may provide Financial assistance to eligible individuals; the financial
assistance shall not exceed five percent (5%) of the respective fiscal year award.
3. Financial assistance above $250 per individual, in a fiscal term, must be approved by System
Agency.
4. If an incentive or alternative activity is not described within this Contract, Performing Agency
shall contact System Agency staff for prior approval before implementation of the activity.
V. REPORTING REQUIREMENTS:
Performing Agency shall submit required reports of monitoring activities to System Agency by the
applicable due date outlined below. The following reports must be submitted to System Agency to
GlobalScape EFT (https: sftp.hhs.texas. gov ) assigned Subject Matter Expert (SME) with
Substance Intervention Treatment Programs Unit. and assigned contract manager by the required
due date and report name described in Section VI: Submission Requirements:
1. Performing Agency shall submit all documents listed in the table displayed in this section by
the due date stated.
2. Performing Agency will note that if the due date is on a weekend or holiday, the due date is
the following business day.
Page 7 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
3. Performing Agency shall develop, implement, and enforce a written policy for Oriented Values
and Principles within 90 calendar days of Contract execution.
4. Performing Agency shall develop, implement and submit a behavioral health disparities impact
statement, no later than 60 calendar days of Contract execution.
5. Performing Agency shall submit System Agency provided Work Log by the 15th of the month
preceding the end of each quarter. The Work Log, at a minimum, shall include a summary of
a. Efforts performed by CHWs;
b. Financial assistance provided;
c. Distribution of materials;
d. Count of Opioid Reversal kits dispersed;
e. Self -Care and/or Team building provided; and
f. CHW or Program Director retention
6. Performing Agency shall submit a Financial Status Report (FSR), quarterly in CMBHS. FSR
are due the last business day of the month following the end of each quarter.
7. Performing Agency shall submit a quarterly report that will include the submission of; work
logs, self -care, and/or team building activities, and financial assistance.
8. Performing Agency shall submit monthly invoices in Clinical Management for Behavioral
Health Services (CMBHS) by the 15th of the following month.
9. Performing Agency shall submit annual Contract Closeout documentation, this is required each
fiscal year, and a final contract closeout will be due October 15.
10. Performing Agency shall submit a CMBHS Security Attestation Form, the form shall be
submitted electronically on or before September 15th and March 15th to the designated
folder in GlobalScape EFT.
11. Performing Agency will report the performance measures for the previous months activities in
CMBHS by the 15th of the current month.
12. Performing Agency's duty to submit documents will survive the termination or expirationof
this Contract.
13. System Agency requires all deliverables excluding the CMBHS deliverables be submitted
within GlobalScape EFT. Performing Agency is required to maintain access to GlobalScape
EFT for the term of this contract.
VI. CLINICAL MANAGEMENT FOR BEHAVIORAL HEALTH SERVICES (CMBHS)
SYSTEM MINIMUM REQUIREMENTS
Performing Agency shall:
1. Designate a Security Administrator and a back-up Security Administrator. The Security
Administrator is required to implement and maintain a system for management of user
accounts/user roles to ensure that all the CMBHS user accounts are current;
2. Establish and maintain a security policy that ensures adequate system security and protection of
Page 8 of 18
DocuSlgn Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
confidential information;
3. Notify the CMBHS Help -desk within ten (10) business days of anychange to the designated
Security Administrator or the back-up Security Administrator;
4. Ensure that access to CMBHS is restricted to only authorized users. Performing Agency shall,
within 24 hours, remove access to users who are no longer authorized to have access to secure
data;
5. In addition to CMBHS Helpdesk notification, Performing Agency shall submit a signed
CMBHS Security Attestation Form and a list of Performing Agency's employees, contracted
laborers and subPerforming Agency's authorized to have access to secure data. The CMBHS
Security Attestation Form shall be submitted electronically on or before September 15 t h and
March 15th to the designated folder in Globalscape EFT; and
6. Attend System Agency training on CMBHS documentation.
VII. SUBMISSION REQUIRMENTS
System Agency will monitor Performing Agency's performance of the requirements
set forth in this revised Attachment A, as well as its compliance with the Contract's
terms and conditions.
Requirement
Deliverable
Due Date
Submission
(Report Name
System
Section II. A. 9
Oriented Values and
Within 90 calendar days of
GlobalScape
Principles Written
contract execution.
Policy
Section II. A. 12
Behavioral Health
Within 60 calendar days of
GlobalScape
Disparities Impact
contract execution, and Dec 1 st of
Statement
each fiscal year.
Section II. B. 1
Policies and Procedures
Within 60 calendar days of
GlobalScape
contract execution.
Section II. B. 2
Quarterly report
Quarterly; report includes the
GlobalScape
previous Quarter information, as
follows:
Q 1 reporting period, due December
31 st.
Q2 reporting period, due March
31 st.
Q3 reporting period, due June
30th.
Q4 reporting period, due September
Page 9 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
Section V. 7
Financial Status Report
Financial Status Report (FSR)
CMBHS
(FSR)
Quarterly; report includes the
previous Quarter information, as
follows:
Q 1 reporting period, due December
31 st.
Q2 reporting period, due March
31 st.
Q3 reporting period, due June
30th.
Q4 reporting period, due September
30th.
Section V. 9
Invoices in CMBHS
Invoice for previous month's
CMBHS
activities on the 15th of the
current month.
Section V. 10
Closeout documents
Final closeout documents due
GlobalScape
October 15 each fiscal year.
Section VII. 5
CMBHS Security
15 days after execution, September
GlobalScape
Attestation Form and
15th.& March 15th.
list of authorized users
Attachment A-1, F
Performance Measures
Invoice Report for previous
CMBHS
month's activities due on the 15th
of the current month.
VIII. DEFINITIONS
Definition of Health Disparities:
Healthy People 2020 defines a health disparity as a "particular type of health difference that is
closely linked with social, economic, and/or environmental disadvantage. Health disparities
adversely affect groups of people who have systematically experienced greater obstacles to health
based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health;
cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location;
or other characteristics historically linked to discrimination or exclusion."
Page 10 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT A-1
STATEMENT OF WORK SUPPLEMENTAL
(REVISED SEPTEMBER 2021)
1�_�:_-_►_1�U:__1�
Vendor ID:
17560005906
City of Lubbock
Contractor Name:
HHS000780500002
Contract Number:
Subrecipient
Contract Type
Cost Reimbursement
Payment Method:
058213893
DUNS Number:
B08TIO83478-01
Federal Award Identification
Number (FAIN):
Not Required Pursuant to Applicability and Authorized
Solicitation Document:
Use of the Interlocal Cooperation Act, Chapter 791 of the
Texas Government Code, for Contract Between State
Agency and Local Government
Services or activities will be provided to participants and/or clients from the following counties:
Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam,
Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill,
Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree,
Oldham, Partner, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, and Yoakum
Counties.
Region: 1
Adults — Male and Female.
This Contract has no renewal options.
Page 11 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
Name:
Bryan Hunter
Email:
Bryan.Hunter.hhs.texas.gov
Telephone:
(512) 206-5313
Address:
909 W 45 Street, Bldg 555 (MC 2058)
City/Zip:
I Austin TX 78751
F. PERFORMANCE MEASURES
1. Performing Agency will report the performance measures monthly through Clinical
Management for Behavioral Health Services (CMBHS) by the 15th of the following
month for the previous month's activities.
2. Performing Agency's performance will be measured in part on the achievement of the
key performance measures stated below.
3. The Fiscal Year (FY) 2022-2024 Performance measures are as follows:
Measure
ISt
2nd
3rd
4th
Annual
Quarter
Quarter
Quarter
Quarter
1. Number of contacts with individuals
800
800
800
800
3200
eligible for program services
2. Number of substance use services,
40
40
40
40
160
including intervention and treatment,
referrals, linkage, and support provided
to individuals eligible for program
services
(5%)
3. Number of mental health referrals,
20
20
20
20
80
linkage, and support provided to
individuals eligible for program
services
(2.5%)
4. Number of medical services referrals,
20
20
20
20
80
linkage, and support provided to
individuals eligible for program
services
(2.5%)
5. Number of referrals, linkage, and
20
20
20
20
80
support provided to other services and
community resources to individuals
eligible for program services
(2.5%)
Page 12 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
6. Number of Overdose Reversal Kits
20
20
20
20
80
distributed to eligible individuals
Number of contacts with individuals eligible for program services.
Any contact, unduplicated per FY, with an individual eligible for services as described in
ATTACHMENT A. These are most often the initial face to face contacts in the community.
When a Community Health Worker (CHW) identifies a contact is an eligible individual
count this a "I". Each month report the total number.
2. Number of substance use services, including intervention and treatment, referrals, linkage,
and support provided to individuals eligible for program services.
Any service the CHWs provide for an eligible individual specific to addressing substance
use. The CHW's function is to ensure eligible individuals can access needed services.
During a contact there may be multiple referrals, linkage or support activities that are
counted.
Basic information and resources such as providing telephone numbers, pamphlets, meeting
schedules and similar is not included in this measure. Distribution of harm reduction kids
or group education is not counted in this measure.
For the purposes of this measure:
"Referral" is defined as the process in which the CHW helps the eligible individual to
become enrolled into substance use services with a licensed provider.
"Linkage" us defined as actions by a CHW which help the eligible individual begin, retain,
or maintain their enrollment in substance use services after receiving a referral.
"Support' is defined as any other CHW activity that helps the eligible individual to
eliminate barriers related to substance use services or address substance use concerns.
Examples which may be counted in this measure: transportation to services, follow up
contacts related to a referral, individual education on harm reduction and safer use,
overdose prevention education, service coordination, helping an individual identify and
plan to attend community support groups, helping the individual to call the number the
CHW provided and schedule an intake for services, and motivational interviewing sessions.
Page 13 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
Each referral, linkage, or support activity counts as "1". Each month report the total
number. There is no limit per individual per FY.
3. Number of mental health referrals, linkage, and support provided to individuals eligible
for program services.
The same standards as Measure 2 (see above) with the distinction being mental health
needs for an eligible individual.
Examples which may be counted in this measure: transportation to psychiatric emergency
services, transportation to appointments or pharmacy, helping an individual identify and
plan to attend community support groups, and helping the individual to call the number the
CHW provided and schedule an intake for services.
Each referral, linkage, or support activity counts as "I". Each month report the total
number. There is no limit per individual per FY.
4. Number of medical services referrals, linkage, and support provided to individuals eligible
for program services.
The same standards as Measure 2 (see above) with the distinction being medical needs of
the eligible individual.
Examples which may be counted in this measure: transportation to the hospital, referral to
community medical clinics, individual education on condom use, referrals to HIV and
HCV treatment or testing, and referrals to pregnancy testing.
Each referral, linkage, or support activity counts as "I". Each month report the total
number. There is no limit per individual per FY.
5. Number of referrals, linkage, and support provided to other services and community
resources to individuals eligible for program services.
The same standards as Measure 2 (see above) with the distinction being other services not
listed.
Examples which may be counted in this measure: housing, financial assistance, legal
services, immigration services, educational or employment programs, community courts
or probation, food banks, and the Nutrition Program for Women, Infants, and Children
(WIC) office.
Each referral, linkage, or support activity counts as "I". Each month report the total
number. There is no limit per individual per FY.
6. Number of Overdose Reversal Kits distributed to eligible individuals.
Kits intended to reverse an active opioid overdose. An overdose reversal kit includes at
min Naloxone, any needed equipment for its use, instructions and information on using
Naloxone, your CHW team's contact information.
Each overdose reversal kit distributed counts as "1". There is no limit per individual
per FY.
Page 14 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT B
BUDGET
(REVISED SEPTEMBER 2021)
A. Funding from the United States Health and Humans Services (HHS) and the Substance
Abuse and Mental Health Services Administration (SAMSHA), requires Performing
Agency compliance with 45 CFR Part 96, Subpart C, as applicable: https:/ecfr.io Title-
45 /pt45.1.96#sp45.1.96.c.
B. Performing Agency shall comply with the requirements applicable in the Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards, 2 CFR 200, and the Uniform Grant Management Standards (UGMS) Standards.
C. Performing Agency shall review and comply with the System Agency's Grants Technical
Assistance Guide (Guide), which provides guidance on financial administration in order to
clarify applicable laws, rules, and regulations. The Guide is located at the following:
https:llhhs.texas. og v/doin -business-hhs ,rants.
D. Performing Agency may access the Transactions List report in Clinical Management for
Behavioral Health Services (CMBHS) to identify the amount of federal funds allocated to
this award for each transaction.
E. The Assisted Listing Number for the Substance Abuse Prevention and Treatment (SAPT)
Block Grant is 93.959.
F. The Substance Abuse Prevention Treatment Block Grant, Assisted Listing Number 93.959
requires a five percent (5%) match requirement.
G. Invoice and Payment:
1. Submit all monthly invoices to the System Agency through CMBHS. Performing
Agency shall ensure the supportive documents for the expenditures are emailed to
the assigned Contract Manager and copied to the Substance Use Disorder Contracts
Mailbox: SubstanceAbuse.Contracts a hhsc.state. tx.us.
2. Be paid on a monthly basis and in accordance with services performed under this
Contract.
H. Any unexpended balance associated with any other System Agency -funded contract
may not be applied to this Contract.
Page 15 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
I. Funding:
1. System Agency Share total reimbursements will not exceed Two MILLION EIGHTY-
EIGHT THOUSAND DOLLARS ($2,088,000.00), for the period from July 1, 2020
through August 31, 2024, as follows:
a. FY 2020, July 1, 2020 through August 31, 2020: $232,000.00.
b. FY 2021, September 1, 2020 through August 31, 2021: $464,000.00.
c. FY 2022, September 1, 2021 through August 31, 2022: $464,000.00.
d. FY 2023, September 1, 2022 through August 31, 2023: $464,000.00.
e. FY 2024, September 1, 2023 through August 31, 2024: $464,000.00.
2. Performing Agency's budgeted match requirement per Fiscal Year is as follows:
a. FY2020, July 1, 2020 through August 31, 2020: $11,600.00.
b. FY 2021, September 1, 2020 through August 31, 2021: $23,200.00.
c. FY 2022, September 1, 2021 through August 31, 2022: $23,200.00.
d. FY 2023, September 1, 2022 through August 31, 2023: $23,200.00.
e. FY 2024, September 1, 2023 through August 31, 2024: $23,200.00.
3. The total amount of this Contract, including applicable match, will not exceed Two
MILLION ONE HUNDRED NINETY-TWO THOUSAND FOUR HUNDRED DOLLARS
($2,192,400.00), as follows:
a. FY 2020, July 1, 2020 through August 31, 2020: $243,600.00
b. FY 2021, September 1, 2020 through August 31, 2021: $487,200.00
c. FY 2022, September 1, 2021 through August 31, 2022: $487,200.00
d. FY 2023, September 1, 2022 through August 31, 2023: $487,200.00
e. FY 2024, September 1, 2023 through August 31, 2024: $487,200.00
Cost Reimbursement Budget:
1. The Cost Reimbursement budget documents all approved and allowable
expenditures; Performing Agency shall only utilize the funding detailed in this
ATTACHMENT B for approved and allowable costs. If Performing Agency requests
to utilize funds for an expense not documented on the approved budget, Performing
Agency shall notify, in writing, the System Agency assigned Contract Manager and
request approval prior to utilizing the funds. System Agency shall provide written
notification regarding if the requested expense is approved.
2. If needed, Performing Agency may revise the System Agency approved Cost
Reimbursement budget. The requirements are as follows:
a. Performing Agency is allowed to transfer funds from the budgeted direct
categories only; with the exception of the Equipment category. Performing Agency
may transfer up to ten (10) percent of the Fiscal Year Contract value without System
Agency approval. Budget revisions exceeding the ten percent requirement require
System Agency's written approval.
Page 16 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
b. Performing Agency may request revisions to the approved Cost Reimbursement
budgeted direct categories that exceed the ten (10) percent requirement stated in
Section (J) (2) (a), by submitting a written request to the assigned Contract Manager.
This change is considered a minor administrative change and does not require an
amendment. The System Agency shall provide a Technical Guidance Letter (TGL) if the
budget revision is approved; and the assigned Contract Manager will update CMBHS, as
needed.
c. Performing Agency may revise the Cost Reimbursement budget "Equipment"
and/or "Indirect Cost" Categories, however a formal Amendment is required.
Performing Agency shall submit to the assigned Contract Manager a written request
to revise the budget, which includes a justification for the revisions. The assigned
Contract Manager shall provide written notification stating if the requested revision
is approved. If the revision is approved, the budget revision is not authorized, and
funds cannot be utilized until the Amendment is executed and signed by both
parties.
d. The budgeted indirect cost amount is provisional and subject to change. The
System Agency reserves the right to negotiate Performing Agency's indirect cost
amount, which may require Performing Agency to provide additional supporting
documentation to the assigned Contract Manager.
K. Categorical Budget:
1. Below is the approved Categorical Budget for Fiscal Year 2021 and Fiscal Year
2022:
FY2021
PERSONNEL
$235,364.00
FRINGE BENEFITS
$112,975.00
TRAVEL
$3,947.00
SUPPLIES
$3,000.00
CONTRACTUAL
$22,200.00
EQUIPMENT
$23,888.00
OTHER
$85,826.00
TOTAL DIRECT CHARGES
$487,200.00
INDIRECT CHARGES
$0.00
TOTAL CONTRACT VALUE
$487,200.00
SYSTEM AGENCY SHARE
$464,000.00
MATCH
$23,200.00
Page 17 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
FY2022
PERSONNEL
$225,023.00
FRINGE BENEFITS
$108,013.00
TRAVEL
$16,595.00
SUPPLIES
$9,079.00
CONTRACTUAL
$10,200.00
EQUIPMENT
$0.00
OTHER
$118,290.00
TOTAL DIRECT CHARGES
$487,200.00
INDIRECT CHARGES
$0.00
TOTAL CONTRACT VALUE
$487,200.00
SYSTEM AGENCY SHARE
$464,000.00
MATCH
$23,200.00
Page 18 of 18
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
TEXAS
Health and Human Services
Health and Human Services Commission
Special Conditions
Version 1.3
Page 1 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REv[SED AUGUST 2021)
TABLE OF CONTENTS
ARTICLEI -SPECIAL DEFINITIONS.........................................................................................................................................................................................................................................................3
ARTICLE 11 - GRANTEES PERSONNELAND SUBCONTRACTORS.....................................................................................................................................................................................................4
:.III Qualifications.........................................................................................................................................................................................................................4
2.02 Conduct and Removal...........................................................................................................................................................................................................4
2.03 Contracts with Subcontractors.............................................................................................................................................................................................4
2.04 Status of Subcontractors.......................................................................................................................................................................................................5
2.05 Incorporation of Terms in Subcontracts..............................................................................................................................................................................5
2.06 Notice of Legal Matter or Litigation..............................................................................................................................................................................6
2.07 Unilateral Amendment...................................................................................................................................................................................................6
ARTICLEIII - CONFIDENTIALITY............................................................................................................................................................................................................................................................6
3.01 Confidential System Information.........................................................................................................................................................................................6
ARTICLEIV -MISCELLANEOUS PROVISIONS......................................................................................................................................................................................................................................7
4.01 Minor Administrative Changes............................................................................................................................................................................................7
4.02 Conflicts ofInterest...............................................................................................................................................................................................................7
4.03 Flow Down Provisions...........................................................................................................................................................................................................8
4.04 Disaster Declarations..............................................................................................................................................................8
ARTICLEV - DSHSLEGACY PROVISIONS.......................................................................................................................................................................................................................................9
5.01 Notice of a Contract Action..................................................................................................................................................................................................9
5.02 Notice of IRS or TWCInsolvency........................................................................................................................................................................................9
5.03 Notice of Criminal Activity and Disciplinary Actions.......................................................................................................................................................10
5.04 Child Abuse Reporting Requirement................................................................................................................................................................................10
5.05 Abuse, Neglect, Exploitation...............................................................................................................................................................................................10
5.06 Notification of Change of Contact Person or Key Personnel............................................................................................................................................10
5.07 Notification of Organization Change..................................................................................................................................................................................11
5.08 Significant Incidents............................................................................................................................................................................................................11
5.09 Responsibilities and Restrictions Concerning Governing Body, Officers, and Employees.............................................................................................11
5.10 Direct Operations.................................................................................................................................................................................................................12
5.11 Interim Extension Amendment............................................................................................................................................................................................12
5.12 Medical Records Retention.................................................................................................................................................................................................12
5.13 Grantee's Certification of Meeting or Exceeding Tobacco -Free Workplace Policy Minimum Standards.................................................................... 13
5.14 Electronic and Information Resources Accessibility and Security Standards................................................................................................................. 13
5.15 Equipment, Supplies and Property ....................................................................................................................................................................................15
5.16 Clinical Management for Behavioral Health Services (CMBHS) System........................................................................................................................ 22
a. Resources.............................................................................................................................................................................................................................22
b. Security Administrator and Authorized Users.................................................................................................................................................................. 22
C. Security Violations and Accounts Updates........................................................................................................................................................................23
d. Electronic Transfer of Information.................................................................................................................................................................................... 23
e. Access...................................................................................................................................................................................................................................23
I. Customer Support and Training........................................................................................................................................................................................ 24
5.17 HIV/AIDS Model Workplace Guidelines......................................................................................................................................................................... 24
5.18 Medicaid Enrollment.......................................................................................................................................................................................................... 24
5.19 Billing for Treatment and Payment Restrictions.............................................................................................................................................................. 24
5.20 Persons on Probation or Parole.......................................................................................................................................................................................... 24
5.21 Substance Abuse Block Grant (SABG) Requirements...................................................................................................................................................... 25
5.22 Match and ProgramIncome................................................................................................................................................................................................25
5.23 Contract Reconciliation......................................................................................................................................................................................................26
Page 2 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
The terms and conditions of these Special Conditions are incorporated into and made a part of the
Contract. Capitalized items used in these Special Conditions and not otherwise defined have the
meanings assigned to them in HHSC Uniform Terms and Conditions — Grant, Version 2.16.1.
If any provision contained in this HHSC Special Conditions is in conflict with, or inconsistent with
the HHSC Uniform Terms and Conditions (UTC), the provision contained in the UTCs shall
prevail. If any provision contained in this HHSC Special Conditions is in conflict with, or
inconsistent with the Substance Use Disorder Utilization Management Guidelines (UM), the
provision contained in the UM shall prevail.
ARTICLE I - SPECIAL DEFINITIONS
"Conflict of Interest" means a set of facts or circumstances, a relationship, or other situation
under which Grantee, a Subcontractor, or individual has past, present, or currently planned
personal or financial activities or interests that either directly or indirectly: (1) impairs or
diminishes the Grantee's, or Subcontractor's ability to render impartial or objective assistance or
advice to the HHSC; or (2) provides the Grantee or Subcontractor an unfair competitive advantage
in future HHSC procurements.
"Grantee Agents" means Grantee's representatives, employees, officers, as well as any contractor
or subgrantee's employees, contractors, officers, principals and agents.
"Data Use Agreement" means the agreement incorporated into the Contract to facilitate creation,
receipt, maintenance, use, disclosure or access to Confidential Information.
"Item of Noncompliance" means Grantee's acts or omissions that: (1) violate a provision of the
Contract; (2) fail to ensure adequate performance of the Project; (3) represent a failure of Grantee
to be responsive to a request of HHSC relating to the Project under the Contract.
"Minor Administrative Change" refers to a change to the Contract that does not increase the
fees or term and done in accordance with Section 4.01 of these Special Conditions.
"Other Confidential System Information" means any communication or record (whether oral,
written, electronically stored or transmitted, or in any other form) provided to or made available to
Grantee; or that Grantee may create, receive, maintain, use, disclose or have access to on behalf of
HHSC or through performance of the Project, which is not designated as Confidential Information
in a Data Use Agreement.
"State" means the State of Texas and, unless otherwise indicated or appropriate, will be interpreted
to mean HHSC and other agencies of the State of Texas that may participate in the administration
of HHSC Programs; provided, however, that no provision will be interpreted to include any entity
other than HHSC as the contracting agency.
Page 3 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
"Software" means all operating system and applications software used or created by Grantee to
perform the work under the Contract.
"Third Party Software" refers to software programs or plug -ins developed by companies or
individuals other than Grantee which are used in performance of the Project. It does not include
items which are ancillary to the performance of the Project, such as internal systems of Grantee
which were deployed by Grantee prior to the Contract and not procured to perform the Project.
"UTC" means the HHSC Uniform Terms and Conditions - Grant, Version 2.16.1.
ARTICLE II - GRANTEES PERSONNEL AND SUBCONTRACTORS
2.01 Qualifications
Grantee agrees to maintain the organizational and administrative capacity and capabilities
to carry out all duties and responsibilities under the Contract. Grantee Agents assigned to
perform the duties and responsibilities under the Contract must be and remain properly
trained and qualified for the functions they are to perform. Notwithstanding the transferor
turnover of personnel, Grantee remains obligated to perform all duties and responsibilities
under the Contract without degradation and in strict accordance with the terms of the
Contract.
2.02 Conduct and Removal
While performing the Project, Grantee Agents must comply with applicable Contract
terms, State and federal rules, regulations, HHSC's policies, and HHSC's requests
regarding personal and professional conduct; and otherwise conduct themselves in a
businesslike and professional manner.
If HHSC determines in good faith that a particular Grantee Agent is not conducting himself
or herself in accordance with the terms of the Contract, HHSC may provide Grantee with
notice and documentation regarding its concerns. Upon receipt of such notice, Grantee
must promptly investigate the matter and, at HHSC's election, take appropriate action that
may include removing the Grantee Agent from performing the Project.
Any person employed by Grantee shall, at the written request of HHSC, and within
HHSC's sole discretion, be removed immediately by Grantee from work relating to the
Contract.
2.03 Contracts with Subcontractors
a. Grantee may enter into contracts with subcontractors unless restricted or otherwise
prohibited in the Contract.
b. Grantees are prohibited from subcontracting with for -profit organizations under this
Contract.
c. Prior to entering into a subcontract agreement equaling or exceeding $100,000, Grantee will
Page 4 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
obtain written approval from the System Agency.
d. Grantee will obtain written approval from System Agency before modifying any
subcontract agreement to cause the agreement to exceed $100,000.
e. Grantee will establish written policies and procedures for competitive procurement and
monitoring of subcontracts and will develop a subcontracting monitoringplan.
f. Grantee shall monitor subcontractors for both financial and programmatic performance
and will maintain pertinent records.
g. Grantee shall submit quarterly monitoring reports to the System Agency in a format
determined by the System Agency.
h. Grantee shall ensure that subcontracts are fully aware of the requirements placed upon
them by state/federal statutes, rules, and regulations and by the provisions of this
Contract.
i. Grantee shall ensure all subcontracts, must be in writing and include the following:
1. Name and address of all parties and the subcontractor's Vendor IdentificationNumber
(VIN) or Employee Identification Number (EIN);
2. Detailed description of the services to be provided;
3. Measurable method and rate of payment and total not -to -exceed amount of the contract;
4. Clearly defined and executable termination clause; and
5. Beginning and ending dates that coincide with the dates of the Contract.
j. Grantee shall ensure and be responsible for the performance of the subcontractor(s).
k. Grantee shall not contract with a subcontractor, at any tier, that is debarred, suspended, or
excluded from or ineligible for participation in federal assistance programs or if the
subcontractor would be otherwise ineligible to abide by the terms of this Contract.
2.04 Status of Subcontractors
Grantees will require that all subcontractors certify that they are/have:
a. In good standing with all state and federal funding and regulatory agencies;
b. Not currently debarred, suspended or otherwise excluded from participation in federal
grant programs;
c. Not delinquent on any repayment agreements;
d. Not had a required license or certification revoked;
e. Not ineligible under the terms of the Contract; and
f. Not had a System Agency contract terminated for cause.
2.05 Incorporation of Terms in Subcontracts
a. Grantee will include in all its contracts with subrecipient subcontractors and solicitations
for subrecipient subcontracts, without modification (except as required to make applicable
to the subcontract):
1. Statement of Work
2. Uniform Terms and Conditions
3. Special Conditions
4. Federal Assurances and Certifications
5. Non -Exclusive List of Applicable Laws
6. A provision granting to the System Agency, State Auditor's Office (SAO), Office of
Inspector General (OIG), and the Comptroller General of the United States, and any of
Page 5 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
their representatives, the right of access to inspect the work and the premises on which
any work is performed, and the right to audit the subcontractor.
b. Grantee will ensure that all written agreements with subcontractors incorporate the terms
of this Contract so that all terms, conditions, provisions, requirements, duties and liabilities
under this Contract applicable to the services provided or activities conducted by a
subcontractor are passed down to that subcontractor.
c. No provision of this Contract creates privity of contract between the System Agency and
any subcontractor of Grantee.
2.06 Notice of Legal Matter or Litigation
Grantee will send notice to the Substance Use Disorder (SUD) email box,
SubstanceAbuse.Contracts hhsc.state.tx.us of any litigation or legal matter related to or
affecting this Contract within seven calendar days of becoming aware of the litigation or
legal matter.
2.07 Unilateral Amendment
The System Agency reserves the right to amend this Contract through execution of a
unilateral amendment signed by the contract manager for this Contract and provided to the
Grantee with ten days notice prior to execution of the amendment under the following
circumstances to:
a. To comply with a court order or judgment
b. Incorporate new or revised federal or state laws, regulations, rules or policies
c. Correct an obvious clerical error in this Contract;
d. Change the name of the Contractor in order to reflect the Contractor's name as
recorded by the Texas Secretary of State.
e. To correct the name, mailing address, or contact information for persons named in
the Contract;
f. To update service descriptions or rates (if applicable);
ARTICLE III - CONFIDENTIALITY
3.01 Confidential System Information
HHSC prohibits the unauthorized disclosure of Other Confidential Information. Grantee
and all Grantee Agents will not disclose or use any Other Confidential Information in any
manner except as is necessary for the Project or the proper discharge of obligations and
Page 6 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
securing of rights under the Contract. Grantee will have a system in effect to protect Other
Confidential Information. Any disclosure or transfer of Other Confidential Informationby
Grantee, including information requested to do so by HHSC, will be in accordance with
the Contract. If Grantee receives a request for Other Confidential Information, Grantee will
immediately notify HHSC of the request, and will make reasonable efforts to protect the
Other Confidential Information from disclosure until further instructed by the HHSC.
Grantee will notify HHSC promptly of any unauthorized possession, use, knowledge, or
attempt thereof, of any Other Confidential Information by any person or entity that may
become known to Grantee. Grantee will furnish to HHSC all known details of the
unauthorized possession, use, or knowledge, or attempt thereof, and use reasonable efforts
to assist HHSC in investigating or preventing the reoccurrence of any unauthorized
possession, use, or knowledge, or attempt thereof, of Other Confidential Information.
HHSC will have the right to recover from Grantee all damages and liabilities caused by or
arising from Grantee or Grantee Agents' failure to protect HHSC's Other Confidential
Information as required by this section.
IN COORDINATION WITH THE INDEMNITY PROVISIONS
CONTAINED IN THE UTC, GRANTEE WILL INDEMNIFY AND HOLD
HARMLESS HHSC FROM ALL DAMAGES, COSTS, LIABILITIES, AND
EXPENSES (INCLUDING WITHOUT LIMITATION REASONABLE
ATTORNEYS' FEES AND COSTS) CAUSED BY OR ARISING FROM
GRANTEE OR GRANTEE AGENTS FAILURE TO PROTECT OTHER
CONFIDENTIAL INFORMATION. GRANTEE WILL FULFILL THIS
PROVISION WITH COUNSEL APPROVED BY HHSC.
ARTICLE IV - MISCELLANEOUS PROVISIONS
4.01 Minor Administrative Changes
System Agency is authorized to provide written approval of mutually agreed upon Minor
Administrative Changes to the Project or the Contract that do not increase the fees or term.
Upon approval of a Minor Administrative Change, HHSC and Grantee will maintain
written notice that the change has been accepted in their Contract files.
4.02 Conflicts of Interest
Grantee warrants to the best of its knowledge and belief, except to the extent already
disclosed to HHSC, there are no facts or circumstances that could give rise to a Conflict of
Interest and further that Grantee or Grantee Agents have no interest and will not acquire
any direct or indirect interest that would conflict in any manner or degree with their
performance under the Contract. Grantee will, and require Grantee Agents, to establish
safeguards to prohibit Contract Agents from using their positions for a purpose that
constitutes or presents the appearance of personal or Organizational Conflict of Interest, or
Page 7 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
for personal gain. Grantee and Grantee Agents will operate with complete independence
and objectivity without actual, potential or apparent Conflict of Interest with respect to the
activities conducted under the Contract.
Grantee agrees that, if after Grantee's execution of the Contract, Grantee discovers or is
made aware of a Conflict of Interest, Grantee will immediately and fully disclose such
interest in writing to HHSC. In addition, Grantee will promptly and fully disclose any
relationship that might be perceived or represented as a conflict after its discovery by
Grantee or by HHSC as a potential conflict. HHSC reserves the right to make a final
determination regarding the existence of Conflicts of Interest, and Grantee agrees to abide
by HHSC's decision.
If HHSC determines that Grantee was aware of a Conflict of Interest and did not disclose
the conflict to HHSC, such nondisclosure will be considered a material breach of the
Contract. Furthermore, such breach may be submitted to the Office of the Attorney
General, Texas
4.03 Flow Down Provisions
Grantee must include any applicable provisions of the Contract in all subcontracts based
on the scope and magnitude of work to be performed by such Subcontractor. Any necessary
terms will be modified appropriately to preserve the State's rights under the Contract.
4.04 Disaster Declarations
In the event of a local, state, or federal emergency, including natural, pandemics, man- made, criminal,
terrorist, and/or bioterrorism events, declared as a state disaster by the Governor, or a federal disaster
declared by the appropriate federal official, Grantee may be called upon to assist the System Agency in
providing the following services:
a. Expand, increase, or modify service delivery in impacted areas;
b. Community evacuation;
C. Health and medical assistance;
d. Assessment of health and medical needs;
e. Health surveillance;
f. Medical care personnel;
g. Health and medical equipment and supplies;
h. Patient evacuation;
i. In -hospital care and hospital facility status;
j. Food, drug and medical device safety;
k. Worker health and safety;
1. Mental health and substance abuse;
in. Public health information;
n. Vector control and veterinary services; and
o. Victim identification and mortuary services.
Page 8 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
Disaster related services may not commence, or expenditures incurred, until System Agency provides
Grantee with a written Notification to Proceed. The contract may be amended to incorporate additional
funds and performance or reporting requirements to support disaster services in the event services must
be expanded, increased, or modified.
ARTICLE V - LEGACY PROVISIONS
5.01 Notice of a Contract Action
Grantee will send notice to the Substance Use Disorder (SUD) email box,
SubstanceAbuse.Contracts uihhsc.state.tx.us if Grantee has had any contract suspended or
terminated for cause by any local, state or federal department or agency or nonprofit entity
within five business days of becoming aware of the action and include the following:
a. Reason for such action;
b. Name and contact information of the local, state or federal department or agency or
entity;
c. Date of the contract;
d. Date of suspension or termination; and
e. Contract or case reference number.
5.02 Notice of IRS or TWC Insolvency
Grantee will send notice to the SUD email box,
SubstanceAbuse.Contracts(cDhhsc.state.!LI!L of its insolvency, incapacity or outstanding
unpaid obligations of Grantee to the Internal Revenue Service (IRS), Texas Workforce
Commission (TWC), the State of Texas, or any agency or political subdivision of the State
of Texas within five days of the date of Grantee's becoming aware of such.
Page 9 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
5.03 Notice of Criminal Activity and Disciplinary Actions
a. Grantee shall immediately send notice to the SUD email box,
SubstanceAbuse.Contracts()hhsc.state. tx.us when the Grantee learns of or has any
reason to believe it or any person with ownership or controlling interest in the
organization/business, or their agent, employee, subcontractor or volunteer that is
providing services under this Contract has:
1. Engaged in any activity that could constitute a criminal offense equal to or greater
than a Class A misdemeanor or grounds for disciplinary action by a state or federal
regulatory authority; or
2. Been placed on community supervision, received deferred adjudication, or been
indicted for or convicted of a criminal offense relating to involvement in any
financial matter, federal or state program or felony sex crime.
b. Grantee shall not permit any person who engaged, or was alleged to have engaged, in
any activity subject to reporting under this section to perform direct client services or
have direct contact with clients, unless otherwise directed in writing by the System
Agency.
5.04 Child Abuse Reporting Requirement
Grantee shall:
a. comply with child abuse and neglect reporting requirements in Texas Family Code Chapter
261. This section is in addition to and does not supersede any other legal obligation of
the Grantee to report child abuse.
b. develop, implement and enforce a written policy that includes at a minimum the System
Agency's Child Abuse Screening, Documenting, and Reporting Policy for
Grantees/Providers and train all staff on reporting requirements.
c. use the System Agency Child Abuse Reporting Form located at
https:,'Iwww.dfps.state. tx.us; Contact Us. report abuse.asp as required by the
System Agency.
d. retain reporting documentation on site and make it available for inspection bythe System
Agency.
5.05 Abuse, Neglect, Exploitation
Grantee shall;
a. take all steps necessary, to protect the health, safety and welfare of its clients and
participants.
b. develop and implement written policies and procedures for abuse, neglect and
exploitation.
c. notify appropriate authorities of any allegations of abuse, neglect, or exploitation as
required by 25 TAC § 448.703.
5.06 Grantee's Notification of Change of Contact Person or Key Personnel
Page 10 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
Within 10 business days, Grantee will submit notice to the SUD email box,
SubstanceAbuse.Contracts@hhsc.state.tx.us and
Substance Use Disorder hhsc.state.tx.us of any change in the Grantee's Contact
Persons or Key Personnel.
5.07 Notice of Organizational Change
Grantee will submit notice to the SUD email box,
SubstanceAbuse.Contracts@hhsc.state.tx.us and
Substance Use Disorder hhsc.state.tx.us within 10 business days of any change to
Grantee's name, contact information, organizational structure, such as merger,
acquisition, or change in form of business, legal standing, or authority to do business in
Texas.
5.08 Significant Incidents
In addition to notifying the appropriate authorities, Grantee will submit notice to the SUD
email box, SubstanceAbuse.Contracts hhsc.state.tx.us and
Substance Use Disorder@hhsc.state.tx.us significant incidents involving substantial
disruption of Grantee's program operation or affecting or potentially affecting the health,
safety or welfare of the System Agency funded clients or participants within three calendar
days of discovery.
5.09 Responsibilities and Restrictions Concerning Governing Body, Officers and
Employees
Grantee and its governing bodyshall:
a. Bear full responsibility for the integrity of the fiscal and programmatic management of
the organization.
b. Be accountable for all funds and materials received from the System Agency. The
responsibility of Grantee's governing body will also include accountability for
compliance with the System Agency Rules, policies, procedures, and applicable federal
and state laws and regulations; and correction of fiscal and program deficiencies
identified through self -evaluation and the System Agency's monitoring processes.
c. Ensure separation of powers, duties, and functions of governing body members and staff.
No member of Grantee's governing body, or officer or employee of Grantee will vote
for, confirm or act to influence the employment, compensation or change in status of
any person related within the second degree of affinity or the third degree of
consanguinity (as defined in Texas Government Code Chapter 573) to the member of
the governing body or the officer or any employee authorized to employ or supervise
such person. This prohibition does not prohibit the continued employment of a person
who has been continuously employed for a period of two years prior to the election,
appointment or employment of the officer, employee, or governing body member
related to such person in the prohibited degree. These restrictions also apply to the
governing body, officers, and employees of Grantee's subcontractors.
Page 11 of 27
DocuSign Envelope ID: 5087415C4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
5.10 Direct Operation
System Agency may temporarily assume operations of a Grantee's program or programs
funded under this Contract when the continued operation of the program by Grantee puts
at risk, the health or safety of clients and/or participants served by Grantee.
5.11 Interim Extension Amendment
a. Prior to or on the expiration date of this Contract, the Parties agree that this Contract
can be extended as provided under this Section.
b. The System Agency will provide written notice of interim extension amendment to the
Grantee under one of the following circumstances:
1. Continue provision of services in response to a disaster declared by the governor;
or
2. To ensure that services to clients continue without interruption.
c. The System Agency will provide written notice of the interim extension amendment
that specifies the reason and length of time for the extension.
d. Grantee will provide and invoice for services in the same manner as stated in the
Contract.
e. An interim extension under Section (b)(1) above will extend the term of the contract
not longer than 30 days after governor's disaster declaration is declared unless the
Parties agree to a shorter period of time.
f. An interim extension under Section (b)(2) above will be a one-time extension for time
determined by the System Agency.
5.12 Medical Records Retention
Grantee will:
a. Retain medical records in accordance with 22 TAC § 165.1(b) or other applicable statutes,
rules and regulations governing medical information.
b. Retain and preserve records in accordance with applicable state and federal statutes,
rules and regulations.
c. Maintain all non -financial records that are generated or collected by Grantee under the
provisions of this Contract for a period of at least seven years after the termination of
this Contract.
d. Retain the records in accordance with the federal retention period, if the federal retention
period for services funded through Medicaid is more than seven years
e. Retain all records pertaining to this Contract that are the subject of litigation or an audit
until the litigation has ended or all questions pertaining to the audit areresolved.
f. Include this provision concerning records retention in any subcontract it awards.
g. Ensure that records relating to this Contract are securely stored and are accessible by the
System Agency upon System Agency's request for at least seven years from the date Grantee
ceases business or from the date this Contract terminates, whichever is sooner.
Page 12 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
h. Provide and update as necessary, the name and address of the party responsible for storage
of records to the SUD emailbox, SubstanceAbuse.Contractsna,hhsc.state.tx.us.
5.13 Grantee's Certification of Meeting or Exceeding Tobacco -Free Workplace Policy
Minimum Standards
Grantee certifies that it has adopted and enforces a Tobacco -Free Workplace Policy that
meets or exceeds all of the following minimum standards of:
a. Prohibiting the use of all forms of tobacco products, including but not limited to
cigarettes, cigars, pipes, water pipes (hookah), bidis, kreteks, electronic cigarettes,
smokeless tobacco, snuff and chewing tobacco;
b. Designating the property to which this Policy applies as a "designated area," which
must at least comprise all buildings and structures where activities funded under this
Contract are taking place, as well as Grantee owned, leased, or controlled sidewalks,
parking lots, walkways, and attached parking structures immediately adjacent to this
designated area;
c. Applying to all employees and visitors in this designated area; and
d. Providing for or referring its employees to tobacco use cessation services.
If Grantee cannot meet these minimum standards, it must obtain a waiver from the System
Agency.
5.14 Electronic and Information Resources Accessibility and Security Standards
a. Applicability:
The following Electronic and Information Resources (EIR) requirements apply to the
Contract because the Grantee performs services that include EIR that the System
Agency's employees are required or permitted to access or members of the public are
required or permitted to access.
This Section does not apply to incidental uses of EIR in the performance of the
Agreement, unless the Parties agree that the EIR will become property of the State of
Texas or will be used by HHSC's clients or recipients after completion of the
Agreement.
Nothing in this section is intended to prescribe the use of particular designs or
technologies or to prevent the use of alternative technologies, provided they result in
substantially equivalent or greater access to and use of a Product.
b. Definitions:
"Accessibility Standards" means accessibility standards and specifications for Texas
agency and institution of higher education websites and EIR set forth in 1 TAC Chapter
206 and/or Chapter 213.
"Electronic and Information Resources" means information resources, including
information resources technologies, and any equipment or interconnected system of
Page 13 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
equipment that is used in the creation, conversion, duplication, or delivery of data or
information. The term includes telephones and other telecommunications products,
information kiosks, transaction machines, Internet websites, multimedia resources, and
office equipment, including copy machines and fax machines.
"Electronic and Information Resources Accessibility Standards" means the
accessibility standards for electronic and information resources contained in 1 Texas
Administrative Code Chapter 213.
"Product" means information resources technology that is, or is related to EIR.
"Web Site Accessibility Standards/Specifications" means standards contained in
Volume 1 Tex. Admin. Code Chapter 206(c) Accessibility Requirements. Under Tex.
Gov't Code Chapter 2054, Subchapter M, and implementing rules of the Texas
Department of Information Resources, the System Agency must procure Products and
services that comply with the Accessibility Standards when those Products are available
in the commercial marketplace or when those Products are developed in response to a
procurement solicitation. Accordingly, Grantee must provide electronic and
information resources and associated Product documentation and technical support that
comply with the Accessibility Standards.
c. Evaluation, Testing, and Monitoring
1. The System Agency may review, test, evaluate and monitor Grantee's Products and
services, as well as associated documentation and technical support for compliance
with the Accessibility Standards. Review, testing, evaluation and monitoring may
be conducted before and after the award of a contract. Testing and monitoring may
include user acceptance testing. Neither the review, testing (including acceptance
testing), evaluation or monitoring of any Product or service, nor the absence of
review, testing, evaluation or monitoring, will result in a waiver of the State's right
to contest the Grantee's assertion of compliance with the Accessibility Standards.
2. Grantee agrees to cooperate fully and provide the System Agency and its
representatives timely access to Products, records, and other items and information
needed to conduct such review, evaluation, testing, and monitoring.
d. Representations and Warranties
1. Grantee represents and warrants that:
i. As of the Effective Date of the Contract, the Products and associated
documentation and technical support comply with the Accessibility Standards
as they exist at the time of entering the Agreement, unless and to the extent the
Parties otherwise expressly agree in writing; and
ii. If the Products will be in the custodyof the state or a System Agency's client or
recipient after the Contract expiration or termination, the Products will continue
to comply with Accessibility Standards after the expiration or termination of the
Contract Term, unless the System Agency or its clients or recipients, as
applicable, use the Products in a manner that renders it noncompliant.
Page 14 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
In the event Grantee becomes aware, or is notified that the Product or service and
associated documentation and technical support do not comply with the
Accessibility Standards, Grantee represents and warrants that it will, in a timely
manner and at no cost to the System Agency, perform all necessary steps to satisfy
the Accessibility Standards, including remediation, replacement, and upgrading of
the Product or service, or providing a suitable substitute.
i. Grantee acknowledges and agrees that these representations and warranties are
essential inducements on which the System Agency relies in awarding this
Contract.
ii. Grantee's representations and warranties under this subsection will survive the
termination or expiration of the Contract and will remain in full force and effect
throughout the useful life of the Product.
e. Remedies
1. Under Tex. Gov't Code § 2054.465, neither the Grantee nor any other person has
cause of action against the System Agency for a claim of a failure to comply with
Tex. Gov't Code Chapter 2054, Subchapter M, and rules of the Department of
Information Resources.
2. In the event of a breach of Grantee's representations and warranties, Grantee will
be liable for direct, consequential, indirect, special, or liquidated damages and any
other remedies to which the System Agency may be entitled under this Contract and
other applicable law. This remedy is cumulative of any other remedies to which the
System Agency may be entitled under this Contract and other applicable law.
5.15 Equipment, Supplies and Property
a. Equipment.
Equipment is defined as tangible personal property having a useful lifetime of more
than one year and a per -unit acquisition cost that exceeds $5,000 or more.
Grantee will:
1. inventory all equipment and report the inventory on the Grantees Property Inventory
Form.
2. initiate the purchase of all equipment, approved in writing by the System Agency, in
the first quarter of the Contract or Contract term, as applicable. Failure to initiate
purchase of equipment may result in the loss of availability of funds for the purchase
of equipment. Requests to purchase previously approved equipment after the first
quarter in the Contract must be submitted to the SUD email box,
S ubstanceAbuse. Contracts Li�hhsc. state. tx. us.
b. Equipment List.
1. All items of equipment to be purchased with funds under this Contract must be
itemized in Grantee's equipment list as finally approved by the System Agency in
the executed Contract.
The equipment list must include:
i. Description of the property;
ii. Serial number or other identification number;
Page 15 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
iii. Source of funding for the property (including the Federal Assistance Identification
Number);
iv. Who holds title,
v. Acquisition date and cost of the property;
vi. Percentage of Federal participation in the project costs for the Federal award under
which the property was acquired;
vii. Location use and condition of the property; and
viii.Any ultimate disposition data including the date of disposal and sale price of
property.
2. Any changes to the approved equipment list in this Contract must be approved in writing
by the System Agency prior to the purchase of equipment.
3. Grantee will submit to the assigned contract manager, a written description including
complete product specifications and need justification prior to purchasing any item of
unapproved equipment. If approved, the System Agency will acknowledge its approval
by means of a written amendment.
c. Supplies.
1. Supplies are defined as consumable items necessary to carry out the services under
this Contract including medical supplies, drugs, janitorial supplies, office supplies,
patient educational supplies, software, and any items of tangible personal property
other than those defined as equipment above.
2. Tangible personal property includes controlled assets, including firearms,
regardless of the acquisition cost, and the following assets with an acquisition cost
of $500 or more, but less than $5,000, which includes desktop and laptop computers
(including notebooks, tablets and similar devices), non -portable printers and
copiers, emergency management equipment, communication devices and systems,
medical and laboratory equipment, and media equipment are also considered
Supplies.
3. Prior approval by the System Agency of the purchase of Controlled Assets is not
required, but such purchases must be reported on the Grantees Property Inventory
Form.
d Property Inventory and Protection of Assets.
Grantee shall:
maintain an inventory of equipment, supplies defined as controlled assets, and
property described in this Contract and submit to the assigned contract manager,
upon request.
2. maintain, repair, and protect assets under this Contract to assure their full
availability and usefulness.
3. if Grantee is indemnified, reimbursed, or otherwise compensated for any loss of,
destruction of, or damage to the assets provided or obtained under this Contract,
use the proceeds to repair or replace those assets.
Page 16 of 27
OocuSign Envelope 10: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
e. Assets as Collateral Prohibited.
Grantees will not encumber equipment purchased with System Agency funds without
prior written approval from the System Agency.
J. Bankruptcy.
1. In the event of bankruptcy, Grantee will;
i. sever the System Agency property, equipment, and supplies in possession of
Grantee from the bankruptcy, and title must revert to the System Agency.
ii. when directed by the System Agency, return all such property, equipment and
supplies to the System Agency.
iii. ensure that its subcontracts, if any, contain a specific provision requiring that in
the event of the subcontractor's bankruptcy, the subcontractor must sever the
System Agency property, equipment, and supplies in possession of the
subcontractor from the bankruptcy, and title must revert to the System Agency,
who may require that the property, equipment and supplies be returned to the
System Agency.
g. Title to Property
At the expiration or termination of this Contact for any reason, title to any
remaining equipment and supplies purchased with funds under this Contract reverts
to System Agency. Title may be transferred to any other party designated by System
Agency. The System Agency may, at its option and to the extent allowed by law,
transfer the reversionary interest to such property to Grantee.
h. Disposition of Property
1. Grantee will follow the procedures in the American Hospital Association's(AHA)
"Estimated Useful Lives of Depreciable Hospital Assets" in disposing, at any time
during or after the Contract term, of equipment purchased with the System Agency
funds, except when federal or state statutory requirements supersede or when the
equipment requires licensure or registration by the state, or when the acquisition
price of the equipment is equal to or greater than $5,000.
2. All other equipment not listed in the AHA reference (other than equipment that
requires licensure or registration or that has an acquisition cost equal to or greater
than $5,000) will be controlled by the requirements of UGMS.
3. If, prior to the end of the useful life, any item of equipment is no longer needed to
perform services under this Contract, or becomes inoperable, or if the equipment
requires licensure or registration or had an acquisition price equal to or greater than
$5,000, Grantee will request disposition approval and instructions in writing from
the contract manager assigned to this Contract.
4. After an item reaches the end of its useful life, Grantee will ensure that disposition
of any equipment is in accordance with Generally Accepted Accounting Principles,
and any applicable federal guidance.
Page 17 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
Closeout of Equipment
1. At the end of the term of a Contract that has no additional renewals or that will not
be renewed (Closeout), or when a Contract is otherwise terminated, Grantee will
submit to the SUD email box, SubstanceAbuse.ContractsAhhsc.state.tx.us an
inventory of equipment purchased with System Agency funds and request
disposition instructions for such equipment.
2. All equipment purchased with System Agency funds must be secured by Grantee
at the time of Closeout, or termination of this Contract, and must be disposed of
according to the System Agency's disposition instructions, which may include
return of the equipment to System Agency or transfer of possession to another
System Agency Grantee, at Grantee's expense.
j. Insurance.
In addition to the Insurance provision of the Uniform Terms and Conditions,
Grantee shall:
1. Maintain insurance or other means of repairing or replacing assets purchased with
System Agency funds.
2. Repair or replace with comparable equipment any such equipment not covered by
insurance that is lost, stolen, damaged or destroyed. If any insured equipment
purchased with System Agency funds is lost, stolen, damaged or destroyed.
3. Notify the contract manager assigned to this Contract within 5 business days of
learning of the loss, to obtain instructions whether to submit and pursue an
insurance claim.
4. Use any insurance proceeds to repair the equipment or replace the equipment with
comparable equipment or remit the insurance proceeds to System Agency.
k. Travel
The System Agency's travel policy will apply to all travel reimbursement if Grantee
does not have a formal Travel Policy. If Grantee has a formal Travel Policy,
Grantee shall:
1. Submit Grantee's formal travel policy to be approved by the assigned
contract manager.
2. Ensure travel policy specifies reimbursement limits for meals, lodging, and
the mileage rate.
3. Ensure all travel costs are reasonable and necessary.
4. Ensure all out-of-state travel is approved by the assigned contract manager prior
to travel.
5. Submit all out-of-state travel requests to the SUD email box,_
SubstanceAbuse.Contracts(a)hhsc.state.tx.us, at least, thirty (30) days prior to
travel.
L Management and Control Systems
Grantee will:
Page 18 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
1. Maintain an appropriate contract administration system to ensure that all terms,
conditions, and specifications are met during the term of the contract through the
completion of the closeout procedures.
2. Develop, implement, and maintain financial management and control systems that
meet or exceed the requirements of Uniform Statewide Accounting System
(UGMS). Those requirements and procedures include, at a minimum, the
following:
i. Financial planning, including the development of budgets that adequately reflect
all functions and resources necessary to carry out authorized activities and the
adequate determination of costs;
ii. Financial management systems that include accurate accounting records that are
accessible and identify the source and application of funds provided under each
Contract of this Contract, and original source documentation substantiating that
costs are specifically and solely allocable to a Contract and its Contract and are
traceable from the transaction to the general ledger;
iii. Effective internal and budgetary controls;
iv. Comparison of actual costs to budget; determination of reasonableness,
allowableness, and allocability of costs;
v. Timely and appropriate audits and resolution of any findings;
vi. Billing and collection policies; and
vii. Mechanism capable of billing and making reasonable efforts to collect from
clients and third parties.
m. Property Acquisitions
System Agency funds must not be used to purchase buildings or real property. Any
costs related to the initial acquisition of the buildings or real property are not allowable.
n. Condition Precedent to Requesting Payment
Grantee will disburse program income, rebates, refunds, contract settlements, audit
recoveries, and interest earned on such funds before requesting cash payments
including any advance payments from the System Agency.
o. Overtime Compensation.
1. Except as provided in this section, Grantee will be responsible for any obligations
of premium overtime pay due employees. Premium overtime pay is defined as any
compensation paid to an individual in addition to the employee's normal rate of pay
for hours worked in excess of normal working hours.
2. Funds provided under this Contract may be used to pay the premium portion of
overtime only under the following conditions:
i. With the prior written approval of System Agency;
ii. Temporarily, in the case of an emergency or an occasional operational bottleneck;
iii. When employees are performing indirect functions, such as administration,
maintenance, or accounting;
iv. In performance of tests, laboratory procedures, or similar operations that are
Page 19 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
continuous in nature and cannot reasonably be interrupted or otherwise completed;
or
v. When lower overall cost to System Agency will result.
p. Fidelity Bond
For the benefit of System Agency, Grantee is required to carry a fidelity bond or
insurance coverage equal to the amount of funding provided under this Contract up to
$100,000 that covers each employee of Grantee handling funds under this Contract,
including person(s) authorizing payment of such funds.
1. The fidelity bond or insurance must provide for indemnification of losses
occasioned by any fraudulent or dishonest act or acts committed by any of Grantee's
employees, either individually or in concert with others, and/or failure of Grantee
or any of its employees to perform faithfully his/her duties or to account properly
for all monies and property received by virtue of his/her position or employment.
The bond or insurance acquired under this section must include coverage for third
party property.
2. Grantee will notify, and obtain prior approval from, the System Agency Contract
Oversight and Support Section before settling a claim on the fidelity bond or
insurance.
q. Liability Coverage.
For the benefit of System Agency, Grantee will at all times maintain liability insurance
coverage, referred to in Tex. Gov. Code § 2261.102, as "director and officer liability
coverage" or similar coverage for all persons in management or governing positions
within Grantee's organization or with management or governing authority over
Grantee's organization (collectively "responsible persons").
Grantee will:
1. maintain copies of liability policies on site for inspection by System Agency and
will submit copies of policies to System Agency upon request.
2. maintain liability insurance coverage in an amount not less than the total value of
this Contract and that is sufficient to protect the interests of System Agency in the
event an actionable act or omission by a responsible person damages System
Agency's interests.
3. notify, and obtain prior approval from, the System Agency Contract Oversightand
Support Section before settling a claim on the insurance.
r. Quality Management.
Grantee shall:
1. Comply with quality management requirements as directed by the System Agency.
2. Develop and implement a Quality Management Plan (QMP) that conforms with 25
TAC § 448.504 and make the QMP available to System Agencyupon request. The
QMP must be developed no later than the end of the first quarter of the Contract
term.
Page 20 of 27
DocuSlgn Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
3. Update and revise the QMP each biennium or sooner, if necessary. Grantee's
governing body will review and approve the initial QMP, within the first quarter of
the Contract term, and each updated and revised QMP thereafter. The QMP must
describe Grantee's methods to measure, assess, and improve -
i. Implementation of evidence -based practices, programs and research -based
approaches to service delivery;
ii. Client/participant satisfaction with the services provided by Grantee;
iii. Service capacity and access to services;
iv. Client/participant continuum of care; and
v. Accuracy of data reported to the state.
4. Participate in continuous quality improvement (CQI) activities as defined and
scheduled by the state including, but not limited to data verification, performing
self -reviews; submitting self -review results and supporting documentation for the
state's desk reviews; and participating in the state's onsite or desk reviews.
5. Submit plan of improvement or corrective action plan and supporting
documentation as requested by System Agency.
6. Participate in and actively pursue CQI activities that support performance and
outcomes improvement.
7. Respond to consultation recommendations by System Agency, which may include,
but are not limited to the following:
i. Staff training;
ii. Self -monitoring activities guided by System Agency, including use of quality
management tools to self -identify compliance issues; and
iii. Monitoring of performance reports in the System Agency electronic clinical
management system.
s. Abuse, Neglect, Exploitation.
Grantee shall:
1. Take all steps necessary, to protect the health, safety and welfare of its clients and
participants.
2. Develop and implement written policies and procedures for abuse, neglect and
exploitation.
3. Notify appropriate authorities of any allegations of abuse, neglect, or exploitation
as required by 25 TAC § 448.703.
t. Persons on Probation or Parole.
Grantee will:
1. Develop and implement written policies and procedures that address the delivery of
services by employees, subcontractors, or volunteers on probation or parole.
2. Notify the contract manager assigned to the Contract immediately of any of its
employees, volunteers or subcontractors who are on parole or probation if the
employee, volunteer, or subcontractor provides or will provide direct client or
participant services or who has or may have direct contact with clients or
participants.
3. Maintain copies of all notices required under this section for System Agency
Page 21 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
review.
u. Personnel Requirements and Documentation.
Grantee shall:
1. Maintain current personnel documentation on each employee. All documents must
be factual and accurate. Health -related information must be stored separately with
restricted access as appropriate under Tex. Gov. Code §552.102. Training records
may be stored separately from the main personnel file but must be easily accessible
upon request. Required documentation includes the following, as applicable:
i. A copy of the current job description signed by the employee;
ii. Application or resume with documentation of required qualifications and
verification of required credentials;
iii. Verification of work experience;
iv. Annual performance evaluations;
v. Personnel data that includes date hired, rate of pay, and documentation of all
pay increases and bonuses;
vi. Documentation of appropriate screening and/or background checks, to include
probation or parole documentation;
vii. Signed documentation of initial and other required training; and
viii. Records of any disciplinary actions.
2. Document authentication must include signature, credentials when applicable, and
date. If the document relates to past activity, the date of the activity must also be
recorded. Documentation must be permanent and legible. When it is necessary to
correct a required document, the error must be marked through with a single line,
dated, and initialed by the writer.
5.16 Clinical Management for Behavioral Health Services (CMBHS) System
The CMBHS is the official record of documentation by System Agency.
Grantee shall:
1. Request access to CMBHS via the CMBHS Helpline at (866) 806-7806.
2. Use the CMBHS time frames specified by System Agency.
3. Use System Agency -specified functionality of the CMBHS in its entirety.
4. Submit all bills and reports to System Agency through the CMBHS,
unless otherwise instructed.
a. Resources
Grantee shall ensure that Grantee's employees have appropriate Internet access and an
adequate number of computers of sufficient capabilities to use the CMBHS.
Equipment purchased with System Agency funds must be inventoried, maintained in
working order, and secured.
b. Security Administrator and Authorized Users
Grantee shall:
Page 22 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
1. Designate a Security Administrator and a back-up Security Administrator. The
Security Administrator is required to implement and maintain a system for
management of user accounts/user roles to ensure that all the CMBHS user
accounts are current.
2. Have a security policy that ensures adequate system security and protection
of confidential information.
3. Notify the CMBHS Help -desk within ten (10) business days of any change to
the designated Security Administrator or the back-up Security Administrator.
Grantee will:
i. Ensure that access to CMBHS is restricted to only currently authorized users.
ii. Within 24 hours, remove access to users who are no longer authorized to
have access to secure data in CMBHS.
iii. Maintain the CMBHS Authorized Users List which includes former and
current Grantee's employees, contracted labor, subcontractors or any other
users authorized to have access to secure data in CMBHS. The CMBHS
Authorized Users List shall document whose authority has been added and
terminated; and the date the authority was added and terminated.
4. Submit the CMBHS Security Attestation Form and the CMBHS Authorized
Users List as stated in Attachment A, to the following e-mail address:_
SubstanceAbuse.Contracts(a)hhsc. state.tx. us.
5. Continually maintain the current CMBHS Authorized Users List on file and
make available to System Agency upon request within five business days.
6. Immediately block access to CMBHS of any person who should no longer
have access to CMBHS, due to severance of employment with Grantee or
otherwise,
i. immediately modify access when there is a change in a user's job
responsibilities that affects the user's need for access to CMBHS,
ii. update records on a daily basis to reflect any changes in account status.
c. Security Violations and Accounts Updates.
Grantee will adhere to the Confidentiality Article requirements and HHS Data Usage
Agreement of this contract and immediately contact System Agency if a security
violation is detected, or if Grantee has any reason to suspect that the security or
integrity of the CMBHS data has been or may be compromised in any way.
d. Electronic Transfer of Information.
Grantee will establish and maintain adequate internal controls, security, and oversight
for the approval and electronic transfer of information regarding payments and
reporting requirements. Grantee certifies that the electronic payment requests and
reports transmitted will contain true, accurate, and complete information.
e. Access.
System Agency reserves the right to limit or deny access, to the CMBHS by Grantee,
at any time for any reason deemed appropriate by System Agency. Grantee access to
CMBHS will be placed in inactive status when theGrantee ceases to have an executed
contract with System Agency Mental Health and Substance Abuse Division.
Page 23 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
f. Customer Support and Training.
System Agency will provide support for the CMBHS, including problem tracking and
problem resolution. System Agency will provide telephone numbers for Grantees to
obtain access to expert assistance for CMBHS-related problem resolution. System
Agency will provide initial CMBHS training. Grantee shall provide subsequent
ongoing end -user training.
5.17 HIV/AIDS Model Workplace Guidelines
Grantee shall:
a. Implement the System Agency's policies based on the Human Immunodeficiency
Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), AIDS Model Workplace
Guidelines for Businesses at http://www.dshs.state.tx.us/hivstd/policy/policies.shtm,
State Agencies and State Grantees Policy No. 090.021.
b. Educate employees and clients concerning HIV and its related conditions, including
AIDS, in accordance with the Texas. Health & Safety Code §§ 85.112-114.
5.18 Medicaid Enrollment
Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare
Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee's service
region within the first quarter of this procurement term and maintain through the
procurement term.
5.19 Billing for Treatment and Payment Restrictions
Grantees shall:
a. Bill for only one intensity of service and service type (either outpatient or
residential) per client per day
b. Not bill for an intensity of service and service type if another System Agency -
funded Treatment Grantee is providing and billing System Agency for another
intensity of service and service type.
c. The following are the exceptions to Item (b):
A client may receive the following services at the same time the client receives SUD
outpatient or residential treatment services:
a. Co-occurring psychiatric / substance use disorder services,
b. Ambulatory detoxification, or
c. Opioid substitution therapy services.
d. If two Grantees provide services to the same client under this exception, the
Grantees must coordinate services and both Grantees must document the service
coordination in CMBHS.
5.20 Persons on Probation or Parole.
Grantee shall;
a. Develop and implement written policies and procedures that address the delivery of
Page 24 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
services by employees, subcontractors, or volunteers on probation or parole.
b. Submit to the SUD email box, SubstanceAbuse.Contractsna,hhsc.state.tx.us, noticeof
any of its employees, volunteers or subcontractors who are on parole or probation if
the employee, volunteer, or subcontractor provides or will provide direct client or
participant services or who has or may have direct contact with clients or participants.
c. Maintain copies of all notices required under this section for System Agency review.
d. Ensure that any person who is on probation or parole is prohibited from
performing direct client/participant services or from having direct contact with
clients or participants until authorized by System Agency.
5.21 Substance Abuse Block Grant (SABG) Requirements
Grantee will comply with the requirements of the SABG, including the restrictions on
expenditure of grant funds, stated in 45 CFR § 96.135 and the Notice of Grant Award:
The State shall not expend the Block Grant on the following activities:
a. To provide inpatient hospital services, except as provided in paragraph (c) of this
section;
b. To make cash payments to intended recipients of health services;
c. To purchase or improve land, purchase, construct, or permanently improve (other
than minor remodeling) any building or other facility, or purchase major medical
equipment;
d To satisfy any requirement for the expenditure of non -Federal funds as a condition for
the receipt of Federal funds;
e. To provide financial assistance to any entity other than a public or nonprofit private
entity; or
f. To provide individuals with hypodermic needles or syringes so that such individuals
may use illegal drugs, unless the Surgeon General of the Public Health Service
determines that a demonstration needle exchange program would be effective in
reducing drug abuse and the risk that the public will become infected with the
etiologic agent for AIDS.
5.22 Match and Program Income
Grantee shall:
a. Contribute match that is, at minimum, the percentage, stated on Attachment B, of Total
System Agency Share unless otherwise stated on Attachment B.
b. Report match on each Financial Status Report (FSR) or Quarterly Match Report,
including description, source, and dollar amount in the FSR comment section for the
non -System Agency funding and in -kind contributions for the program or as directed
by System Agency.
c. Adhere to the Program Income requirements in Uniform Grants Management Standards
(UGMS).
d. Not use program income as match without prior approval of the contract manager
assigned to the Contract.
e. If the match ratio requirement is not met by the beginning of the last three months of
Page 25 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
the term of the Contract, System Agency may withhold or reduce payments to satisfy
match insufficiency or demand a refund of the amount of the match insufficiency.
5.23 Contract Reconciliation
Grantee, within 45 calendar days after the end of each fiscal term year, will submit to the
System Agency email box, SubstanceAbuse.Contracts cr,hhsc.state.tx.us, financial and
reconciliation reports required by System Agency in forms as determined by System
Agency.
5.24 Breach of Contract and Liquidated Damages
a. contract monitoring.
System Agency:
1. will monitor Grantee for programmatic and financial compliance with this
Contract and;
2. may impose liquidated damages for any breach of this Contract.
3. at its discretion, may place Grantee on accelerated monitoring, which entails more
frequent or more extensive monitoring than ordinarily conducted by System
Agency.
4. may allow the Grantee the opportunity to correct identified deficiencies prior to
imposing actions stated in this section.
b. Liquidated Damages.
Grantee agrees that noncompliance with the requirements specified in the Contract
causes damages to System Agency that are difficult to ascertain and quantify.
Grantee further agrees that System Agency may impose liquidated damages each
month for so long as the noncompliance continues. Failure to comply with any of the
Contract requirements, System Agency may impose liquidated damages of.
1. $500 for the first occurrence of noncompliance during a fiscal year;
2. $750 for the second occurrence of noncompliance with the same requirement
during the same fiscal year; and
3. $1,000 for the third and subsequent occurrence(s) of noncompliance with the
same requirement during the same fiscal year.
c. Grantee Repayment.
System Agency may withhold payments to Grantee to satisfy any recoupment or
liquidated damage imposed by System Agency under this Article. System Agency
may take repayment from funds available under this Contract, active or expired, or
any subsequent renewal, in amounts necessary to fulfill Grantee's repayment
obligations.
d. Notice of Liquidated Damages.
System Agency will formally notify Grantee in writing when liquidated damages action
is imposed, stating the nature of the action, the reasons for imposing, and the method of
appealing. Grantee must submit a written appeal, within 10 calendar days of receipt of
the notice, to the SUD email box, SubstanceAbuse.Contracts(d,hhsc. state. tx.us.
Page 26 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
ATTACHMENT E (REVISED AUGUST 2021)
A submitted appeal must;
1. include documented proof that Grantee submitted the information by the due date
or received an exemption from the assigned contract manager.
2. demonstrate the findings on which the Liquidated Damage is based are either
invalid or do not warrant the action(s).
If System Agency determines the liquidated damage is warranted, System Agency's
decision is final and the remedy or sanction shall be imposed.
Page 27 of 27
DocuSign Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
CERTIFICATION
The certifications enumerated below represent material facts upon which HHSC relies when reporting
information to the federal government required under federal law. If HHSC later determines that the
Contractor knowingly rendered an erroneous certification, HHSC may pursue all available remedies in
accordance with Texas and U.S. laws. Signor further agrees that it will provide immediate written notice
to HHSC if at any time Signor learns that any of the certifications provided for below were erroneous
when submitted or have since become erroneous by reason of changed circumstances. If the Signor
cannot certify all of the statements contained in this section, Signor must provide written notice to
Legal Name of Contractor:
FFATA Contact # 1 Name, Email and Phone Number:
City of Lubbock
Linda Cuellar
Lcuellar@mylubbock.us
806-775-3253
Primary Address of Contractor:
FFATA Contact #2 Name, Email and Phone Number:
1314 Ave K
ZIP Code: 9-digits Required www.usps.com
Primary DUNS Number: 9-digits Required
http://www.dnb.com/us/
794 1- 830 _
058 13 93
State of Texas Comptroller Vendor Identification Number (VIN)14 Digits
000 75 000 906
Printed Name of Authorized Representative
Signature of Authorized Representative
Daniel Pope
by:
rDoeuSigned
vaLuc,l, pert,
Title of Authorized Representative
Date
Mayor
September 1, 2021
- 1 -
DocuSlgn Envelope ID: 5087415C-4FA3-4167-AC52-089F4329EC4B
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
CERTIFICATION
As the duly authorized representative (Signor) of the Contractor, I hereby certifythat
the statements made by me in this certification form are true, complete and correct to
the best of my knowledge.
Did your organization have a gross income, from all sources, of less than $300,000 in
your previous tax year? ❑ Yes ❑x No
If your answer is "Yes," skip questions "A," '%," and "C" and finish the certification.
If your answer is "No," answer questions "A" and "B."
A. Certification Regarding Percent M of Annual Gross from Federal Awards.
Did your organization receive 80% or more of its annual gross revenue from federal
awards during the preceding fiscal year? ❑ Yes ❑x No
B. Certification Regarding Amount of Annual Gross from Federal Awards.
Did your organization receive $25 million or more in annual gross revenues from federal
awards in the preceding fiscal year? x❑ Yes ❑ No
If your answer is "Yes" to both question "A" and '%," you must answer question "C."
If your answer is "No" to either question "A" or "B," skip question "C" and finish the
certification.
C. Certification Regarding Public Access to Compensation Information.
Does the public have access to information about the highly compensated officers/senior
executives in your business or organization (including parent organization, all branches,
and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 U.S.0 78m(a), 78o(d)) or section 6104 of the
Internal Revenue Code of1986? ❑ Yes ❑ No
If your answer is "Yes" to this question, where can this information be accessed?
If your answer is "No" to this question, you must provide the names and total
compensation of the top five highly compensated officers below.
Provide compensation information here:
-2-
Certificate Of Completion
Envelopeld: 5087415C4FA34167AC52089F4329EC4B
Subject: Amending $2,192,400; HHS000780500002; City of Lubbock A-1; HHSC/MSS-IDD-SUDCMU
Source Envelope:
Document Pages: 77 Signatures: 2
Certificate Pages: 2 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
Record Tracking
Status: Original
8/29/2021 12:43:25 PM
Signer Events
Daniel Pope
Dpope@mylubbock.us
Mayor
City of Lubbock
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Sonja Gaines
Sonja.Gaines@hhs.texas.gov
SG
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events
Editor Delivery Events
Agent Delivery Events
Intermediary Delivery Events
Certified Delivery Events
Carbon Copy Events
Jennifer Silva
Jennifer.Silva0l@hhs.texas.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Holder: Texas Health and Human Services
Commission
PCS—DocuS!gn@hhsc.state.tx.us
Signature
FDocuS1qn*dby'
aa.ic,l, Poet,
3F037B5315554-
Signature Adoption: Pre -selected Style
Using IP Address: 208.84.91.41
Signature
Status
Status
Status
Status
Status
COPIED
DocuSign
Status: Sent
Envelope Originator:
Texas Health and Human Services Commission
1100 W. 49th St.
Austin, TX 78756
PCS—DocuSign@hhsc.state.tx.us
IP Address: 167.137.1.18
Location: DocuSign
Timestamp
Sent: 8/29/2021 1:00:22 PM
Viewed: 9/1/2021 8:47:41 AM
Signed: 9/1/2021 8:50:16 AM
Sent: 9/1/2021 8:50:20 AM
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Sent: 8/29/2021 1:00:21 PM
Viewed: 8/31/2021 3:08:59 PM
SA Mailbox COPIED Sent: 8/29/2021 1:00:22 PM
SubstanceAbuse.Contracts@hhsc.state.tx.us Viewed: 8/31/2021 5:02:33 PM
Security Level: Email, Account Authentication
(None)
Carbon Copy Events Status Timestamp
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Bryan Hunter COPIED Sent: 8/29/2021 1:00:21 PM
Bryan.Hunter@hhs.texas.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 8/29/2021 1:00:22 PM
Payment Events Status Timestamps
CITY OF LUBBOCK
ATTEST:
By: 4
DANIEL M. POPE, Mayor
ATTEST:
By: Q Lk4'
CA GARZA, City Secr to
AS A'O CONTENT:
KATHERINE WELLS, Director of Public Health
APPROVED AS TO FORM:
By:
AN ROOKE, Xssistant City Attorney