HomeMy WebLinkAboutResolution - 2023-R0440 - Amendment No. 3, HHSC Contract No. HHS0007795500002, TRA - 09/12/2023Resolution No. 2023-R0440
Item No. 5.35
September 12, 2023
RESOLUTION
BE IT IZESOLVED BY TIIE CITY COUNCIL OF TIIE CITY Ol� LUBBOCK:
THAT the acts of the Mayor of the City of Lubbock in executing, on behalf of the City of
Lubbock, Amendment No. 3 to the Health and Human Services Commission Contract No.
HHS000779500002, under the Substance Use Prevention, Treatment and Recovery Services
Block Grant, to provide funding for Treatment for Adults (TRA), by and between the City of
Lubbock and the State of Texas' Health and Human Services Commission, 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 12, 2023_ ___ __
A"I'TEST:
Courtney Paz, City Sec ary
I��iTZ�I�7
TO CON"1'1;N"1':
APPROVED AS TO PORM:
Rachael Foster,�ls�s�ant City Attorncy
RES.HHSC Contract No. I II IS000779500002 Amendment No.3 Ratification
8.29.23
DocuSign Envelope ID: AAFAB1AE-6BD1-4D03-B79B-540E8C3AA874
Resolution No. 2023-RO440
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS000779500002
AMENDMENT No. 3
The HEALTH AND HUMAN SERVICES COMMISSION ("HHSC" or "System Agency") and CITY OF
LUBBOCK ("Grantee"), who are collectively referred to herein as the "Parties," to that certain Treatment for
Adults (TRA) Contract effective August 1, 2020, and denominated HHSC Contract No. HHS000779500002
("Contract"), as amended, now desire to further amend the Contract.
WHEREAS, HHSC desires to revise Attachment A, Statement of Work;
Whereas, HHSC desires to revise Attachment B, Program Services and Unit Rates;
Whereas, HHSC desires to add funding to serve additional clients and/or process payment in
accordance with Attachment B; and
Whereas, HHSC desires to update Attachment H and certain Contract information.
Now, THEREFORE, the Parties hereby amend and modify the Contract as follows:
1. ARTICLE IV of the Contract Signature Document, BUDGET, is hereby deleted in its entirety
and replaced with the following to add state allotted funding of $3,962,751.00. The HHSC
funding, amount added, required match, and total for each State Fiscal Year (September 1 -
August 31) (FY), as well as the Total Contract Value is documented in the table below:
A. The HHSC allocated share and Grantee required match per State Fiscal Year (FY)
is as follows:
Fiscal Year
HHSC Share
Amount
Grantee
Total
Added
Required Match
2021
$1,144,980.00
$0.00
$57,249.00
_
$1,202,229.00
2022
$1,219,980.00
$0.00
$57,249.00
$2,702,879.00
2023
$2,645,630.00
$1,320,917.00
$128,531.00
$4,095,078.00
2024
$2,645,630.00
$1,320,917.00
$128,531.00
$4,095,078.00
2025
$2,645,630.00
$1,320,917.00
$128,531.00
$4,095,078.00
Totals
$10,301,850.00
$3,962,751.00
$500,091.00
$16,190,342.00
B. All expenditures under the Contract No. HHS000779500002 will be in accordance
with ATTACHMENT B, PROGRAM SERVICES AND UNIT RATES
(REVISED AUGUST 2023).
2. ATTACHMENT A of the Contract, STATEMENT OF WORK (REVISED APRIL 2021), is deleted in
its entirety and replaced withATTACHMENT A, STATEMENT OF WORK (REVISED AUGUST
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
1
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2023).
3. ATTACHMENT B of the Contract, PROGRAM SERVICES AND UNIT RATES (OCTOBER 2022), is
deleted in its entirety and replaced with ATTACHMENT B, PROGRAM SERVICES AND UNIT
RATES (REVISED AUGUST 2023).
4. ATTACHMENT H of the Contract, FEDERAL FUNDING ACCOUNTABILITY AND
TRANSPARENCY ACT (FFATA) CERTIFICATION, is hereby supplemented with the addition
of an up-to-date FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
CERTIFICATION FORM, to be completed by Grantee and incorporated into the Contract to
meet the Federal requirement.
5. The U.S. Health and Services Commission, Substance Abuse and Mental Health Services
Administration (SAMHSA) revised the name of the Substance Abuse Prevention and
Treatment Block Grant (SABG) or (SAPT), assistance listing number 93.959. Therefore, the
Contract is revised as follows:
All references in the Contract to Substance Abuse Prevention and Treatment Block Grant
(SABG) or (SAPT) are hereby replaced with the following: Substance Use Prevention,
Treatment and Recovery Services (SUPTRS) Block Grant.
6. This Amendment No. 3 shall be effective as of August 31, 2023.
7. Except as amended and modified by this Amendment No. 3, all terms and conditions of the
Contract, as amended, shall remain in full force and effect.
8. Any further revisions to the Contract shall be by written agreement of theParties.
SIGNATURE PAGE FOLLOWS
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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SIGNATURE PAGE FOR AMENDMENT NO. 3
HEALTH AND HUMAN SERVICES COMMISSION CONTRACT NO. HHS000779500002
HEALTH AND HUMAN SERVICES
COMMISSION
I�r DocuSlgned by:
b a Ga ivxs
By:
Sonja Gaines
NoSG
Date of Execution: August 29, 2023
CITY OF LUBBOCK
DocuSlgned by:
: BY
Tray Payne
Mayor
Date of Execution: August 29, 2023
THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE
CONTRACT:
ATTACHMENT A STATEMENT OF WORK (REVISED AUGUST2023)
ATTACHMENT B PROGRAM SERVICES AND UNIT RATES (REVISED AUGUST 2023)
ATTACHMENT H FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT
(FFATA) CERTIFICATION FORM
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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ATTACHMENT A
STATEMENT OF WORK
(REVISED AUGUST 2023)
Grantee shall provide substance use disorder treatment services to the target population at one or
more of the following service types/levels of care. The service types/levels of care below are based
on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder
(SUD) Program Guide, located at the following link:
http s: //www. hhs. texas. gov/providers/behav ioral-health-seivi ces-providers/substance-use-service-
providers and the American Society of Addiction Medicine (ASAM) criteria located at the
following link: https://www.asam.org which is a collection of objective guidelines that give
clinicians a standardized approach to admission and treatment planning.
SECTION II: TARGET POPULATION
A. TREATMENT FOR ADULTS (TRA)
Target Population
Adult Texas residents who meet Client Eligibility for HHSC-funded services as stated in the SUD
Program Guide, located at the following link: https://www.hhs.texas.gov/providers/behavioral-
health-seivices-providers/substance-use-service-providers. Persons who are living with HIV are
eligible for these programs/service types.
1. Outpatient Treatment Services
(ASAM Level 1 Outpatient Services)
2. Supportive Residential Treatment Services
(ASAM Level 3.1 Clinically Managed Low -Intensity Residential Services)
3. Intensive Residential Treatment Services
(ASAM Level 3.5 Clinically Managed High -Intensity Residential Services)
4. Residential Detoxification Services
(ASAM Level 3.7 Medically Monitored Withdrawal Services)
5. Ambulatory Detoxification Services
(ASAM Level 2 Withdrawal Management)
B. TREATMENT FOR ADULTS (TRA)
HIV Statewide Intensive Residential Program
Target Population
Adult Texas residents living with HIV who meet Client Eligibility requirements for HHSC-funded
substance use disorder services as stated in the SUD Program Guide, located at the following link:
https://www.hhs.texas.gov/providers/behavioral-health-services-providers/substance-use-service-
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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providers.
1. Human Immunodeficiency Virus (HIV) Statewide Intensive Residential
(ASAM Level 3.5 Clinically Managed High -Intensity Residential Services)
Grantee shall comply with the following:
A. Administrative Requirements
1. Adhere to the most current SUD Program Guide.
2. Provide age -appropriate medical and psychological therapeutic services designed to
treat an individual's SUD while promoting recovery.
3. Adhere to Level of Care Service Type licensure requirements.
4. Comply with all applicable Texas Administrative Code (TAC) rules as adopted by
HHSC related to SUD treatment.
5. Document all specified required activities and services in the Clinical Management of
Behavioral Health Services (CMBHS) system. Documents that require client or staff
signature shall be maintained according to TAC requirements and made available to
HHSC for review upon request.
6. In addition to TAC and SUD Program Guide -required Policies and Procedures,
Grantee shall develop and implement organizational policies and procedures for the
following:
i. A marketing plan to engage local referral sources and provide information to these
sources regarding the availability of SUD treatment and the Client Eligibility
criteria for admissions;
ii. All marketing materials published shall include state and federal priority
populations admissions;
iii. Client retention in services, including protocols for addressing clients absent from
treatment, and policies defining treatment non-compliance; and
iv. All policies and procedures shall be provided to HHSC upon request.
7. Ensure that Program Directors participate in their specific program and service type
conference calls as scheduled by HHSC. Program Directors shall participate unless
otherwise agreed to by HHSC in writing. Grantee executive management may
participate in the conference calls.
8. Actively attend and share representative knowledge about Grantee's system and
services at the Outreach, Screening, Assessment, and Referrals (OSAR) quarterly
regional collaborative meetings.
9. Ensure compliance with Client Eligibility requirements to include: Texas eligibility,
financial eligibility, and clinical eligibility as required in the SUD Program Guide.
10. Develop a local agreement with the Texas Department of Family and Protective
Services (DFPS) local offices to address referral process, coordination of services, and
sharing of information as allowed per the consent and agreement form.
11. Adhere to Memorandums of Understanding requirements as stated in the SUD
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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Program Guide.
B. Service Delivery
1. Adhere to the Federal Priority Populations for Treatment Programs and State Priority
Populations for Treatment Programs as stated in the SUD Program Guide.
2. Maintain a Daily Capacity Management Report in CMBHS as required in the SUD
Program Guide.
3. Maintain a Wait List to track all eligible individuals who have been screened but cannot
be admitted to SUD treatment immediately.
i. Grantee that has an individual identified as a federal and state priority
population on the wait list shall confirm this in the Daily Capacity Management
Report.
ii. Grantee shall arrange for appropriate services in another treatment facility or
provide access to interim services as indicated within 48 hours when efforts to
refer to other appropriate services are exhausted.
iii. Grantee shall offer directly or through referral interim services to wait -listed
individuals.
iv. Establish a wait list that includes priority populations and interim services
while awaiting admission to treatment services.
V. Develop a mechanism to maintain contact with individuals awaiting admission.
4. If unable to provide admissions to individuals within Federal Priority Populations for
Treatment Programs and State Priority Populations for Treatment Programs
according to the SUD Program Guide:
i. Implement written procedures that address maintaining weekly contact with
individuals waiting for admissions as well as what referrals are made when a
client cannot be admitted for services immediately.
ii. When Grantee cannot admit a client, who is at risk for withdrawal, Grantee
shall ensure that an emergency medical care provider is notified.
iii. Coordinate with an alternate provider for immediate admission.
iv. Notify Substance Use Disorder (Substance Use Disorder Ahhs.texas. gov) so
that assistance can be provided that ensures immediate admission to other
appropriate services and proper coordination when appropriate.
V. Provide pre -admission service coordination to reduce barriers to treatment,
enhance motivation, stabilize life situations, and facilitate engagement in
treatment.
vi. Adhere to Informed Consent Documentation for Opioid Use Disorder
applicable to the individual as stated in the SUD Program Guide.
vii. When an individual is placed on the waiting list, Grantee shall document
interim services as referrals that provides applicable testing, counseling, and
treatment for Human Immunodeficiency Virus (HIV), tuberculosis (TB), and
sexually transmitted infections (STIs).
C. Screening and Assessment
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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1. Comply with all applicable rules for SUD programs in theTAC regarding Screening
and Assessment, as referenced in State Information, Rules, and Regulations of the
SUD Program Guide.
2. When documenting a CMBHS screening, Grantee shall conduct the screening in a
confidential, face-to-face interview in accordance with TAC.
3. Document Financial Eligibility in CMBHS as required in the SUD Program Guide.
4. Conduct and document a CMBHS SUD initial assessment with the client to determine
the appropriate levels of care for SUD treatment. The CMBHS assessment will
identify the impact of substances on the physical, mental health, and other identified
issues including Tuberculosis, Hepatitis C, sexually transmitted infection (STI), and
Human Immunodeficiency Virus (HIV).
i. If client indicates risk for these communicable diseases, Grantee shall refer the
client to the appropriate community resources for further testing and counseling.
ii. If the client is at risk for HIV, Grantee shall refer the client to pre and post-test
counseling on HIV.
5. Grantee must also consider referring to the TRA Statewide HIV Intensive Residential
Treatment facility to concurrently address medical needs and SUD.
6. If a client is living with HIV, Grantee must refer the client to the appropriate
community resources to complete the necessary referrals and health related
paperwork.
7. The assessment shall be signed by a Qualified Credential Counselor (QCC) and filed
in the client record within three (3) service days of admission or a program may
accept an evaluation from an outside entity if it meets the criteria for admission and
was completed during the 30 business days preceding admission.
D. Treatment Planning, Implementation and Review
1. Comply with all applicable rules for SUD programs in the TAC regarding Treatment
Planning, Implementation and Review, as referenced in State Information, Rules, and
Regulations of the SUD Program Guide.
2. Collaborate actively with clients and family, when appropriate, to develop and
implement an individualized, written treatment plan that identifies services and
support needed to address problems and needs identified in the assessment. The
treatment plan shall document the expected length of stay and treatment intensity.
Grantee shall use clinical judgment to assign a projected length of stay for each
individual client.
3. Document referral and referral follow-up in CMBHS to the appropriate community
resources based on the individual need of the client.
4. The treatment plan shall be signed by a QCC and filed in the client record within five
service days of admission.
E. Discharge
1. Comply with all applicable rules in the TAC regarding Discharge, as referenced in
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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Information, Rules, and Regulations of the SUD Program Guide.
2. Develop and implement an individualized discharge plan with the client to assist in
sustaining recovery.
3. Document in CMBHS the client -specific information that supports the reason for
discharge listed on the discharge report. A QCC shall sign the discharge summary.
Appropriate referrals shall be made and documented in the client record. A client's
treatment is considered successfully completed if the following criteria are met:
i. Client has completed the clinically recommended number of treatment units
(either initially projected or modified with clinical justification) as indicated in
CMBHS.
ii. All problems on the treatment plan have been addressed.
4. Utilize the treatment plan component of CMBHS to create a final and completed
treatment plan version.
5. Problems designated as "treat" or "case manage" status shall have all objectives
resolved prior to discharge:
i. Problems that have been "referred" shall have associated documented referrals in
CMBHS;
ii. Problems with "deferred" status shall be re -assessed. Upon successful discharge,
all deferred problems shall be resolved, either through referral, withdrawal,
treatment, or case management with clinical justification reflected in CMBHS,
through the Progress Note and Treatment Plan Review Components; and
iii. "Withdrawn" problems shall have clinical justification reflected in CMBHS,
through the Progress Note and Treatment Plan Review Components.
F. Additional Service Requirements
I. Comply with all applicable rules in the TAC for SUD programs, as stated in
Information, Rules, and Regulations of the SUD Program Guide.
2. Deliver and provide access to services at times and locations that meet the needs of the
target population. Provide or arrange for transportation to all required services not
provided at Grantee's facility.
3. Accept referrals from the OSAR.
4. Provide evidenced -based education at minimum on the following topics: (i)
Tuberculosis; (ii) HIV; Hepatitis B and C; (iii) Sexually Transmitted
Infections/Diseases; and (iv) health risks of tobacco and nicotine product use.
5. Provide Case Management as needed with documentation in CMBHS, as Case
Management is essential to the ultimate success of the client.
6. Ensure client access to the full continuum of treatment services and shall provide
sufficient treatment intensity to achieve treatment plan goals.
7. Provide all services in a culturally, linguistically, non -threatening, respectful and
developmentally appropriate manner for clients, families, and/or significant others.
8. Provide trauma -informed services that address the multiple and complex issues related
to violence, trauma, and substance use disorders.
9. Provide overdose prevention and reversal education to all clients.
10. Specific overdose prevention activities shall be conducted with clients with opioid use
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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disorders and those clients that use drugs intravenously. Grantee will directly provide
or refer to community support services for overdose prevention and reversal education
to all identified at risk clients prior to discharge. Grantee will document all overdose
prevention and reversal education in CMBHS.
11. Ensure access to adequate and appropriate medical and psychosocial tobacco cessation
treatment as follows:
i. Assess all clients for tobacco use and all clients seeking to cut back or quit.
ii. If the client indicates wanting assistance with cutting back or quitting, the client
will be referred to appropriate tobacco cessation treatment.
12. Utilize HHSC as the payer of last resort if the client has other/outside funding available
(i.e., wages, insurance, etc.).
A. All personnel shall receive the training and supervision necessary to ensure compliance with
HHSC rules, provision of appropriate and individualized treatment, and protection of client
health, safety, and welfare.
B. Ensure that all direct care staff receive a copy of this statement of work and SUD Program
Guide requirements.
C. Ensure that all direct care staff review all policies and procedures related to the program or
organization on an annual basis.
D. Ensure compliance with all applicable rules in the TAC for SUD Programs regarding
Personnel Practices and Development, as stated in Personnel Requirements and
Documentation of the SUD Program Guide.
E. Within 90 business days of hire and prior to service delivery direct care staff shall have
specific documented training in the following:
1. Motivational interviewing techniques or Motivational Enhancement Therapy;
2. Trauma -informed care;
3. Cultural competency;
4. Harm reduction trainings;
5. HIPAA and 42 CFR Part 2 training; and
6. State of Texas co-occurring psychiatric and substance use disorder (COPSD) training
located at the following website: www.centralizedtraining.com.
F. Ensure all direct care staff complete annual education on Health Insurance Portability and
Accountability Act (HIPAA) and 42 CFR Part 2 training.
G. Ensure all direct care staff complete a minimum of 10 hours of training each state fiscal year
in any of the following areas:
1. Motivational interviewing techniques;
2. Cultural competencies;
3. Reproductive health education;
4. Risk and harm reduction strategies;
5. Trauma informed care; or
6. Suicide prevention and intervention.
H. Individuals responsible for planning, directing, or supervising treatment services shall be
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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QCC.
I. Grantee shall have a clinical program director known as a "Program Director" with at least
two years of post-QCC licensure experience providing substance use disorder treatment.
J. Substance Use Disorder counseling shall be provided by a QCC, or Chemical Dependency
Counselor Intern. Substance use disorder education and life skills training shall be provided
by counselors or individuals who have been trained in the education. All counselor interns
shall work under the direct supervision of a QCC.
K. Licensed Chemical Dependency Counselors shall recognize the limitations of their
licensee's ability and shall not provide services outside the licensee's scope of practice of
licensure or use techniques that exceed the person's license authorization or professional
competence.
L. Develop a policy and procedure on staff training, available for HHSC review, to ensure that
information is gathered from clients in a respectful, non -threatening, and culturally
competent manner.
M. For HIV Residential Grantee, all counseling staff will have one year of experience working
with persons living with HIV or the at -risk population.
1. Specific training for direct care staff is required annually in harm, risk reduction, and
overdose training.
2. The Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Physician's
Assistant must have at least two years' experience working with persons living with
HIV. All shifts will be staffed with either a LVN or RN.
3. Food service staff will include at least one full time employee who has certification in
food service management and the ability to plan and accommodate diets recommended
for individuals served by Grantee.
A. OUTPATIENT TREATMENT SERVICES
ASAM Level 1 Outpatient Services
Grantee will adhere to the following service requirements:
1. Adhere to TAC requirements and SUD Program Guide for outpatient treatment
programs/services.
2. Provide and document in CMBHS one (1) hour of group or individual counseling
services for every six (6) hours of educational activities.
3. Document in CMBHS a discharge follow-up no sooner than sixty (60) calendar days
and no later than ninety (90) calendar days after discharge from the outpatient
treatment services.
B. SUPPORTIVE RESIDENTIAL TREATMENT SERVICES
ASAM Level 3.1 Clinically Managed Low -Intensity Residential Services
Grantee will adhere to the following service requirements:
1. Adhere to TAC requirements and SUD Program Guide for residential treatment
programs/services.
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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2. Document in CMBHS a discharge follow-up no sooner than sixty (60) calendar days
and no later than ninety (90) calendar days after discharge from the residential
treatment services.
C. INTENSIVE RESIDENTIAL TREATMENT SERVICES
ASAM Level 3.5 Clinically Managed High -Intensity Residential Services
Grantee will adhere to the following service requirements:
1. Adhere to TAC requirements and SUD Program Guide for residential treatment
programs/services.
2. Document in CMBHS a discharge follow-up no sooner than sixty (60) calendar days
and no later than ninety (90) calendar days after discharge from the residential
treatment services.
D. HIV STATEWIDE INTENSIVE RESIDENTIAL TREATMENT SERVICES
Grantee will adhere to applicable TAC residential services requirements. In addition, Grantee
will adhere to the following service requirements:
1. Work collaboratively with other community -based case management services to
resolve admission barriers for clients seeking treatment for SUD or medical care.
2. Provide and document medical monitoring and treatment of HIV and ensure the
provision of expedited timely co-occurring needs and treatment for related conditions,
addressing issues associated with antiviral drug resistance and adherence, symptoms
associated with drug -induced side effects and prescribed prophylaxis for opportunistic
infection(s).
3. Ensure individual counselling and groups (including educational groups and other
structured activities) will be documented in CMBHS and include goals for the client
to achieve and involve discussion and active learning situations. Required topics
include but are not limited to the following:
i. HIV disease management including medical adherence;
ii. Nutrition;
iii. Risk reduction, including the opportunity to address risk reduction in lifestyle
specific settings;
iv. Mental health;
v. Relapse prevention;
vi. 12-step support; and
vii. Life skills.
4. Provide directly or through referral, brief family intervention, support and educational
groups, and associated family therapy designed to build support and resources for
clients in treatment.
5. Facilitate two (2) hours per month of HIV and Hepatitis C co -infection group
counseling.
6. Provide and document a referral in CMBHS for psychiatric evaluations as needed and
indicated.
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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7. Provide nursing care 24 hours a day, 7 days a week.
8. Provide client meals in accordance with recommended nutritional guidelines,
specifically adjusted for persons living with HIV.
9. Maintain a clean client living environment in accordance with Universal and Standard
Precaution Guidelines prescribed by the Center for Disease Control and Prevention
(CDC) including linen care, hand -washing habits, food areas, flooring, and air
conditioning located at: https://www.cdc.gov/infectioncontrol/basics/standard-
precautions.html.
10. Ensure access to recreational facilities and scheduled daily exercise / activity for all
clients capable of participation.
11. Conduct discharge planning and emphasize referrals to community resources for
continued medical care and other support services.
12. Document a referral and referral follow-up prior to discharge to HIV medical care and
community resources for ongoing support.
13. Complete and document in CMBHS a discharge follow-up no sooner than sixty (60)
calendar days and no later than ninety (90) calendar days after discharge from the
treatment program.
E. RESIDENTIAL WITHDRAWAL MANAGEMENT SERVICES
ASAM Level 3.7 Medically Monitored Withdrawal Management
Grantee will adhere to the TAC applicable residential detoxification/withdrawal services
requirements. Grantee will adhere to the following service requirements:
1. Adhere to the SUD Program Guide for detoxification/withdrawal management
services.
2. Adhere to the following additional service delivery requirements:
i. Document in CMBHS a Detoxification Assessment for withdrawal management
per CMBHS.
ii. Document in CMBHS a discharge plan prior to discharge or transfer.
iii. Document in CMBHS a discharge follow-up no more than 10 calendar days after
discharge from withdrawal management services.
iv. Develop and implement policies, procedures, and medical protocols to ensure
client placement into the appropriate level of withdrawal management services in
accordance with national guidelines, peer -reviewed literature, and best practices
and have available for HHSC review.
F. AMBULATORY WITHDRAWAL MANAGEMENT
ASAM Level 2 Withdrawal Management
Grantee will adhere to the following service requirements:
1. Adhere to the SUD Program Guide for detoxification/withdrawal management
services.
2. Adhere to the following additional service delivery requirements:
i. Document in CMBHS a Detoxification Assessment for withdrawal
management per CMBHS.
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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ii. Document in CMBHS a discharge plan prior to discharge or transfer.
iii. Document in CMBHS a discharge follow-up no more than 10 calendar days after
discharge from withdrawal management services.
iv. Develop and Implement Policies, Procedures, and Medical Protocols to ensure
client placement into the appropriate level of withdrawal management services in
accordance with national guidelines, peer -reviewed literature, and best practices
and have available for HHSC review.
3. Grantee will adhere to the TAC applicable ambulatory services requirements.
Ambulatory detoxification shall not be a stand-alone service. Grantees shall ensure the
client is simultaneously admitted to a substance use disorder treatment service while
admitted to ambulatory detoxification services.
SECTION VI: REPORTING AND SUBMISSION REOUIREMENTS
A. Grantee shall submit required reports of monitoring activities to HHSC by the applicable due
date outlined below. The following reports must be submitted to HHSC through SUD Mailbox
at SUD.Contract, a,hhs.texas.gov, CMBHS, and/or another HHSC submission system, by the
required due date and report name described in Table 1: Submission Requirements.
B. Grantee shall submit all documents listed in Table 1 by the Due Date stated.
C. Grantee will note that if the due date is on a weekend or holiday, the due date is the following
business day.
D. Grantee shall submit monthly claims in Clinical Management for Behavioral Health Services
(CMBHS) by the 15th of the following month.
E. Grantee shall submit a Quarterly Match Report on System Agency approved template, which
documents Grantee's compliance to contribute five percent (5%) match. The report is due on
the 15th day of the month, following the closure of the state quarter.
F. Grantee shall submit annual Contract Closeout documentation each fiscal year due on October
15th; the final Contract closeout is due by 45 days after Contract end date.
G. Grantee shall submit a CMBHS Security Attestation Form electronically on or before
September 15th and March 15th each state fiscal year.
H. Grantee's duty to submit documents will survive the termination or expiration of this Contract.
I. HHSC will monitor Grantee's performance of the requirements in this Attachment and
compliance with the Contract's terms and conditions.
Table 1: Submission Requirements
Submission System
Requirement
Deliverable
Due Date
(Report Name
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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Section VI
Quarterly Match
Each FY, Ouarterly:
SUD Mailbox
Report
Q1: December 15th
SUD.ContractsRhhs.texas.gov
Q2: March 15th
Q3: June 15th
Q4: September 15th
Section IV
FY Closeout
Each FY:
SUD Mailbox at
documents
Final closeout
SUD.Contracts @hhs.texas.gov
documents due October
15th
Section IV
Final Contract
By 45 days after
SUD Mailbox at
Closeout documents
Contract end date
SUD.Contractsohhs.texas.gov
Section IV
CMBHS Security
Each FY:
SUD Mailbox at
Attestation Form
September 151h &
SUD.ContractsCcbhhs.texas.gov
and list of
March 15th
authorized users
SECTION VII: CLINICAL MANAGEMENT FOR BEHAVIORAL HEALTH SERVICES
(CMBHS) SYSTEM MINIMUM REQUIREMENTS
A. All CMBHS requirements for the TRA program are detailed in Section V, System of Record
of the SUD Program Guide, which includes the following references:
1. Designation of Security Administrator and backup Security Administrator.
2. Establishment of Security Policy.
3. Notifications to CMBHS Help -desk within 10 business days of any changes to Security
Administrator.
4. CMBHS user access, including removal of user access within 24 hours for those who are
no longer authorized to have access to secure data.
B. In addition to CMBHS Helpdesk notification, Grantee shall submit a signed CMBHS Security
Attestation Form and a list of Grantee's employees and contracted laborers authorized to have
access to secure data. The CMBHS Security Attestation Form shall be submitted electronically
on or before the 15th day of September and March 15th, to SUD Mailbox at
SUD.Contracts((Dhhs.texas. gov.
C. Attend HHSC training on CMBHS documentation.
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
Amendment No. 3
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ATTACHMENT B
PROGRAM SERVICES AND UNIT RATES
(REVISED AUGUST 2023)
A. This Contract is funded through the United States Health and Human Services (HHS),
Substance Abuse and Mental Health Services Administration (SAMSHA), Substance Use
Prevention Treatment, Recovery Services (SUPTRS) Block Grant, Assistance Listing Number
(ALN) 93.959, and System Agency General Revenue.
B. Grantee shall comply with the applicable Code of Federal Regulations (CFR), including the
following:
1. SUPTRS Block Grant: 45 CFR Part 96, Subpart C, link: 45 CFR Part 96.
2. Federal Uniform Grant Guidance Code of Federal Regulations, Title 2, Grants and
Agreements, Subtitle A, Office of Management and Budget Guidance for Grants and
Agreements, Chapter Il, Office of Management and Budget Guidance, Part 200, Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards, link: https://www.hhs.texas.gov/business/grants/federal-uniform- rg ant -guidance.
C. Grantee shall comply with Texas Grant Management Standards, located at Texas Comptroller
of Public Accounts link: https://comptroller.texas.gov/purchasing/grant-management/.
D. Funding
1. System Agency's share of total reimbursements is not to exceed $15,690,251.00 for the
period of August 01, 2020 through August 31, 2025, as further specified and allocated by
fiscal year (FY) in Article IV, Budget of the Contract Signature Document.
2. The required Grantee match for the same period is $500,091.00. Grantee is required to
contribute five (5%) matching of funds. All funding from the SUPTRS Supplemental
funding (HR133 and/or COVID-19) do not require the matching of funds and is excluded
from the match calculations.
E. Claims and Payment Requirements
1. Grantee shall submit claims in CMBHS after services are rendered; no later than monthly.
2. After the closure of each fiscal year, System Agency shall conduct contract close-out
activities. Grantee shall ensure all claims for each state fiscal year (September — August)
are submitted in CMBHS by October 15t1i. Claims submitted after October 151h may be
denied.
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
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All claims for the September service period of the current fiscal year must be submitted by
October 15th. Claims submitted after this date may be denied due to the grant budget period
being closed.
4. System Agency may request additional supportive documentation to support the claims.
All requests for additional information shall be provided by the deadline requested.
F. Except as indicated by the CMBHS financial eligibility assessment, Grantee shall accept
reimbursement or payment from System Agency as payment in full for services or goods
provided to clients or participants; and Grantee shall not seek additional reimbursement or
payment for services or goods, to include benefits received from federal, state, or local sources,
from clients or participants.
G. Budget Program Adjustment (BPA) Requirements
Grantee may request revisions to the approved service group distribution of funds
budgeted in the Service Type/Numbers Served/Capacity/Funding Amounts Chart, by
completing a Budget Program Adjustment (BPA) Form and submitting to the System
Agency Contract Manager and the SUD Mailbox at SUD.Contracts@hhs.texas.gov.
2. System Agency will review the request to determine if the request is allowable under the
RFA, if applicable, and if the request is approved or denied. The estimated timeline for
System Agency to review and provide written communication on the results of the BPA
request is 30 days from receiving an accepted form. Any revisions to the distribution of
funds will result in revised numbers served and/or capacity requirements.
Each Fiscal Year (FY), the deadline to submit a BPA is March 1 St.
H. Any unexpended balance associated with any other System Agency Contract may not be
applied to this System Agency Contract.
I. System Agency funded capacity is defined as the stated number of clients who will be
concurrently served as determined by this Contract.
J. Service Unit Rates
1. The unit rates for the service charts referenced in Section N of this Attachment are located
at the HHSC Substance Use Disorder Service Provider's webpage, under Forms,
document name: Treatment Rate Sheet, the link to the webpage is below. All unit rates
are subject to change and contingent on available funding.
https:Hhhs.texas.gov/doing-business-hhs/provider-portals/behavioral-health-services-
providers/substance-use-disorder-service-providers
If the link to the webpage and/or location of the applicable unit rate document changes,
System Agency will provide Grantee notice through a broadcast message via email.
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
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If unit rates are adjusted in accordance with Section J.1. of this Attachment, System
Agency will provide Grantee notice through a broadcast message via email. All broadcast
messages will be maintained in Grantees Contract file, and document the following:
a. Treatment Program/Service Type unit rate adjustments;
b. Treatment Program/Service Type unit rate adjustments effective date;
c. Treatment Program/Service Type method for receiving payments for the unit rate
adjustment, in accordance with Section J.3. of this Attachment.
There may be a delay between the effective date of the rate adjustment and those updated
rates being reflected in CNIBHS. In the event of a difference in the posted adjusted rate and
the rate in CMBHS, the posted rate controls and payment will be adjusted as described in
Section J.4. of this Attachment.
4. The System Agency effective date of the rate adjustment will determine the method(s) to
implement the unit rate adjustment, as follows:
a. During the fiscal year close-out, System Agency may conduct reconciliation to extract
paid claims data for services provided by Grantee during the unit rate adjustment
approval period. System Agency may calculate the difference between Grantee's
payment utilizing the unit rate in CMBHS versus the revised unit rate. System Agency
will thereafter issue Grantee a final reconciliation payment for the difference between
the two service unit rates. Grantee's fiscal year payment may not exceed the total fiscal
year allocation set forth in Contract Signature Document, Section IV and/or
amendments documenting revisions to FY allocations.
b. System Agency may revise the service unit rates in CMBHS to ensure all service claims
during the approved service period may be reimbursed at the revised rate.
c. System Agency reserves the right to utilize different method(s) to process unit rate
adjustments.
d. Method(s) used to process unit rate adjustments will be described in the broadcast
message in Section J.1. of this Attachment.
K. Clinic numbers must be approved by the System Agency Contract Manager before billing can
occur. The Clinic Change Request Form is located at the HHSC Substance Use Disorder
Service Provider's webpage, under Forms, document name: Clinic Request Form, the link to
the webpage is below:
https://hhs.texas.gov/doing-business-hhs/provider-portals/behavioral-health-services-
providers/substance-use-disorder-service-providers.
L. Service Types with no associated amount will be paid from the preceding Service Type with
an associated amount.
M. Reimbursement of Allowable Costs for State Fiscal Year 2022 and State Fiscal Year2023
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
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Grantees may be eligible to receive additional payments for fiscal years 2022 and 2023 for
COVID 19-related costs incurred for covered services that were not included under the fee -for
service payment reimbursement mechanism.
Additional payments will only be made upon written approval from System Agency. The
agency does not guarantee the additional payments will cover all COVID 19-related costs. In
no event will the total amount paid to any Grantee exceed the contract values as specified in
Article IV, Budget, for the associated fiscal year.
At its sole discretion, System Agency will determine additional payment amounts by applying
inflationary and/or market adjustment factors, such as the Consumer Price Index. Additional
payments will be based on Grantee's actual claim services provided and submitted to System
Agency for reimbursement through CMBHS no later than October 15th of each fiscal year.
Additional payments shall comply with applicable provisions within Title 2 of the Code of
Federal Regulations, Part 200 (Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards), and Title 45 of the Code of Federal Regulations Part
96 (Block Grants), and the Texas Grant Management Standards (TxGMS).
Additional payments will be made at the sole discretion of System Agency and are subject to
availability of appropriated funding.
N. The Service Types, Numbers Served, Capacity, and Funding Amounts in the table below are
approved by System Agency. Grantee shall perform the required services set forth in
Attachment A of this Contract in accordance with the following cost categories:
SERVICE TYPE/NUMBERS SERVED/CAPACITY/FUNDING AMOUNTS
FY 23 SERVICE CHART
Service Type
Number
Served
Capacity
Amount
Adult Outpatient — Individual
380
53
$500,000.00
Outpatient -Group Counseling
Outpatient -Group Education
Outpatient -Individual Counseling
Adult Intensive Residential
678
52
$2,145,594.00
Adult - Supportive Residential
81
g
$121,985.00
Adult - Ambulatory Detoxification
0
0
$0.00
Adult - Residential Detoxification
1,023
14
$1,198,968.00
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
44
DocuSign Envelope ID: AAFAB1AE-6BD1-4D03-B79B-540E8C3AAB74
Adult - HIV Residential
0
0
$0.00
Adult HIV Residential Wraparound
Services (Medicaid Adult -21 and Over)
Totals
2,162
$3,966,547.00
FY 24 SERVICE CHART
Service Type
Number
Served
Capacity
Amount
Adult Outpatient — Individual
380
53
$500,000.00
Outpatient -Group Counseling
Outpatient -Group Education
Outpatient -Individual Counseling
Adult Intensive Residential
678
52
$2,145,594.00
Adult - Supportive Residential
81
8
$121,985.00
Adult - Ambulatory Detoxification
0
0
$0.00
Adult - Residential Detoxification
1,023
14
$1,198,968.00
Adult - HIV Residential
0
0
$0.00
Adult HIV Residential Wraparound
Services (Medicaid Adult -21 and Over)
Totals
2,162
$3,966,547.00
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
54
DocuSign Envelope ID: AAFAB1AE-6BD14D03-B79B-540E8C3AAB74
FY 25 SERVICE CHART
Service Type
Number
Served
Capacity
Amount
Adult Outpatient — Individual
380
53
$500,000.00
Outpatient -Group Counseling
Outpatient -Group Education
Outpatient -Individual Counseling
Adult Intensive Residential
678
52
$2,145,594.00
Adult - Supportive Residential
81
8
$121,985.00
Adult - Ambulatory Detoxification
0
0
$0.00
Adult - Residential Detoxification
1,023
14
$1,198,968.00
Adult - HIV Residential
0
0
$0.00
Adult HIV Residential Wraparound
Services (Medicaid Adult -21 and Over)
Totals
2,162
$3,966,547.00
HHSC Solicitation No. HHS0007795
HHSC Contract No. HHS000779500002
64
DocuSign Envelope ID: AAFAB1AE-6BD1-4D03-B79B-540E8C3AAB74
TES Form 8040-A
Health and Human
go
August 2022-E
Services Federal Funding Accountability and Transparency Act (FFATA)
Certification Form
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. The signer further agrees that they will provide immediate written notice to HHSC
if at any time they learn that any of the certifications provided for below were erroneous when submitted or have since become erroneous by
reason of changed circumstances. Note: If the signer cannot certify all of the statements contained in this section, they must provide written
notice to HHSC detailing which of the below statements they cannot certify and why.
Did your organization have a gross income, from all sources, of less than $300,000 in your previous tax year?
Q Yes - Skip questions A, B and C and continue to section D. () No - Answer questions A and B.
A. Certification Regarding Percent 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?
p Yes ® No - Skip question C.
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?
® Yes p No - Skip question C.
If your answer is Yes to both questions A and B, you must answer question C.
If your answer is No to either question A or B, skip question C and continue to section D.
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.C. 78m(a), 78o(d)) or Section 6104 of the Internal Revenue Code of 1986?
® Yes p No - Provide the names and total compensation of the top five highly compensated officers/senior executives.
Name of Officer or Senior Executive
Total Compensation
1.
2.
3.
4.
5.
D. Signatures
As the duly authorized representative (signer) of the contractor, I hereby certify that the statements made by me in this certification form are
true, complete and correct to the best of my knowledge.
CDocuSig-d by:
P Vi- August 29, 2023
3781 F!!4 1146D...
Signature of Authorized Representative Date
Printed Name of Authorized Representative
Tray Payne
Title of Authorized Representative
Mayor
Legal Name of Contractor
Unique Entity Identifier
City of Lubbock
Applicable HHSC Contract No.(s):
DocuSign
Certificate Of Completion
Envelope Id: AAFABlAE6BD14DO3B79B54OE8C3AAB74 Status: Completed
Subject: Amending $16,190,342.00; HHS000779500002; CITY OF LUBBOCK A-3; HHSC/MSS-SUDCMU
Procurement Number:
Source Envelope:
Document Pages: 48 Signatures: 3 Envelope Originator:
Certificate Pages 2 Initials: 0 Texas Health and Human Services Commission
AutoNav: Enabled 1100 W. 49th St.
Envelopeld Stamping: Enabled Austin, TX 78756
Time Zone: (UTC-06:00) Central Time (US & Canada) PCS_DocuSign@hhsc.state.tx.us
IP Address: 168.60.253.53
Record Tracking
Status: Original Holder: Texas Health and Human Services Location: DocuSign
8/28/2023 3:58:12 PM Commission
PCS_DocuSign@hhsc.state.tx.us
Security Appliance Status: Connected Pool: FedRamp
Storage Appliance Status: Connected Pool: Texas Health and Human Services Location: DocuSign
Commission
Signer Events Signature Timestamp
Andy Marker Completed Sent: 8/28/2023 4:23:58 PM
Edward.Marker@hhsc.state.tx.us Viewed: 8/28/2023 4:26:29 PM
Director, System Contracting Signed: 8/28/2023 4:33:13 PM
Texas Health and Human Services Commission Using IP Address: 167.137.1.13
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Tray Payne °OCU$ignidby: Sent: 8/28/2023 4:33:16 PM
TrayPayne@mylubbock.us Eltti�, P�VA- Viewed: 8/29/2023 8:05:09 AM
Mayor FE32C114B Signed: 8/29/2023 8:05:34 AM
City of Lubbock
Security Level: Email, Account Authentication Signature Adoption: Pre -selected Style
(None) Using IP Address: 208.84.91.41
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Sonja Gaines o Us1o.dby: Sent: 8/29/2023 8:05:37 AM
Sonja.Gaines@hhs.texas.gov 514'7'CCA4"
Ota Ga V'LS Viewed: 8/29/2023 9:03:34 AM
NoSG 134D941B. Signed: 8/29/2023 9:03:53 AM
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre -selected Style
Using IP Address: 151.124.105.50
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events
Cristina Bunyard
cdstina.bunyard@hhs.texas.gov
Contract Specialist IV
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Status
COPIED
SA Mailbox COPIED
SUD.Contracts@hhs.texas.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Gloria Diaz COPIED
gdiaz@mylubbock.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Katherine Wells COPIED
kwells@mylubbock.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Timestamp
Sent: 8/28/2023 4:23:57 PM
Sent: 8/28/2023 4:23:57 PM
Viewed: 8/28/2023 5:08:04 PM
Sent: 8/28/2023 4:33:16 PM
Viewed: 8/29/2023 9:19:14 AM
Sent: 8/28/2023 4:33:16 PM
Viewed: 8/28/2023 4:34:29 PM
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
8/28/2023 4:23:57 PM
Certified Delivered
Security Checked
8/29/2023 9:03:34 AM
Signing Complete
Security Checked
8/29/2023 9:03:53 AM
Completed
Security Checked
8/29/2023 9:03:53 AM
Payment Events
Status
Timestamps
No Text