HomeMy WebLinkAboutResolution - 2020-R0205 - Contract HHS000779500002, Substance Use Disorder Treatment - Adult Service - 06/23/2020Resolution No. 2020-R0205
Item No. 7.18
June 23. 2020
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor ol'lhe City ol'Lubbock is hereby authorized and directed to execute for
and on behalf of the City of L.ubbock. Health and Human Services Commission Contract
No, 11118000770500002. under the Substance Use Disorder 'i'reatmcnt. to provide funding
for Treatment Adult Services, and all related documents. Said Contract is attached hereto
and incorporated in this resolution as if fully set forth herein and shall be included in the
minutes of the Citv Council.
Passed by the City Council on June 23. 2020
DANIEL M. POPE, MAYOR
ATPEST:
l^bqcca Garza. City SecretaN
APPROVED AS rO CONTENT
City MtBill How
APPROVED AS TO FORM:
e. Assfetanl City Attorney
RHS.HHS Conlract No. I fl tSl)007795000()2
6.9.20
Resolution No. 2020-RO205
SIGNATURE DOCUMENT FOR
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS000779500002
UNDER THE SUBSTANCE USE DISORDER TREATMENT
TREATMENT ADULT SERVICES
I. PURPOSE
The Health and Human Services Commission ("System Agency"), a pass -through entity, and City
of Lubbock ("Grantee") (each a "Party" and collectively the "Parties") enter into the following
grant contract to provide funding for Treatment Adult Services (TRA) services (the "Contract").
II. LEGAL AUTHORITY
This Contract is authorized by and in compliance with the provisions of the Substance Abuse
Prevention and Treatment Block Grant, 42 U.S.C. 300x-21, et seq., and Texas Government Code
Chapters 531.039.
III. DURATION
The Contract is effective on July 1, 2020, and terminates on August 31, 2021, unless extended or
terminated pursuant to the terms and conditions of the Contract. The System Agency, at its own
discretion, may extend this Contract subject to terms and conditions mutually agreeable to both
Parties.
IV. BUDGET
The System Agency allocated share by State Fiscal Year is as follows:
1. Fiscal Year 2020, July 1, 2020 through August 31, 2020: $1,136,708.00
2. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $1,144,980.00
The required match per State Fiscal Year is as follows:
1. Fiscal year 2020, July 1, 2020 through August 31, 2020: $56,835.00
2. Fiscal Year 2021, September 1, 2020 through August 31, 2021: 57, 249.00
The total amount of this Contract, including applicable match, will not exceed $2,395,772.00.
All expenditures under the Contract will be in accordance with ATTACHMENT B. PROGRAM
SERVICES & UNIT RATES.
V. REPORTING REQUIREMENTS
Grantee shall submit all documents identified below, in accordance with ATTACHMENT A.
STATEMENT OF WORK:
Document Name
Due Date
Clinical Management of Behavioral Health
September 15 & March 15 annually
Services (CMBHS) System Security
Attestation Form and List of Authorized Users
Quarterly Match Report
Due 15t` day following quarter being reported
Closeout documents
October 15 (45 calendar days after end of state
fiscal year)
VI. CONTRACT REPRESENTATIVES
The following will act as the Representative authorized to administer activities under this Contract
on behalf of their respective Party.
System Agency
Health and Human Services Commission
P.O. Box 149347, MC 2058
Austin, TX 78714
Attention: Bryan Hunter, Contract Manager
Grantee
City of Lubbock
1625 13th Street
Lubbock, TX 79401
Attention: Daniel Pope
VII. LEGAL NOTICES
Any legal notice required under this Contract shall be deemed delivered when deposited by the
System Agency either in the United States mail, postage paid, certified, return receipt requested; or
with a common carrier, overnight, signature required, to the appropriate address below:
System Agency
Health and Human Services Commission
Brown-Heatly Building
4900 N. Lamar Blvd.; MC 1100
Austin, TX 78756-2316
Attention: Office of Chief Counsel
Grantee
City of Lubbock
1625 13th Street
Lubbock, TX 79401
Attention. Daniel Pope
VIII. NOTICE REQUIREMENTS
Notice given by Grantee will be deemed effective when received by the System Agency. Either Party
may change its address for notices by providing written notice to the other Party. All notices
submitted to the System Agency must:
A. include the Contract number;
B. be sent to the person(s) identified in the Contract; and,
C. comply with all terms and conditions of the Contract.
IX. ADDITIONAL GRANT INFORMATION
Federal Award Identification Number (FAIN):
Federal Award Date:
Name of Federal Awarding Agency:
CFDA Name and Number:
Awarding Official Contact Information:
B08TIO10051-18
10/01/2017
Department of Health and Human Services
(HHS), Substance Abuse and Mental Health
Services Administration (SAMHSA)
93.959
Odessa Crocker, Grants Management
Officer, Point of Contact is Wendy Pang,
Grants Specialist, Contact Number: (240)
276-1419, Facsimile: (240) 276-1430, Email:
Wendy.Pang@samhsa.hhs.gov
SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS000779500002
HEALTH AND HUMAN SERVICES COMMISSION CITY OF LUBBOCK
Date of execution:
Name: Daniel M. Pope
Title: Mayor
Date of execution: June 23, 2020
THE FOLLOWING DOCUMENTS ARE HEREBY ATTACHED TO SYSTEM AGENCY CONTRACT NO.
HHS000779500002:
ATTACHMENT A
ATTACHMENT A-1
ATTACHMENT A-2
ATTACHMENT B
ATTACHMENT C
ATTACHMENT D
ATTACHMENT E
ATTACHMENT F
ATTACHMENT G
ATTACHMENT H
ATTACHMENT I
,�,a,arto+oarc
WROM AS TO COMM.
STATEMENT OF WORK
STATEMENT OF WORK SUPPLEMENTAL
SUBSTANCE ABUSE PREVENTION AND TREATMENT (SAPT)
BLOCK GRANT CONTRACT SUPPLEMENTAL
PROGRAM SERVICES & UNIT RATES
GENERAL AFFIRMATIONS
UNIFORM TERMS AND CONDITIONS -GRANTEE
SPECIAL CONDITIONS VERSION 1.2
FEDERAL ASSURANCES AND CERTIFICATIONS
DATA USE AGREEMENT VERSION 8.5
FISCAL FEDERAL FUNDING ACCOUNTABILITY AND
TRANSPARENCY ACT (FFATA) FORM
UTILIZATION MANAGEMENT (UM) GUIDELINES
ATTACHMENTS FOLLOW
ATTACHMENT A
STATEMENT OF WORK
I. PURPOSE
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 below service types/levels of care are based
on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder
(SUD) Utilization Management (UM) Guidelines, located at the following link:
htt s://hhs.texas. ov/doin -business-hhs/ rovider- ortals[behavioral-health-services-
roviderslbehavioral-health-provider-resourceslutilization-mana ement- uidelines-manual, and
American Society of Addiction Medicine (ASAM) criteria located at the following link:
www.asam.com, which is a collection of objective guidelines that give clinicians a standardized
approach to admission and treatment planning.
IL SERVICE REQUIREMENTS
Grantee shall comply with the following:
A. Administrative Requirements
1. Adhere to the most current SUD UM Guidelines.
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 adopted by
System Agency related to SUD treatment.
S. 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
System Agency for review upon request.
5. In addition to TAC and SUD UM 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 Priority Populations for
Treatment Programs 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 System Agency upon request.
7. Ensure that program directors participate in their specific program and service type
conference calls as scheduled by System Agency. Program Directors shall participate
unless otherwise agreed to by System Agency 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 SUD UM Guidelines.
10. Develop a local agreement with 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 Memorandum of Understanding requirements as stated in the SUD UM
Guidelines.
B. Service Delivery
Grantee shall:
1. Adhere to the Priority Populations for Treatment Programs as stated in the SUD UM
Guidelines.
2. Maintain Daily Capacity Management Report in CMBHS as required in the SUD
UM Guidelines.
3. Maintain a Waiting 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 waiting 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 Priority Populations for
Treatment Programs according to SUD UM Guidelines:
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 dangerous 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@hhsc.state.tx.us)
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 Document for Opioid Use Disorder applicable to
the individual as stated in the SUD UM Guidelines.
vii. When an individual is placed on the Wait 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
Grantee shall:
1. Comply with all applicable rules in the TAC for SUD programs as stated in the SUD
UM Guidelines Information, Rules, and Regulations regarding Screening and
Assessment.
2. When documenting a CMBHS Substance Use Disorder screening, Grantee shall
conduct the screening in a confidential, face-to-face interview unless there is
documented justification for an interview by phone.
3. Document Financial Eligibility in CMBHS as required in the SUD UM Guidelines.
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 will also consider referring to the TRA Statewide HIV Intensive Residential
Treatment facility to concurrently address medical needs and SUD.
b. If a client is living with HIV, Grantee will 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 thirty (30) business days preceding admission.
D. Treatment Planning, Implementation and Review
Grantee shall:
1. Comply with all applicable rules in the TAC for SUD programs as stated in the SUD
UM Guidelines Information, Rules, and Regulations regarding Treatment Planning,
Implementation, and Review.
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
(5) service days of admission.
E. Discharge
Grantee shall:
l . Comply with all applicable rules in the TAC for SUD programs as stated in the SUD
UM Guidelines Information, Rules, and Regulations regarding Discharge.
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 small 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:
L 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:
L 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
Grantee shall:
Comply with all applicable rules in the TAC for SUD programs as stated in the SUD
UM Guidelines Information, Rules, and Regulations.
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.
5. 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 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 System Agency as the payer of last resort if the client has other 1 outside
funding available (i.e., wages, insurance, etc.).
11I. STAFF COMPETENCIES AND REQUIREMENTS
1. All personnel shall receive the training and supervision necessary to ensure
compliance with System Agency rules, provision of appropriate and individualized
treatment, and protection of client health, safety, and welfare.
2. Ensure that all direct care staff receive a copy of this statement of work and SUD UM
Guidelines.
3. Ensure that all direct care staff review all policies and procedures related to the
program or organization on an annual basis.
4. Ensure compliance for Personnel Practices and Development with TAC and SUD
UM Guideline requirements.
5. Within ninety (90) business days of hire and prior to service delivery direct care staff
shall have specific documented training in the following:
i. Motivational interviewing techniques or Motivational Enhancement Therapy;
ii. Trauma -informed care;
iii. Cultural competency;
iv. Harm reduction trainings;
v. HIPAA and 42 CFR Part 2 training; and
vi. State of Texas co-occurring psychiatric and substance use disorder (COPSD)
training located at the following website: www.centralizedtraining.com.
6. Ensure all direct care staff complete annual education on Health Insurance Portability
and Accountability Act (HIPAA) and 42 CFR Part 2 training.
7. Ensure all direct care staff complete a minimum of 10 hours of training each state
fiscal year in any of the following areas:
i. Motivational interviewing techniques;
ii. Cultural competencies;
iii. Reproductive health education;
iv. Risk and harm reduction strategies;
v. Trauma informed care; or
vi. Suicide prevention and intervention.
8. Individuals responsible for planning, directing, or supervising treatment services
shall be QCC.
9. 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.
10. 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.
11. 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.
12. Develop a policy and procedure on staff training, available for System Agency
review, to ensure that information is gathered from clients in a respectful, non-
threatening, and culturally competent manner.
13. For HIV Residential Grantee, all counseling staff will have one year of experience
working with persons living with HIV or the at -risk population.
i. Specific training for direct care staff is required annually in harm, risk
reduction, and overdose training.
ii. 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.
iii. 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 Contract.
IV. LEVELS OF CARE / SERVICE TYPES
A. OUTPATIENT TREATMENT SERVICES
ASAM Level 1 Outpatient Services
Grantee will adhere to the following service requirements:
1. Adhere to TAC requirements and SUD UM Guidelines for outpatient treatment
programs 1 services.
2. Provide and document in CMBHS one hour of group or individual counseling
services for every six hours of educational activities.
3. Document in CMBHS a discharge follow-up sixty (60) 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 UM Guidelines for residential treatment
programs 1 services.
2. Document in CMBHS a discharge follow-up sixty (60) 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 UM Guidelines for residential treatment
programs 1 services.
2. Document in CMBHS a discharge follow-up sixty (60) calendar days after discharge
from the residential treatment services.
D. HIV STATEWIDE INTENSIVE RESIDENTIAL TREATMENT SERVICES
Grantee will adhere to applicable TAC intensive 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. 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.
S. 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.
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:
htt s://www.edc. ov/infectioncontrol/basics/standard- recautions.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 sixty (60) business days
after discharge from the treatment program.
E. RESIDENTIAL WITHDRAWAL MANAGEMENT SERVICES
ASAM Level 3.7 Medically Monitored Withdrawal Management
Grantee will adhere to TAC applicable residential detoxification/withdrawal services
requirements. Grantee will adhere to the following service requirements:
1. Adhere to the SUD UM Guidelines for detoxification / withdrawal management
services.
2. Adhere to the following additional service delivery requirements:
i. Document in CMBHS a Withdrawal Management Intake Form.
ii. Document in CMBHS a discharge plan prior to discharge or transfer.
iii. Document in CMBHS a discharge follow-up no more than ten (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 System Agency review.
F. AMBULATORY WITHDRAWAL MANAGEMENT
ASAM Level 2 Withdrawal Management
Grantee will adhere to the following service requirements:
1. Adhere to the SUD UM Guidelines for detoxification / withdrawal management
services.
2. Adhere to the following additional service delivery requirements:
i. Document in CMBHS a Withdrawal Management Intake Form.
ii. Document in CMBHS a discharge plan prior to discharge or transfer.
iii. Document in CMBHS a discharge follow-up no more than ten (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 System Agency review.
Grantee will adhere to 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.
V. REPORTING REQUIREMENTS
Grantee shall submit required reports of monitoring activities to System Agency by the end of the
following month of the applicable reporting period, as specified in Article V, Reporting
Requirements, of the Contract. The following reports must be submitted to System Agency via
the Substance Abuse mailbox (SA mailbox) at SubstanceAbuse. Contracts c hhsc.state.tx.us, and
assigned contract manager by the required due date.
1. All communication to the SubstanceAbuse.Contracts@hhsc.state.tx.us mailbox must
include Grantee's Contract Number, legal entity name, and purpose in the email
subject line.
2. Submit all documents listed in the table displayed in this section by the due date
stated.
3. If the due date is on a weekend or holiday, the due date is the next business day.
ATTACHMENT A-1
STATEMENT OF WORK SUPPLEMENTAL
A. CONTRACT INFORMATION
Vendor ID:
1756000590-034
Grantee Name:
City of Lubbock
Contract Number:
HHS000779500002
Contract Type
Treatment
Payment Method:
Fee -for -Service
DUNS Number:
058213893
Federal Award Identification
Number (FAIN)
B08TIO10051-18
Solicitation Document:
Exempt Government
B. SERVICE AREA
Services or activities will be provided to individuals from the following counties:
Region (1): 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, Yoakum
C. TARGET POPULATION
A. TREATMENT FOR ADULT (TRA)
Adult Texas residents who meet Client Eligibility for System Agency -funded substance
use disorder services as stated in the Substance Use Disorder (SUD) Utilization
Management (UM) Guidelines, https://hhs.texas.gov/doing-business-hhs/provider-
coilals/behavioral-health-services-uroviders/substance-use-disorder-service-providers.
Persons who are living with HIV are eligible for these programs / service types.
I . 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 ADULT (TRA)
HIV Statewide Intensive Residential Program
Adult Texas residents living with HIV who meet Client Eligibility requirements for
System Agency -funded substance use disorder services as stated in the Substance Use
Disorder (SUD) Utilization Management (UM) Guidelines, https://lihs.texas_.govidoinp,-
business-hhsl rovider- ortals/behavioral-health-services- roviderslbehavioral-health-
Rrovider-resources/utilization-management- uidelines-manual
1. Human Immunodeficiency Virus (HIV) Statewide Intensive Residential
(ASAM Level 3.5 Clinically Managed High -Intensity Residential Services)
D. RENEWALS
System agency may renew this contract for four (4) additional funding years, which is
contingent on the availability of funds.
E. CONTACT INFORMATION
Name:
Bryan Hunter
Email:
Bryan.Hunter@hhsc.state.tx.us
Telephone:
(512) 206-5313
Address:
909 W 45th Street, Bldg. 552 (MC 2058)
City/Zip:
Austin TX 78751
ATTACHMENT B
PROGRAM SERVICES & UNIT RATES
Grantee Name: CITY OF LUBBOCK
Contract Number: HHS000779500002
A. Funding from The United States Health and Human Services (HHS) and the Substance Abuse
and Mental Health Services Administration (SAMHSA) fund the HHSC Substance Use
Disorder project(s), which includes this Contract.
B. The Catalog of Federal Domestic Assistance (CFDA) funds, if any, are listed as part of the
System Agency Share.
1. Substance Abuse Prevention Treatment (SAPT) Grant, CFDA 93.959
2. State General Revenue
C. Funding
1. System Agency Share total reimbursements will not exceed $2,281,688.00 for the period
from July 1, 2020 through August 31, 2021, as further specified in Article IV, Budget, of
the Contract.
2. For each Fiscal Year noted in Section C, (3) (a-b), Grantee shall provide a five percent
(5%) match requirement as follows:
a. Fiscal Year 2020, July 1, 2020 through August 31, 2020: $56,835.00
b. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $57,249.00
3. Total Contract Value will not exceed $2,395,772.00 for the period from July 1, 2020
through August 31, 2021, as follows:
a. Fiscal Year 2020, July 1, 2020 through August 31, 2020. $1,193,543.00
b. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $1,202,229.00
D. Grantee will submit claims to the System Agency through the Clinical Management for
Behavioral Health Services (CMBHS) system monthly.
E. Except as indicated by the CMBHS financial eligibility assessment, Grantee shall accept
reimbursement or payment from the 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.
F. Grantee may request revisions to the approved distribution of funds budgeted in the Service
Type/Capacity/Unit Rate Chart, 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
revision is approved; and the assigned Contract Manager will update CMBHS, as needed.
G. Any unexpended balance associated with any other System Agency Contract may not be
applied to this System Agency Contract.
H. System Agency funded capacity is defined as the stated number of clients that will be
concurrently served as determined by this Contract.
I. Clinic Numbers must be approved by the assigned Contract Manager before billing can occur.
Clinic Change Request Form is located at: htt s:l/hhs.texas. ov'doin business-hhsl rovider-
ortals/behavioral-health-services- roviders/substance-use-disorder-service- roviders
J. Service Types with no associated amount will be paid from the preceding Service Type with
an associated Amount.
K. In accordance with Rider 64, substance abuse treatment rates for services provided in July and
August 2020 will be increased effective July 1, 2020. Grantee will be paid the service rates in
effect prior to July 1, 2020 for the remainder of FY 2020. Beginning September 1, 2020,
System Agency will extract paid claim data for services provided by Grantee during July and
August 2020 and calculate the difference between Grantee's payment (s) using the pre -July 1,
2020 service rates versus the amended rates. System Agency will thereafter issue Grantee a
final reconciliation payment for the difference between the two service rates. Grantee's FY
2020 payment(s) shall not exceed the total reimbursement amount stated in section C of this
Attachment B.
L. The following Service Types, Capacity, and Unit Rates are approved and shall be delivered
through this Contract:
SERVICE TYPE/CAPACITY/UNIT RATE CHART
FV20
Service Type
Number
Served
Capacity
Unit
Rate
Amount
Adult Outpatient - Individual
181
25
$235,416.00
Outpatient -Group Counseling
$18.00
Outpatient -Group Education
$17.00
Outpatient -Individual Counseling
$58.00
Adult Intensive Residential
249
19
$108.00
$789,425.00
Adult - Supportive Residential
$41.00
Adult - Ambulatory Detoxification
$85.00
Adult - Residential Detoxification
95
1
$224.00
$111,867.00
Adult - HIV Residential
$172.00
Adult HIV Residential Wraparound Services
(Medicaid Adult -21 and Over)
$34.00
FY21
Service Type
Number
Served
Capacity
Unit
Rate
Amount
Adult Outpatient - Individual
183
26
$238,305.00
Outpatient -Group Counseling
$18.84
Outpatient -Group Education
$17.79
Outpatient -Individual Counseling
$60.69
Adult Intensive Residential
250
19
$113.02
$792,425.00
Adult - Supportive Residential
$42.90
Adult - Ambulatory Detoxification
$88.95
Adult - Residential Detoxification
97
1
$234.41
$114,250.00
Adult - HIV Residential
$180.00
Adult HIV Residential Wraparound Services
(Medicaid Adult -21 and Over)
$35.58
No Text