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HomeMy WebLinkAboutResolution - 2020-R0206 - Contract HHS000779500003, Substance Use Disorder Treatment, Youth - 06/23/2020Resolution No. 2020-R0206 Item No. 7.19 June 23.2020 RESOLUTION BE IT RESOLVE^i) BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor olThe City ofLubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Health and iluman Services Commission Contract No. HHS000779500003. under the Substance Use Disorder 'freatmeni, to provide funding for freatment Yoiiih 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 AITEST: \jJlAXi Rebecca Garza. City Secretary APPROVED AS TO CONTENT: 1^1Bill ilowc^t^. Deputy CityJ»4tlnTiger APPROVED AS TO FORM: Ryan Bro()ke. Assistant City Attorney RiiS.Hl-IS Cinuracl No. I IHSOl)077y.S00003 6,9.20 Resolution No. 2020-R0206 SIGNATURE DOCUMENT FOR HEALTH AND HUMAN SERVICES COMMISSION CONTRACT No. HHS000779500003 UNDER THE SUBSTANCE USE DISORDER TREATMENT TREATMENT YOUTH 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 Youth Services (TRY) 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: $56,664.00 2. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $57,497.00 The required match per State Fiscal Year is as follows: 1. Fiscal year 2020, July 1, 2020 through August 31, 2020: $2,833.00 2. Fiscal Year 2021, September 1, 2020 through August 31, 2021: 2,875.00 The total amount of this Contract, including applicable match, will not exceed $119,869.00. 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 151h day following quarter being reported Closeout documents October 15 (45 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 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. Mail Code 1100 Austin, TX 78751-2316 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. HHS000779500003 HEALTH AND HUMAN SERVICES COMMISSION Date of execution: CITY OF LUBBOCK Name: Daniel M. Pope Title: Mayor Date of execution: June 23, 2020 THE FOLLOWING DOCUMENTS ARE HEREBY ATTACHED TO SYSTEM AGENCY CONTRACT NO. HHS000779500003: ATTACHMENT A STATEMENT OF WORK ATTACHMENT A-1 STATEMENT OF WORK SUPPLEMENTAL ATTACHMENT A-2 SUBSTANCE ABUSE PREVENTION AND TREATMENT (SAPT) BLOCK GRANT CONTRACT SUPPLEMENTAL ATTACHMENT B PROGRAM SERVICES & UNIT RATES ATTACHMENT C GENERAL AFFIRMATIONS ATTACHMENT D UNIFORM TERMS AND CONDITIONS -GRANTEE ATTACHMENT E SPECIAL CONDITIONS VERSION 1.2 ATTACHMENT F FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT G DATA USE AGREEMENT VERSION 8.5 ATTACHMENT H FISCAL FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA) FORM ATTACHMENT I UTILIZATION MANAGEMENT (UM) GUIDELINES ATTACHMENTS FOLLOW App101M0 M b IOIIIC -,ppROVM AS1D 1 Attes .Re Garza, �Y tary ATTACHMENT A STATEMENT OF WORK I. PURPOSE Provide Substance Use Disorder Treatment Services for one (1) 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: https://hlis.texas.fzovi'doiniz- business-hlis/provider-portals/behavioral-health-services-providers/substance-use-disorder- service-providers, 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. 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) 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 and restore functions while promoting Recovery. 3. Adhere to Level of Care/Service Type licensure requirements. 4. Comply with all applicable TAC rules adopted by the System Agency 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 System Agency for review upon request. 6. In addition to TAC and SUD UM Guidelines 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. Adhere to Adolescent Program and Adult Program requirements and provisions as provided in the SUD UM Guidelines. 10. Ensure compliance with Client Eligibility requirements to include: Texas residence eligibility, Financial Eligibility, and clinical eligibility as specified in SUD UM Guidelines. 11. Grantee will develop a local agreement with 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. 12. 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 forty-eight (48) hours when efforts to refer to other appropriate services are exhausted. iii. Grantee shall offer directly or through referral interim services to waitlisted individuals. iv. Establish a wait list that includes priority populations and interim services while awaiting admission to treatment services. v. Develop a mechanism for maintaining contact with individuals awaiting admission. 4. If unable to provide admissions to individuals within these 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 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 individual as stated in the SUD UM Guidelines. vii. When an individual is placed on a waiting list, Grantee shall screen and 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 SUD 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 B and C, sexually transmitted infection (STI), 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. If the Client is living with HIV, Grantee will refer the Client to the appropriate community resources to complete the necessary referrals and health related paperwork. 6. 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) calendar 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. E. Discharge 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 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 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; and ii. All problems on the treatment plan have been addressed. Grantee shall use the treatment plan component of CMBHS to create a final and completed treatment plan version. 4. 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 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. 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: Tuberculosis, HIV, Hepatitis B and C, Sexually Transmitted Infections/Diseases, and 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. Ensure that clients have the right to define their "families" broadly to include biological relatives, significant others, and be included in the SUD treatment process; Family counseling, Family Group, etc., of the Family Support Network group of components of the curriculum. 10. Ensure that clients and their family are referred to community support services. 11. Provide overdose prevention education to all clients. 12. Specific overdose prevention activities shall be conducted with clients with opioid use disorders and those clients that use drugs intravenously. 13. 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. 14. Ensure access to adequate and appropriate medical and psychosocial tobacco cessation treatment as follow: i. Assess all Clients for tobacco use and 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. iii. Obtain parental consent, if applicable, to refer client for tobacco cessation materials. 15. Utilize System Agency as the payer of last resort if the client has other/outside funding available (i.e., wages, insurance, etc.). III. STAFF COMPETENCY AND REQUIREMENTS Grantee shall: 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 System Agency 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 on 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 coin. 6. Ensure all direct care staff complete annual education on HIPAA and 42 CFR Part 2 training. 7. Ensure all direct care staff complete a minimum of ten (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 QCCs. 9. Grantee shall have a clinical Program Director known as a "Program Director" with at least two (2) years of post- QCC licensure experience providing SUD treatment. 10. SUD counseling shall be provided by a QCC, or Chemical Dependency Counselor Intern. SUD education and life skills training shall be provided by counselors or individuals who have appropriate specialized education and expertise. 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, nonthreatening, and culturally competent manner. 13. Adapt services and accommodate persons as appropriate to meet the needs of special populations. 14. Adhere to TAC requirement related to Additional Requirements for Adolescent Programs regarding direct care staff knowledge, skills, and abilities. 15. Ensure direct care staff in adolescent Programs have the knowledge, skills, and abilities to provide services to adolescents, as they relate to the individual's job duties. 16. Demonstrate through documented training, credentials and/or experience that all direct care staff are proficient in areas pertaining to adolescent services, including but not limited to areas regarding: substance use, misuse and substance use disorder treatment specific to adolescent treatment; appropriate treatment strategies, including family engagement strategies; and emotional, developmental, and mental health issues for adolescents. 17. Choose and implement with fidelity one (1) of the following evidence -based models: i. Cannabis Youth Treatment Series (CYT); or ii. Seeking Safety Treatment Series; or iii. The Seven Challenges; or iv. Grantee may choose to use additional models, practices, or curricula that are evidence -based and approved in writing by System Agency. IV. LEVELS OF CARE/SERVICE TYPES A. OUTPATIENT TREATMENT SERVICES (ASAM Level 1 Outpatient Services) Grantee shall: 1. Adhere to TAC requirements and SUD UM Guidelines for outpatient treatment services. 2. Adhere with all applicable rules in the TAC Additional Requirements for Adolescent Programs. 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 shall: 1. Adhere to TAC applicable supportive residential services requirements. 2. Adhere to SUD UM Guidelines for residential services. 3. Adhere with all applicable rules in the TAC Additional Requirements for Adolescent Programs. 4. Document a discharge follow-up sixty (60) calendar day after discharge from the residential treatment services in CMBHS. 5. Facilitate regular communication between an adolescent client and the client's family and shall not arbitrarily restrict any communications without clear individualized clinical justification documented in the client record. 6. Develop and implement written Policy and Procedures addressing notification of parents or guardians in the event an adolescent leaves a residential Program without authorization and have available for System Agency review. 7. For pregnant and parenting clients, Grantee shall address the needs of parents on the treatment plan either directly or through referral including but not limited to the following: i. Gender -specific parenting education; ii. Reproductive health education and pregnancy planning; iii. DFPS coordination; iv. Family violence and safety; v. Fetal and child development; vi. Current infant and child safety guidelines; vii. Financial resource needs; and viii. And any other needs of the Client's children. C. INTENSIVE RESIDENTIAL TREATMENT SERVICES (ASAM Level 3.5 Clinically Managed High -Intensity Residential Services) Grantee shall: 1. Adhere to TAC applicable intensive residential services requirements. 2. Adhere to SUD UM Guidelines for residential services. 3. Adhere with all applicable rules in the TAC Additional Requirements for Adolescent Programs. 4. Document a discharge follow-up sixty (60) calendar day after discharge from the residential treatment services in CMBHS. 5. Facilitate regular communication between an adolescent Client and the Client's family and shall not arbitrarily restrict any communications without clear individualized clinical justification documented in the Client record. 6. Develop and implement written Policy and Procedures addressing notification of parents or guardians in the event an adolescent leaves a residential Program without authorization and have available for System Agency review. 7. For pregnant and parenting Clients, Grantee shall address the needs of parents on the treatment plan either directly or through referral including but not limited to the following: i. Gender -specific parenting education; ii. Reproductive health education and pregnancy planning; iii. DFPS coordination; iv. Family violence and safety; v. Fetal and child development; vi. Current infant and child safety guidelines; vii. Financial resource needs; and viii. And any other needs of the Client's children. 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.Contractsnhhsc.state. tx.us, and assigned contract manager by the required due date. 2. All communication to the SubstanceAbuse.Contracts ci;hhsc.state.tx.us mailbox must include Grantee's Contract Number, legal entity name, and purpose in the email subject line. 3. Submit all documents listed in the table displayed in this section by the due date stated. 4. 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: HHS000779500003 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, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum C. TARGET POPULATION Youth Texas residents who meet Client Eligibility for System Agency -funded substance use disorder services as stated in the System Agency's Substance Use Disorder (SUD) Utilization Management (UM) Guidelines 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 450' Street, Bldg. 552 (MC 2058) City/Zip: Austin TX 78751 ATTACHMENT B PROGRAM SERVICES & UNIT RATES Grantee Name: City of Lubbock Contract Number: HHS000779500003 A. Funding from The United States Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) fund the System Agency Substance Use Disorder project(s), which includes this Contract. B. The Catalog of Federal Domestic Assistance (CFDA) funds 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 $114,161.00 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: $2,833.00 b. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $2,875.00 3. Total Contract Amounts, per fiscal year, is documented below: a. Fiscal Year 2020, July 1, 2020 through August 31, 2020: $59,497.00 b. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $60,372.00 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: https://Iihs.texas.gov/doing-business-hhs/provider- portal s/behavioral-health-services-providers/substance-use-treatment-providers. 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 FY20 Service Type Number Served Capacity Unit Rate Amount Youth Residential Intensive $161.00 Youth Intensive Residential Wraparound Services - Room & Board (Medicaid Youth) $25.00 Youth Residential Supportive $102.00 Youth Outpatient Services 26 3 $56,664.00 Youth Outpatient Group Counseling 28.00 Youth Outpatient Group Education $17.00 Youth Outpatient Individual 58.00 $9,318.00 Youth Adolescent Support $60.00 $4,075.00 Youth Adolescent Support — Medicaid Youth Wraparound $60.00 Youth Family Counseling $75.00 $33,298.00 Youth Family Counseling — Medicaid Youth Wraparound — Parent Education Sessions $75.00 Youth Family Support $75.00 $8,973.00 Youth Family Support — Medicaid Youth Wraparound $75.00 Youth Psychiatrist Consultation $125.00 $1,000.00 FY21 Service Type Number Served Capacity Unit Rate Amount Youth Residential Intensive $168.49 Youth Intensive Residential Wraparound Services - Room & Board (Medicaid Youth) $26.16 Youth Residential Supportive $106.74 Youth Outpatient Services 26 3 $57,497.00 Youth Outpatient Group Counseling $29.30 Youth Outpatient Group Education $17.79 Youth Outpatient Individual $60.69 $9,458.00 Youth Adolescent Support $62.79 $4,136.00 Youth Adolescent Support — Medicaid Youth Wraparound $62.79 Youth Family Counseling $78.49 $33,797.00 Youth Family Counseling — Medicaid Youth Wraparound — Parent Education Sessions $78.49 Youth Family Support $78.49 $9,107.00 Youth Family Support Medicaid Youth Wraparound $78.49 Youth Psychiatrist Consultation $130.81 $999.00 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: https:Hhhs texas.gov/doing-business-hhs/provider-portals/behavioral-healtli-services- providers/behavioral-health-provider-resources/utilization-management-guidelines-manual, and American Society of Addiction Medicine (ASAM) criteria located at the following link: www.asani.coni, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning. II. 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. 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 System Agency for review upon request. 6. 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. 6. 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: 1. 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 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 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. 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 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 / outside funding available (i.e., wages, insurance, etc.). III. STAFF COMPETENCIES AND REQUIREMENTS I. 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 coin. 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 / 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 / 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 / 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. 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. 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 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 a,hhsc.state.tx.Lis, and assigned contract manager by the required due date. 1. All communication to the SubstanceAbuse.Contractsnhlisc.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.