HomeMy WebLinkAboutResolution - 2020-R0207 - Contract HHSC000779500004, Substance Use Disorder Treatment - Adult Female - 06/23/2020Resolution No. 2020-R0207
Item No. 7.20
.lune 23, 2020
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of l.ubbock is hereby authorized and directed to execute for
and on behalf of the City of Lubbock, Health and Human Services Commission Contract
No. linS000779500004. under the Substance Use Disorder Treatment, to provide funding
for Treatment Adult - Spctiali/e female Services, and ail 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 City Council.
Passed by the City Council on June 23, 2020
DANIEL M. POPE, MAYOR
AITESf:
RebcLca Gar/a, City
APPROVED AS TO CONTEN 1:
Bi How eputy Ctty Manager
APPROVED AS TO FORM:
R^Jan Brooke, Assistant City Attorney
kHS.HHS Comracl No. HHS0(J0779500004
6.9.20
Resolution No. 2020-R0207
SIGNATURE DOCUMENT FOR
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS000779500004
UNDER THE SUBSTANCE USE DISORDER TREATMENT
TREATMENT ADULT- SPECIALIZE FEMALE
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- Specialized Female (TRF) services (the
"Contract").
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.
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.
BUDGET
The System Agency allocated share by State Fiscal Year is as follows:
1. Fiscal Year 2020, July 1, 2020 through August 31, 2020: $ $578,242.00
2. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $ $583,521.00
The required match per State Fiscal Year is as follows:
1. Fiscal year 2020, July 1, 2020 through August 31, 2020: $28,912.00
2. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $29,176.00
The total amount of this Contract, including applicable match, will not exceed $1,219,851.00.
All expenditures under the Contract will be in accordance with ATTACHMENT B, PROGRAM
SERVICES & UNIT RATES.
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 15`h day following quarter being reported
Closeout documents
October 15 (45 days after end of state fiscal
year)
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
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
Attention: Office of Chief Counsel
Grantee
City of Lubbock
1625 13th Street
Lubbock, TX 79401
Attention: Daniel Pope
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 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. HHS000779500004
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.
HHS00077950000¢:
ATTACHMENT A STATEMENT OF WORK
ATTACHMENT A-1 STATEMENT OF WORK SUPPLEMENTAL
ATTACHMENT A-2
ATTACHMENT B
ATTACHMENT C
ATTACHMENT D
ATTACHMENT E
ATTACHMENT F
ATTACHMENT G
ATTACHMENT H
ATTACHMENT I
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
App a* Y tD tome
Vv
ApppOM AS TO CO VOM'
► �k
SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS000779500004
HEALTH AND HUMAN SERVICES COMMISSION CITY OF LUBBOCK
Date of execution:
Name: Daniel M. Pope
Title: Mayor
Date of execution:
THE FOLLOWING DOCUMENTS ARE HEREBY ATTACHED TO SYSTEM AGENCY CONTRACT NO.
HHS000779500004:
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
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://hhs.texas.cov,/doing-
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: wwNAT.asam.com, which is a collection of objective guidelines that give clinicians
a standardized approach to admission and treatment planning.
II. SERVICE REQUIREMENTS
Grantee shall:
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 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:
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 residence
eligibility, Financial Eligibility and clinical eligibility as specified in SUD UM
Guidelines.
10. Document a Life Event Note in CMBHS upon active Client's delivery of newborn.
11. Grantee will develop a local agreement with 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.
13. Maintain a list of community resources and document referrals when appropriate to
ensure that children of the client have access to services to address their needs and
support healthy development including primary pediatric care, early childhood
intervention services, and other therapeutic interventions that address the children's
development needs and any issues of abuse and neglect.
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 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 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:
l . 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 TB, Hepatitis B and C, STI, 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: (i) TB; (ii)
HIV; (iii) Hepatitis B and C; (iv) STIs/Diseases; and (v) 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 education to all Clients. Document overdose prevention
education in CMBHS.
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 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.
12. Provide and document in CMBHS case management activities as indicated by
assessment and treatment plan.
13. Provide and document in CMBHS research -based education on the effects of Alcohol,
Tobacco, and Other Drugs (ATOD) on the fetus.
14. Utilize an evidenced -based, trauma -informed curriculum in the treatment of women
with substance use disorders.
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 COMPETENCIES 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 in the following:
i. Motivational Interviewing Techniques or Motivational Enhancement
Therapy;
ii. Trauma -informed care;
iii. Cultural competency;
iv. Harm reduction trainings;
V. Health Insurance Portability and Accountability Act (HIPAA) and 42 Code
of Federal Regulations (CFR) Part 2 training;
vi. Alcohol, Tobacco and Other Drugs on the Developing Fetus;
vii. Child welfare education, and
viii. 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 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;
vi. Substance exposed pregnancy (such as Fetal Alcohol Spectrum Disorder or
vii. Neonatal Abstinence Syndrome);
viii. Child welfare education; or
ix. Suicide prevention and intervention.
8. Individuals responsible for planning, directing, or supervising treatment services shall
be QCCs.
9. Contractor shall have a clinical Program Director known as a "Program Director" with
at least two (2) 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 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. Contractor shall train staff and develop a policy to ensure that information gathered
from Clients is conducted in a respectful, non -threatening, and culturally competent
manner.
13. Contractor shall adapt services and accommodate persons as appropriate to meet the
needs of special populations.
14. Contractor shall develop and implement a mechanism to ensure that all direct care staff
have the knowledge, skills, and abilities to provide services to women and children, as
they relate to the individual's job duties.
15. Contractor shall be able to demonstrate through documented training, credentials
and/or experience that all direct care staff are proficient in areas pertaining to the needs
of and provision of services to women and children.
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
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 sixty (60) calendar days after discharge
from the outpatient treatment services.
4. When the assessment indicates placement in System Agency funded Women and
Children Intensive or Supportive Residential services but there are no available beds,
Grantee shall provide coordinated interim care until a Women and Children Intensive
or Supportive Residential bed becomes available. A pregnant Client, if she chooses
and is appropriate for this service type, shall be transferred to Women and Children
Intensive and Supportive Residential services no later than the eighth month of
pregnancy in order to provide sufficient time to adjust to the changes prior to delivery
of her child.
5. As part of the education hours, Grantee will provide and document in CMBHS:
i. A minimum of one (1) hour per week (or one (1) hour per month for Clients
who have been transferred to outpatient after successfully completing a
residential level of care) of evidence -based parenting education and document
these services; and
ii. A minimum of six (6) hours (or two (2) hours for Clients who have been
transferred to outpatient after successfully completing a residential level of
care) of reproductive health education prior to discharge and document these
services.
6. Provide and document in CMBHS research -based education on the effects of ATOD
on the fetus.
B. SUPPORTIVE RESIDENTIAL TREATMENT SERVICES
(ASAM Level 3.1 Clinically Managed Low -Intensity Residential Services)
Grantee shall:
1. Adhere to TAC and SUD UM Guidelines applicable to supportive services
requirements.
2. When the assessment indicates placement in System Agency -funded Women and
Children Intensive or Supportive Residential services but there are no available beds,
Contractor shall provide coordinated interim care until a Women and Children
Intensive or Supportive Residential bed becomes available. A pregnant Client, if she
chooses and is appropriate for this service type, shall be transferred to Women and
Children Intensive and Supportive Residential services no later than the eighth month
of pregnancy in order to provide sufficient time to adjust to the changes prior to
delivery of her child.
3. As part of education hours, Grantee will provide:
i. A minimum of one (1) hour per week of evidenced -based parenting education;
and
ii. A minimum of two (2) hours of reproductive health education within thirty
(30) Service Days of admission.
4. Document in CMBHS a discharge follow-up sixty (60) calendar days after discharge
from the residential treatment services.
C. SUPPORTIVE RESIDENTIAL FOR WOMEN AND CHLDREN
(ASAM Level 3.1 Clinically Managed Low -Intensity Residential Services)
Grantee shall:
1. Adhere to TAC and SUD UM Guidelines applicable to supportive services
requirements.
2. In addition, adhere to TAC requirements applicable to Treatment Services for Women
and Children.
3. As part of education hours, Grantee will provide and document in CMBHS:
i. A minimum of two (2) hours per week of evidence -based parenting education
and document these services;
ii. A minimum of six (6) hours of reproductive health education within thirty
(30) service days of admission and document these services; and
iii. At minimum, evidenced -based education on the effects of ATOD during
pregnancy.
4. Document in CMBHS a discharge follow-up sixty (60) calendar days after
discharge from the residential treatment services.
D. INTENSIVE RESIDENTIAL TREATMENT SERVICES
(ASAM Level 3.5 Clinically Managed High -Intensity Residential Services)
Grantee shall:
1. Adhere to TAC and SUD UM Guidelines applicable to intensive services
requirements.
2. When the assessment indicates placement in System Agency -funded Women and
Children Intensive or Supportive Residential services but there are no available beds,
Grantee shall provide coordinated interim care until a Women and Children Intensive
or Supportive Residential bed becomes available. A pregnant Client, if she chooses
and is appropriate for this service type, shall be transferred to Women and Children
Intensive and Supportive Residential services no later than the eighth month of
pregnancy in order to provide sufficient time to adjust to the changes prior to delivery
of her child.
3. As part of education hours, Grantee will provide and document in CMBHS:
i. A minimum of two (2) hours per week of evidenced -based parenting
education; and
ii. A minimum of six (6) hours of reproductive health education within thirty (30)
Service Days of admission.
4. Document in CMBHS a discharge follow-up sixty (60) calendar days after discharge
from the residential treatment services.
E. INTENSIVE RESIDENTIAL FOR WOMEN AND CHLDREN
(ASAM Level 3.5 Clinically Managed High -Intensity Residential Services)
Grantee shall:
1. Adhere to TAC and SUD UM Guidelines applicable to intensive services
requirements.
2. Adhere to TAC requirements applicable to Treatment Services for Women and
Children.
3. As part of education hours, Grantee will provide:
i. A minimum of two (2) hours per week of evidence -based parenting education
and document these services; and
ii. A minimum of six (6) hours of reproductive health education within thirty (30)
Service Days of admission and document these services.
F. RESIDENTIAL DETOXIFICATION / WITHDRAWAL MANAGEMENT
(ASAM LEVEL 3.7 MEDICALLY MONITORED WITHDRAWAL
MANAGEMENT)
Grantee shall:
1. Adhere to TAC requirements for detoxification services.
2. Adhere to the SUD UM Guidelines for detoxification services.
3. 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.
G. AMBULATORY WITHDRAWAL MANAGEMENT (ASAM LEVEL 2
WITHDRAWAL MANAGEMENT)
Grantee shall:
1. Adhere to TAC requirements for detoxification services.
2. Adhere to the SUD UM Guidelines for detoxification services.
3. 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.
4. 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.Contractsnhlisc.state.tx.us, and assigned contract manager by the
required due date.
2. All communication to the SubstanceAbuse. Contracts(d;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:
HHS000779500004
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
A. TREATMENT FOR FEMALES (TRF)
Adult pregnant women and women with Dependent Children (including women whose
children are in custody of the State) who meet Client Eligibility for System Agency -funded
substance use disorder services as stated in the System Agency Substance Use Disorder (SUD)
Utilization Management (UM) Guidelines (attached as RFA Exhibit O within the Solicitation,
Attachment I).
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 WOMEN AND CHLDREN
Adult pregnant women and women with Dependent Children (including women whose
children are in custody of the State) who meet Client Eligibility for System Agency -funded
substance use disorder services as stated in the System Agency Substance Use Disorder (SUD)
Utilization Management (UM) Guidelines.
Clients being admitted into Women and Children's treatment facilities must meet at least one
(1) of the following criteria:
A. Be in the third trimester of her pregnancy; and/or
B. Have at least one (1) child physically residing overnight with her in the facility; and/or
C. Have a referral by Department of Family and Protective Services (DFPS).
Note: DFPS will not allow at least one (1) child to initially reside overnight but DFPS plans
to place the child in the facility within the first thirty (30) Service Days of treatment.
1. Women and Children's Intensive Residential Services
(ASAM Level 3.5 Clinically Managed High -Intensity Residential Services)
2. Women and Children's Supportive Residential Services
(ASAM Level 3.1 Clinically Managed Low -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 450' Street, Bldg. 552 (MC 2058)
Cite I Austin TX 78751 1
ATTACHMENT B
PROGRAM SERVICES & UNIT RATES
Grantee Name: CITY OF LUBBOCK
Contract Number: HHS000779500004
A. Funding from The United States Health and Humans 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 $1,161,763 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: $28,912.00
b. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $29,176.00
3. Total Contract Value will not exceed $ for the period from July 1, 2020 through August
31, 2021, as follows:
a. Fiscal Year 2020, July 1, 2020 through August 31, 2020: $607,154.00
b. Fiscal Year 2021, September 1, 2020 through August 31, 2021: $612,697.00
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://hhs.texas.gov/doing-business-lihs./provider-
portals/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
Adult Specialized Female Residential Intensive
125
10
$108.00
$424,085.00
Adult Specialized Female Residential Supportive
$79.00
Adult Specialized Female Residential Detox
88
1
$224.00
$102,596.00
Adult Specialized Female Ambulatory Detox
$85.00
Adult Specialized Female W/C Residential Intensive
$208.00
Adult Spec Fem. W/C Residential Wraparound
Services -LESS THAN 21
$52.00
Adult Spec Fern W/C Residential Wraparound
Services- 21 and OVER
$103.00
Adult Specialized Female W/C Residential Supportive
$177.00
Adult Specialized Female Outpatient Services
32
5
$51,561.00
Adult Spec Female Outpatient Group Counseling
$28.00
Adult Spec Female Outpatient Group Education
$17.00
Adult Spec Female Outpatient Individual
77.00
FY21
Service Type
Number
Served
Capacity
Unit
Rate
Amount
Adult Specialized Female Residential Intensive
126
10
$113.02
$427,071.00
Adult Specialized Female Residential Supportive
$82.67
Adult Specialized Female Residential Detox
88
1
$234.41
$103,525.00
Adult Specialized Female Ambulatory Detox
$88.95
Adult Specialized Female W/C Residential Intensive
$217.67
Adult Spec Fern W/C Residential Wraparound
Services -LESS THAN 21
$54.41
Adult Spec Fern W/C Residential Wraparound
Services- 21 and OVER
$107.78
Adult Specialized Female W/C Residential Supportive
$185.22
Adult Specialized Female Outpatient Services
33
5
$52,925.00
Adult Spec Female Outpatient Group Counseling
$29.30
Adult Spec Female Outpatient Group Education
$17.79
Adult Spec Female Outpatient Individual
$80.57