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Home My WebLink AboutC03-249 Nine County Regional Agreement Core Services Program - Substance Abuse• ~ PURCHASE OF SERVICE CONTRACT - NINE COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - SUBSTANCE ABUSE - 2003-2004 THIS PURCHASE OF SERVICE CONTRACT for Core Services (this "Agreement") made by and between the Boards of County Commissioners of Garfield County, Eagle County, Grand County, Jackson County, Moffat County, Pitkin County, Rio Blanco County, Routt County and Summit County, State of Colorado (collectively "BOCCs" -and individually "BOCC") and Colorado West Regional Mental Health Inc., a Colorado Corporation, whose address is 6916 Highway 82, Box 40, Glenwood Springs, Colorado 81602, and whose tax identification number is 84-0625890 ("Contractor"). WHEREAS, BOCCs are mandated to provide Core Services, through their County Departments of Human/Social Services ("County Departments"), by the Human Services Code, X26-1-101, et seq., C.R.S. as amended and the Colorado Children's Code, §19-3-208, C.R.S. as amended; and WHEREAS, Contractor is engaged in the business of providing substance abuse services and is willing to provide such services in a nine county region; and WHEREAS, BOCCs desire to engage the Contractor to render certain substance abuse services. NOW THEREFORE, in consideration of the premises and the obligations, agreements, and promises contained herein, the parties agree as follows: I. SCOPE OF SERVICES. A.. Services, Clients, Place of Service. Within the financial parameters described in Section IV.E., below, Contractor shall provide substance abuse .services, including but not limited to intensive outpatient group therapy, individual therapy, random urinalysis and drug patch program, substance abuse evaluations, halfway house services and "ARU" residential programs to all clients referred to Contractor in the nine county area governed by the BOCCs. Such services shall be provided in Eagle, Garfield, Pitkin, and Summit Counties ("4-county Group") and in Grand, Jackson, Moffat, Rio Blanco, and Routt Counties ("5- county Group".). Services shall be delivered at designated offices, clients' homes and other locations approved by the BOCCs or any one of them, through their County Department Directors, as stated in Section XIV, below. Contractor shall provide services in accordance-with State Department of Human Nine-co~mty Regional Core ServicesSu6stence Abuse Colorado West FY 03-04, 8!7/2003 Final ~ r Services regulations, found at 12 CCR 2509-4, Section 7.303.1, as amended, .and ~as described in that certain County Core Services Plan, executed by the Garfield County BOCC on April 21, 2003 on behalf of the 4-county Group and the 5-county Group. Services shall be provided in a satisfactory and proper manner, as determined in the sole discretion of the BOCCs. B. Contractor's Reports. Contractor shall provide each BOCC, through its County Department Director or his/her designated representative, as stated in Section XIV, below, with reports on its provision of services, as follows: 1. Treatment Plan. Within four (4) weeks of initiation of services for an identified client, Contractor shall submit an individualized treatment plan, with stated objectives and target dates, to the appropriate County Department Director or his/her designated representative. Treatment plans shall be subject to the approval of the County Department Director ar his/her designated representative, who shall initiate discussion between the client's social caseworker and substance abuse professional, as needed to develop an agreed upon services plan. , 2. Progress Reports. At monthly intervals from the time of initiation of services, Contractor shall provide the appropriate County Department Director or his/her designated representative with follow-up reports for each identified client. C. Confidentiality. It is specifically understood that only aggregated non-identifiable client services data shall be presented to the BOCCs or any one of them in public session. Client specific reports are subject to the confidential rules of Sections 19-1-101, et seq. and 26-1-101, et seq., C.R.S., as amended; the federal Health Insurance Portability and Accountability Act of 1996 and the federal statute regarding confidentiality of alcohol and drug abuse patient records, at 42 U.S.C. Section 290 dd-2; and other applicable federal and state law and regulation. II. COUNTY RESPONSIBILITIES. The BOCCs, through their County Departments, shall: (1) determine client eligibility; (2) provide Contractor with written authorization for provision of services, specifying begin and end service dates; (3) provide Contractor with referral updates detailing changes in service types; (4) provide Contractor with appropriate referral information, such as name; address, State ID number, and social, medical and Nme-county Regional Core ServicesSubstence Alwse r~ Colorado West FY 03-04, 8(1/2003 Final G educational information provide the appropriate contract administrator, with summary financial c records, identified by S basis. I.J as appropriate to the referral; (5) 4-county Group and 5-county Group ~s identified in Section XIV, below, ata including client specific billing :ate ID number and' name, on a monthly III. TERM OF AGREEMENT. The term of this Agreement shall begin, retroactively, on June 1, 2003, and shall terminate on May 31, 2004, no matter the date of execution. IV. COMPENSATION. A. Amount and Method of Payment. For performance. of the scope of services set forth in Section I, above, Garfield BOCC shall pay the Contractor Three Thousand Thirty-One Dollars and Twenty- Five Cents ($3,031.25) per month, on or before the last day of each month for services provided to referred clients in the 4- county Group. Moffat BOCC shall pay the Contractor Three Thousand Thirty-One Dollars and Twenty-Five Cents ($3,031.25) per month, on or before the last day of each month for services provided to referred clients in the 5-county. Group. The monthly compensation reflects a three percent (3 °s) retainage of State allocated funds by Garfield BOCC and Moffat BOCC for administration of this Agreement on behalf of the 4-county Group and the 5-county Group. B: Not to Exceed Figures. In no event shall the compensation paid under this Agreement to Contractor by Moffat County exceed Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for all services provided to all referred clients in the 5-county group. In no event shall the compensation paid under this Agreement by Garfield County to Contractor exceed Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for all services provided to all referred clients in the 4-county Group. C. No Fee-For-Service. Contractor shall not charge referred clients fees for services provided under this Agreement. Compensation in accordance with the terms of this Agreement represents full payment of fees by the BOCCs for services provided to referred clients. D. Contractor's Submittals. Contractor shall submit a statement, including a summary invoice of services provided to all clients in each county and client specific billing records, to each County Department Director or his/her designated representative in a timely manner. Client specific billing Nine-county Regioml Core Services-Substance Abuse Colorado West FY 03-04, 8/7/2003 Final records shall be due, in no event, not later than forty-five (45} days after the provision of service. Contractor shall also provide the 4-county Group and 5-county Group contract administrators, as identified in Section XIV, below, with a quarterly "summary invoice" of services provided within each area, without client specific billing records. Such quarterly invoices shall include, at a minimum, summary information as to type of service, total hours provided, rate for service, and total dollar amounts per type of service. E. Risk Corridor. It is recognized that the dollar amounts specified in Subsections A and B, above, .represent a retainer method of Contractor compensation, not a client-number fee for service payment system. The parties agree to continue to make efforts to co-ordinate client specific service and cost tracking, in accordance with the "2003 Fee Schedule", attached to and incorporated herein by this reference as "Exhibit A". In order to control costs and manage the expenditure of public funds, the BOCCs and Contractor agree: 1. Ceiling. At any point in the contract period if it appears from Contractor's recordkeeping that the Contractor is likely to exceed the not-to-exceed figures for the 4-county Group or the 5-county Group, specified in Subsection B, above, Contractor shall notify the BOCCs through the 4-county Group and 5-county Group contract administrators, identified in Section XIV, below. Upon such notification, the 4-county Group and 5-county Group contract administrators shall initiate a reconciliation of billing records and negotiations with Contractor regarding payment for continued services. In any event Contractor shall continue to provide services to referred clients, without additional payment by the BOCCs, until the dollar value of delivered services reaches a ceiling of One Hundred Twenty Percent (1200) of the not-to-exceed figures (1.20 x $37,500.00 = $45,000.00, minus 30 administrative retainage fee). Should the 120% ceiling be reached without agreement on additional payment by way of an amendment to this Agreement regarding the appropriate 4-county Group and/or 5-county Group, Contractor shall cease provision of services and the BOCCs shall cease referral of clients. 2. Floor. At any point in the contract period if it appears from the BOCCs' records that compensation, paid under terms of Subsection A above, is likely to be under expended such that Eighty Percent (80%) or less of the not-to-exceed figures, identified in Subsection B above, (.80 x $37,500.00 = $30,000.00, minus 3o administrative retainage fee) will likely Nine-toasty Regions] Core Services-Substance Abuse Colorado West FY 03-04, 8P7/2003 Final • be used by Contractor, the BOCCs, through the 4-county Group and 5-county Group contract administrators, shall notify the Contractor and initiate a reconciliation of billing records. Should account reconciliation show an under-usage of Eighty Percent (80%) or less of the not-to-exceed figures, i.e, usage of $30,000.00 in either the 4-county Group or the 5-county Group (minus 3% administrative retainage fee) or less, Contractor and the BOCCs shall negotiate a resolution in good faith, including without limitation, termination of this Agreement under terms of Section XII., below. V. FUNDING CONTINGENCY. In accordance with X29-1-110, C.R.S., as amended, the BOCCs are not authorized to expend monies which have not been appropriated. Payment pursuant to this Agreement is subject to and contingent upon- funds being appropriated, budgeted and otherwise made available by the BOCCs, the State of Colorado, and/or federal funding sources, as applicable to this Agreement. VI. INDEPENDENT CONTRACTOR. The Contractor shall provide the services identified in Section I, above, as an independent contractor providing supervision of its employees, agents and subcontractors. The Contractor represents that it has ar will secure at its own expense all personnel required to perform the scope of services identified in Section I, above. Contractor shall ensure that its personnel are professionally licensed, as required by law, and meet applicable State Department of Human Services qualification requirements. Contractor's employees, agents and subcontractors are not employees or agents of the BOCCs or any of them and do not have a contractual relationship with the BOCCs or any of them. Neither the Contractor, nor any of Contractor's employees, agents or subcontractors shall be entitled to any benefits or attributes of employment by the BOCCs or any of them, including without limitation workers compensation or health insurance coverage. VII. SUBCONTRACT AND ASSIGNMENT. A. General. Contractor shall not subcontract with another individual or entity for performance of the services described in Section I, above, and shall not assign or otherwise transfer its rights or delegate its obligations under this Agreement without the prior approval of the BOCCs. B. Individual Case Basis. In the event that Contractor cannot provide an eligible client with substance abuse services, as deemed adequate and appropriate by the referring County Nme-calmly Regional Cole Services-Since Abuse Colon3do West FY 03-04, 8P/f2003 Final • Department Director, Contractor shall purchase the services on a subcontract basis. Within two (2) weeks of such a referral, Contractor, through its local Program Directors, shall consult with the referring County Department Director of his/her authorized representative regarding alternative treatment resources and resolve disputes, if any, regarding subcontracted services. County Department Directors shall have final authority over the purchase price of subcontracted services and the selection of the alternate service provider. Subcontracting shall not exceed the not-to-exceed amounts stated in Section IV. B., above, Thirty Seven Thousand Five Hundred Dollars ($37,500..00) for the 4-county Group and Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for the 5-county group. Subcontracting on an individual case basis shall be approved by the signature of the County Department Director or his/her authorized representative on the named County Department's referral form. VIII. INFORMATION, AUDITS AND INSPECTIONS. At such times and in such forms as the BOCCS or any of them may require, Contractor shall furnish statements, records, reports, data and information pertaining to the matters covered by this Agreement. At any time during normal business hours and as often as the BOCCS or any of them may deem necessary, Contractor shall make available for examination and audit by the BOCCs or any of them and the. State Department of Human Services or authorized representatives thereof, all of the .Contractor's records, materials, reports, information and data with respect to matters covered by this Agreement. All such information shall be maintained by Contractor for a period of seven (7) years after final payment is made to the Contractor under this Agreement. IX. INDEMNIFICATION. The Contractor shall indemnify, hold harmless and defend the BOCCs and each of them and their employees, agents, and officers, acting officially or otherwise, from and against any and all claims, damages, liability and proceedings of any kind, including attorneys fees, arising out of this Agreement, other then those resulting from the negligence or willful misconduct of the BOCCs or any of them, their employees, agents, or officers. X. INSURANCE. Contractor shall maintain insurance with companies authorized to do business in Colorado, on forms satisfactory to the BOCCs, in at least the following minimum coverage amounts: GENERAL LIABILITY: $150,000.00 per person, $600;000.00 per occurrence. Nine-couray xe~onal core services-s,il~arance abuse Colorndo West FY 03-04, 8/7!2003 Final V AUTOMOBILE LIABILITY: $150,000.00 per person, $600,000.00 per occurrence. WORKERS COMPENSATION: As required by Colorado Law. PROFESSIONAL MALPRACTICE INSURANCE: Contractor and its personnel, in a minimum amount of $1,000,000 per claim, $3,000,000 aggregate. Contractor shall name each of the BOCCs as additional insureds, as applicable, on the general and automobile liability policies. Contractor shall deliver copies of policies or Certificates of Insurance to the appropriate BOCC within a reasonable time after execution of this Agreement and on each policy renewal date. XI. COMPLIANCE WITH LAWS. The Contractor shall comply with all laws, ordinances, codes and regulations of the federal, state, and local governments applicable to this Agreement. Without limiting the generality of this Section XI., Contractor, in its performance under this Agreement: (1)shall maintain client confidentiality, including confidentiality of records, in accordance with state and federal law, rules and regulations; and (2) shall not discriminate against any person on the basis of race, color, national origin, religion, sex, age or handicap. Any fines paid or expenses incurred by the BOCCs or any of them, due- to Contractor's violation of applicable law or regulation, shall be reimbursed to the payor by the Contractor. XII. MUTUAL TERN may terminate this upon thirty (30) party. Upon such compensation for termination. :INATION FOR CONVENIENCE. BOCCs and Contractor Agreement, without cause and for convenience, days written notice to the non-terminating termination, Contractor shall be entitled to services performed prior to the date of XIII. BOCCs' TERMINATION FOR CAUSE. If the Contractor fails to fulfill its obligations under this Agreement in a timely and proper manner, as determined by the BOCCs, or if the Contractor violates any of the terms or provisions of this Agreement, the BOCCs shall have the right, in their sole discretion, to terminate this Agreement by giving written notice to the Contractor at least fifteen (15) days before the effective date of the termination. In such event, Contractor shall be entitled to receive just and equitable compensation for work satisfactorily completed prior to termination. Contractor shall not, however, be relieved of liability to the BOCCs for damages sustained by the BOCCs by virtue of any breach of this Agreement by the Contractor. The BOCCs may withhold payments due to the Contractor for the purpose of set-off until such time as the exact amount of damages due the BOCCs from Contractor is determined. Nine-coumy Regional Core Services-Subst~ce Abuse Colorado West FY 03-04, 8(1/2003 Final XIV. CONTRACT ADMINISTRATOR, CONTACT PERSONS, AND CONFLICT RESOLUTION A. Contract Administrators. Contract administrators regarding contract administration, financial management, .and evaluation of the performance of the scope of services described in Section I, above, are as follows: 1. BOCCs. Lynn Renick, Garfield County Director, for the 4- county Group and Marie Peer, Moffat County Director, for the 5-county Group; and 2. Contractor. Ken Stein, Executive Director, Colorado West Regional Mental Health, Inc. B. Contact individual are: Persons. Contact persons for issues regarding an county or an individual client of a County Department 1. BOCCs. The appropriate County Department Director or his/her designated representative(s); and 2. Contractor. The appropriate Program Director in each county. XV. AMENDMENT. Any mutually agreed upon amendment, including without limitation any change in the-scope of services, whether or not resulting in an increase or decrease in the amount of compensation, shall be incorporated in a written amendment to this Agreement. Amendments shall be executed with the same formality. as this Agreement, except as to change of address or name of contact person. Address and contact information shall not be considered an amendment to this Agreement and notice of such may be given by way of regular mail, telephone, or facsimile transmission. XVI. NOTICE. Notices required under this Agreement, other than changes in address or contact information, shall be delivered by way of certified mail, return receipt requested, to the addresses for signatories, written below. XVII. CONTROLLING LAW. This Agreement shall be governed by the laws of the State of Colorado and venue for any action arising out of or relating to performance of this Agreement shall be in Garfield County or Moffat County, as appropriate. Nine-co~mty Regional Core ServicesSubstance Abuse p Colorado West FY 03-04, 8/7/2003 Final ~ ~ XVIII. SEVERABILITY. If any term or provision of this Agreement is declared invalid or becomes inoperative for any reason, such invalidity or failure shall not affect the validity of any other term or provision. XIX. AUTHORIZATION. Each of the individuals signing below affirms that he/she is properly authorized to execute this Agreement on behalf of the governmental agency or private entity party to this Agreement. XX. INTEGRATION. The entire agreement of the parties is encompassed within this Agreement. No other oral. or written representation or agreement shall be of any force or effect. IN WITNESS WHEREOF the parties hereto have. executed this document. .BOARD OF COUNTY COMMISSIONERS ATTEST: GARFIELD COUNTY, COLORADO By: Garfield County Clerk John Martin, Chair Date: APPROVED: Garfield County Department of Social Services, or Designee By: Lynn Renick, Director P.O. Box 850 Glenwood Springs, CO 81602 Nine-county Ragioaal Core ServicesSubstmmce Abuse (1 Colatado Wes[ FY 03-04, SP/P2003 Fmsl 7 ATTEST: Grand County Clerk ATTEST: Jackson County Clerk APPROVED: Grand County and Jackson County Department of Social Services, or Designee By: BOARD OF COUNTY COMMISSIONERS GRAND COUNTY, COLORADO By: Chair Date• BOARD OF COUNTY COMMISSIONERS JACKSON COUNTY, COLORADO By: Chair Date: Philip Maes, Director Address: P.O. Box 204 Hot Sulphur Spgs, CO 80451 ., Eagi e County BOARD OF COUNTY COMMISSIONERS EAGLE COUNTY, COLORADO By: ~ Chair Date ~ g 0 3 APPROVED: Eagle County Department of Health & H}~man Services, or Designee, Kathl en L. Fo~n2(sh, Dirac or~J/ Address: .O. Box 660 Eagle, CO 81631 Nme-county Regional Core Services-Substance Abuse Colorado West FY 03-04, 8PJ/2W3 Final 10 ATTEST: Pitkin County Clerk BOARD OF COUNTY COMMISSIONERS PITKIN COUNTY, COLORADO BY: Chair Date: APPROVED: Pitkin County Department of Social Services, or Designee By: Kate Jangula, Director Address: 100 Elk Run Drive, #122 Basalt, CO 81621 ATTEST: Rio Blanco County Clerk APPROVED: Rio Blanco County Department of Social Services, or Designee By: Bonnie Ruckman, Director Address: 345 Market Street Meeker, CO 81641 ATTEST: Routt County Clerk BOARD OF COUNTY COMMISSIONERS RIO BLANCO COUNTY By: Chair Date: BOARD OF COUNTY COMMISSIONERS ROU"TT COUNTY, COLORADO By: Chair Date: Nine-county Rtgioml Core Services-Substance Abuse 11 Colorado Went FY 03-04, BP//2003 Final APPROVED: Routt County Department of Social Services, or Designee By: Robert White, Director Address: P.O. Box 772790 Steamboat Spgs, CO 80477 ATTEST: Summit County Clerk APPROVED: Summit County Department of Social Services, or Designee By: - Susan Gruber, Director Address: P.O. Box 869 Frisco, CO 80443 ATTEST: Moffat County Clerk APPROVED: Moffat County Department of Social Services, or Designee By: Marie Peer, Director Address: 595 Breeze Street Craig, CO 81625 BOARD OF COUNTY COMMISSIONERS SUMMIT COUNTY, COLORADO By :. Date: Chair BOARD OF COUNTY COMMISSIONERS MOFFAT COUNTY, COLORADO By: Chair Date: Niue-county Regional Core Services-Substance Abuse ~I Colorado West FY 03-04, 8P1Y1003 Final 1 • • CONTRACTOR: COLORADO WEST REGIONAL MENTAL HEALTH, INC. By: Ken Stein, Exec. Director Address: 6916 Highway 82, Box 40 Glenwood Springs, CO 81601 Date: Nmo-county Regional Core Services-Substance Abuse 13 Colorado West FY 03-04, BP//2003 Final Colorado West Regional Mental Health Center, In.c 2003 Fee Schedule -1~SD Fees - ~ - tract Allowance/Discoant 30% CPT Code Description 90801 Psychiatric Diag Interview $ 190.00 90802 Diag Interview, Interactive $ 205.00 90862 Pharmacolgical management $ 95.00 90882 Environmental Intervention $ 140.00 (Case Management) 99058 Emergency Crisis Evaluation $1.25.00 $133.00 $ 143.50 $ 66.50 $ 98.00 $ 87.50 PhD Fees '90801 Psychiatric Diag Interview $ 170.00 90802 Diag Interview -Interactive $ 185.00 90804 Psychotherapy,, 20-30 mins $ 100.00 90806 Psychotherapy, 45-50 mins $ 140.00 . 90808 Psychotherapy,. 75-80 mins $ 220.00 90810 Psychotherapy, Int 20-30 mins $110.00 90812 Psychotherapy, Int 45-50 mins $ 150.00 90814 Psychotherapy, Int 75-80 mins $ 220.00 90846 Psychotherapy, family(w/o client). $140.00 90847 Psychotherapy, family(with/client) $160.00 90849 Psychotherapy, multiple family. ~ $ 110.00 90853 Psychotherapy, group $ 80.00 90857 Psychotherapy, grp, interactive $ 70.00 96100 Psych testing per hour ~ . ~ ..$145.00 90882 Case Management $105.00 99058 Emergency Crisis Evaluation $110.00 90899 Emergency Crisis Phone Call $ 80.00 99078 • Psychoeducational Services $ 35.00 Licensed Clinician Fees 90801 Psychiatric Diag Interview $120.00 Contract Allowance/Disconnt 30%. $119.00 $129.50 • $ 70.00 • $ 98.00 $154.00 $ 77.00 $105.00 • $154.00 $ 98.00 $112.00 $ 77.00 $ 56.00 ~~ ,_ $ 49.00 $1.01.50 $ 73.50 77.00 $ 56.00 $ 24.50 Contract Allowance/Disconnt 30% $ 84.00 90802 Diag Interview -Interactive $130.00 . $ 91.00 90804 Psychotherapy, 20-30 mins $ 70.00 $ 49.00 90806 Psychotherapy, 45-50 mins $100.00 $ 70.00 90808 Psychotherapy, 75-80 mins $150.00 $105.00 90810 Psychotherapy, Int 20-30 mins $ 75.00 $ 52.50 90812 Psychotherapy, Int 45-50 mins $ 100.00 $ 70.00 90814 .Psychotherapy, Int 75-80 mins $155.00 ~ $108.50 90846 ~ Psychotherapy, family(w/o client) $105.00 $ 73.50 90847 ,Psychotherapy, family(with/client) $130.00 $ 91.00 90849 Psychotherapy, multiple family • $ 75.00 $ 52.50 90853 Psychotherapy, group $ 60:00 ~ $ 42.00 90857 Psychotherapy, grp, interactive $ 50.00 $ 35.00 9085322 .IOP group (alcohol and drug) $ -90.00 $ 63.00 90882 Case Management $ 95.00 $ 66.50 99058 Emergency Crisis Evaluation $100.00 $ 70.00 90899 Emergency Crisis Phone Call $ 70.00 $ 49.00 99078. Psychoeducafional Services $ 30.00 $ 21.00 ~u~9 ~ ~a~-i 1~( ~ss~ss ~.~ ~,f ~~ oo•dc~ 3~~ ~a ~ aoa EXHIBIT A -MENTAL HEALTH AGR - ~ ~ _ _. .. • 5ulistance Abuse Servi~2003 Fee Schedule . ,- Service Substance Abuse Evaluation, 45-50 mins Substance Abuse Evaluation, 75-80 mins Intensive Outpatient Group Therapy, 3 hours Individual Therapy 90804 Psychotherapy, ' 20-30 mins 90806 Psychotherapy, 45-50 mins 90808 Psychotherapy, 75-80 mins Fee $ 75.00 $ 150.OQ $ 90.00 $ 70.00 $ 100.00 $ 150.00 Urinalysis Collection $ 25.00 Drug Patch Program $ 10.00 Halfway House Residential Program, (daily rate) $ 65.00 °ARU° Residential Program -CLOSED- n/a Contractor's Submittals: Contract Allowance/Discount 30% $ 52.50 $105.00 $ 63.U0 $ 49.00 $ 70.00 $105.00 $ 17.50 $ 7.00 $ 45.50 Statement of services provided to all clients in each county within 45 days of receipt of services. ~.(,(cu~tlt~~,iaa~rly summary invoice of services provided, without client specific information to be submitted to the 4 county administrator Lynn Renick, Garfield County Director and the 5 county administrator, Marie Peer, Moffat County Director. Definition of Services: Family Assessment - a thorough assessment of family strengths, to identify areas of needed strengthening and to develop strategies to live together in a healthy and productive home, school, workplace and community.. Case Management - consists of monitoring progress and the treatment of a client; facilitating communication between all treatment providers; linking the client with community resources. Services may be provided face to face, by phone or written contact. ,- . ' C' o~ -~~~-Zz PURCHASE OF SERVICE CONTRACT - NINE COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - SUBSTANCE ABUSE - 2003-2004 ' THIS PURCHASE OF SERVICE CONTRACT for Core Services (this "Agreement") made by and between the Boards of County Commissioners of Garfield County, Eagle County, Grand County, Jackson County, Moffat County, Pitkin County, Rio Blanco County, Routt County and Summit County, State of Colorado (collectively "BOCCs" and individually "BOCC") and .Colorado West Regional Mental Health Inc., a Colorado Corporation, whose address is 6916 Highway 82, Box 40, Glenwood Springs, Colorado 81602, and whose tax identification number is 84-0625890 ("Contractor"). WHEREAS, BOCCs are mandated to provide Core Services, through their County Departments of Human/Social Services ("County Departments"), by the Human Services Code, X26-1-101, et seq., C.R.S. as amended and the Colorado Children's Code, X19-3-208, C.R.S. as amended; and WHEREAS, Contractor is engaged in the business of providing substance abuse services and is willing to provide such services in a nine county region; and i WHEREAS, BOCCs desire to engage the Contractor to render certain substance abuse services. NOW THEREFORE, in consideration of the premises and the obligations, agreements, and promises contained herein, the parties agree as follows: I. SCOPE OF SERVICES. A. Services, Clients, Place of Service. Within the financial parameters described in Section IV.E., below, Contractor shall provide substance abuse .services, including but not limited to intensive outpatient group therapy, individual therapy, random urinalysis and drug patch program, substance abuse evaluations, halfway house services and "ARU" residential programs to all clients referred to Contractor in the nine county area governed by the BOCCs. Such services shall be provided in Eagle, Garfield, Pitkin, and Summit Counties ("4-county Group") and in Grand, Jackson, Moffat, Rio Blanco, and Routt Counties ("5- county Group".). Services shall be delivered at designated offices, clients' homes and other locations approved by the BOCCs or any one of them, through their County Department Directors, as stated in Section XIV, below. Contractor shall provide services in accordance with State Department of Human Nine-county Regional Core Servicem-Substance Abuse Colorado West FY 03-04, 8P//2003 Fiml Services regulations, found at 12 CCR .2509-4, Section 7.303.1, as amended, ,and ~as described in that certain County Core Services Plan, executed by the Garfield County BOCC on April 21, 2003 on behalf of the 4-county Group and the 5-county Group. Services shall be provided in a satisfactory and proper manner, as determined in the sole discretion of the BOCCs. B. Contractor's Reports. Contractor shall provide each BOCC, through its County Department Director or his/her- designated representative, as stated in Section XIV, below, with reports on its provision of services, as follows: 1. Treatment Plan. Within four (4) weeks of initiation of services for an identified client, Contractor shall submit an individualized treatment plan, with stated objectives and target dates, to the appropriate County Department Director or his/her designated representative. Treatment plans shall be subject to the approval of the County Department Director or his/her designated representative, who shall initiate discussion between the client's social caseworker and substance abuse professional, as needed to develop an agreed upon services plan. , 2. Progress Reports. At monthly intervals from the time of initiation of services, Contractor shall provide the appropriate County Department Director or his/her designated representative with follow-up reports for each identified client. C. Confidentiality. It is specifically understood that only aggregated non-identifiable client services data shall be presented to the BOCCs or any one of them in public session. Client specific reports are subject to the confidential rules of Sections 19-1-101, et seq. and 26-1-101, et seq., C.R.S., as amended; the federal Health Insurance Portability and Accountability Act of 1996 and the federal statute regarding confidentiality of alcohol and drug abuse patient records, at 42 U.S.C. Section 290 dd-2; and other applicable federal and state law and regulation. II. COUNTY RESPONSIBILITIES. The BOCCs, through their County Departments, shall: (1) determine client eligibility; (2) provide Contractor with written authorization for provision of services, specifying begin and end service dates; (3) provide Contractor with referral updates detailing changes in service types; (4) provide Contractor with appropriate referral information, such as name; address, State ID number, and social, medical and Nme-county Ragioml Core Semces-Substance Abuse Colorado West FY 03-04, 8P7/2003 Final 2 • • educational information provide the appropriate contract administrator, with summary financial c records, identified by S basis. as appropriate to the referral; (5) 4-county Group and 5-county Group ~s identified in Section XIV, below, ata including client specific billing :ate ID number and' name, on a monthly III. TERM OF AGREEMENT. The term of this Agreement shall begin, retroactively, on June 1, 2003, and shall terminate on May 31, 2004, no matter the date of execution. IV. COMPENSATION. A. Amount and Method of Payment. For performance of the scope of services set forth in Section I, above, Garfield BOCC shall pay the Contractor Three Thousand Thirty-One Dollars and Twenty- Five Cents ($3,.031.25) per month, on or before the last day of each month for services provided to referred clients in the 4- county Group. Moffat BOCC shall pay the Contractor Three Thousand Thirty-One Dollars and Twenty-Five Cents ($3,031.25) per month, on or before the last day of each month for services provided to referred clients in the 5-county. Group. The monthly compensation reflects a three percent (30) retainage of State allocated funds by Garfield BOCC and Moffat BOCC for administration of this Agreement on behalf of the 4-county Group and the 5-county Group. B: Not to Exceed Figures. In no event shall the compensation paid under this Agreement to Contractor by Moffat County exceed Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for all services provided to all referred clients in the 5-county group. In no event shall the compensation paid under this Agreement by Garfield County to Contractor exceed Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for all services provided to all referred clients in the 4-county Group. C. No Fee-For-Service. Contractor shall not charge referred clients fees for services provided under this Agreement. Compensation in accordance with the terms of this Agreement represents full payment of fees by the BOCCs for services provided to referred clients. D. Contractor's Submittals. Contractor shall submit a statement, including a summary invoice of services provided to all clients in each county and client specific billing records, to each County Department Director or his/her designated representative in a timely manner. Client specific billing Nine-co~mty Regional Core Service4-Substmce Abuse Colorado west xx os-oa, annoo3 Finat 3 • records shall be due, in no event, not later than forty-five (45) days after the provision of service. Contractor shall also provide the 4-county Group and 5-county Group contract administrators, as identified in Section XIV, below, with a quarterly "summary invoice" of services provided within each area, without client specific billing records. Such quarterly invoices shall include, at a minimum, summary information as to type of service, total hours provided, rate for service, and total dollar amounts per type of service. E. Risk Corridor. It is recognized that the dollar amounts specified in Subsections A and B, above, .represent a retainer method of Contractor compensation, not a client-number fee for service payment system. The parties agree to continue to make efforts to co-ordinate client specific service and cost tracking, in accordance with the "2003 Fee Schedule", attached to and incorporated herein by this reference as "Exhibit A". In order to control costs and manage the expenditure of public funds, the BOCCs and Contractor agree: 1. Ceiling. At any point in the contract period if it appears from Contractor's recordkeeping that the Contractor is likely to exceed the not-to-exceed figures for the 4-county Group or the 5-county Group, specified in Subsection B, above, Contractor shall notify the BOCCs through the 4-county Group and 5-county Group contract administrators, identified in Section XIV, below. Upon such notification, the 4-county Group and 5-county Group contract administrators shall initiate a reconciliation of billing records and negotiations with Contractor regarding payment for continued services. In any event Contractor shall continue to provide services to referred clients, without additional payment by the BOCCs, until the dollar value of delivered services reaches a ceiling of One Hundred Twenty Percent (120%) of the not-to-exceed figures (1.20 x $37,500.00 = $45,000.00, minus 3% administrative retainage fee). Should the 120% ceiling be reached without agreement on additional payment by way of an amendment to this Agreement regarding the appropriate 4-county Group and/or 5-county Group, Contractor shall cease provision of services and the BOCCs shall cease referral of clients. 2. Floor. At any point in the contract period if it appears from the BOCCs' records that compensation, paid under terms of Subsection A above, is likely to be under expended such that Eighty Percent (80%) or less of the not-to-exceed figures, identified in Subsection B above, (.80 x $37,500.00 = $30,000.00, minus 3% administrative retainage fee) will likely Nine-county Regioaal Core Services-Substance Abuse Colorndo West FY 03-04, 8/7/2003 Final 4 • n U be used by Contractor, the BOCCs, through the 4-county Group and 5-county Group contract administrators, shall notify the Contractor and initiate a reconciliation of billing records. Should account reconciliation show an under-usage of Eighty Percent (80%) or less of the not-to-exceed figures, i.e, usage of $30,000.00 in either the 4-county Group or the 5-county Group (minus 3o administrative retainage fee) or less, Contractor and the BOCCs shall negotiate a resolution in good faith, including without limitation, termination of this Agreement under terms of Section XII., below. V. FUNDING CONTINGENCY. In accordance with X29-1-110, C.R.S., as amended, the BOCCs are not authorized to expend monies which have not been appropriated. Payment pursuant to this Agreement is subject to and contingent upon funds being appropriated, budgeted and otherwise made available by the BOCCs, the State of Colorado, and/or federal funding sources, as applicable to this Agreement. VI. INDEPENDENT CONTRACTOR. The Contractor shall provide the services identified in Section I, above, as an independent contractor providing supervision of its employees, agents and subcontractors. The Contractor represents that it has ar will secure at its own expense all personnel required to perform the scope of services identified in Section I, above. Contractor shall ensure that its personnel are professionally licensed, as required by law, and meet applicable State Department of Human Services qualification requirements. Contractor's employees, agents and subcontractors are not employees or agents of the BOCCs or any of them and do not have a contractual relationship with the BOCCs or any of them. Neither the Contractor, nor any of Contractor's employees, agents or subcontractors shall be entitled to any benefits or attributes of employment by the BOCCs or any of them, including without limitation workers compensation or health insurance coverage. VII. SUBCONTRACT AND ASSIGNMENT. A. General. Contractor shall not subcontract with another individual or entity for performance of the services described in Section I, above, and shall not assign or otherwise transfer its rights or delegate its obligations under this Agreement without the prior approval of the BOCCs. B. Individual Case Basis. In the event that Contractor cannot provide an eligible client with substance abuse services, as deemed adequate and appropriate by the referring County rrme-co~mty xegionat core savicessnbstance ntuso Colorado West FY 03.04, BP//2003 Final 5 • Department Director, Contractor shall purchase the services on a subcontract basis. Within two (2) weeks of such a referral, Contractor, through its local Program Directors, shall consult with the referring County Department Director of his/her authorized representative regarding alternative treatment resources and resolve disputes, if any, regarding subcontracted services. County Department Directors shall have final authority over t'he purchase price of subcontracted services and the selection of the alternate service provider. Subcontracting shall not exceed the not-to-exceed amounts stated in Section IV. B., above, Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for the 4-county Group and Thirty Seven Thousand Five Hundred Dollars ($37,500.00) for the 5-county group. Subcontracting on an individual case basis shall be approved by the signature of the County Department Director or his/her authorized representative on the named County Department's referral form. VIII. INFORMATION, AUDITS AND INSPECTIONS. At such times and in such forms as the BOCCS or any of them may require, Contractor shall furnish statements, records, reports, data and information pertaining to the matters covered by this Agreement. At any time during normal business hours and as often as the BOCCS or any of them may deem necessary, Contractor shall make available for examination and audit by the BOCCs or any of them and the State Department of Human Services or authorized representatives thereof, all of the .Contractor's records, materials, reports, information and data with respect to matters covered by this Agreement. All such information shall be maintained by Contractor for a period of seven (7) years after final payment is made to the Contractor under this Agreement. IX. INDEMNIFICATION. The Contractor shall indemnify, hold harmless and defend the BOCCs and each of them and their employees, agents, and officers, acting officially or otherwise, from and against any and all claims, damages, liability and proceedings of any kind, including attorneys fees, arising out of this Agreement, other then those resulting from the negligence or willful misconduct of the BOCCs or any of them, their employees, agents, or officers. X. INSURANCE. Contractor shall maintain insurance with companies authorized to do business in Colorado, on forms satisfactory to the BOCCs, in at least the following minimum coverage amounts: GENERAL LIABILITY: $150,000.00 per person, $600;000.00 per occurrence. Nme-roomy Regional Core Services-Substmce Abuse L Colorado West FY 03-04, BP//2003 Final V AUTOMOBILE LIABILITY: $150,000.00 per person, $600,000.00 per occurrence. WORKERS COMPENSATION: As required by Colorado Law. PROFESSIONAL MALPRACTICE INSURANCE: Contractor and its personnel, in a minimum amount of $1,000,000 per claim, $3,000,000 aggregate. Contractor shall name each of the BOCCs as additional insureds, as applicable, on the general and automobile liability policies. Contractor shall deliver copies of policies or Certificates of Insurance to the appropriate BOCC within a reasonable time after execution of this Agreement and on each policy renewal date. XI. COMPLIANCE WITH LAWS. The Contractor shall comply with all laws, ordinances, codes and regulations of the federal, state, and local governments applicable to this Agreement. Without limiting the generality of this Section XI., Contractor, in its performance under this Agreement: (1)shall maintain client confidentiality, including confidentiality of records, in accordance with state and federal law, rules and regulations; and (2) shall not discriminate against any person on the basis of race, color, national origin, religion, sex, age or handicap. Any fines paid or expenses incurred by the BOCCs or any of them, due to Contractor's violation of applicable law or regulation, shall be reimbursed to the payor by the Contractor. XII. MUTUAL TERN may terminate this upon thirty (30) party. Upon such compensation for termination. ;INATION FOR CONVENIENCE. BOCCs and Contractor Agreement, without cause and for convenience, days written notice to the non-terminating termination, Contractor shall be entitled to services performed prior to the date of XIII. BOCCs' TERMINATION FOR CAUSE. If the Contractor fails to fulfill its obligations under this Agreement in a timely and proper manner, as determined by the BOCCs, or if the Contractor violates any of the terms or provisions of this Agreement, the BOCCs shall have the right, in their sole discretion, to terminate this Agreement by giving written notice to the Contractor at least fifteen '(15) days before the effective date of the termination. In such event, Contractor shall be entitled to receive just and equitable compensation for work satisfactorily completed prior to termination. Contractor shall not, however, be relieved of liability to the BOCCs for damages sustained by the BOCCs by virtue of any breach of this Agreement by the Contractor. The BOCCs may withhold payments due to the Contractor for the purpose of set-off until such time as the exact amount of damages due the BOCCs from Contractor is determined. Nme-wumy Regional Core Services-Substmmce Abuse Colorado West FY 03-04, 8/7/2003 Fiml 7 ~i XIV. CONTRACT ADMINISTRATOR, CONTACT PERSONS, AND CONFLICT RESOLUTION A. Contract Administrators. Contract administrators regarding contract administration, financial management, .and evaluation of the performance of the scope of services described in Section I, above, are as follows: 1. BOCCs. Lynn Renick, Garfield County Director, for the 4- county Group and Marie Peer, Moffat County Director, for the 5-county Group; and 2. Contractor. Ken Stein, Executive Director, Colorado West Regional Mental Health, Inc. B. Contact Persons. Contact persons for issues regarding an individual county or an individual client of a County Department are: 1. BOCCs. The appropriate County Department Director or his/her designated representative(s); and 2. Contractor. The appropriate Program Director in each county. XV. AMENDMENT. Any mutually agreed upon amendment, including without limitation any change in the scope o.f services, whether or not resulting in an increase or decrease in the amount of compensation, shall be incorporated in a written amendment to this Agreement. Amendments shall be executed with the same formality. as this Agreement, except as to change of address or name of contact person. Address and contact information shall not be considered an amendment to this Agreement and notice of such may be given by way of regular mail, telephone, or facsimile transmission. XVI. NOTICE. Notices required under this Agreement, other than changes in address or contact information, shall be delivered by way of certified mail, return receipt requested, to the addresses for signatories, written below. XVII. CONTROLLING LAW. This Agreement shall be governed by the laws of the State of Colorado and venue for any action arising out of or relating to performance of this Agreement shall be in Garfield County or Moffat County, as appropriate. Nme-county Regioml Core Smicav-Subst~ce Abuse p Colorado West FY 03-04, 8/7/2003 Fioal O 1 XVIII. SEVERABILITY. If any term or provision of this Agreement is declared invalid or becomes inoperative for any reason, such invalidity or failure shall not affect the validity of any other term or provision. XIX. AUTHORIZATION. Each of the individuals signing below affirms that he/she is properly authorized to execute this Agreement on behalf of the governmental agency or private entity party to this Agreement. XX. INTEGRATION. The entire agreement of the parties is encompassed within this Agreement. No other oral. or written representation or agreement shall be of any force or effect. IN WITNESS WHEREOF the parties hereto have executed this document. ATTEST: COMMISSIONERS By. - Ga field;County Clerk J t' Chair Date APPROVED: Garfield County Department of Social a s, or Designee By: L nick, Director P.O. x 850 Glenwood Springs, CO 81602 Nine-county Regional Core Services-Substance Abuse Colorado Went FY 03-04, 8/7!1003 Final 9. ATTEST: BOARD OF COUNTY COMMISSIONERS GRAND COUNTY, COLORADO -;~,.-~-n . BY . ~ . ounty Clerk Chair ~o~ m ~ t Date: 8''6-°3 ATTEST: //~'/ ~ ,y AiC ~wA~ ~ b v(S ~ ~t ~ Jackson County Clerk BOARD OF COUNTY COMMISSIONERS JACKSON COUNTY, COLORADO By : O~-~s Chair Date : ~ ~~`"~ APPROVED: Grand County and Jackson County Department of Social Services, or Designee By : i~~~Gr.Gi~ Phil p M s, Director Address: P.O. Box 204 Hot Sulphur Spgs, CO 80451 ATTEST: Eagle County Clerk APPROVED: Eagle County Department of Health & Human Services, or Designee By: Kathleen L. Fornash, Director Address: P.O. Box 660 Eagle, CO 81631 Nine-couaty Regional Cam Services-Substance Above Colorado West FY 03-04, g/7R003 Final BOARD OF COUNTY COMMISSIONERS EAGLE COUNTY, COLORADO By: Date :. 10 Chair i ATTEST: Grand County Clerk ATTEST: Jackson County Clerk APPROVED: Grand County and Jackson County Department of Social Services, or Designee By: • BOARD OF COUNTY COMMISSIONERS GRAND COUNTY, COLORADO By: Chair Date: BOARD OF COUNTY COMMISSIONERS JACKSON COUNTY, COLORADO By: Chair Date: Philip Maes, Director Address: P.O. Box 204 Hot Sulphur Spgs, CO 80451 Y=-J~-, ~~o~~~ ~, ~o ~~ s ~ o,~~, ~` a ~ BOARD OF COUNTY COMMISSIONERS ~: ~~ ~~~ r~ ' ~,~ : EAGLE COUNTY COLORADO ~¢~~',~~ ~ ~ ~ ,a~ By : Eag; a County< Cti rk Chair Date :. APPROVED: Eagle County Department of Health & Human Services, or Desictnee~ By : ! ~LC:eLcc._ l./ Kath~.een L . F(orn~,~sh, Did ctor ~ Address: P.O. Box 660 Eagle, CO 81631 yx~~ c~ s~;~-s.a~ comredo w~ x~ o3-aa, annoo3 ~t 10 BOARD OF COUNTY COMMISSIONERS ATTEST: PITKIN COUNTY, COLORADO ~~ By: Pitkin County Clerk Chair Date: ~/I/~~~~ APPROVED: Pitkin County Department of Social Ser/y~ces, or Desig~e -K~te~Jangul , 1reC o Address: 100 1 Run D ive, #122 Basa CO 81621 ATTEST: Rio Blanco County Clerk APPROVED: Rio Blanco County Department of Social Services, or Designee Bv: BOARD OF COUNTY COMMISSIONERS RIO BLANCO COUNTY By: Chair Date: Bonnie Ruckman, Director Address: 345 Market Street Meeker, CO 81641 ATTEST: BOARD OF COUNTY COMMISSIONERS ROU'TT COUNTY , COLORADO By: Routt County Clerk Chair Date: Nino-county Regional Core Services-Substance Abase '1 1 Colorado West FY 03-04, Sr/2003 Fiml 1 1 ~ ~ ATTEST: Pitkin County Clerk APPROVED: Pitkin County Department of Social Services, or Designee By: Kate Jangula, Director Address: 100 Elk Run Drive, #122 Basalt, CO 81621 ATTEST: Rio B anc County Clerk APPROVED: Rio Blanco County Department of Social Services, or Designee By: Bonnie Ruckman, Director Address: 345 Market Street Meeker, CO 81641 ATTEST: Routt County Clerk BOARD OF COUNTY COMMISSIONERS PITKIN COUNTY, COLORADO By: Chair Date: BOARD OF COUNTY COMMISSIONERS RIO BLANCO COUN~}TY l Chair Date: ~~ 2 5 '~~ BOARD OF COUNTY COMMISSIONERS ROUTT COUNTY, COLORADO By: Date: Chair Ninetounty Regional Core Services-Substance Abuse 11 colaradn w~ »t o3-oa, gnrzoo3 3:inal ATTEST: Pitkin County Clerk APPROVED: Pitkin County Department of Social Services, or Designee By: Kate Jangula, Director Address: 100 Elk Run Drive, #122 Basalt, CO 81621 ATTEST: Rio Blanco-County Clerk APPROVED: Rio Blanco County Department of Social Services, or Designee Bv: Bonnie Ruckman, Director Address: 345 Market Street Meeker, CO 81641 .,C~bd; . ATTEST : ~~ : ~ ••~~~ •;0,~;. ?.• ~~ ~~i Ro Count~~y Vie' ~~'~~`~` ~ ~~' BOARD OF COUNTY COMMISSIONERS PITKIN COUNTY, COLORADO By: Chair Date: BOARD OF COUNTY COMMISSIONERS RIO BLANCO COUNTY By: Chair Date: BOARDibF fCpUNTY COMMISSIONERS `~~ / Chair Date : ~ '2 Nine-coumy Regioml Core Seavices-Substaaca Abuse Colorado West FY 03-04, 8/7/2003 Final APPROVED: Routt County Department of Social Services, or Designee By: Robert White, Director Address: P.O. Box 772790 Steamboat Spgs, CO 80477 ATTEST: Summ unty e . APPROVED: Summit County Department of Social Services, or Designee By : ~~ti~ Susan Gruber, Director Address: P.O. Box 869 Frisco, CO 80443 ATTEST: ISSIONERS BOARD OF COUNTY SUMMIT ~UNTY~1 By: Date: (.~ti~S~'o~- Chair $~~~~~ ~AAreve~l ~~ 20 fors ~~ Legal BOARD OF COUNTY COMMISSIONERS MOFFAT COUNTY, COLORADO Moffat County Clerk APPROVED: Moffat County Department of Social Services, or Designee By: By: Date: Marie Peer,.Director Address: 595 Breeze Street Craig, CO 81625 Chair Nmwwmry Regional Core Setvvioea-Since Abusa 12 Colan3do west FY o~-oa, gnnoo~ >rmal . 1. U APPROVED: Routt County Department of Social Services, or Designee By: Robert White, Director Address: P.O. Box 772790 Steamboat Spgs, CO 80477 ATTEST: • BOARD OF COUNTY COMMISSIONERS SUMMIT COUNTY, COLORADO Summit County Clerk APPROVED: Summit County Department of Social Services, or Designee By: Susan Gruber, Director Address: P.O. Box 869 Frisco, CO 80443 ATTEST: Moffat County Clerk By: Chair Date: BOARD OF COUNTY COMMISSIONERS MOFFAT COUNTY, COLORADO By~~~/ Chair Date : ~-Q U3 APPROVED: Moffat County Department of Social Services, or Designee By: , Marie Peer, Di ctor Address: 595 Breeze Street Craig, CO 81625 Niac-eouMy Regioml Core Swioes-Su~tanee Above Colorado Wat PY 03.04, 8r7R003 Fine! 12 ~ ~ CONTRACTOR: COLORADO WEST REGIONAL MENTAL HEALTH, INC. By: Ken Stein, Exec. Director Address: 6916 Highway 82, Box 40 Glenwood Springs, CO 81601 Date: rrme-wu¢ry xeg;cml com secvicea-s,~ce .41wae 13 Colorado w~ FY o3-aa, ann~s Final v ~ Colorado West Regional Mental Health Center, Inc 2003 Fee Schedule ` NID Fees ~ ~ ~ Contract Allowance/Discoant 30% CPT Code Description 90801 Psychiatric Diag Interview $ 190.00 90802 Diag Interview, Interactive $ 205.00 90862 Pharmacoigical management $ 95.00 90882 Environmental Intervention $ 140.00 (Case Management ) 99058 Emergency Crisis Evaluation $ 1.25.00 PhD Fees '90801 Psychiatric Diag Interview $170.00 90802 Diag Interview -Interactive $ 185.00 90804 Psychotherapy; 20-30 mans $ 100.00 90806 Psychotherapy, 45-50 mins $ 140.00 . 90808 Psychotherapy,. 75-80 mins $ 220.00 90810 Psychotherapy, Int 20-30 mins $ 110.00 90812 Psychotherapy, Int 45-50 mins $150.00 90814 Psychotherapy, Int 75-80 mins $ 220.00 90846 Psychotherapy, family(w/o client) $140.00 90847 Psychotherapy, family(with/client) $ 160.00 90849 Psychotherapy, multiple family. ~ $ 110.00 90853 Psychotherapy, group $ 80.00 90857 Psychotherapy, grp, interactive $ 70.00 96100 Psych testing par hour - , .$145.00 90882 Case Management $105.00 99058 Emergency Crisis Evaluation $110.00 90899 Emergency Crisis Phone Call $ 80.00 99078 ~ Psychoeducational Services $ 35.00 Licensed Clinician Fees 90801 Psychiatric Diag Interview $120.00 $133.00 $143.50 $ 66.50 $ 98.00 $ 87.50 Contract Allowance/Disconnt 30% $119.00 $129.50 $ 70.00 $ 98.00 $154.00 $ 77.00 $105.00 $154.00 $ 98.00 $112.00 $ 77.00 $ 56.00 ~~ . $ 49.00 $1.01.50 .' $ 73.50 $ 77.00 - $ 56.00 $ 24.50 . Contract Allowance/Disconnt 30% $ 84.00 90802 Diag Interview -Interactive $130.00 . $ 91.00 90804 Psychotherapy, 20-30 mins $ 70.00 $ 49.00 90806 Psychotherapy, 45-50 mins $100.00 $ 70.00 90808 Psychotherapy, 75-80 mins $150.00 ~ $ 105.00 90810 Psychotherapy, Int 20-30 mins $ 75.00 $ 52.50 90812 Psychotherapy, Int 45-50 mins $100.00 $ 70.00 908'14 .Psychotherapy, Int 75-80 mins $ 155.00 $108.50 90846 ~ Psychotherapy, family(w/o client) $105.00 $ 73.50 90847 ,Psychotherapy, family(w(th/client) $130.00 $ 91.00 90849 Psychotherapy, multiple family - $ 75.00 $ 52.50 90853 Psychotherapy, group $ 60:00 $ 42.00 90857 Psychotherapy, grp, interactive $ 50.00 $ 35.00 9085322 -IOP group (alcohol and drug) $ 90.00 $63.00 90882 Case Management $ 95.00 $ 66.50 99058 Emergency Crisis Evaluation $100.00 $ 70.00 90899 Emergency Crisis Phone Call ~ $ 70.00 $ .49.00 99078. Psychoeducational Services $ 30.00 $ 21.00 EXHIBIT A - SUBSTANCE ABUSE AGR Substance Abuse 5ervia~003 Fee Schedule Service Substance Abuse Evaluation, 45-50 mins Substance Abuse Evaluation, 75-80 mins Intensive Outpatient Group Therapy, 3 hours Individual Therapy 90804 Psychotherapy, ~ 20-30 mins 90806 Psychotherapy, 45-50 mins 90808 Psychotherapy, 75-80 mins Urinalysis Collection Drug Patch Program Halfway House Residential Program, (daily rate) °ARU" Residential Program - CLOSED- Coatractor's Submittals: Fee $ 75.00 $ 150.00 $ 90.00 $ 70.00 $ 100.00 $ 150.00 $ 25.00 $ 10.00 $ 65.00 n/a • Contract Allowance/Discount 30% $ 52.50 $105.00 $ 63.00 $ 49.00 $ 70.00 $ 105.00 $ 17.50 $ 7.00 $ 45.50 Statement of services provided to all clients in each county within 45 days of receipt of services. ~~;G~A--rly summary invoice of services provided, without client specific information to be submitted to the 4 county administrator Lynn Renick, Garfield County Director and the 5 county administrator, Marie Peer, Moffat County Director. . Definition of Services: Family Assessment - a thorough assessment of family strengths, to identify areas of needed strengthening and to develop strategies to live together in a healthy and productive home, school, workplace and community,. Case Management - consists of monitoring progress and the treatment of a client; facilitating communication between all treatment providers; linking the client with community resources. Services may be provided face to face, by phone or written contact. lorado West Regional Mental Health Center, Inc 2003 Fee Schedule Fees ~ ~ C~.ract Allowance/Disconnt 30% CPT Code Description 90801 Psychiatric Diag Interview $190.00 __ $133.00 90802 Diag Interview, Interactive $ 205.00 $143.50 90862 Pharmacolgical management $ 95.00 $ 66.50 90882 Environmental Intervention $ 140.00 $ 98.00 (Case Management ) 99058 Emergency Crisis Evaluation $1.25.00 $ 87.50 PhD Fees °90801 Psychiatric Diag Interview $170.00 90802 Diag Interview -Interactive $185.00 90804 Psychotherapy,, 20-30 miss $ 100.00 90806 Psychotherapy, 45-50 mins $140.00 . 90808 Psychotherapy,. 75-80 mins $220.00 90810 Psychotherapy, Int 20-30 mins $110.00 90812 Psychotherapy, Int 45-50 mins $ 150.00 90814 Psychotherapy, Int 75-80 mins $ 220.00 90846 Psychotherapy, family(w/o client), $140.00 90847 Psychotherapy, family(with/client) $160.00 90849 Psychotherapy, multiple family. ~ $110.00 90853 Psychotherapy, group $ 80.00 90857 Psychotherapy, grp, interactive $ 70.00 96100 Psych testing per hour ~ . ~ ..$ 145.00 90882 Case Management $ 105.00 99058 Emergency Crisis Evaluation ~ $110.00 90899 Emergency Crisis Phone Call $ 80.00 99078 • Psychoeducational Services $ 35.00 Licensed Clinician Fees 90801 Psychiatric Diag Interview $120.00 Contract Allowance/Disconnt 30%. $119.00 $ 129,50 • $ 70.00 $ 98.00 • $154.00 $ 77.00 • $105.00 • $154.00 ~ . $ 98.00 • $112.00 $ n.oo $ 56.00 ~~ . $ 49.00 $101.50 $ 73.50 77.00 • $ 56.00 $ 24.50 Contract Allowance/Disconnt 30% $ 84.00 90802 Diag Interview -Interactive $130.00 . $ 91.00 • 90804 Psychotherapy, 20-30 mins $ 70.00 $ 49.00 90806 Psychotherapy, 45-50 mins $100.00 $ 70.00 90808 Psychotherapy, 75-80 mins $150.00 $105.00 . 90810 Psychotherapy, Int 20-30 mins $ 75.00 $ 52.50 90812 Psychotherapy, Int 45-50 mins $100.Ob $ 70.00 908'14 .Psychotherapy, Int 75-80 mins $155.00 $108.50 • 90846 • Psychotherapy, family(w/o client) $105.00 $ 73.50 90847 .Psychotherapy, family(with/client) $130.00 $ 81.00 90849 Psychotherapy, multiple family ~ $ 75.00 $ 52.50 90853 Psychotherapy, group $ 60:00 ~ $ 42.00 90857' Psychotherapy, grp, interactive $ 50.00 $ 35.00 9085322 .IOP group (alcohol and drug) $ 90.00 $ 63.00 90882 Case Management $ 95.00 $ 66.50 99058 Emergency Crisis Evaluation $100.00 $ 70.00 90899 , • Emergency Crisis Phone Call $ 70.00 $ 49.00 99078, Psychoeducational Services $ 30.00 $ 21.00 ~u~9 q ~ -~ ERHIBIT A - i~NTAL HEALTH AGR - _ _.. . Substance Abuse Servic~003 Fee Schedule Service Substance Abuse Evaluation, 45-50 _mins Substance Abuse Evaluation, 75-80 mins Intensive Outpatient Group Therapy, 3 hours Individual Therapy 90804 Psychotherapy, 20-30 mins 90806 Psychotherapy, 45-50 mins 90808 Psychotherapy, 75-80 mins Fee $ 75.00 150.00 $ 90.00 $ 70.00 $ 100.00 $150.00 Urinalysis Collection $ 25.00 Drug Patch Program $ 10.00 Halfway House Residential Program, (daily rate) $ 65.00 °ARU" Residential Program -CLOSED- n/a Contractor's Submittals: Contract Allowance/Discount 30% $ 52.50 $105.00 $ 63.00 $ 49.00 $ 70.00 $105.00 $ 17.50 $ 7.00 $ 45.50 Statement of services provided to all clients in each county within 45 days of receipt of services. c.,~~rly summary invoice of services provided, without client specific information to be submitted to the 4 county administrator Lynn Renick, Garfield County Director and the 5 county administrator, Marie Peer, Moffat County Director. Definition of Services: Family Assessment - a thorough assessment of family strengths, to identify areas of needed strengthening and to develop strategies to live together in a healthy and productive home, school, workplace and community.. Case Management - consists of monitoring progress and the treatment of a client; facilitating communication between all treatment providers; linking the client with community resources. Services may be provided face to face, by phone or written contact.