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HomeMy WebLinkAboutC03-250 Nine County Regional Agreement Core Services Program - Mental Health~o~-zsa-zz
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PURCHASE OF SERVICE CONTRACT - NINE COUNTY REGIONAL AGREEMENT
CORE SERVICES PROGRAM - MENTAL HEALTH - 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 "BOCCE) 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
mental health services and is willing to provide such services
in a nine county region; and
WHEREAS, BOCCs desire to engage the Contractor to render
certain mental health 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 mental health services, including but not limited to
psychiatric and psychological assessments, family assessments,
individual therapy, family and group therapy, crisis counseling,
medication management, psycho-educational services and case
management 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.
Nine County Regional Core Services - Mental Health 1
Colo West FY 03-04 8P//2003 Final
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Contractor shall provide services in accordance with State
Department of Human Services .regulations, found at 12 CCR 2509-
4, Section 7.303, 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 mental health 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, trough 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)
Nine County Regional Core Services - Mental Health 2
Colo West FY 03-04 817/2003 Final
provide Contractor with appropriate referral information, such
as name, address, State ID number- and social, medical and
educational information as appropriate to the referral; (5)
provide the appropriate 4-county Group and 5-county Group
contract administrator, as identified in Section XIV, below,
with summary financial data including client specific billing
records, identified by State ID number and name, on a monthly
basis. .
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 Ten Thousand Seven Hundred Eight Dollars and
Fifty-five Cents ($10,708.55)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 Ten
Thousand Seven Hundred Eight Dollars and Fifty-five Cents
.($10, 708.55) 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%) 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
One Hundred Thirty Two Thousand -Four Hundred Ninety-seven
Dollars and Fifty Cents ($132,497.50) 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 One Hundred Thirty Two Thousand Four
Hundred Ninety-seven Dollars and Fifty Cents ($132,497.50) 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.
Nine County Regional Core Services - Mental Health 3
Colo 9Vest FY 03-04 8/7/2003 Final
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
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 aid 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 $132,497.50 = $158,997.00, 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.
Nine County Regional Core Services -Mental Health 4,
Colo West FY 03-04 8/7/2003 Final
• •
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 (800) or less of the not-to-exceed figures,
identified in Subsection B above, (.80 x $132,497.50 =
$105,998.00, minus 3~S administrative retainage fee) will
likely 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 (800) or less of. the not-to-exceed figures,
i.e, usage of $105,998.00 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 or 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
Nine Cotmty Regional Core Services - Mental Health 5
Colo West FY 03-04 8!712003 Final
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 mental health services, as
deemed adequate and appropriate by the referring County
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, One Hundred Thirty Two Thousand Four Hundred Ninety-
seven Dollars and Fifty Cents (.$132,497.50) for the 4-county
Group and One .Hundred Thirty Two Thousand Four Hundred Ninety-
seven Dollars and Fifty Cents ($132,497.50) for the 5-county
group. Subcontracting on an individual case basis shall be
approved by the signature of the 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. INDEMI~TIFICATION. 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
Nine County Regional Core Services -Mental Health 6
Colo West FY 03-04 SP7/2003 Final
•
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.
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 B~CCs 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 TERMINATION FOR CONVENIENCE. BOCCs and Contractor
may terminate this Agreement, without cause and for convenience,
upon thirty (30) days written notice to the non-terminating
party. Upon such termination, Contractor shall be entitled to
compensation for services performed prior to the date -of
termination.
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
Nine County Regional Core Services - Mental health 7
Colo West FY 03-04 8/7/2003 Final
! '
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.
XIV. CONTRACT ADMINISTRATORS AND CONTACT PERSONS.
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 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.
Nine County Regional Core Services - Mental Health g
Colo West FY 03-04 8f7/2003 Final
•
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.
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 o~ 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, birector
P.O. Box 850
Glenwood Springs, CO 81602
Nine County Regional Core Services -Mental Health 9
Colo West FY 03-04 8P72003 Final
ATTEST:
Grand County Clerk
ATTEST:
Jackson County Clerk
APPROVED:
Grand County and Jackson County
Department of Social Services,
or Designee
By:
Philip Maes, Director
Address: P.O. Box 204
Hot Sulphur Spgs,
..,,,i,~~,~ nqr,,.
07 J ~ 1 ` ~^Z~
,,
e
APPROVED:
Eagle County Department of
Health & Human Services, or
Designee
B
Ka hleen L. F mash,
Director
Address: P.O. Box 660
Eagle, CO 81631
•
BOARD OF COUNTY COMMISSIONERS
GRAND COUNTY; COLORADO
By:
Chair
Date:
BOARD OF COUNTY COMMISSIONERS
JACKSON COUNTY, COLORADO
By:
Date:
Chair
CO 80451
BOARD OF COUNTY COMMISSIONERS
EAGLE COUNTY, COLORADO
By: ~;~.
Chair
Date : ~' ~1 ~6 .~
Nine County Regional Core Services -Mental health 1
Colo West FY 03-04 8/7/2003 Final
•
ATTEST:
Pitkin County~Clerk
APPROVED:
Pitkin County Department of
Social Services, or Designee
By
Kate Jangula, Director
Address: 100 Elk Run Dr, #122
Basalt, CO 81621
ATTEST:
BOARD OF COUNTY COMMISSIONERS
PITKIN COUNTY, COLORADO
By:
• Chair
Date:
BOARD OF COUNTY COMMISSIONERS
RIO BLANCO COUNTY
By:
Rio Blanco County Clerk
APPROVED:
Rio Blanco County Department of
Social Services, or Designee
By:
Bonnie Ruckman, Director
Address: 345 Market Street
Meeker, CO $1641
Chair
Date:
Nine County Regional Core Services - Mental Health 11
Colo West FY 03-04 8P7/2003 Final
•
BOARD OF COUNTY COMMISSIONERS
ATTEST: ~ ROUTT COUNTY, COLORADO
By:
Routt County Clerk Chair
Dade:
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
By: '
Chair
Date-
Nine County Regional Core Services -Mental Health 12
Colo West FY 03-04 8/7/2003 Final
. •
BOARD OF COUNTY COMMISSIONERS
ATTEST: MOFFAT COUNTY, COLORADO
By: •
Moffat County•Clerk Chair
Date:
APPROVED:
Moffat County Department of
Social Services, or Designee
By
Marie Peer, Director
Address: 595 Breeze Street
Craig, CO 81625
CONTRACTOR:
COLORADO WEST REGIONAL
MENTAL HEALTH, INC.
By:
Ken Stein, Exec. Director
Address: 6916 Highway 82,
Box 40
Glenwood Springs, CO
816.01
Date:
Niue County Re~amel Core Services -Mental Health 13
Colo West FY 03-04 8P!/2003 Final
. Colorado West Regional Mental Health Center, Inc 2003 Fee Schedule
' NID Fees ~ ~ - tract Allowance/Discount 30%
CPT Cod® Description
. ~ 90801 Psychiatric Diag Interview $190.00 ~ $133.00
90802 Dfag Interview, Interactive $ 205.00 $ 143.50
90862 Pharmacolglcal management $ 85.00 $ 66.50
90882 Environmental Intervention $140.00 ~ $ 88.00
(Case Management )
99058 Emergency Crisis Evaluation $125.00 $ 87.50
PhD Fees Contract Allowance/Disconnt 30%
'90801 Psychiatric Diag Interview $170.00 $119.00
90802 Dlag Interview -Interactive $ 185.00 $129.50
90804 Psychotherapy; 20-30 mins $100.00 $ 70.00 •
90806 Psychotherapy, 45-50 mins $140.00. $ 98.00
80808 Psychotherapy,. 75-80 mins $ 220.00 - $154.00
90810 Psychotherapy, Int 20-30 mins $190.00 $ 77.00 - .
- 90812 Psychotherapy. Int 45-50 mins $ 150.00 _
$105.00
90814 Psychotherapy, Int 75-60 mins $220.00 $154.00
90846 Psychotherapy, family(w/o client) $ 140.00 ~ $ 98.00.
90847 Psychotherapy, family(with/cflent) $ 160.00 $112.00
90849 Psychotherapy. mulQple family. ~ $110.00 $ 77.00
90853 Psychotherapy, group _
$ 80.00 $ 56.00 •~ •
90857 Psychotherapy, grp, Interactive $ 70.00 $ 49.00
86100 Psych testing per hour ~ . -, .$ 145.00 ~ $101.50
90882 Case Management $105.00 $ 73.50
99058 Emergency Crisis Evaluation $ 110.00 $ 77.00
90899 Emergency Crisis Phone Call $ 80.00 $ 56.00 .
99078 ~ ~ Psychoeducatlonal Services ~ $ 35.00 $ 24.50
Licensed Clinffciaa Fees Contract Allowance/Disconnt 30%
• ~ 90801 Psychiatric Dlag Interview $120.00 ~ $ 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 cllen4) $105.00 $ 73.50
90847 .Psychotherapy, family(with/dlent) $130.00 $ 81.00
90849 Psychotherapy, multiple family • $ 75.00 $ 52.50
90853 Psychotherapy, group ~ ~ $ 60:00 $ 42.00
90857 Psychotherapy, grp, interactivve $ 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. Psychoeducatlonat Services $ 30.00 $ 21.00
~~ i ~~ ~~~.~v s
X0$99 ~ ( ~'SS~SS m~ of 3~ ~a 10.0
EI~IHIT A~ - SUBS.T~i1~TCE ABUSE AGR ~~ ~~
Substance Abase Servi~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:
r~
L`J
Contract
Fee Allowance/Discount 30%
$ 75.00 $ 52.50
$ 150.OQ $105.00
$ 90.00 $ 63.D0
$ 70.00 $ 49.00
$ 100.00 $ 70.00
$ 150.00 $105.00
$ 25.00 $ 17.50
$ 10.00 $ 7.00
$ 65.00 $ 45.50
n/a _
Statement of services provided to all clients in each county within 45 days of receipt of services.
L~rAd .. un~rly summary invoice of services rovid
~f -~ . p ed, 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. ~ .
Defimttion 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. ~ ~ .
Casa 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.
~ r
PURCHASE OF SERVICE CONTRACT - NINE COUNTY REGIONAL AGREEMENT
CORE SERVICES PROGRAM - MENTAL HEALTH - 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, §26-1-101,
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
mental health services and is willing to provide such services
in a nine county region; and
WHEREAS, BOCCs desire to engage the Contractor to render
certain mental health 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 mental health services, including but not limited to
psychiatric and psychological assessments, family assessments,
individual therapy, family and group therapy, crisis counseling,
medication management, psycho-educational services and case
management 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.
Nine County Regional Core Services -Mental Health 1
Colo West FY 03-04 8/7!2003 Final
• •
Contractor shall provide services in accordance with State
Department of Human Services regulations, found at 12 CCR 2509-
4, Section 7.303, 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 mental health 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)
Nine County Regional Core Services -Mental Health 2
Colo West FY 03-04 8/7/2003 Final
• •
provide Contractor with appropriate referral information, such
as name, address, State ID number and social, medical and
educational information as appropriate to the referral; (5)
provide the appropriate 4-county Group and 5-county Group
contract administrator, as identified in Section XIV, below,
with summary financial data including client specific billing
records, identified by State ID number and name, on a monthly
basis.
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 Ten Thousand Seven Hundred Eight Dollars and
Fifty-five Cents ($10,708.55)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 Ten
Thousand Seven Hundred Eight Dollars and Fifty-five Cents
.($10,708.55) 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%) 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
One Hundred Thirty Two Thousand Four Hundred Ninety-seven
Dollars and-Fifty Cents ($132,497.50) 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 One Hundred Thirty Two Thousand Four
Hundred Ninety-seven Dollars and Fifty Cents ($132,497.50) 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.
Compensationin accordance with the terms of this Agreement
represents full payment of fees by the BOCCs for services
provided to referred clients.
Nine County Regional Core Services -Mental Health 3
Colo West FY 03-04 8/7/2003 Final
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
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 ~l.ot-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 $132,497.50 = $158,997.00, 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.
Nine County Regional Core Services - Mental Health q,
Colo West FY 03-04 8/7/2003 Final
~ •
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 (800) or less of the not-to-exceed figures,
identified in Subsection B above, (.80 x $132,497.50 =
$105,998.00, minus 3o administrative retainage fee) will
likely 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 (800) or less of the not-to-exceed figures,
i.e, usage of $105,998.00 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 or 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
Nine County Regional Core Services - Mental Health 5
Colo W est FY 03-04 8/7/2003 Final
r ~
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 mental health services, as
deemed adequate and appropriate by the referring County
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, One Hundred Thirty Two Thousand Four Hundred Ninety-
seven Dollars and Fifty Cents ($132,497.50) for the 4-county
Group and One Hundred Thirty Two Thousand Four Hundred Ninety-
seven Dollars and Fifty Cents ($132,497.50) for the 5-county
group. Subcontracting on an individual case basis shall be
approved by the signature of the 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
Nine County Regional Core Services - Mental Health
Colo West FY 03-04 8/7/2003 Final
-~
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.
AUTOMOBILE LIABILITY: $150,000.00 per person, $600,00.0.00 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
Nine County Regional Core Services -Mental Health 7
Colo West FY 03-04 8/7/2003 Final
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.
XIV. CONTRACT ADMINISTRATORS AND CONTACT PERSONS.
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 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.
Nine County Regional Core Services -Mental Health 8
Colo West FY 03-04 8/7/2003 Final
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.
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.
Ga.fiel3 County Clerk
APPROVED:
Garfield County Department of
Social erv'ces, or Designee
By:
Lyn R ick, Director
P.O. B 850
Glenwood Springs, CO 81602
BOARD OFgqC~ Y COMMISSIONERS
ARF I ELDI ~O Y ~JCC~JLORADO
By: \
J
Date:/
C~
Nine County Regional Core Services - Mental health (~
Colo West FY 03-04 8/7/2003 Final
BOARD OF COUNTY COMMISSIONERS
ATTEST: GRAND COUNTY, COLORADO
By:
`9 rand CC u_~~C1~~ Chair
~ Date : ~ 26 - 03
ATTEST:
~/ /~
Jackson County Clerk
BOARD OF COUNTY COMMISSIONERS
JACKSON COUNTY, COLORADO
By:
Chair
Date : ~ r-,~~~~
APPROVED:
Grand County and Jackson County
Department of Social Services, ,
or Designee
By : ~ ~ ~~~c~~~
Philp M s, Director
Address: P.O. Box 204
Hot Sulphur Spgs, CO 80451
ATTEST:
BOARD OF COUNTY COMMISSIONERS
EAGLE COUNTY, COLORADO
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
By:
Chair
Date:
Nine County Regional Core Services - Mental Health 1 ~
Colo West FY 03-04 8/7/2003 Final
BOARD OF COUNTY COMMISSIONERS
ATTEST: GRAND COUNTY; COLORADO
Grand County Clerk
ATTEST:
By:
Chair
Date:
BOARD OF COUNTY COMMISSIONERS
JACKSON COUNTY, COLORADO
Jackson County Clerk
APPROVED:
Grand County and Jackson County
Department of Social Services,
or Designee
By:
By:
Chair .
Date:
Philip Maes, Director
Address: P.O. Box 204
Hot Sulphur Spgs, CO 80451
~~n~'il Rtl 'li Ilrl r, 1 1 ~~ y 1` ~ F ~} ~
I~
~> s= ~ ~ P \
~T T.~ N d s E~ ~ ~
ry~ /~~ d
Eag~~ County C~'"`'"
BOARD OF COUNTY COMMISSIONERS
EAGLE COUNTY, COLORADO
z ay
' Chair
Date:
APPROVED:
Eagle County Department of
Health & Human Services, or
Designee
By : G(,~
Kath een L. F ash,
D' etor
Address: P.O. Box 660
Eagle, CO 81631
Nine Cmmty Regional Core Services - M®tal Health
Colo West FY 03-04 8{7/2003 Final
iQ
A~~TIlTEST
-V~
Pitkin County~Clerk
n
L_~
BOARD OF COUNTY COMMISSIONERS
PIT'KIN COUNTY, COLORADO
By:
Chair
Date : ~ ~~~
APPROVED:
Pitkin County Department of
Social S rv' s, or De 'gnee
Bey
Kate Jang a, Di for
Address: 100 k Run Dr, #122
Basalt, CO 81621
ATTEST:
Rio Blanco County Clerk
APPROVED:
Rio Blanco County Department of
Social Services, or Designee
By:
Bonnie Ruckman,
Address: 345 Market
Meeker, CO
Director
Street
81641
BOARD OF COUNTY COMMISSIONERS
RIO BLANCO COUNTY
By:
Chair
Date:
Nine County Regional Core Services - Mental Health 11
Cblo West FY 03-04 8P7/2003 Final
ATTEST:
Pitkin County Clerk
APPROVED:
Pitkin County Department of
Social Services, or Designee
By:
Kate Jangula, Director
Address: 100 Elk Run Dr, #122
Basalt, CO 81621
ATTEST:
Rio Bl nco County Clerk
APPROVED:
Rio Blanco County Department of
Social Services, or Designee
By:
Bonnie Ruckman,
Address: 345 Market
Meeker, CO
Director
Street
81641
•
BOARD OF COUNTY COMMISSIONERS
PITKIN COUNTY, COLORADO
By:
Chair
Date:
BOARD OF COUNTY COMMISSIONERS
RIO BLANCO COUNTY
By, ~-- ~~
Chair
Date: ~ ~ 2s-63
Nine County Regional Core Services - Mental Health 11
Cblo West FY 03-04 8/7/2003 Final
•
•
~
t ~:~ '.
s
~~~
'~ BOARD OF
ATTEST : ' ''~ ~ ROUTT
7 ~
r
~.
t._~~~ ~
By:
Rotitt County Clerk '`~=~"
'~~~ - 5
~~ ~ ~~~ ~~
~~~ '~ t,~ Date
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
•
~!'Y COMMISSIONERS
OLORADO
APPROVED AS TU
RQUTT COUNTY ATT©Rf
Date: ~~3Rv;
BOARD OF COUNTY COMMISSIONERS
SUMMIT COUNTY, COLORADO
By:
Chair
Date:
Nine County Regional Core Services -Mental Health 12
Colo West FY 03-04 8/7/2003 Final
BOARD OF COUNTY COMMISSIONERS
ATTEST: ROUTT COUNTY, COLORADO
By:
Routt County Clerk Chair
Date:
APPROVED:
Routt County Department of
Social Services, or Designee
By:
Robert
Address:
White, Director
P.O. Box 772790
Steamboat Spgs, CO 80477
ATTEST:
~~ypyiq~
Summit County Cle
APPROVED:
Summit County Department of
Social Services, or Designee
By : /rl . Liar ~~ ~~e~~
Susan Gruber, Director
Address: P.O. Box 869
Frisco, CO 80443
Nine County Regional Core Services -Mental Health
Colo West FY 03-04 8/7/2003 Final
BOARD OF COUNTY COMMISSIONERS
SUMMIT C LINTY C O O
By:
~c,~~~•~.~~S~v~M, , Chair
Date : $ ~ I g 103 ,,,proven ~
~o lorm ~
~=°m
l.e9al
12
CI
ATTEST:
Moffat County~Clerk
APPROVED:
Moffat County Department of
Social Services, or Designee
By:
Marie Peer, D ector
Address: 595 Breeze Street
Craig, CO 81625
•
BOARD OF COUNTY COMMISSIONERS
MOFFAT COUNTY, COLORADO
By:
Chair
Date : L~.,~,~-1 Zj y o Q3
CONTRACTOR:
COLORADO WEST REGIONAL
MENTAL HEALTH, INC.
By:
Ken Stein, Exec. Director
Address: 6916 Highway 82,
Box 4 0
Glenwood Springs, CO
81601
Date:
Nine County Regional Coro Services - Mental Health 13
Colo West FY 03-04 8/7/2003 Final '
•
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
MOFFAT COUNTY, COLORADO
By:
, Chair
Date:
CONTRACTOR:
COLORADO WEST REGIONAL
MENT TH, INC.
By:
Ken Stein, Exec. Director
Address: 6916 Highway 82,
Box 40
Glenwood Springs, CO
81601
Date : ~/l~ l VUI/7J'
Nine County Regional Core Services -Mental Health 13
Colo West FY 03-04 8/7/2003 Final '
Colorado West Regional Mental Health Center, Inc 2003 Fee Schedule
• NID Fees ~ • ~ act Allowance/Disconnt 30%
CPT Code Description
90801 PsychiaMc 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
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, tnt 75-80 mins $ 220.00
90846 Psychotherapy, family(w/o client), $140.00
90847 Psychotherapy, family(wlth/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
$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
$ 101.50 ~ ,.
$ 73.50
77.00
$ 56.00
$ 24.50 .
Contract Allowance/Disconnt 30%
$ 84.00
90802 Diag Intervlew -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, famlly(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. Psychoeducational Services $ 30.00 $ 21.00
3 ~a 10.0
~u~q ~ ~"~^~' 1~~ ~ss~ss,h~ ~~ ~~ 00•~C~
EXHIBIT A -MENTAL HEALTH AGR - ~ _ _. ..
Substance Abuse Servi~l003 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:
1~
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.
~~~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.
Colorado West Regional Mental Health Center, Inc 2003 Fee Schedule
-~~
MD Fees •
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
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/cHent) $ 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
G~.ract Allowance/Discount 30%
$ 133.00
$143.50
$ 66.50
$ 98.00
$ 87.50
Contract Allowance/Discount 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
$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 Psychoth®rapy, 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. Psychoeducational Services $ 30.00 $ 21.00
EXHIBIT A~= SUBSTANCE ABUSE AGR
__ e~ 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
Urinalysis Collection
Drug Patch Program
Halfway House Residential Program, (daily rate)
"ARU" Residential Program - CLOSED-
Contractor's Submittals:
•
Contract
Fee
$ 75.00
$150.00
$ 90.00
$ 70.00
$ 100.00
$ 150.00
$ 25.00
$ 10.00
$ 65.00
n/a
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;u~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.