REGION 6 BEHAVIORAL HEALTHCARE
CONTRACT NUMBER R6 FY17 - TEMPLATE
Regional Contract for Behavioral Health Services
The Region 6 Governing Board (hereinafter referred to as Region 6) and ______(hereinafter referred to as Service Provider) have entered into a contract for the provision of mental health and/or substance abuse services (hereinafter referred to as behavioral health or BH services), and specialized services as Federal legislation may require.
CFDA Title and Number: 93.958
Award Name: Block Grants for Community Mental Health Services
Award Date: 10/1/15 through 9/30/17
Issue Date: 12/2/15
Name of Federal Agency: Department of Health & Human Services, Substance Abuse and
Mental Health Services Administration, Center for Mental Health Services
Federal Award Identifier #: SM010034-16
This contract is not for research.
CFDA Title and Number: 93.959
Agreement Name: Substance Abuse Prevention & Treatment Block Grant
Award Date: 10/1/15 through 9/30/17
Issue Date: 3/15/16
Name of Federal Agency: Department of Health & Human Services, Substance Abuse and
Mental Health Services Administration, Center for Substance Abuse Treatment
Federal Award Identifier #: T1010034-16
This contract is not for research.
PURPOSE. The purpose of this contract is for the provision of behavioral health (mental health and substance abuse) services. This contract includes Federal dollars listed above, state appropriations and/or county dollars.
I. PERIOD OF PERFORMANCE AND TERMINATION
A. TERM. This contract is in effect from July 1, 2016 through June 30, 2017.
B. TERMINATION. This contract may be terminated at any time upon mutual written consent or by either party for any reason upon submission of written notice to the other party at least thirty (30) days prior to the effective date of termination. Region 6 may also terminate this contract in accord with the provisions designated “FUNDING AVAILABILITY” and “BREACH OF CONTRACT.” In the event either party terminates this contract, the Service Provider shall provide to Region 6 all work in progress, work completed, and materials provided in connection with this contract immediately.
II. AMOUNT OF CONTRACT
A. TOTAL CONTRACT. Region 6 shall pay the Service Provider a total amount, not to exceed $______for the activities specified herein. Specific funding source is identified in Attachment A.
B. PAYMENT STRUCTURE. Payment shall be structured as follows:
1. Service Provider shall submit billings no later than the 7th day of the month following the month service was delivered in the format specified by Region 6.
a. When the 7th falls on a Saturday it is due to the Region on Friday the 6th. If the 7th falls on a Sunday or a Monday that is a Region 6 holiday then it is due to the Region on the following day.
b. A billing that has incorrect or incomplete information will not be accepted or processed until such time that the information is accurate and complete.
c. Service Provider shall submit the current billing forms required by Region 6 and the Nebraska Department of Health and Human Services (hereafter DHHS).
2. The Service Provider will only submit billings for services provided to individuals who meet the Clinical Criteria for an identified level of care, meet Financial Eligibility Criteria set by DHHS, are Nebraska residents, and are either a US Citizen or living in the US legally. Service Provider must deduct copayments from consumers and other third party payments received for the service prior to billing any service paid on an expense reimbursement basis. If the expense reimbursement billed is a Capacity Access Guarantee (CAG), Capacity Development (CD), Service Enhancement (SE), or Pilot Project for a service paid on a Region or state rate, the provider must apply any excess funds generated by the primary service against the CAG, CD, SE, or Pilot Project prior to billing.
3. Region 6 will release funds to Service Provider when funds are received from DHHS.
4. The Service Provider will not submit reimbursement requests for services for any Medicaid eligible individual receiving Medicaid eligible services.
5. Final invoices must be submitted by last billing in the contract term or will not be paid.
C. TERMS DEFINED:
1. Nebraska Behavioral Health System (NBHS): The combined structure of the state Division of Behavioral Health, the six Regional Behavioral Health Authorities, Regional Behavioral Health providers, and the State-operated Regional Centers into an organized structure that manages and provides mental health and substance abuse services for residents of the State of Nebraska.
2. Regional Behavioral Health Authority (RBHA) means the regional administrative entity responsible for the development and coordination of publicly funded behavioral health services for each Behavioral Health Region, and receives State and Federal funds from DHHS. The RBHA is responsible for ensuring compliance with all state and federal statutes, regulations, rules, conditions and limitations associated with these funds. For the purposes of this contract, the Regional Behavioral Health Authority shall be referred to as “Region 6”.
3. Behavioral Health (BH) services: Services that include mental health, substance abuse and prevention services. For the purposes of this contract, MH shall mean Mental Health and SA shall mean Substance Abuse.
4. Service Provider: An entity that receives Federal and/or State funds from a Region through a subgrant, contract or other agreement and is responsible for ensuring compliance with all state and federal statutes, regulations, rules, conditions and limitations associated with these funds.
5. Service Category: Service categories shall be defined as emergency, inpatient, residential, non-residential, children, prevention and coordination/administration. Service categories are designated as either being MH or SA.
D. DOCUMENTS DEFINED:
- The following documents are incorporated herein by this reference:
a) Attachment A – Behavioral Health Services Funding Summary
b) Attachment B – Service Provider Responsibilities
c) Attachment C – Federal and State Mandates
- The Service Provider will comply with the following documents:
a) Nebraska’s Health and Human Services -State Title 206 Regulations and Service Definitions
b) Most recently approved version of the Region 6 Billing Basics Document
c) Most recent approved version of the Supported Employment Manual (this only applies to Service Providers of supported employment)
E. BUDGET CHANGES.
1. Region 6 is permitted to reassign funds within service categories.
2. Funding for any of the following services may not be altered without prior written consent of Region 6:
- Total funding for SA Prevention Activities
- Total funding for Children’s Mental Health Services
- Total funding for SA Women Set Aside Services
- Total funding for MH Housing Assistance Program
- Total funding for Supported Employment Services
III. STATEMENT OF WORK
A. Service Provider shall do the following:
1. Service Provider’s budget plan for behavioral health services for each fiscal year shall be submitted to Region 6 annually by the deadline set by Region 6.
2. Service Provider agrees to ensure the provision of services in accordance with all applicable State standards and regulations, and Federal regulations and requirements relative to the allocation of funds and provision of services specified in this contract.
- Service Provider must participate in any Needs Assessments conducted by DHHS or Region 6;
- Be accredited;
- Demonstrate quality, appropriateness, and efficiency of treatment as required by 42 USC § 300x-53 (a) (1) (A);
- Service Provider shall ensure Federal confidentiality procedures are in place for 42 CFR part 2 and part 54, as well as requirements for the Health Insurance Portability and Accountability Act (HIPAA);
- Service Providers will assist in the referral of individuals to the treatment modality that is most appropriate for the individuals.
3. Service Provider shall comply with the following priorities for admission to behavioral health services, including inpatient, residential and non-residential services as applicable and reimbursed under this contract:
- Mental Health community services priorities are listed in ranking for first priority to fourth:
1) Persons being treated in the Regional Center who are ready for discharge
2) Persons being treated in a community inpatient setting or crisis center and who are awaiting discharge
3) Persons committed to outpatient care by a Mental Health Board
4) All others
- Substance Abuse priority populations are listed in ranking for first priority to fifth:
1) Pregnant injecting drug users
2) Other pregnant substance users
3) Other injecting drug users
4) Women with dependent children
5) All others
4. Service Providers will utilize a ‘no refusal’ approach to admitting persons determined eligible for community-based BH services in Region 6’s network.
5. The Service Provider agrees that no person shall be denied access to mental health or substance abuse treatment solely on the basis of participation in medication assisted treatment for a substance use disorder. Medication assisted treatment refers to a range of pharmacotherapy available to detoxify, maintain or otherwise medically manage clients to treat addiction.
6. The Service Provider agrees to notify Region 6 of any incident that results in death or serious injury to any client, community member or staff member according to Region 6’s policy and procedure on reporting sentinel events. Notification should occur within 48 hours of the incident.
7. Service Providers agree that with the exception of providers of clinically managed residential detoxification (aka social detox), and halfway house, if a Service Provider’s services are eligible for Medicaid funding, the Service Provider must be enrolled as a Medicaid provider. Region 6 may annually request a waiver of this provision for any service.
8. Service Providers will immediately notify Region 6 when a Service Provider’s license is denied, suspended or revoked in any funded service. Region 6, in its sole discretion, may immediately terminate this contract with Service Provider when the Service Provider’s licensure is denied, suspended or revoked in any funded service, or in the event that Service Provider places a consumer in imminent jeopardy of their health and safety.
9. Service Provider agrees to purchase and maintain adequate insurance coverage to cover their exposure. Service Provider will provide Region 6 with proof of insurance upon request for the following types of coverage:
a. Workers’ Compensation;
b. Motor vehicle liability insurance in accordance with the minimums set by State law and agrees that Region 6 or DHHS will not provide any insurance coverage for vehicle(s) operated by the Service Provider;
c. Professional liability coverage of not less than $1,000,000, including participation in The Excess Liability funder under the Nebraska Hospital Medical Liability Act, if the Service Provider qualifies;
d. Director and Officers’ Liability Insurance or an Official’s Bond or a Fidelity Bond for all members of boards and commissions; and
e. General liability insurance in an amount not less than $1,000,000.
10. Provisions relating to Independent Annual Audits by a Certified Public Accountant (CPA):
a. Service Provider agrees to pay for and provide Region 6 with one (1) copy of an independent annual financial CPA audit, including any correspondence or letters to management from the CPA completing the audit, as specified in the rules and regulations and in this contract. Annual financial CPA audits can be sent electronically.
1) Service Provider agrees that all revenues for all MH and/or SA services must be reported in the financial CPA audit separately from other programs and services provided by Service Provider.
2) Service Provider agrees that the annual financial CPA audit shall include a two-year comparison of funds.
3) Service Provider’s annual financial CPA audit shall be due to Region 6 180 days (6 months) after the end of Service Provider’s fiscal year.
4) Service Provider shall ensure that a copy of this contract is provided to the CPA firm doing the financial audit.
b. Service Provider providing any type of BH services under this contract receiving less than $50,000 annually may comply with this section through one of the following:
1) An annual fiscal audit by a CPA firm, with revenue and expenditure details of programs funded under this contract;
2) A fiscal year-end unaudited financial statement of revenues and expenditures, including a use of funds statement and a statement of fund balances for all fund sources for the specific service(s) fully or partially paid with funds identified in this contract.
3) The due date for the appropriate independent financial review to be forwarded to Region 6 is no longer than 6 months after the end of the Service Provider’s fiscal year.
4) If audits, complications, or reviews are not received by the appropriate date, funds will be withheld in any current contract until such financial reports are received. If such reports are not received by the end of the current contract year, Region 6 shall require a repayment of funds paid under the previous contract.
5) Region 6 will not contract with Service Provider when a required fiscal audit or other fiscal documentation has not been submitted as required above.
6) Service Provider shall provide annual financial audits by a CPA firm that are in conformance with the requirements of Office of Management and Budget (OMB) Circular A-133, or any other applicable Federal requirements.
c. Service Provider shall keep financial records which are sufficient to permit the preparation of reports required by Region 6 and DHHS and to permit the tracking of Federal block grant funds to a level of expenditure adequate to ensure the funds have been spent in accordance with applicable Federal restrictions on expenditures, uses of set aside and maintenance of effort funds included as part of the financial audit.
11. Service Providers of children’s services must ensure they have a policy requiring a psychosocial screening within two (2) weeks of admission for every youth treatment client, unless such screen has been conducted within the last six (6) months and is received by the treatment program.
- Screenings must assess suicide risk and other developmental, psychological, and familial factors which may indicate the client’s need for MH services.
- Screenings must be developed in consultation with a professional, as allowed within their scope of practice.
- Screenings must be administered in consultation with a professional, as allowed within their scope of practice.
- Should screening show the need for further assessment or MH services, the provider shall initiate a referral for such services within one (1) week.
12. Service Provider agrees to provide an accounting to Region 6 of all sources and expenditures of funds for all service(s) reimbursed by Region 6 under this contract.