6636 Contract Manit Cnty Vivitrol 11 29 17.doc

State of Wisconsin Department of Corrections

Scott Walker

Governor ADVANCE \Y 83.50Jon E. Litscher Secretary

Mailing Address

3099 E. Washington Ave.

Post Office Box 7991

Madison, WI 53707-7991

Telephone (608) 240-5571

Fax (608) 240-3342

C O N T R A C T Services:

DOC Opioid Addiction Treatment Pilot program Services (Service), provided for the Department of Corrections, Division of Community Corrections.

Contract Period:

The Contract shall commence and be effective as of the date when all parties hereto have affixed their respective signatures below and shall continue in effect until June 30, 2018. (2 possible 1-year renewal options may be available by mutual agreement between the Provider and the Department of Corrections).

Provider: Manitowoc County Contract Number:

410036-V18-ELB6636-ING-1

I. DEFINITIONS:

Agency:

Office, department or agency or other body in state government created by the constitution or any law, including the legislature and the courts but not including an authority.

Clean invoice:

Invoice completed according to terms of the Contract and Section 11 of the Standard Terms and Conditions.

Provider:

Successful vendor or provider awarded the Contract.

Provider Staff:

Includes all employees, interns, subproviders, temporary employees and volunteers.

County:

A region created by territorial division for the purpose of local government.

DAI:

Division of Adult Institutions administers all adult state correctional incarceration facilities with administrative offices at DOC Central Offices, 3099 E Washington Ave., Madison, WI 53704.

DCC:

Division of Community Corrections supervises adult offenders outside secure facilities.

DOA:

Department of Administration has statutory authority [WI Stats. Chapter 16] to define, regulate and delegate all aspects of procurement of services and commodities for state agencies.

DOC:

Wisconsin Department of Corrections also referred to as the department or the DOC headquartered at DOC Central Offices, 3099 E Washington Ave., Madison, WI 53704.

DOC Staff:

Includes all employees, interns, subcontractors, temporary employees, and volunteers Offender:

Person under the custody or supervision of the Wisconsin Department of Correction.

Prison:

A correctional institution where persons are confined after being convicted of a crime.

State:

State of Wisconsin.

SubProvider:

SubProvider is a person who is awarded a portion of an existing Contract by a principal or general Provider.

Third Party:

Refers to a person or entity who is not a party to this Contract.

II. RELATIONSHIP BETWEEN PARTIES

II. This Contractual agreement (“Contract”) is entered into for the period from the final signature date through June 30, 2017 with potential options to extend two additional years by and between the State of Wisconsin Department of Corrections, whose principal business address is 3099 East Washington Ave., P.O. Box 7925, Madison, WI 53707-7925, (the “DOC”), and Manitowoc County whose principal business address is 926 S. 8th Street, Manitowoc, WI 54220 (the “Provider”).

II. The DOC employee responsible for administration of this Contract will be Michael Meulemans, Program and Policy Analyst (“Contract Administrator”) whose principal business address is Division of Community Corrections, Northeastern WI Region 4 Office. In the event that the Contract Administrator is unable to administer this agreement, DOC will contact Provider and designate a new Contract Administrator.

III. CONTRACT AUTHORITY

This Contract is entered under the authority of Wis. Stats.16.75 and Wis. Adm. Code Chapter Adm 10.

IV. STATEMENT OF DELIVERABLES

IV. This Contract detail for providing Service hereunder is specified in Attachment A which is attached hereto and incorporated herein by reference.

V. CONTRACT DOCUMENTS

DOA-3681 (“Supplemental Standard Terms and Conditions for Procurement of Services”) is incorporated into this Contract by reference. To the extent that any term or condition set forth in either Form DOA-3681 differs or conflicts with this Contract, the term, condition, or Contract provision determined by the DOC to be the more favorable to the DOC in any given situation shall govern and control.

VI. CONTRACT REVISIONS / ADDENDUMS

Any subsequent addendum to this Contract must be in writing and signed by the parties.

VII. CONTRACT SCOPE

The purpose of this contract is to administer the pharmaceutical Vivitrol and to monitor medical implications as well as psychological and counseling support.

VIII. GENERAL SERVICE PROVISIONS

VIII. The Provider must complete or currently have on file a facility self-survey and a program and policy self-evaluation to address compliance with the Americans with Disability Act and make such document available to the DOC upon request. (Public Law 101-336, July 26, 1990, 104 Stat. 327 and Title 42, U.S.C.A., ss. 12101 to 12213). During the course of the Contract, the Provider must take action to comply with the facility, program and employment provisions of the Americans with Disability Act. Applicants may obtain information on the Americans with Disability Act by contacting the Director, Office of Diversity and Employee Services, Wisconsin Department of Corrections, 3099 E. Washington Ave., P.O. Box 7925, Madison, Wisconsin 53707-7925.

VIII. Provider may not subcontract, refer to outside/community resources, or assign any part or obligations of this Contract without the prior written consent of DOC. If DOC approves, Provider is responsible for having subcontracts in place to provide the Service to the subcontracted agencies under this Contract. Provider retains responsibility for fulfillment of all terms and conditions of this Contract when it enters into sub Contractual agreements.

VIII. This Contract and the performance of the parties' obligations hereunder will be governed by and construed and enforced in accordance with the laws of the State of Wisconsin, other than any conflict-of-laws provisions thereof that would otherwise require the application of the law of any other jurisdiction. Provider consents to personal jurisdiction in the State of Wisconsin. The venue for any action hereunder shall be in Dane County, Wisconsin.

VIII. No waiver by either party of any default hereunder shall be deemed as a waiver of any prior or subsequent default of the same or other provisions of this Contract.

VIII. If any provision hereof is held invalid or unenforceable by a court of competent jurisdiction, such invalidity shall not affect the validity or operation of any other provision and said provision shall continue to apply to the extent allowed by said court or, if not so allowed, be deemed severed from this Contract entirely.

VIII. Provider guarantees that the sale or use of any software utilized in the provision of services required under this Contract will not infringe any patent or copyright. The Provider selling to the State of Wisconsin the articles described herein guarantees the articles were manufactured or produced in accordance with applicable federal labor laws. Further, that the sale or use of the articles described herein will not infringe on any United States patent. Provider covenants that it will at its own expense defend every suit which shall be brought against DOC (provided that Provider is promptly notified of such suit, and all papers therein are delivered to it) for any alleged infringement of any patent or copyright by reason of the sale or use of such article or software, and agrees that it will pay all costs, damages, and profits recoverable in any such suit.

VIII. DOC will own all right, title, and interest in all data, documentation, programs, information systems, innovations, and all other original works of authorship developed under or associated with this Contract. All such materials shall be deemed works made for hire, subject to a non-exclusive perpetual license, with the right to sublicense reserved by Provider, of DOC for all purposes of copyright law, and any copyright shall belong solely to DOC. In the event that any such work is adjudged not to be a work made for hire, Provider agrees to assign, and hereby assigns, all copyright in such work to DOC. Title to such materials will pass to DOC at the time of acceptance of the deliverable into which the materials and/or Services are incorporated, subject to payment in full for the deliverable and/or Service by DOC. Provider shall, at the expense of DOC, assist DOC or its nominees to obtain copyrights or trademarks for all such works in the United States or other countries. Provider agrees to execute all papers and to give all facts known to it necessary to secure United States or foreign country copyrights and trademarks, and to transfer or cause to transfer to DOC all the right, title and interest in and to such works. DOC reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use, all aforementioned materials specially developed under this Contract. Any discovery or invention arising out of, or developed in the course of work or Services aided by this Contract, shall be promptly and fully reported to the DOC.

VIII. Providers are prohibited from responding to legal or legislative matters as a representative of DOC. All legal or legislative inquires requiring a response by DOC are to be referred to DOC Secretary’s Office in a timely manner for an appropriate response.

VIII. The parties hereto agree that Provider, its officers, agents, and employees, in the performance of this Contract shall act in the capacity of an independent Provider and not as an officer, employee, or agent of DOC. Provider agrees to take such steps as may be necessary to ensure that each of its subProviders will be deemed to be an independent Provider and will not be considered or permitted to be an agent, servant, joint venturer, or partner of DOC. Furthermore, neither DOC nor Provider will represent itself as the agent or legal representative of the other or as partner or joint venturers for any purpose whatsoever, and neither shall have any right to create or assume any obligations of any kind, express or implied, for or on behalf of the other in any way whatsoever.

VIII. All Provider’s staff must understand and be trained in all relevant requirements of this contract.

VIII. Any and all notices or other communications necessary or desirable to be given hereunder will be deemed given and received when personally delivered or sent by facsimile, delivered prepaid same-day or overnight delivery service, proof of delivery requested, or deposited in U.S. certified or registered mail, postage prepaid, return receipt requested, addressed as follows:

(i) If to DOC – Division of Community Corrections

Contract Administrator: Michael Meulemans Facsimile number: 920-751-4601 Michael.Meulemans@wisconsin.gov

(ii) If to Provider– Attention: Daniel Whitney Company: Manitowoc County Human Services Department Facsimile number: 920-683-4512 E-mail:danielwhitney@co.manitowoc.wi.us

IX. PAYMENT TERMS AND INVOICING

IX. Provider will be paid for Service. DOC shall initiate payment to Provider upon receipt of a clean invoice. The Provider shall submit invoices at a minimum showing the description of Service, Contracted unit of measure, Contract price and purchase order. The invoice shall be submitted within 90 days of the last day of the month during which Service was provided. Fee schedule is Attachment B.

IX. If for any reason the DOC is dissatisfied with the quality of the Service the DOC may, at DOC’s sole discretion, provide written notice to the Provider of the deficiency. If the Provider fails to correct the deficiency by the identified date, the DOC may, at DOC’s sole discretion, withhold funds under this Contract. Nothing set forth herein shall prevent or prohibit the DOC from availing itself of other legal or equitable remedies.

X. REPORTING AND AUDITING

X. Provider shall comply with the reporting and auditing requirements of DOC including, without limitation, the requirement that Provider retain all documents applicable to the Contract for a period of not less than three (3) years after the final Contract payment is made. Any required reports shall be forwarded to the Contract Administrator according to the schedule of DOC. If Provider does not submit the forms as required, DOC may cease all payments for Services to Provider under this Contract.

X. DOC may require, at its discretion that Provider provide an audit covering all DOC funds paid pursuant to the Contract. In the event that Provider fails to comply with a DOC audit request including all follow-up requests for information pertaining to said audit, DOC reserves the right to conduct an independent audit and DOC’s costs for completing the same will be charged back to Provider. Provider agrees to retain and make available to DOC all program and fiscal records until the audit and, if necessary, subsequent audit resolution processes have been completed.

X. No Service is to be provided until an official State of Wisconsin Purchase Order is issued by DOC to Provider. When there is more than one State fiscal year (July 1 through June 30) or a portion of a fiscal year in the Contract period, a separate purchase order will be issued for each fiscal year in accordance with Department policy on the issuance of purchase orders.

X. Provider agrees to inform DOC within three (3) working days of any inquiry from outside entities regarding a participant, former participant or the program provided under this Contract. This includes requests for information from the media, legislature, local officials, neighbors and participant's family members. Nothing in this Contract prohibits the Provider from freely communicating with any entity regarding the program or participants to the extent allowed by confidentiality requirements.

X. Program evaluation is intended to document program implementation, as well as return useful information to program sites for the purpose of program improvement. The Provider agrees to collaborate and participate in program evaluation activities set by the DOC.

XI. RECORDS

A. Provider shall maintain such records as are required by State and Federal law and shall comply with all applicable confidentiality laws and requirements pertaining to said records and the information contained therein.

B. Provider will allow inspection of records and programs, insofar as is permitted by State and Federal law, by representatives of DOC and its authorized agents, and Federal agencies, in order to confirm Provider's compliance with the specifications of this Contract.

C. Provider agrees to retain and make available to DOC all program and fiscal records until the audit and subsequent audit resolution processes have been completed.

D. To ensure confidentiality of records and safeguard access to these records, Provider must maintain sufficient locked storage space for current and closed offender records.

E. Provider agrees to have a written policy on confidential destruction of case records.

XII. INSURANCE RESPONSIBILITY

A. Provider shall:

(i) Maintain worker's compensation insurance as required by Wisconsin Statutes, for all employees engaged in any work under this Contract.

(ii) Maintain commercial liability, bodily injury and property damage insurance against any claim(s) which might occur in carrying out this Contract. Minimum coverage shall be one million dollars ($1,000,000) liability for bodily injury and property damage including products liability and completed operations.

(iii) Medical Malpractice Insurance in limits required by the State of WI B. DOC reserves the right to require higher or lower limits where warranted.

Provider is required to submit an insurance certificate adding State of Wisconsin as an additional insured, covering the period of the Contract and each year thereafter during the current Contract period. When the period of this Contract does not coincide with the coverage period of the Provider's insurance, Provider is required to submit an updated certificate to verify coverage in compliance with this subsection. The insurance certificate is required to be presented prior to the issuance of the purchase order or before commencement of the Contract.

XIII. EMPLOYMENT OF CURRENT OFFENDERS AND EMPLOYMENT AND RETENTION OF INDIVIDUALS ARRESTED, CHARGED OR CONVICTED OF CRIMINAL OFFENSES.

A. Provider may not employ a person who is on probation, parole, extended supervision, lifetime supervision or an inmate who is supervised by Intensive Sanctions for any position where the primary duties and responsibilities involve the supervision or treatment of inmates, probationers or parolees or involve access to offenders' records or funds.

B. Provider will implement policies and procedures to ensure that:

1. Job applicants or current employees shall be dealt with as follows:

a. For a job applicant who has a pending criminal charge: Where the circumstances of said criminal charge substantially relate to the circumstances of a particular job or licensed activity, the applicant will not be hired for that job;

b. For a current employee who has a pending criminal charge: Where the circumstances of said criminal charge substantially relate to the circumstances of a particular job or licensed activity, the employee will not be continued in that particular job;

c. For a job applicant who is convicted of a criminal charge: Where the circumstances of said criminal charge substantially relate to the circumstances of a particular job or licensed activity, the applicant will not be hired for that job; and

d. For a current employee who is convicted of a criminal offense: Where the circumstances of said conviction of a criminal or other offense that substantially relates to the circumstances of the current job or licensed activity, the employee will not be retained in that particular job; and

e. For a job applicant who is required to use an Ignition Interlock Device (IID): Where the circumstances of said court ordered requirement substantially relate to the circumstances of a particular job or licensed activity, the applicant will not be hired for that job; and

f. For a current employee who is required to use an Ignition Interlock Device (IID): Where the circumstances of said court ordered requirement substantially relate to the circumstances of a particular job or licensed activity, the employee will not be retained in that particular job.

2. Nothing in this Contract prohibits the Provider from reassigning or suspending the employee or, in the case of a conviction, terminating the employee.

C. In hiring and retention decisions, Provider may consider records of pending criminal charges and convictions when it can be demonstrated that the circumstances of the offense substantially relate to the circumstances of the job or licensed activity. When determining whether the circumstances of a pending charge or conviction are substantially job related, Provider should take into consideration elements related to the position, the offense, and the individual.

D. To make determinations on substantial relationships to the circumstances of the job, Provider must have written policies on how the applicant for employment and the employee will be reviewed. To guide the development of the policy, the Provider may obtain a copy of Chapter 301, attachment A of the Department of Corrections Supervisor's Manual from the Contract Administrator.

XIV. FRATERNIZATION

A. Provider agrees to have a written policy on fraternization which prohibits the forming of improper relationships between Provider's employees and offenders. The policy must be substantially equivalent to the Department of Corrections' policy as expressed in Executive directive 16, May 1991 - Revised October 2001. A copy of Executive Directive 16 may be obtained from the Contract Administrator.

B. Provider’s policy required in subsection A above shall provide, at a minimum, for the following: definitions of employee, relationships and offender; a statement of prohibited relationships; duty of an employee to inform Provider of unplanned contacts with offenders; a statement that Provider-directed contacts or those which are part of the employee's job duties are exempt from the policy; an exception procedure which may be carried out by Provider’s designee; and a standard employee statement indicating that each employee has read a copy of the Provider's policy on fraternization.

C. Provider shall also agree to have a written policy which prohibits Provider’s employees from engaging in any sexual contact or sexual intercourse with offenders under the custody and control of the DOC. The policy must be substantially equivalent to the DOC’s policy as expressed in Executive Directive 16-A, August 2006. A copy may be obtained from the Contract Administrator.

D. Provider must maintain a copy of the signed employee statement on fraternization in each employee's personnel file.

XV. FAITH-BASED ORGANIZATIONS

A. A faith-based organization is eligible to be a Provider on the same basis as any other private organization. If Provider is a faith-based organization it shall retain its independence from the State of Wisconsin, including without limitation Provider’s control over the definition, development, practice, and expression of its religious beliefs. Except as otherwise provided by state or federal law, DOC shall not interpret this Contract to require a faith-based organization to alter its form of internal governance or remove religious art, icons, scriptures, or other symbols.

B. A religious organization does not, by Contracting with the State of Wisconsin, lose the exemption provided under Section 702 of the Civil Rights Act (42 U.S.C. 2000e-1(a)) regarding its employment practices. Furthermore, if a faith-based organization segregates the government funds provided under the Contract, then only the financial assistance provided by these funds will be subject to audit.

C. Neither DOC’s selection of a faith-based Provider to provide the Services described herein nor the expenditure of funds under this Contract is an endorsement of the Provider’s religious character, practices, or expression. The purpose of this Contract is the provision of Services; none of DOC’s expenditures have as their objective the funding of sectarian worship, instruction, or proselytization. As such, a faith-based Provider of Non-secular Services under this Contract shall post at its place(s) of business the following written notice and personally apprise all assisted offenders of the same unless its programming is exclusively secular and it does not display conspicuous symbols of its religious character, practices, or expression:

Neither the State of Wisconsin’s selection of a faith-based Provider of services nor the expenditure of funds under any Contract with said Provider is an endorsement of that Provider’s religious character, practices, or expression. No Provider of services may discriminate against you on the basis of religion, a religious belief, or your refusal to actively participate in a religious practice. If you object to a particular Provider because of its religious character, you may request assignment to a different non-sectarian Provider by contacting your Agent.

XVI. TERMINATION / CANCELLATION:

In addition to grounds for termination set forth elsewhere in the Contract, this Contract may be terminated under any of the following conditions:

A. DOC may terminate the Contract at any time, with or without cause and without penalty by delivering thirty (30) days written notice to the Provider.

B. DOC has a Vendor Performance Evaluation process for soliciting feedback from Contract users about vendor performance and compliance with Contract specifications. Vendor noncompliance with the terms, conditions or specifications that is persistent and/or significantly impacts the quality and performance provided pursuant to the Contract may be considered in breach of Contract. Negative Vendor Performance Evaluation Surveys may result in non-renewal or termination of Contract.

C. The State of Wisconsin reserves the right to cancel this Contract if the Provider fails to follow the requirements of including Wis. Stats. 77.66, and related statutes regarding registration and certification for collection of sales and use tax D. If at any time the Provider performance threatens the health and/or safety of DOC employees, offenders or the public, DOC has the right to cancel and terminate the Contract without notice.

E. Failure to maintain the required Certificates of Insurance, Permits and Licenses shall be cause for Contract termination.

F. If at any time a petition in bankruptcy shall be filed against the Provider and such petition is not dismissed within 90 calendar days, or if a receiver or trustee of Provider's property is appointed and such appointment is not vacated within 90 calendar days, DOC has the right, in addition to any other rights of whatsoever nature that it may have at law or inequity, to terminate the Contract by giving 10 calendar days’ notice in writing of such termination.

G. Failure of DOC to comply with Contract terms, conditions or specifications shall provide the sole cause for which the Provider is entitled to terminate the Contract. The Provider shall notify the Department in writing within thirty (30) days after the Provider becomes aware of the alleged noncompliance with a complete description of the same. If the DOC does not, within forty-five (45) days after its receipt of the Provider’s notice, either (1) effect a cure or (2) if the noncompliance is not one that can reasonably be cured within forty-five (45) days, develop a plan to cure the noncompliance and diligently proceed according to that plan unto a cure is effected, then the Provider may terminate the Contract for cause by written notice to DOC. The Provider may not terminate the Contract without cause unless express written consent to do so is provided by DOC.

XVII. EXECUTED CONTRACT TO CONSTITUTE ENTIRE AGREEMENT

A. The contents of this Contract (including all attachments) and the bid of the successful bidder, and additional terms agreed to, in writing, by DOC and the Provider shall become part of the Contract.

B. The following priority for Contract documents will be used if there are conflicts or disputes:

State of Wisconsin supplemental standard terms and conditions

Final Signed Contract including amendments Official State of Wisconsin Purchase Order Statement of Deliverables

XVIII. CONFIDENTIALITY

A. All confidential health, mental health, drug and alcohol information or educational information reviewed and collected in connection with this Contract shall be handled by the Provider in a manner consistent with the applicable state and federal confidentiality laws.

B. Provider acknowledges that some of the data and documentation it may become privy to in the performance of this Contract is of a confidential nature. Provider shall make all reasonable efforts to ensure that it or its employees and subProviders do not disseminate such confidential information without the Purchaser’s prior permission and in a manner that complies with all applicable confidentiality laws and requirements.

C. Provider or its employees may have direct or indirect contact with offenders, staff, or other parties. All services provided to offenders are confidential in nature. Provider shall make all reasonable efforts to ensure that it or its employees and subProviders do not disseminate such confidential information, including but not limited to identity of offenders or services being received. Provider must have a policy regarding ethics and confidentiality for their staff to follow.

D. Provider or its employees and subProviders will not reuse, sell, or make use in any format the data researched or compiled for this Contract for any venture, profitable or not, outside this Contract.

E. Provider agrees to observe complete confidentially with respect to all aspects of any confidential information, proprietary data and/or trade secrets and any parts thereof, whether such contents are the State's or the manufacturer's, proposer's, or distributor's whereby Provider or any Provider's personnel may gain access while engaged by the State or while on State premises.

F. The restrictions herein shall survive the termination of this Contract for any reason and shall continue in full force and effect and shall be binding upon the Provider or its agents, employees, successors, assigns, subProviders, or any party claiming an interest in this Contract on behalf of or under the rights of Provider following any termination. Provider shall advise all Providers’ agents, employees, successors, assigns and subProviders which are engaged by the State of the restrictions, present and continuing, set forth herein. Provider shall defend and incur all costs, if any, for actions that arise as a result of noncompliance by Provider, its agents, employees, successors, assigns and subProviders regarding the confidentiality restrictions herein.

XIX. CONCEALED CARRY

Provider is prohibited under Executive Directive 80, signed October 31, 2011 from possession of any weapon by Provider's employees while providing services to DOC offenders.

Provider will prohibit firearms/weapons in any owned, leased/rented, or available location in which program services are provided for DOC. Signs shall be posted at every public entrance. Each sign must be at least five inches by seven inches state the restriction on carrying a firearm, and inform people that weapons or firearms are prohibited. Sample signage will be available through the Contract Administrator.

XX. DEBARMENT

Federal Executive Order 12549, titled “Debarment”, requires that all Providers receiving individual awards, using federal funds, and all sub recipients certify that the organization and its principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from doing business with the Federal Government. Information on debarment is available at the following websites: www.epls.gov and www.arnet.gov/far/. In the event the Provider is debarred, the DOC reserves the right to cancel the Contract upon notice.

In WITNESS THEREOF, the undersigned authorized officers have subscribed their names on behalf of the parties to this Contract.

Provider's Authorized Representative

Date

Name:

Title:

DOC Contract Administrator / Manager

Name: Michael Meulemans Title: Program and Policy Analyst

Cathy A. Jess, Deputy Secretary

WI Department of Corrections

ATTACHMENT A

DELIVERABLES

Manitowoc County Human Services Department (MCHSD) shall provide program services to clients who are currently under community supervision with the DOC in Manitowoc County.

Program Elements

1. Participants: Will currently be on supervision through the DOC, Division of Community Corrections and referred by the Division of Community Corrections. There will be no minimum number of referrals by the Division of Community Corrections for programming under this contract. MCHSD will provide services to a maximum of ten (10) participants per contract year.

2. Program Format: May include any and all services including psychiatric evaluation and med management, Vivitrol injections, urine drug screens (UDS) at the discretion of the provider, bio-psychosocial assessment, group (primary outpatient and relapse prevention), family, and individual counseling.

3. Programming:

a. Psychiatric Evaluation: Each participant will be provided an evaluation by our adult psychiatrist (CPT 90792)

b. Medication Management: The participant will attend follow-up appointments with the psychiatrist to monitor medications, overall progress and adjust medications as appropriate. Orders for a UDS may also occur. (E&M established patient code usually 99213)

c. Bio-psychosocial assessment: The participant will be evaluated by a mental health/substance abuse counselor which will include determining appropriate level of care, establishing a treatment plan, and orienting the participant to the AODA program. (CPT 90791)

d. Group Counseling: The participant will participate in a primary outpatient group that focuses upon basic recovery skills. The group meets twice each week for two and one-half hours. (5:30 pm to 8:00 pm) The participant will usually attend at least seven (7) weeks. After completing this group, the participant will attend at least twelve (12) weeks in the Relapse Prevention group. (CPT 90853. If the participant completes all group requirements, he/she may continue to participate in the Relapse Prevention group for an additional eight (8) weeks at no charge.)

e. Individual and Family therapy: The participant will be provided with individual counseling as deemed appropriate by the clinical staff. At least one family counseling session is usually required. (CPT 90834 or 90847)

f. Program participants are required to be compliant with HFMBH policies and current business practices including those pertaining to discharge from the program with cause as determined by HFMBH clinicians and/or operations manager. Participants will follow the HFMBH No Show Policy. (attached)

ATTACHMENT B

FEE SCHEDULE

Psychiatric Evaluation $165.00

AODA Assessment $130.00

Includes a 2 hour clinical evaluation, UA, and benefit specialist assistance if required

AODA Group counseling $40.00 per session

AODA Individual counseling $60.00 per hour

IOP consists of (3) 3-hour group sessions and (1) 1 hour individual counseling

Vivitrol $1,178.00 per dose

Vivitrol Injection by RN $65.00 per dose

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