DHHS91073 Scope of Work.doc

SCOPE OF WORK

Article 1

GENERAL ADMINISTRATIVE REQUIREMENTS

1.1 Applicability. The requirements in Article 1 apply to all contracts unless explicitly stated otherwise.

1.2 Definitions. In this contract, the following definitions apply:

“Authorization Form” means a form documenting the services that are pre-approved for a specific Person. Examples of this form include a Medicaid Service Authorization (“MSA”), Purchase Service Authorization (“PSA”), and Domestic Violence PSA (“DVPSA”).

“Business Days” means Monday through Friday, excluding state and federal holidays.

Scope of Work Effective: 8/1/24

“Calendar Days” means all days in a month, including weekends and holidays.

“Care Manager” means a DHHS employee or DHHS designee with primary responsibility for facilitating a high fidelity wraparound process, developing an integrated wraparound plan, and coordinating services and supports.

“Case Manager” means a DHHS employee, DHHS designee, or a Utah Administrative Office of the Courts (“AOC”) Probation Officer with primary responsibility for a Person.

“Collateral Information” means information obtained from the Person’s medical records, a Nursing Facility (“NF”), hospital, Family, Legal Guardian, and or DHHS PASRR Specialist. Collateral information includes: current medical physical examination; medical doctor orders, including prescribed medications; PASRR Level I Screening and Level II Evaluations; functional assessments; social and medical histories; medical documentation justifying the need for NF level of care and specialized services or specialized rehabilitation services; and ID.RC diagnosis documentation and available psychological evaluations that include IQ testing, or any other medical documentation relating to diagnosis.

“Criminogenic Factors” (applicable to Domestic Violence (“DV”) Services only) means DV Offender dynamic factors such as substance abuse (alcohol and other drugs), antisocial attitudes, personality traits, associates, employment, marital and family relationships, and other dynamic variables statistically shown to be correlated with criminal conduct and amenability to change.

“Criminogenic Needs” means needs related to dynamic risk factors that are specific to the Person that cause or are likely to cause criminal behavior.

“DCFS” means the DHHS Division of Child and Family Services.

“DHHS PASRR Specialist” means the DHHS worker assigned to process PASRR Level II Evaluation referrals and determinations.

“DJJYS” means the DHHS Division of Juvenile Justice and Youth Services. “DLBC” means the DHHS Division of Licensing and Background Checks.

“DOPL” means the Utah Department of Commerce, Division of Professional Licensing.

“DSM” means the most current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

“DSPD” means the DHHS Division of Services for People with Disabilities.

“DV Offender” means adult DV Offenders convicted of perpetrating intimate partner violence or cohabitant abuse, or those who self-disclose having done so.

“DV Offender Evaluation” means an evaluation that is conducted before treatment and includes an assessment of the DV Offender’s psychosocial characteristics, history of abusive behavior, risk of harm to self or others, and capacity to benefit from treatment.

“DV Survivor” means an adult or child who has experienced abusive and coercive behaviors perpetrated by a current or former intimate partner or family member who used abusive behaviors to maintain power and control. Abuse can be emotional, financial, sexual, or physical and can include threats, isolation, and intimidation.

“Family” includes the Person’s biological family, a kinship caregiver’s family, adopted family, or other identified permanent caregiver’s family.

“Forensic Evaluation” means a competency evaluation as defined in Utah Code Section 77-15-2(1) and as referenced in Section 80-6-402.

“Foster” means a family licensed to provide out-of-home care by the DLBC and who has completed all of the DCFS requirements for prospective adoptive parents.

“ICD” means the most current edition of the International Statistical Classification of Diseases and Related Health Problems.

“ID.RC” means Intellectual Disability and Related Conditions. A Person with ID.RC has significant limitations both in intellectual functioning (measured as mild, moderate, severe, or profound) and in adaptive behavior required for daily living that is manifested before age 18, as defined by 42 CFR § 483.102(b)(3) and UAC R539-1.

“Legal Guardian” means a parent or legal custodian.

“Non-Clinical Direct Care Staff” means staff trained in accordance with contract requirements to provide supervision or care directly to Persons.

“Non-Medicaid” means any service that is not eligible for payment through Medicaid. “OSUMH” means the DHHS Office of Substance Use and Mental Health.

“PASRR Level I Screening” means the preliminary screening completed by a health care professional that determines if an individual has a suspected mental illness or ID.RC diagnosis which requires a referral for a PASRR Level II Evaluation. This screening must be completed prior to admission to the NF.

“PASRR Level II Evaluation” means an individualized comprehensive evaluation that considers the appropriate setting and unique treatment needs of the Person. The evaluation is used to determine if the Person’s mental illness or ID.RC indicates there is a need for the Person to be in a NF level of care and specialized services.

“Peer Support Services” means an individual certified under Utah Administrative Code R523-6 who has lived experience raising a Child, Youth, or Youth-In Transition, who has navigated the community mental health services, state social services, and special education services on their Child’s behalf, and who has completed, or is working toward FPSS credential completion. The FPSS provides peer support to parents and Caregivers of a Child, Youth, and Young Adult.

“Person” means an individual referred by DHHS or AOC to the Contractor for services.

“PII” means Person identifying information and includes information that identifies or may lead to the identity of the Person or Person’s family. Identifying information includes verbal or written communication, photographs or digital images and video clips, data, and other similar identifying information.

“Person’s Plan” means written, individualized plans for the Person including Treatment Plans, Wraparound Support Plans, service plans, and other similar plans.

“PRA” means Protective Risk Assessment. A PRA is a validated risk and needs assessment administered by DJJYS Case Managers that examines a Person’s risk level to re-offend, and the Person’s Protective Factors and Priority Risk Factors.

“Significant Change Reassessment” means a PASRR Level II Evaluation that is not scheduled and is performed by the Contractor when a significant change occurs to the Person to determine continued NF services.

“Social Networking Mediums” include blogs, email, social network sites (such as Facebook, Twitter, Instagram, Pinterest, Snapchat, LinkedIn, Flickr, or other similar social network sites or applications), letters, newsletters, and other similar mediums.

“Team” means a group of individuals authorized by the Case Manager or the Care Manager that participates in planning, providing, and coordinating supports and services for the Person and family or legal guardian.

“Telehealth” means the practice of mental health care delivery through secure interactive video communications when distance or other hardships create difficulty with consistent access to services. Telehealth occurs in real-time or near real-time.

“Treatment Plan” means a written, individualized plan that addresses the assessed mental health needs of the Person and incorporates the specific targeted treatment needs of the Person.

“Utah Medicaid Manual” means Medicaid policy, as contained in the Utah Medicaid Provider Manual, Rehabilitative Mental Health, and Substance Use Disorder Services. and Utah Administrative Rule R414.

“Victim Advocate” means a professional that is trained to support victims of crime. Victim Advocates offer victims information, emotional support, and help finding resources and filling out paperwork. Sometimes Victim Advocates go to court with victims.

“Volunteer” means an individual who performs a service willingly without pay.

“Wraparound Support Plan” means a frequently updated document that describes the family, Team, and work to be managed to meet the family’s needs and achieve the family’s long-term vision. The Wraparound Support Plan coordinates plans, formal and informal supports, and services across systems.

1.3 Population Served. The Contractor may serve Persons identified by DHHS or AOC and referred to receive one or more contract service.

1.4 Qualifications. The Contractor shall:

(1) if it has more than one DOPL-licensed professional, maintain a current license issued by the DLBC commensurate to the services to be provided;

(2) ensure each Qualified Mental Health Professional (“QMHP”) providing services maintains a current, applicable DOPL license;

(3) maintain a current business license if required by the Contractor’s municipality; and

(4) ensure that its direct care staff are at least 21 years of age.

1.5 Medicaid Enrollment.

(a) If the Contractor provides mental health and substance use disorder services or DV treatment, it shall become a Utah Medicaid Provider prior to providing services. Contractors providing DV treatment may be exempt from this requirement if they have received written approval from the DCFS State Office DV Program Administrator prior to providing services.

(b) The Contractor’s business organization, each licensed QMHP, and each qualified non-licensed staff affiliated with the Contractor who will provide mental health and substance use disorder services or DV services shall enroll separately as a Utah Medicaid Provider prior to providing such services.

1.6 Medicaid Provider Compliance. If the Contractor provides mental health or substance use disorder services, it shall comply with all requirements for providers of Medicaid mental health and substance use disorder services specified in the current Utah Medicaid Manual. In the event this contract and the Utah Medicaid Manual do not agree, the Utah

Medicaid Manual requirements apply. The Contractor shall only bill Medicaid using the DHHS approved rates in the Rate Table.

1.7 Prioritizing Medicaid Services. For all Medicaid eligible clients, the Contractor shall bill Medicaid before this contract. If the Contractor provides both Medicaid services and Non-Medicaid services, whenever possible and clinically appropriate, the Contractor shall utilize Medicaid services over Non-Medicaid services.

1.8 Training Requirements for ALL Staff. The Contractor shall ensure that all pre-service training requirements are met by all staff, Volunteers, and mental health providers prior to working with Persons. The Contractor shall obtain staff signature or electronic verification that staff understands the training they have received. Pre-service training must include:

(1) review of and agreement to abide by the DHHS Provider Code of Conduct, Utah Administrative Code (“UAC”) R495-876; and

(2) orientation to the applicable sections of the Contractor’s emergency management and business continuity plan, including emergency response and evacuation procedures.

1.9 Training Requirements for Non-Clinical Direct Care Staff.

(a) The Contractor shall ensure that Non-Clinical Direct Care Staff are trained in the following subjects prior to providing direct care or supervision of a Person, unless staff are being supervised by a trained direct care staff who is on duty and in the presence of the Person:

(1) trauma informed care/approach, which is a treatment and philosophy that is responsive to the high prevalence of traumatic experiences in Persons who receive services;

(2) separation, grief, and loss;

(3) sensitivity to the unique backgrounds of all Person’s;

(4) attend the provider practice model training hosted by DCFS that will include DCFS practice guidelines;

(5) behavior management, including the relevant behavior management elements in this contract;

(6) first-aid and cardiopulmonary resuscitation (“CPR”) certification;

(7) DHHS Incident Report Reference Guide;

(8) suicide prevention, including identification of warning signs and risk factors, the Contractor’s procedures regarding suicide prevention, observing and monitoring suicidal and self-harming Persons, and coordinating with the Contractor’s licensed QMHP(s) to determine necessary treatment and safety plans;

(9) medication management procedures, including documentation; and

(10) training and coaching specific to the Contractor’s services, the specific strengths and needs of each of the Persons receiving services, and the specific supports and interventions relative to each Person the staff is responsible for.

(b) The Contractor shall ensure that all staff hired prior to this contract complete, or have completed, all training requirements no later than 90 calendar days after the effective date of this contract.

(c) After the first year of employment, and annually thereafter, the Contractor shall ensure that all Non-Clinical Direct Care Staff receive additional training in the following:

(1) applicable sections of the Contractor’s emergency management and business continuity plan, including emergency response and evacuation procedures;

(2) medication management procedures, including documentation;

(3) CPR and first aid certifications;

(4) DHHS Incident Report Reference Guide; and

(5) training and coaching specific to the Contractor’s services, the specific strengths and needs of each of the Persons receiving services, and the specific supports and interventions relative to each Person the staff is responsible for.

1.10 Training Assessment and Documentation. The Contractor shall maintain documentation for all training that includes: (1) training title as listed in this contract; (2) date training completed; instructor name; signatures of staff who completed the training; and curricula utilized in the training. All documentation must be available for review by DHHS.

1.11 Telehealth. The Contractor may use Telehealth to provide services indicated in this contract.

(a) Prior to using Telehealth, the Contractor shall obtain written authorization from the Case Manager, Care Manager, or DSPD Program Administrator (if applicable), except for in crisis interventions.

(b) The Contractor shall use a secure HIPAA-compliant interactive visual telecommunications system that permits real-time communication between the Contractor’s staff and the Person.

(c) The Contractor shall ensure the physical surroundings for all parties are private, quiet, free of interruptions and conducive to a confidential mental health session such as that would normally take place in a mental health practitioner’s office.

(d) If the Contractor records a session, it must be for fidelity monitoring, training and quality assurance purposes. The Contractor shall (1) store records in a HIPAA compliant system; and (2) obtain prior consent from the Person.

(e) The following will not be considered Telehealth: (1) telephone conversations; (2) text messaging; (3) electronic mail messaging (e.g., email or instant messaging); (4) facsimile (fax); and (5) store and forward.

(f) The Contractor may provide the following services via telehealth when clinically indicated and as allowed for Medicaid services: (1) Psychiatric Diagnostic Evaluation (“PDE”); (2) Psychotherapy Services; (3) Pharmacologic Evaluation and Management Services; (4) Therapeutic Behavioral Services; (5) Behavior Analysis Consultation (NOT including Adaptive Behavior Treatment); (6) Clinical Consultation; (7) Non-Clinical Consultation; (8) Evidence-Based Program Models for Prevention of Foster Care Services, if approved by DHHS; and (9) Forensic Evaluation Services.

(g) When using Telehealth, the Contractor will be held to the same standards of quality care and confidentiality as required by state and federal laws, regulations, and policies.

(h) The Contractor shall ensure that all individuals involved in Telehealth sessions identify themselves and that session notes document those in attendance.

(i) Telehealth sessions will be reimbursed at the same rate as a face-to-face encounter.

1.12 PII and Electronic Media.

(a) PII is strictly confidential. The Contractor shall ensure its staff, Volunteers, and subcontractors comply with all confidentiality requirements in this contract and all state and federal laws, regulations, and policies.

(b) The Contractor shall safeguard and not release PII to anyone who is not providing services pursuant to this contract with a need to know, or to any Social Networking Mediums or other public forums unless prior written consent is obtained from:

(1) the Person’s parents, if they retain parental rights in regards to the Person;

(2) the Case Manager, if the Person is in DCFS or DJJYS custody and the parent’s whereabouts are unknown, contact with the parent cannot be made, or the parents do not retain parental rights;

(3) the Person’s legal guardian, if the Person has a legal guardian other than the parent; or

(4) the Person, if the Person is eight years of age or older and has the mental capacity to understand.

(c) When consent is obtained, or the decision is made to allow the Contractor to use information or images in a public forum, the Contractor shall use images that only contain the Person's first name and does NOT identify the Person as a client of the Contractor, a DHHS or AOC client or a client in foster or proctor care.

(d) The Contractor shall only share general information regarding the Person. The Contractor shall not share information that is case specific or that informs other parties of DHHS or AOC involvement or the Person's treatment issues or history.

1.13 Background Screening Requirements. The Contractor shall provide direct supervision of each individual with direct access to any Persons until the individual receives written verification of background screening clearance from DHHS.

1.14 Incident Reporting. The Contractor shall provide proper notice and documentation as required by the most current DHHS Incident Report Reference Guide and per UAC R501-1.

1.15 Prohibited Therapy Techniques.

(a) The Contractor shall not use coercive techniques (e.g., coercive physical restraints, including interference with bodily functions such as vision, breathing, and movement, or noxious stimulation) to evoke an emotional response in the Person such as rage or to cause the Person to undergo a rebirth experience. Coercive techniques are sometimes referred to as holding therapy, rage therapy, rage reduction therapy, or rebirthing therapy.

(b) The Contractor shall not instruct or direct legal guardians or other caregivers in the use of coercive techniques to be used with the Person.

(c) The Contractor shall not use therapy techniques that are prohibited by the American Psychiatric Association, Utah State Law or the Contractor’s professional licensing association code of ethics.

1.16 Authorization to Provide Services. Except as indicated in other service sections of this contract, the Contractor shall not bill for services that have not been pre-authorized in writing on the Authorization Form.

1.17 Utilization Reviews. When applicable, the Contractor shall participate in utilization reviews conducted by DHHS in order to assess the Person’s response to services, assess the fit of services to the Person’s needs, and to determine the clinical necessity of reauthorization. Participation may include (1) providing requested documentation, such as evaluations, treatment plans and reviews; and (2) meeting with DHHS staff in Person, or by phone or Telehealth, to discuss the Person and their services.

1.18 Guardianship Limitations. The Contractor shall NOT be or become the legal guardian of any Person for whom services are being provided pursuant to this contract.

1.19 Documentation Requirements.

(a) Unless specifically stated otherwise or requested by DHHS, documentation may be in written or electronic form.

(b) The Contractor shall maintain administrative documentation that includes (1) any license(s) issued by DLBC; (2) business license(s); (3) staff background screening approvals; (4) DHHS Provider Code of Conduct signed and placed in each personnel file; (5) staff training documentation, including training curriculum; and (6) documentation of staff qualifications, including applicable licenses and certifications.

(c) The Contractor shall maintain documentation for each Person that contains (1) the Authorization Form; (2) date and type of service provided; (3) person-specific incident reports; and (4) all documentation as it pertains to services provided to the Person.

1.20 Billing Requirements.

(a) Payment to Contractors will be based on the rates in the Rate Table.

(b) The Contractor shall submit billings for authorized services to Medicaid for all Medicaid eligible persons prior to billing DHHS. For services with a Medicaid billing code, the billing requirements are outlined in Article 3: Mental Health and Substance Use Disorder Treatment Services and Article 27: Domestic Violence Treatment Services.

(c) For services with a DHHS service code only (no Medicaid billing code), the Contractor shall use the DHHS 520 Billing Form, or other billing form provided by DHHS. If there are any additional billing requirements, they will be outlined in the specific service section.

(d) The Contractor shall only bill for actual units of service delivered and shall maintain records that support the delivery of all billed services.

(e) Payments will be made to the Contractor through the State of Utah, Department of Administrative Services, Division of Finance Electronic Funds Transfer (“EFT”) system. Prior to the submission of invoices, the Contractor shall ensure it is enrolled in the EFT system. Failure to enroll in the EFT system will result in a delay of all payments.

1.21 Rural Incentive (DHHS Service Code: SIR).

(a) The Contractor may receive a rural incentive of an additional 5% payment for evidence-based treatment services, as defined by DHHS, that are provided to Persons residing at home in a rural county. A rural county is any county in the state of Utah except Salt Lake, Utah, Davis, Weber, Washington, Cache, Tooele, and Summit counties.

(b) To request the additional 5% payment, the Contractor shall bill DHHS using the SIR service code, on a form provided by DHHS.

(c) Treatment eligible for the rural incentive must be evidence-based for the needs of the Person receiving services.

(d) The Contractor is ineligible for the rural incentive if the Contractor was sanctioned at the time the services for which the incentive is sought were provided, if this contract is canceled by DHHS, or if there are contract violations.

(e) Payment of the rural incentive is contingent on DHHS verifying implementation of the evidence-based treatment with the Person and through records that demonstrate fidelity to the evidence-based treatment model, including documentation of internal monitoring of fidelity by the Contractor.

1.22 Transportation of Persons.

(a) For services that allow the Contractor to transport Persons, the Contractor shall comply with UAC R501-1-24.

(b) The Contractor shall ensure that staff, subcontractors and Volunteers transporting Persons have (1) driving records checked annually; (2) personal automobile registration, if providing transportation in personal vehicle; and (3) personal automobile insurance that meets the requirements of this contract, if providing transportation in personal vehicle.

(c) The Contractor shall keep documentation of this review and have copies of the driver’s record and auto insurance in the personnel file.

1.23 Travel. If the Contractor resides out of state and is required by a court subpoena to travel for a court hearing and the court will not allow telephonic or virtual testimony of the Contractor to be taken, the Contractor shall contact the DHHS staff responsible for the evaluation. DHHS will then set up travel arrangements and lodging, if needed, according to state travel policy. After completing travel, the Contractor shall submit receipts to the DHHS staff for reimbursement of transportation costs and per diem at the state rates, in accordance with state travel policy. DHHS staff will provide the Contractor with the state travel policy prior to travel.

1.24 Mileage & Travel Reimbursement (DHHS Service Code: MIR).

(a) For trips that exceed a 75-mile round-trip from the Contractor’s place of business to the Person’s residence, the Contractor may, with authorization from DHHS, bill for travel related to the provision of (1) Mental Health and Substance Use Disorder Treatment Services (except for Family and Youth Peer Support Services); (2) Day Treatment Services (transportation of clients); (3) Behavior Consultation and Adaptive Behavior Treatment Services; (4) Clinical Consultation Services; (5) DSPD Eligibility Evaluation and Specialty Psychological Services; (6) Forensic Evaluation Services; (7) Non-Clinical Consultation; and (8) Evidence-Based Program Models for Prevention of Foster Care Services.

(b) Travel within 75 miles round trip from the address of the Contractor’s place of business will not be reimbursed unless explicitly authorized in this contract.

(c) Authorized travel exceeding 75 miles round trip from the address of the Contractor’s place of business will be reimbursed at the rate indicated in the Rate Table.

(d) Mileage will be reimbursed on a per trip basis. If the Contractor performs multiple services for one or more Persons during the course of a single trip, the Contractor will only be reimbursed for one trip with mileage divided equally among or apportioned according to the travel related to each service conducted during the trip.

(e) Mileage will be calculated using Google Maps. The Contractor shall utilize the Driving Directions function of Google Maps by inputting the departure and destination addresses. If more than one route is provided, the Contractor shall bill for the route with the lowest mileage.

(f) To obtain reimbursement for travel, the Contractor shall submit a request for travel reimbursement that includes (1) the departure address and destination address; (2) the one-way mileage from the departure address to the destination address as found in Google Maps; (3) date(s) of travel; (4) name(s) of Person(s) served and type(s) of services conducted during each trip; and (5) the Contractor’s contract number.

(g) For Forensic Evaluation Services and DSPD Eligibility Evaluations and Specialty Psychological Services, travel reimbursement requests must be submitted together with the completed evaluation report to which the travel applies.

(h) With written authorization, the MIR code may be approved for trips of less than a 75-mile round-trip for a period of 90 calendar days for intensive in-home treatment or parent skills development. An authorization may be extended beyond 90 calendar days by DHHS or AOC at the discretion of DHHS. MIR may be approved if:

(1) the Person lives at home with their family or it is expected that a Person will be able to return home;

(2) the Contractor’s treatment or parent skills development: (A) meets an evidence-based rating of a one, two, or three on the California Evidence-Based Clearinghouse’s Scientific Rating Scale for the needs of the Person or their family relative to the Person’s needs; or (B) is an evidence-based intervention approved by DHHS.

(3) the in-home treatment or parent skills development includes an average of more than one-time per week in-home intervention;

(4) the Contractor’s treatment or skills development is predominantly skills-based;

(5) the treatment or parent skills development is focused on the needs of the Person and involves the parents (it may also involve the Person); and

(6) the treatment or parent skills development may be delivered by clinical staff or trained and clinically supervised non-clinical staff according to the treatment or parent skills development requirements and the appropriate scope of practice.

(i) The MIR rate is a comprehensive rate that covers all costs associated with travel, such as travel time, lodging, meals, fuel for vehicles, auto expenses, and insurance.

(j) The Contractor shall not bill for MIR at the same time for the same Person as another service.

1.25 Mileage at Standard Rate of Reimbursement (DHHS Service Code: MSR).

(a) For trips that exceed a 60-mile round-trip from the address of the Contractor’s place of business to the destination address, the Contractor may, with authorization, bill for transporting clients as a part of the provision of (1) Family and Youth Peer Support Services; (2) Mentoring Services; and (3) services performed under another current DHHS contract.

(b) The Contractor may bill for transporting clients to and from medical appointments, therapy sessions, home visits, school, extracurricular activities, employment, placement changes, court, and other similar activities.

(c) Transportation within 60 miles round trip from the address of the Contractor’s place of business will not be reimbursed.

(d) Authorized transportation exceeding 60 miles round trip from the address of the Contractor’s place of business will be reimbursed at the rate indicated in the Rate Table.

(e) The Contractor will be entitled to a single reimbursement per trip regardless of the number of clients transported.

(f) When the Contractor is required to transport clients only one way of an otherwise reimbursable round trip, the Contractor will be entitled to reimbursement for the full round trip.

(g) Mileage will be calculated using Google Maps. The Contractor shall utilize the Driving Directions function of Google Maps by inputting the departure and destination addresses. If more than one route is provided, the Contractor shall bill for the route with the lowest mileage.

(h) To obtain reimbursement for transportation, the Contractor shall submit a request for travel reimbursement that includes (1) the departure address and destination address; (2) the one-way mileage from the departure address to the destination address as found in Google Maps; (3) date(s) of travel; (4) name(s) of Person(s) served and type(s) of services conducted during each trip; and (5) the Contractor’s contract number.

Article 2

GENERAL SERVICE REQUIREMENTS

2.1 Applicability. The requirements in Article 2 apply to all contracts unless explicitly stated otherwise.

2.2 Person-Centered, Outcome-Focused Services. In coordination with the Team, the Contractor shall provide individualized, person-centered services that support both immediate treatment outcomes and long-term outcomes related to the best interest of the Person. The Contractor shall:

(1) engage parents, other family members, and other caregivers, as clinically appropriate and pre-approved by the Case Manager, to the greatest extent possible in services;

(2) whenever possible, provide services that are family-driven and Person-guided, with the parent and the Person making significant, meaningful decisions regarding their services and service planning;

(3) to the greatest extent possible, provide services that actively promote permanency in a family setting, including developing the skills, relationships, and natural supports necessary for parents and family members, as well as the Person, to be safe and successful together at home;

(4) at all times, and especially when a parent is unable to participate in services, work with the Case Manager and Care Manager (as applicable) to engage other family members, community members, and positive natural supports in the Person’s services;

(5) seek ways to increase the involvement of natural supports in the Person’s life and decrease dependence on formal supports;

(6) tailor treatment and service planning to the Person’s unique needs and strengths, and the day-to-day culture of the Person and their family;

(7) coordinate closely with other service providers, the Case Manager and Care Manager (when applicable), and other Team members;

(8) evaluate the effectiveness of services on an on-going basis, adjust services in collaboration with the Team as needed to improve effectiveness, and make recommendations on service changes if the Person is not progressing, desired outcomes aren’t being achieved, or there is an approach that may be a better fit for the needs of the Person; and

(9) deliver services and supports within the least restrictive, most normative environments that are clinically appropriate.

2.3 Evidence-Based or Evidence-Informed Treatment. When providing treatment, skill development or behavioral services, the Contractor shall:

(1) provide assessment and treatment that is evidence-based or evidence-informed.

(2) provide treatment that is individualized based on the Person’s age, diagnosis and circumstances and must address issues affecting the Person, including grief, loss, trauma, and criminogenic factors;

(3) maintain fidelity of the evidence-based or evidence-informed treatment through monitoring the effectiveness of the treatment;

(4) maintain documentation of staff training received and skills in the evidence-based or evidence-informed treatment for which the Person will be engaged to restore the highest possible level of function; and

(5) address criminogenic needs, as well as other clinical needs, for Persons involved in delinquency proceedings in the juvenile justice system.

2.4 Mixing Risk Populations.

(a) For youth involved in outpatient groups with DJJYS or AOC, Persons determined low risk must not be placed with Persons moderate or high risk to reoffend and must be kept separate from high and moderate risk Persons at all times.

(b) For youth involved with DJJYS or AOC, Persons determined moderate or high-risk level must only be placed together if determined appropriate and pre-approved in writing by the Division’s designee.

2.5 Team Meetings.

(a) If the Contractor provides ongoing treatment, the Contractor shall:

(1) as part of a clinical mental health service, actively participate as a member of the Person’s Team;

(2) provide rehabilitative mental health and related services in collaboration with the Team to promote stability and long-term permanence for each Person;

(3) convene a Team Meeting when developing the Person’s treatment plan, quarterly treatment plan review, and to gather information from parents, proctor family, teachers, childcare providers, and Case Manager or Care Manager for the purpose of assessing the Person as part of the PDE, as needed; and

(4) participate in all Team Meetings and initiate Team Meetings as appropriate.

(b) The Contractor may receive reimbursement for time spent attending Team Meetings if a QMHP either gathers information significant to the family’s treatment, or provides some therapeutic intervention during the Team Meeting. The Contractor shall use the Target Case Management service code when billing for attendance at Team Meetings to Medicaid eligible clients. If the Contractor is unable to bill Medicaid, the CFTM service code will be used.

2.6 DHHS Care Management and High Fidelity Wraparound. Some Persons and their families that have complex needs and may be involved with, or may be at risk of involvement with, multiple systems may be assigned a DHHS Care Manager. When a Care Manager is assigned, the Care Manager will facilitate planning, together with the Person and their family, utilizing High Fidelity Wraparound, an evidence-based, person-centered planning process. Through this process, a Wraparound Support Plan will be created as an overarching plan to integrate the plans of all DHHS systems involved. When a DHHS Care Manager is assigned, or other SOC administrators are involved, the Contractor shall:

(1) participate in the wraparound planning process and complete agreed upon assignments;

(2) ensure that goals in the Wraparound Support Plan and the treatment or support plan are aligned; and

(3) coordinate closely with the Care Manager, including when there is a change in needs for the Person or family, and when changes in services or supports are needed.

2.7 Behavior Management and Emergency Safety Interventions.

(a) The Contractor shall comply with UAC 501-1 for all behavior management interventions and emergency safety interventions.

(b) The Contractor shall have written policies and procedures for behavior management and emergency safety interventions unless exclusively providing evaluation services or Pharmacologic Management services.

(c) The Contractor shall inform the Person, legal guardian, Case Manager and Care Manager (if applicable) of its behavior management and safety interventions policy for a Person receiving ongoing treatment services prior to admission to the program.

(d) The Contractor shall use passive physical behavioral interventions to manage the Person’s behavior in an emergency situation under the following circumstances:

(1) danger to others: physical violence toward others with sufficient force to cause bodily harm;

(2) danger to self: self-abuse of sufficient force to cause bodily harm; or

(3) threatened abuse: threatened abuse toward others or self that may, with evidence of past threats or actions, result in danger to others or self.

(e) The Contractor shall ensure passive physical behavioral interventions are used only by staff who have completed training on the policy, procedures and implementation of all passive physical behavioral interventions that may be utilized. Training must include: (1) de-escalation methods; (2) thresholds for restraints; (3) the physiological and psychological impact of restraint; (4) monitoring; (5) physical signs of distress and obtaining medical assistance; (6) positional asphyxia; (7) time limits; (8) the process for obtaining approval for continued restraints; (9) documentation; (10) processing with Persons; (11) follow-up with staff; and (12) investigation of injuries and complaints.

(f) The Contractor shall ensure passive physical restraint are:

(1) only used after less intrusive interventions have been determined to be ineffective;

(2) not used in a manner that causes undue physical discomfort, harm or pain to the Person (interventions that use painful stimuli are prohibited);

(3) continued only as long as the Person presents a danger to self or others;

(4) not employed as punishment, for the convenience of staff, or as a substitute for programming; and

(5) not used by Persons or other unauthorized individuals to implement or assist with any behavioral intervention involving a Person.

(g) The Contractor may use staff-directed time-outs when addressing behavioral issues. The Contractor shall never physically prevent a Person in time-out from leaving the time-out area. Time-out may take place away from the area of activity or from other Persons, such as in the Person’s room, or in the area of activity or other Persons. The Contractor shall monitor the Person while he or she is in time-out.

(h) The Contractor shall NOT use seclusion.

(i) The Contractor shall NOT use mechanical or chemical restraints.

2.8 Child Protective Services (“CPS”) and Adult Protective Services (“APS”). The Contractor shall:

(1) follow mandatory reporting laws when child abuse or neglect, as defined in Utah Code § 80-1-102, is suspected for children 17 and younger;

(2) follow mandatory reporting laws when adult abuse, neglect, or exploitation, as defined in Utah Code § 26B-6-205, is suspected for adults 18 and older;

(3) require all staff, Volunteers, and subcontractors to cooperate with investigators conducting the investigation when an allegation of abuse, neglect, or exploitation is made against the Contractor, any of the Contractor’s staff, Volunteers or subcontractors, or any other individual;

(4) suspend further contact between the alleged perpetrator and all Persons until the investigation is complete and a determination is made regarding the allegation if the Contractor reported or is otherwise aware that an allegation has been made against the Contractor or any of the Contractor’s staff, Volunteers or subcontractors;

(5) comply with the determination made by DHHS regarding current Person placement and other safety provisions;

(6) keep knowledge of an investigation confidential; and

(7) send a written notification within one business day to DLBC if the Contractor is aware that an allegation has been supported against the Contractor or any of the Contractor’s staff, Volunteers, or subcontractors.

2.9 Abuse and Harassment Prevention.

(a) The Contractor shall have, implement, and enforce a written policy that (1) mandates zero tolerance toward all forms of abuse and harassment and outlines the Contractor’s approach to preventing and responding to such conduct; and (2) prohibits staff, Volunteers and subcontractors from revealing any information related to an abuse or neglect report to anyone except as necessary to provide for treatment for the alleged victim and as required for the CPS, APS, or law enforcement investigation.

(b) The Contractor shall(1) require all staff to report immediately any knowledge, suspicion, or information they receive regarding an alleged incident of abuse or harassment; (2) report alleged incidents of abuse according to the DHHS Provider Code of Conduct; (3) report allegations of harassment according to the Contractor’s policy requirements; and

(4) require all staff, Volunteers, and subcontractors to comply with mandatory child abuse reporting laws.

(c) The Contractor shall(1) provide multiple internal ways for Persons to privately report abuse and harassment, retaliation by other Persons or staff for reporting abuse and harassment, and staff neglect or violation of responsibilities that may have contributed to such incidents; (2) ensure the Contractor’s staff accepts reports made verbally, in writing, anonymously, and from third parties and shall promptly document any verbal reports; and (3) provide a method for staff to privately report abuse and harassment of a Person.

2.10 Best Practice. The Contractor shall provide services according to the generally recognized best practices and ethical standards of their field.

Article 3

MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT SERVICES

3.1 Contractor and Staff Qualifications.

(a) The Contractor shall comply with all qualification requirements referenced in Article 1 General Administrative Requirements and the current Utah Medicaid Manual.

(b) The Contractor shall have a current DLBC Outpatient Treatment license for each facility where services are provided, unless it meets the requirements for a DLBC license exemption.

(c) For Psychological and Neuropsychological Evaluation Services, the Contractor and staff providing evaluations shall be a:

(1) DOPL - licensed psychologist;

(2) DOPL - licensed psychology resident who is being supervised by a DOPL - licensed psychologist; or

(3) graduate student of an APA accredited doctoral program in psychology who is being supervised by a DOPL - licensed psychologist.

3.2 Utah Medicaid Manual. Regardless of the service-funding source, the Contractor shall comply with the service and documentation requirements of the Utah Medicaid Manual for the following services, as listed on the DHHS91703 Rate Table:

(1) Psychotherapy Services (not including NCC, NNC and MIR);

(2) Psychological and Neuropsychological Evaluation Services (not including NCC and MIR);

(3) Pharmacologic Evaluation and Management Services (not including NCC and MIR);

(4) Psychosocial Rehabilitative Services (not including NNC and MIR);

(5) Therapeutic Behavioral Services (not including NNC and MIR); and

(6) Family and Youth Peer Support Services(not including MSR).

3.3 Service Authorization.

(a) The Contractor shall obtain authorization for a Person’s Medicaid-billable services through one of the following options: (1) the pre-authorization(s) allowed by this contract for the first 30 continuous days; or (2) through a signed/pre-approved Authorization Form from DHHS or AOC.

(b) The Contractor shall obtain a signed/pre-approved Authorization Form from DHHS or AOC prior to providing any services with a DHHS service code only (no Medicaid billing code).

(c) Medicaid-billable services pre-authorized for a Person through this contract do not require an Authorization Form for up to 30 continuous days from the first date of the evaluation or the first date of mental health or substance use disorder treatment services, whichever is first.

(d) If there is a completed Authorization Form from DHHS or AOC for a Person, the Authorization Form takes precedence over all pre-authorized services for the Person.

(e) All services following the first 30 continuous days require an Authorization Form. The Contractor shall identify needed services in conjunction with the Team, including the Care Manager when applicable.

(f) For Medicaid-billable services only, the Contractor may interchange services and units on the Authorization Form according to the treatment needs of the Person and the services awarded to the Contractor; however, the Contractor shall NOT exceed the total monthly cost for services authorized on the Authorization Form. This interchanging of services must be consistent with the treatment plan and is limited to: (1) Pharmacologic Management, Prescriber; (2) Individual Skills Training and Development; (3) Group Psychosocial Rehabilitation; (4) Psychotherapy; (5) Family Psychotherapy; (6) Group Psychotherapy; (7) Therapeutic Behavioral Services; and (8) Peer Support Services.

3.4 Pre-Authorized Medicaid Services (30 Continuous Days). The pre-authorizations in the table below are contingent on the Person’s clinical need(s) and the services awarded to the Contractor. The Contractor shall only render these services when they are clinically necessary. Listed in the table are the pre-authorized maximums per Person up to 30 continuous days for the first 30-day period that a Person is receiving services. The pre-authorization for the first 30 continuous days does NOT apply to Persons whose services are paid by DHHS under a DHHS Service Code.

Psychotherapy with Patient or Family Member (Individual Psychotherapy), 30 minutes; OR Psychotherapy with Patient or Family Member (Individual Psychotherapy), 45 minutes; OR Psychotherapy with Patient or Family Member (Individual Psychotherapy), 60 minutes One session per week

Individual Psychotherapy for Crisis (Assessment & Treatment) - Case Manager and Care Manager Notification (16 through 30 minutes); OR Individual Psychotherapy for Crisis (Assessment & Treatment) - Case Manager and Care Manager Notification (31 through 75 minutes) Four sessions

3.5 Examination and Treatment Planning.

(a) The Contractor shall conduct an initial PDE or an addendum to the most recent examination or psychological evaluation completed within the past 12 months. The examination or addendum must assess the existence, nature, or extent of illness, injury or other health deviation for the purpose of determining the Person’s need for mental health or substance use disorder services.

(b) In addition to the Utah Medicaid Manual requirements, the treatment plan must include:

(1) relevant clinical needs identified in any of DHHS’ and AOC’s assessments and service plans, including the Utah Family and Children Engagement Tool (“UFACET”), the PRA, the Wraparound Support Plan and DCFS and DJJYS service plans;

(2) relevant identified targeted treatment needs as assessed in any other DHHS and AOC assessment(s) provided to the Contractor;

(3) measurable treatment goals addressing the Person’s needs identified in the PDE and developed in conjunction with the Person, family, Case Manager and Care Manager (when applicable); and

(4) discharge criteria and, at the appropriate time, post discharge plans and coordination of related community services to ensure continuity of care with the Person’s family (or others in whose care the Person will be released after discharge), school, and community.

(c) The Contractor shall provide a copy of the Person’s treatment plan and PDE to the Case Manager within 15 calendar days of completion.

3.6 Treatment Plan Review.

(a) The Contractor shall conduct…