ESBD_544717_1785514920382_Attachment A - Specialized Services to be Provided.pdf

FY26 – MH

Prescription Services, Inc.

EXHIBIT A

SPECIALIZED SERVICES TO BE PROVIDED

Type, Frequency, Quantity, and Duration of Services.

Type, frequency, quantity, and duration of services with clearly defined goals, outputs, and measurable outcomes which are directly related to program objectives and consumer needs:

1. Sufficient equipment and medication purchasing capacity to handle the volume at each Authority program to ensure at minimum a forty-eight (48) hour “turnaround” time for new medication orders delivered, phoned, or Faxed from an Authority site;

2. Capacity for a twenty-four (24) hour “turnaround” time for emergency prescriptions to be immediately started by the person served;

3. Capacity for a twenty-four (24) hour “turnaround” time for routine refills;

4. Fill all prescriptions in single dose packaging unless other dispensing methods are requested and approved by an Authority physician or designee;

5. capability of filling all prescriptions in requested increments, i.e., weekly, bi-weekly, monthly, etc., and have/develop a mechanism for refill authorization for consumers that require weekly or monthly monitoring;

6. Provide Authority with prescribed IM medications and provide “stock” IM medications such as

Haldol Decanoate, Prolixin Decanoate and Cogentin;

7. Have in place a quality improvement program which addresses medication dispensing errors, adverse medication reactions. The program must include specifications for all drug purchases and methods for monitoring compliance;

8. Have a pharmacist available during regular business hours for consultation with consumers, Authority physicians and nurses regarding medications, side effects and food/drug interactions and provide written medication education materials as requested;

9. Fill and bill only for medications prescribed by Authority physicians using Authority physicians orders documents and the Authority’s approved medication list, unless otherwise authorized by

Authority;

10. Utilize generic substitutions, when available, unless otherwise indicated to “fill as written” on the written prescription/doctor’s orders. Only Grade A generic or name brand drug substitutes are acceptable but are open to medical and pharmaceutical consideration. Brand name or generic substitutions must be indicated and identified as a substitution and accompanied by the substituted NDC (National Drug Code) number;

11. For confidentiality purposes, only pharmacy personnel and when appropriate, data entry personnel will have access to information regarding whether a customer is a consumer of

Authority’s services, and there will be no overt designation that an individual is a consumer of

Authority’s services;

12. Provide a mechanism that will not allow a consumer to refill their prescriptions until 80% of time has passed from receiving the previous prescriptions unless authorized by an Authority physician or nurse;

Docusign Envelope ID: ED1A74DF-DBC5-418B-843B-74F7F991F4B1

EXHIBIT B

QUALIFICATIONS OF PROVIDER

Certification/Licensure/Accreditation/Privileges:

The Provider represents and warrants that the certification, licenses, accreditation’s and privileges of

Provider personnel related to the performance of this Agreement are in good standing and without restrictions and will maintain these standings through the term of this agreement. Evidence of such certification, accreditation, licensure and privileges will be submitted to the Authority upon request by the Authority at any time during the term of this Agreement. Provider must maintain all certifications, registrations or licenses required by law to remain in good standing in his/her profession during the term of this Contract. In addition, Provider must inform Authority immediately of any changes to such certifications, registrations or licenses during the term of this Contract.

All crisis and inquiry calls will be screened by a Provider employee who meets the criteria of a Qualified

Mental Health Professional-CS (QMHP-CS) as defined by the Texas Administrative Code and Texas

Department of Health Services. In addition, Provider will have at least one bilingual, QMHP available to respond to crisis and information calls at all times. Provider will provide the Authority with intake staff credentials at the time of contract acceptance and upon hiring of new staff that provide services.

Current participant in the Clozaril national Registry and the Clozaril program.

Current and active Texas Controlled Substances Registration Certification through the Texas

Department of Public Safety

Current and active Controlled Substance Registration Certification through the United States Department of Justice Drug Enforcement Administration

Current and active license through the Board of Pharmacy of the State of Texas for pharmacy and all participating pharmacists

Provider agrees to maintain current all licenses, insurance, certifications and certificates and comply with all Texas State Board of Pharmacy laws and regulations, including Texas Controlled Substance

Act, Texas Dangerous Drug Act, CLIA License, Texas Food, Drug and Cosmetic Act, Federal

Controlled Substance Act of 1970 and FDA Regulations.

Provider is required to maintain a valid license at all times during service delivery and provide documentation of such at the request of Authority.

Corporate Compliance Qualifications / Requirements:

1. Is and shall remain a participating provider in good standing under the Medicare and Medicaid programs and is not and has never been excluded from participation in said programs;

2. Is and shall remain competent and duly certified and licensed under applicable law to perform his or her (or its) obligations hereunder;

3. Will notify the Authority immediately upon receiving notice that Provider is the subject of any inquiry, investigation, audit, subpoena, civil investigative demand, warrant, indictment, or civil suit by any agency or branch of federal or state government, or by any fiscal intermediary or carrier contracting with federal or state government;

4. Believes that the arrangement being entered into pursuant to this Agreement does not violate

(and that Provider has never been indicted under a felony count or civil monetary penalty for violation of) any federal or state law or regulation, including, but not limited to, the federal anti-kickback statute, the physician self-referral statute (commonly referred to as the “Stark” law), the regulations governing the assignment and reassignment of Medicare and Medicaid benefits, and the regulations governing conditions of participation in the Medicare and Medicaid programs;

5. Is not a party to any Corporate integrity Agreement (CIA) with any agency or branch of federal or state government, or, if so, has provided a copy of such CIA to the Authority;

6. Will only provide services to consumers of the Authority that are appropriate and medically necessary and that such services shall be provided in accord with all applicable laws. Provider further shall properly chart and document all services provided to Authority consumers and shall maintain such records in accord with applicable laws and regulations; and

7. All claims, bills, statements or reports prepared and delivered by Provider to the Authority or to any third party relating to services provided hereunder shall be truthful, accurate and complete in all material respects.

EXHIBIT C

STANDARDS

Provider will adhere to applicable HHSC or Community Standards for Community Mental Health and

Mental Retardation Centers and Community Service Programs.

Texas Administrative Codes

West Texas Centers Policies and Procedures

EXHIBIT D

RATE, AMOUNT, FREQUENCY OF PAYMENT

Rate, Amount, and Frequency of Payment with Designation of Payees

1. Provider understands that Authority is payor of last resort. Provider will implement a system to appropriately bill all third party payors prior to seeking payment from the Authority. Provider will be able to distinguish those medications being paid for by third party from those being paid for by the Authority as applicable.

2. Authority will be charged only for those medications which are picked up by the person served

(or delivered) and/or the Authority staff as evidenced by signature of person served or Authority staff member.

3. Authority will be charged only for those medications which are prescribed by an Authority physician utilizing the Authority’s approved medication list unless otherwise authorized.

4. For consumers with Medicaid as a pay source, Provider is requested, if possible, to replace a medication prescribed for physical illness with a psychiatric medication to lower the cost to the

Authority. Should Provider take such action, it should be clearly documented on the regular statement indicating which medications were transferred to and from the Medicaid card.

Authority will remain payor of last resort. Provider is allowed and encouraged to monitor consumer Medicaid benefits to assure medication slots are utilized to the maximum benefit for the consumer and the Authority.

5. For consumers with no third party benefits, Authority will continue paying for psychiatric medications as authorized and prescribed by authority physicians in accordance with the

Authority’s approved medication list.

6. Provider will be paid according to the following rates for both brand and generic medications:

Invoice AG Cost Markup Dispensing Fee

>0 2.68 1.50

>8 1.88 1.50

>15 1.60 1.50

>25 1.50 1.50

>50 1.30 1.50

>100 1.20 1.50

>125 1.15 1.50

>250 1.05 1.50

a. Patient Assistance Program drugs: $6.00

b. $700.00 per billing cycle

6. Authority will pay all bills within 30 days unless such invoices are found to be inaccurate. In that case, invoices will be paid once both parties agree to changes. If Authority pays the bill within 7 days of receipt, a 1% discount will be taken.

7. Authority will receive full credit for all unused medications returned within 60 days.

The pay rates disclosed is contingent upon the availability and receipt of state and federal funds as mentioned in Section VIII (2) *Fund Availability. Authority will notify Provider within 30-days on any changes associated to state and federal funding. With respect to such changes, an amendment with new rates will submitted to Provider for signature approval and continuance of services.

Invoices should be submitted as follows:

West Texas Centers

Attention: Accounting Department

409 Runnels Street

Big Spring, Texas 79720

Fax (432) 264-4210

Billing questions related to this contract should be addressed to:

Attn: Director of Behavioral Health

319 Runnels

Phone: (432) 264-3257

All other communication requests referencing this contract should be submitted as follows:

Attention: Contracts Department

409 Runnels Street

Phone: (432) 264-4251