FY 2027 Community Services Performance Contract
(Draft Version for Public Review/Comment)

New River Valley Community Services’ annual Performance Contract with the Virginia Department of Behavioral Health and Developmental Services (DBHDS) for Fiscal Year 2027 is now available for public review and comment. As required by the Code of Virginia, this document serves as the primary accountability and funding mechanism between DBHDS and the local Community Services Board.

A draft version of the document is included below.

Any public comments must be submitted in writing and are due by August 8, 2026 at 5:00 p.m. Those comments should be submitted to the following address:

Ashley Wilson, Executive Assistant
New River Valley Community Services
700 University City Boulevard
Blacksburg, VA 24060

Written comments can also be submitted via email to info@nrvcs.org.

AMENDMENT 4
Behavioral Health and Developmental Services, the CSB shall not modify a licensed service(s) without submitting a modification notice to the Office of Licensing in the Department at least 30 days in advance of the proposed modification.

• Funding Requirements
• Funding Resources

Exhibit A of this contract provides an example of the following resources: state funds and federal funds appropriated by the General Assembly and federal government and allocated by the Department to the CSB, and any other funds associated with or generated by the services shown in Exhibit A. The CSB must review the most recent version of Exhibit A sent by the Department’s Fiscal and Grants Management Office.

• Funding Allocations

1. The Department shall inform the CSB of its state and federal fund allocations in its letter of notification (LON).  Allocations of state and federal funds shall be based on state and federal statutory and regulatory requirements, provisions of the Appropriation Act, State Board policies, and previous allocation amounts.
2. The Department may reduce or restrict state or federal funds during the contract term if the CSB reduces significantly or stops providing services supported by those funds as documented in its community services reports. These reductions shall not be subject to provisions in Section 14.A.and B. of this contract. The Commissioner or designee shall communicate all adjustments to the CSB in writing.
3. Continued disbursement and /or reimbursement of state or federal funds by the Department to the CSB may be contingent on documentation in the CSB’s Data Reporting Mechanism that it is providing the services supported by these funds.

• Expenses for Services

The CSB shall provide those services funded by the Department set forth in Exhibit A and documented in the CSB’s financial management system. The CSB shall distribute its administrative and management expenses across the program areas (mental health, developmental, and substance use disorder services), emergency services, and ancillary services on a basis that is auditable and satisfies Generally Accepted Accounting Principles. CSB administrative and management expenses shall be reasonable and subject to review by the Department.

• Use of Funds

1. The Department has the authority to impose additional conditions or requirements for use of funds, separate from those established requirements or conditions attached to appropriations of state-controlled funds by the General Assembly, the Governor, or federal granting authorities. The Department shall, when possible, provide sufficient notice in writing to the CSB of changes to the use of funds.

2. Medicaid Billing – The CSB shall maximize billing and collecting Medicaid payments and other fees in all covered services to enable more efficient and effective use of the state and federal funds allocated to it and report to the Department on the total Medicaid revenue each year. The CSB shall develop mechanisms to inform clients on how to apply for Medicaid coverage.

Supplanting– State Board Policy 6005 and based on the Appropriation Act prohibition against using state funds to supplant funds provided by local governments for existing services, there should be no reduction of local matching funds as a result of a CSB’s retention of any balances of unspent state funds.

Table of Contents

I.         Background. 2

II.        Defined Terms 2

III.      Federal Grant Requirements for DBHDS as the Pass-through Entity. 5

IV.      General Federal Grant Requirements for the Department and CSBs 6

V.       Federal Grant Specific Requirements 24

VI.      Charitable Choice. 40

VII.     List of Federal Grants 40

                I.          Background

State agencies often administer federal awards received as pass-through funds to other non-federal entities.  These non-federal recipient entities are called Subrecipients, and they assist in carrying out various federally funded programs. Subrecipients are typically units of local government (i.e. city and county agencies) but also include other entities such as Native American tribes, other state agencies, and institutions of higher education, special districts and non-profits.  The nature of these relationships is governed by federal statute, regulations, and policies in addition to state laws and regulations.  The source of the funding determines the regulations and policies that govern the provision of the funds.  The Substance Abuse and Mental Health Services Administration (SAMHSA) is the primary source of federal funds awarded to DBHDS. DBHDS also receives funds from the U.S. Department of Justice, U.S. Department of Education, and other federal entities. 

As a primary recipient of federal funds, state agencies serve a pass-through role in which funds are sub-awarded to Subrecipients. federal regulations require that pass-through entities provide monitoring of their Subrecipient which is outlined in Sections 200.300 through 200.476 in 2 C.F.R. Part 200 and Sections 75.300 through 75.477 in 45 C.F.R. Part 75 for SAMHSA awards. Further, audit requirements contained in 2 C.F.R. Part 200, Subpart F and 45 C.F.R. Part 75, Subpart F for SAMHSA awards, require that pass-through entities monitor the activities of their Subrecipient, as necessary, to ensure that federal awards are used appropriately and that performance goals are achieved.

In order to further the provision of necessary goods and services to the community, DBHDS may enter federally funded subrecipient relationships with Community Service Boards (CSBs).  This exhibit provides certain compliance requirements and other specific and general grant information for the federal grant funds that DBHDS passes-through to the CSBs.

              II.          Defined Terms

Administrative Proceeding – A non-judicial process that is adjudicatory in nature to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative proceedings, Civilian Board of Contract Appeals proceedings, and Armed Services Board of Contract Appeals proceedings). This includes proceedings at the federal and State level but only in connection with performance of a federal contract or grant. It does not include audits, site visits, corrective plans, or inspection of deliverables.

Capital Expenditures – Expenditures to acquire capital assets or expenditures to make additions, improvements, modifications, replacements, rearrangements, reinstallations, renovations, or alterations to capital assets that materially increase their value or useful life.

Conference – A meeting, retreat, seminar, symposium, workshop or event whose primary purpose is the dissemination of technical information beyond the non-federal entity and is necessary and reasonable for successful performance under the federal award.

Conviction – For purposes of this award term and condition, a judgment or conviction of a criminal offense by any court of competent jurisdiction, whether entered upon a verdict or a plea, and includes a conviction entered upon a plea of nolo contendere.

De Minimis Rate – Pursuant to 2 CFR 200.414, this is the default indirect cost rate for any non-federal entity that does not have a current negotiated (including provisional) indirect cost rate.  The rate is set at 15% of modified total direct costs (MTDC).

Drug-Free Workplace – A site for the performance of work done in connection with a specific award to a Subrecipient, the employees of whom are prohibited from engaging in the unlawful manufacture, sale, distribution, dispensation, possession or use of any controlled substance or marijuana during the performance of the federally funded project.

Employee – An individual employed by the subrecipient who is engaged in the performance of the project or program under this award; or another person engaged in the performance of the project or program under this award and not compensated by the subrecipient including, but not limited to, a volunteer or individual whose services are contributed by a third party as an in-kind contribution toward cost sharing or matching requirements.

Entity – Any of the following, as defined in 2 CFR Part 25: a Governmental organization, which is a State, local government, or Indian tribe; a foreign public entity; a domestic or foreign nonprofit organization; a domestic or foreign for-profit organization; a federal agency, but only as a subrecipient under an award or sub-award to a non-Federal entity.

Equipment – Tangible personal property (including information technology systems) having a useful life of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level established by the non-Federal entity for financial statement purposes, or $10,000.

Executive – Officers, managing partners, or any other employees in management positions.

Expenditure – A transaction for which cash has been dispersed to an entity to pay for a good or service.  

Forced labor – Labor obtained by any of the following methods: the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

Funding Opportunity Announcement (FOA) – The document that all federal agencies utilize to announce the availability of grant funds to the public.  This is used interchangeably with NOFO.

Indirect Costs (IDC) – Costs incurred for a common or joint purpose benefiting more than one cost objective and not readily assignable to the cost objectives specifically benefited, without effort disproportionate to the results achieved. 

Intangible Property – Intangible property means property having no physical existence, such as trademarks, copyrights, patents and patent applications and property, such as loans, notes and other debt instruments, lease agreements, stock and other instruments of property ownership (whether the property is tangible or intangible). 

Major Medical Equipment – An item intended for a medical use that has a cost of more than $5,000 per unit.

Minor Renovation, Remodeling, Expansion, and Repair of Housing – Improvements or renovations to existing facilities or buildings that do not total more than $5,000.

Modified Total Direct Cost – The MTDC base consists of 1) all direct salaries and wages; 2) applicable fringe benefits; 3) materials and supplies; 4) services; 5) travel, and 6) up to the first $50,000 of each subaward or contract (regardless of the period of performance of the subaward or contract under the award).

The MTDC base must exclude: expenditures for equipment; capital expenditures; charges for patient care; rental costs; tuition reimbursement; scholarships and fellowships; participant support costs [direct costs for items such as travel allowances and registration fees paid to or on behalf of participants or trainees (but not employees) in connection with conferences or training projects], and; the portion of each subaward or contract in excess of $50,000.

Notice of Award (NOA) – The official award document issued by the federal granting agency that notifies the primary recipient of their award amount. 

Notice of Funding Opportunity (NOFO) – The document that all federal agencies utilize to announce the availability of grant funds to the public.  This is used interchangeably with FOA.

Obligation – Orders placed for property and services, contracts and subawards made, and similar transactions during the Period of Performance.

Pass-Through Entity – Pass-through entity means a non-federal entity that provides a subaward to a subrecipient to carry out part of a federal program.

Period of Performance – The timeframe in which the Subrecipient may incur obligations on funding received because of an agreement between DBHDS and the CSB which is funded with federal grant money.

Recipient – The non-federal entity that receives a grant award from a federal entity.  The recipient may be the end user of the funds or may serve as a pass-through to subrecipient entities.

Subaward – A legal instrument to provide support for the performance of any portion of the substantive project or program for which the Recipient received the federal award and that the recipient awards to an eligible subrecipient.

Subrecipient – A non-federal entity that receives a subaward from the recipient (or Pass-Through Entity) under this award to carry out part of a federal award, including a portion of the scope of work or objectives, and is accountable to the Pass-Through Entity for the use of the Federal funds provided by the subaward. Grant recipients are responsible for ensuring that all sub-recipients comply with the terms and conditions of the award, per 45 CFR §75.101.

Supplant – To replace funding of a recipient’s existing program with funds from a federal grant.

System of Award Management (SAM) – The Federal repository into which an entity must provide information required for the conduct of business as a recipient. Additional information about registration procedures may be found at the SAM Internet site (currently at: http://www.sam.gov).

Total compensation – The cash and noncash dollar value earned by the executive during the recipient’s or subrecipient’s preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)): salary and bonus; awards of stock, stock options, and stock appreciation rights (use the dollar amount recognized for financial statement reporting purposes with respect to the fiscal year in accordance with the Statement of Financial Accounting Standards No. 123 (Revised 2004) (FAS 123R), Shared Based Payments); earnings for services under non-equity incentive plans (this does not include group life, health, hospitalization or medical reimbursement plans that do not discriminate in favor of executives, and are available generally to all salaried employees); change in pension value (this is the change in present value of defined benefit and actuarial pension plans); above-market earnings on deferred compensation which is not tax-qualified and; other compensation, if the aggregate value of all such other compensation (e.g. severance, termination payments, value of life insurance paid on behalf of the employee, perquisites or property) for the executive exceeds $10,000. [75 FR 55669, Sept. 14, 2010, as amended at 79 FR 75879, Dec. 19, 2014]

Total value of currently active grants, cooperative agreements, and procurement contracts – Only the Federal share of the funding under any Federal award with a recipient cost share or match; and the value of all expected funding increments under a federal award and options, even if not yet exercised [81 FR 3019, Jan. 20, 2016].

Unique Entity Identifier (UEI) – The identifier required for SAM registration to uniquely identify business entities.

Unliquidated Obligations – An invoice for which the Subrecipient has already been allocated funding to pay by the pass-through entity that falls within the timeframe for expending unliquidated obligations provided in Section III of this Exhibit.  Unliquidated Obligations cannot include personnel costs and are limited to goods or services that were purchased or contracted for prior to the end of the Period of Performance but were not yet expensed as the goods or services were not yet received or the Subrecipient had not yet received an invoice.

            III.          Federal Grant Requirements for DBHDS as the Pass-through Entity

As the pass-through entity for federal grant funds, DBHDS must comply and provide guidance to the subrecipient in accordance with U.S. C.F.R. 2 § 200.332 and CFR 45 § 75.352 (for SAMHSA awards). DBHDS shall:

1. Ensure every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward. If any of these data elements change, DBHDS will include the changes in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best information available to describe the Federal award and subaward.  This information includes:
   1. Subrecipient name (which must match the name associated with its unique entity identifier).
   1. Subrecipient’s unique entity identifier.
   1. Federal Award Identification Number (FAIN).
   1. Federal Award Date (see § 200.1 and § 75.2 Federal award date) of award to the recipient by the awarding agency.
   1. Subaward Period of Performance Start and End Date (Dates within which DBHDS may expend funds).
   1. Subaward Budget Period Start and End Date (Dates within which the subrecipient may expend funds from a subaward).
   1. Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient.
   1. Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current obligation.
   1. Total Amount of the Federal Award committed to the subrecipient by the pass-through entity.
   1. Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA).
   1. Name of Federal awarding agency, pass-through entity, and contract information for awarding official of the pass-through entity.
   1. CFDA Number and Name; the pass-through entity must identify the dollar amount made available under each Federal award and the CFDA number at time of disbursement.
   1. Identification of whether the award is R&D; and
   1. Indirect cost rate for the Federal award (including if the de minimis rate is charged per § 200.414 and § 75.414).

• Comply with all Federal statutes, regulations and the terms and conditions of the Federal award.

• Negotiate with the subrecipient an approved federally recognized indirect cost rate negotiated between the subrecipient and the Federal Government or, if no such rate exists, either a rate negotiated between the pass-through entity and the subrecipient or a de minimis indirect cost rate as defined in § 200.414(f) and § 75.414(f).

• Be responsible for monitoring the activities of the subrecipient as necessary to ensure that the subaward is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward; and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include, but is not limited to the following:
• Reviewing financial and performance reports required by the pass-through entity.
• Following up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means.
• Issuing a management decision for audit findings pertaining to the federal award provided to the subrecipient from the pass-through entity as required by § 200.521 and § 75.521.
• The Department shall evaluate each subrecipient’s risk of noncompliance with federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring.
• The Department shall verify that every subrecipient is audited as required by subpart F when it is expected that the subrecipient’s federal awards expended during the respective fiscal year equaled or exceeded the threshold set forth in §200.501 and §75.501.
• The Department shall consider whether the results of the subrecipient’s audits, on-site reviews, or other monitoring indicate conditions that necessitate adjustments to the pass-through entity’s own records.

            IV.          General Federal Grant Requirements for the Department and CSBs

The federal grants listed in Section IV of this Exhibit have requirements that are general to the federal agency that issues the funds.  Included below are the general grant terms and conditions for each of the federal agencies for which DBHDS is the pass-through entity to the CSBs.

1. SAMHSA GRANTS

1. Grant Oversight: The CSBs and the Department are legally and financially responsible for all aspects of this award including funds provided to sub-recipients, in accordance with 2 CFR 200.331 – 200.333 and 45 CFR 75.351 – 75.353, Sub-recipient monitoring and management.
2. Acceptance of the Terms of an Award: By drawing or otherwise obtaining funds from DBHDS that resulted from funds obtained from the Health and Human Services (HHS) Payment Management System), the subrecipient acknowledges acceptance of the terms and conditions of the award and is obligated to perform in accordance with the requirements of the award. If the subrecipient cannot accept the terms, the subrecipient should notify the Program contact at DBHDS prior to the execution of its Exhibit D or Notice of Award. Once the Exhibit D or Notice of Award is executed by the subrecipient, the contents of the Exhibit D or Notice of Award are binding on the subrecipient until modified and signed by both parties.

Certification Statement: By invoicing DBHDS for funds, the subrecipient certifies that proper financial management controls and accounting systems, to include personnel policies and procedures, have been established to adequately administer Federal awards and drawdown funds. Recipients of Department of Health and Human Services’(DHHS) grants or cooperative agreement awards, and their Subrecipient, must comply with all terms and conditions of their awards, including: (a) terms and conditions included in the HHS Grants Policy Statement in effect at the time of a new, non-competing continuation, or renewal award (HHS Grants Policy Statement Oct. 1, 2024), including the requirements of HHS grants administration regulations; (b) requirements of the       authorizing statutes and implementing regulations for the program under which the award is funded; (c) applicable requirements or limitations in appropriations acts; and (d) any requirements specific to the particular award specified in program policy and guidance, the FOA, the NOFO, or the NOA.

• Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards: The NOA issued is subject to the administrative requirements, cost principles, and audit requirements that govern Federal monies associated with this award, as applicable, in the Uniform Guidance 2 CFR Part 200 as codified by HHS at 45 CFR Part 75.
• Award Expectations: The eligibility and program requirements originally outlined in the FOA or NOFO must continue to be adhered to as the funded project is implemented. Recipients must comply with the performance goals, milestones, outcomes, and performance data collection as reflected in the FOA and related policy and guidance. Additional terms and/or conditions may be applied to this award if outstanding financial or programmatic compliance issues are identified by Substance Abuse and Mental Health Services Administration (SAMHSA). Subrecipient must comply with the Scope of Services of their award.
• Flow down of requirements to sub-recipients: The grantee, as the awardee organization, is legally and financially responsible for all aspects of this award including funds provided to sub-recipients, in accordance with 2 CFR 200.331 – 2 CFR 200.332 and 45 CFR 75.351 – 75.353, Subrecipient monitoring and management.
• Risk Assessment: SAMHSA’s Office of Financial Advisory Services (OFAS) may perform an administrative review of the subrecipient organization’s financial management system. If the review discloses material weaknesses or other financial management concerns, grant funding may be restricted in accordance with 45 CFR 75 and 2 CFR 200, as applicable. DBHDS reviews and determines the risk associated with its Subrecipient. As part of the risk assessment process, DBHDS may perform an administrative review of the subrecipient’s financial management system.
• Improper Payments: Any expenditure by the Subrecipient which is found by auditors, investigators, and other authorized representatives of DBHDS, the Commonwealth of Virginia, the U.S. Department of Health and Human Services, the U.S. Government Accountability Office or the Comptroller General of the United States to be improper, unallowable, in violation of federal or state law or the terms of the NOA, FOA, NOFO or this Exhibit, or involving any fraudulent, deceptive, or misleading representations or activities of the Subrecipient, shall become Subrecipient’s liability, to be paid by Subrecipient from funds other than those provided by DBHDS for the given program or any other funding agreements between DBHDS and the Subrecipient. This provision shall survive the expiration or termination of the applicable Performance Contract.
• Treatment of Property and Equipment: If the Program permits the Subrecipient or entities that receive funding from the Subrecipient to purchase real property or equipment with grant funds, the Program retains a residual financial interest, enabling the Program to recover the assets or determine final disposition. This will be accomplished on a case-by-case basis, according to the federal grant guidelines applicable to the grant that is funding the service(s) in accordance with 2 CFR 200.1 and 45 CFR 75.2. Equipment is defined in the defined terms section of this Exhibit. 
• Program Income: Program income accrued under this grant award must be reported to the Recipient and must be used to further the objectives of the grant project and only for allowable costs.
• Financial Management: The Subrecipient shall maintain a financial management system and financial records and shall administer funds received in accordance with all applicable federal and state requirements, including without limitation:

            1) the Uniform Guidance, 2 C.F.R. Part 200 and 45 C.F.R. Part 75.

            2) the NOA; and

            3) FOA or NOFO

The Subrecipient shall adopt such additional financial management procedures as may from time to time be prescribed by DBHDS if required by applicable laws, regulations or guidelines from its federal and state government funding sources.  Subrecipient shall maintain detailed, itemized documentation and records of all income received and expenses incurred pursuant to this Exhibit.

1. Audit of Financial Records: The Subrecipient shall comply with the audit and reporting requirements defined by the Federal Office of Management and Budget (OMB) 2 CFR 200.500 – 200.521 (Audits of States, Local, Governments and Non-Profit organizations) and 45 CFR 75.500 – 75.521 as applicable. The Subrecipient will, if total Federal funds expended are $1,000,000 or more a year, have a single or program specific financial statement audit conducted for the annual period in compliance with the General Accounting Office audit standards (2 CFR 200.501(a) and 45 CFR 75-501(a)). 

If total federal funds expended are less than $1,000,000 for a year the Subrecipient is exempt from federal audit requirements (2 CFR 200.501(d) and 45 CFR 75-501(d)), but the Subrecipient’s records must be available to the Pass-Through Agency and appropriate officials of HHS, SAMHSA, the U.S. Government Accountability Office and the Comptroller General of the United States, and it must still have a financial audit performed for that year by an independent Certified Public Accountant.  Further, the subrecipient shall complete the certification letter included in Exhibit F (B) disclosing that they are not subject to the single audit requirement. 

Should an audit by authorized state or federal official result in disallowance of amounts previously paid to the Subrecipient, the Subrecipient shall reimburse the Pass-Through Agency upon demand.

Pursuant to 2 CFR 200.334 and 45 CFR 75.361, the Subrecipient shall retain all books, records, and other relevant documents for three (3) years from the end of the calendar year in which the grant period terminates. If any litigation, claim, or audit is initiated prior to the expiration of the 3-year period, all records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken.  DBHDS, its authorized agents, and/or federal or state auditors shall have full access to and the right to examine any of said materials during said period.

1. Accounting Records and Disclosures: The Subrecipient must maintain records which adequately identify the source and application of funds provided for financially assisted activities, including awards and authorizations, obligations, unobligated balances, assets, liabilities, outlays or expenditures, and income. The Subrecipient should expect that the Recipient and SAMHSA may conduct a financial compliance audit and on-site program review of this project as outlined in paragraph (11).
2. Standards for Documentation of Personnel Expenses: The Subrecipient shall comply with 2 CFR 200.430 and 45 CFR 75.430 Compensation-Personal Services and 2 CFR 200.431 and 45 CFR 75.431 Compensation-Fringe Benefits as required by the Federal Office of Management and Budget (OMB) Circular 2 CFR 200 (Cost Principles for State, Local and Indian Tribal Government).  Per Standards for Documentation of Personnel Expenses 2 CFR 200.430(g)(3) and 45 CFR 75.430(g)(3) in accordance with Department of Labor regulations implementing the Fair Labor Standards Act (FLSA) (29 CFR Part 516), charges for the salaries and wages of nonexempt employees, in addition to the supporting documentation described in this section (2 CFR 200.430 and 45 CFR 75.430), must also be supported by the appropriate records.
3. Non-Supplant: Federal award funds must supplement, not replace (supplant) nonfederal funds. Applicants or award recipients and Subrecipient may be required to demonstrate and document that a reduction in non-federal resources occurred for reasons other than the receipt of expected receipt of federal funds.
4. Unallowable Costs: All costs incurred prior to the award issue date and costs not consistent with the FOA/NOFO, 2 CFR Part 200, 45 CFR Part 75, and the HHS Grants Policy Statement, are not allowable.
5. Executive Pay: Pursuant to Executive Order and effective January 1, 2024, the amount of direct salary to Executive Level II of the Federal Executive Pay scale is restricted to $221,900.
6. Intent to Utilize Funding to Enter into a Procurement/Contractual Relationship: If the Subrecipient utilizes any of these funds to contract for any goods or services, the Subrecipient must ensure that the resultant contract complies with the terms of Appendix II, 45 C.F.R. 75 which governs the contractual provisions for non-federal entity contracts under federal awards issued by the Department of Health and Human Services.
7. Ad Hoc Submissions: Throughout the project period, SAMHSA or DBHDS may require submission of additional information beyond the standard deliverables. This information may include, but is not limited to the following:
8. Payroll
9. Purchase Orders
10. Contract documentation
11. Proof of Project implementation
12. Conflicts of Interest Policy: Subrecipient must establish written policies and procedures to prevent employees, consultants, and others (including family, business, or other ties) involved in grant-supported activities, from involvement in actual or perceived conflicts of interest. The policies and procedures must:
13. Address conditions under which outside activities, relationships, or financial interest are proper or improper.
14. Provide for advance disclosure of outside activities, relationships, or financial interest to a responsible organizational official.
15. Include a process for notification and review by the responsible official of potential or actual violations of the standards; and
16. Specify the nature of penalties that may be imposed for violations.
17. Administrative and National Policy Requirements: Public policy requirements are requirements with a broader national purpose than that of the Federal sponsoring program or award that an applicant/recipient/subrecipient must adhere to as a prerequisite to and/or condition of an award. Public policy requirements are established by statute, regulation, or Executive order. In some cases, they relate to general activities, such as preservation of the environment, while, in other cases they are integral to the purposes of the award-supported activities. An application funded with the release of federal funds through a grant award does not constitute or imply compliance with federal statute and regulations. Funded organizations are responsible for ensuring that their activities comply with all applicable federal regulations.
18. Marijuana Restriction: Grant funds may not be used, directly or indirectly, to purchase, prescribe, or provide marijuana or treatment using marijuana. Treatment in this context includes the treatment of opioid use disorder. Grant funds also cannot be provided to any individual who or organization that provides or permits marijuana use for the purposes of treating substance use or mental disorders. See, e.g., 45 C.F.R. 75.300(a) (requiring HHS to “ensure that Federal funding is expended in full accordance with U.S. statutory requirements.”); 21 U.S.C. § 812(c) (10) and 841 (prohibiting the possession, manufacture, sale, purchase or distribution of marijuana). This prohibition does not apply to those providing such treatment in the context of clinical research permitted by the Drug Enforcement Agency and under an FDA-approved investigational new drug application where the article being evaluated is marijuana or a constituent thereof that is otherwise a banned controlled substance under federal law.
19. Confidentiality of Alcohol and Drug Abuse Patient Records: The regulations (42 CFR 2) are applicable to any information about alcohol and other drug abuse patients obtained by a “program” (42 CFR 2.11), if the program is federally assisted in any manner (42 CFR 2.12b). Accordingly, all project patient records are confidential and may be disclosed and used only in accordance with 42 CFR Part 2. The recipient and/or subrecipient is responsible for assuring compliance with these regulations and principles, including responsibility for assuring the security and confidentiality of all electronically transmitted patient material.
20. Drug-Free Workplace: The Subrecipient agrees to 1) provide a drug-free workplace for the Subrecipient’s employees; 2) post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the Subrecipient’s workplace and specifying the actions that will be taken against employees for violations of such prohibition; 3) state in all solicitations or advertisements for employees placed by or on behalf of the Subrecipient that the Subrecipient maintains a drug-free workplace; and 4) include the provisions of the foregoing clauses in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.
21. Promotional Items: Pursuant to 2 CFR 200.421 and 45 CFR 75.421, SAMHSA grant funds may not be used for Promotional Items. Promotional items include but are not limited to clothing and commemorative items such as pens, mugs/cups, folders/folios, lanyards, and conference bags. HHS Policy on the Use of Appropriated Funds for Promotional Items: https://www.hhs.gov/grants/contracts/contract-policies-regulations/spending-on-promotionalitems/index.html
22. SAM and UEI Requirements: This award is subject to requirements as set forth in 2 CFR 25.300 – Requirement for recipients to ensure subrecipients have a unique entity identifier. This requires the subrecipient to obtain a Unique Entity Identifier (UEI) to be eligible to receive subrecipient awards.
23. Acknowledgement of Federal Funding in Communications and Contracting: As required by HHS appropriations acts, all HHS recipients and Subrecipient must acknowledge Federal funding when issuing statements, press releases, requests for proposals, bid invitations, and other documents describing projects or programs funded in whole or in part with Federal funds. Recipients and Subrecipient are required to state: (1) the percentage and dollar amount of the total program or project costs financed with Federal funds; and (2) the percentage and dollar amount of the total costs financed by nongovernmental sources.
24. Acknowledgement of Federal Funding at Conferences and Meetings: Allowable conference costs paid by the non-Federal entity as a sponsor or host of the conference may include rental of facilities, speakers’ fees, costs of meals and refreshments, local transportation, and other items incidental to such conferences unless further restricted by the terms and conditions of the Federal award. As needed, the costs of identifying, but not providing, locally available dependent-care resources are allowable. Conference hosts/sponsors must exercise discretion and judgment in ensuring that conference costs are appropriate, necessary and managed in a manner that minimizes costs to the Federal award. The HHS awarding agency may authorize exceptions where appropriate for programs including Indian tribes, children, and the elderly. See also 2 CFR 200.438/45 CFR 75.438, 2 CFR 200.456/45 CFR 75.456, 2 CFR 200.475 – 476/45 CFR 75.474, – 75.475.

When a conference is funded by a grant or cooperative agreement, the recipient and/or subrecipient must include the following statement on all conference materials (including promotional materials, agenda, and Internet sites):

Funding for this conference was made possible (in part) by (insert grant or cooperative agreement award number) from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Conference materials and other publications must include language that conveys the following:

1. The publication, event or conference was funded [in part or in whole] by SAMHSA Grant (Enter Grant Number from the appropriate federal NOA that was sent out to your CSB).
   1. The views expressed in written materials or by conference speakers and moderators do not necessarily reflect the official policies of the U.S. Department of Health and Human Services or the Executive Branch of the Commonwealth of Virginia.
   1. Mention of trade names, commercial practices or organizations does not imply endorsement by the U.S. Government or the Commonwealth of Virginia.

• Mandatory Disclosures: Consistent with 2 CFR 200.113 and 45 CFR 75.113, the Subrecipient must disclose in a timely manner, in writing to the HHS Office of Inspector General (OIG), all information related to violations, or suspected violations, of Federal criminal law involving fraud, bribery, waste, abuse, or gratuity violations potentially affecting the Federal award. Subrecipient must disclose, in a timely manner, in writing to the prime recipient (pass through entity) and the HHS OIG, all information related to violations, or suspected violations, of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Disclosures must be sent in writing to the awarding agency and to the HHS OIG at the following addresses:

U.S. Department of Health and Human Services

            Office of Inspector General ATTN: Mandatory Grant Disclosures, Intake Coordinator

            330 Independence Avenue, SW, Cohen Building Room 5527

            Washington, DC 20201

            Fax: (202) 205-0604

(Include “Mandatory Grant Disclosures” in subject line) or email:        MandatoryGranteeDisclosures@oig.hhs.gov

Failure to make required disclosures can result in any of the remedies described in 2 CFR 200.339 and 45 CFR 75.371 remedies for noncompliance, including suspension or debarment (see 2 CFR parts 180 & 376 and 31U.S.C. 3321).

The Subrecipient will notify DBHDS when violations are reported to HHS Office of Inspector General within three business days. 

• Lobbying Restrictions: Pursuant to 2 CFR 200.450 and 45 CFR 75.450, no portion of these funds may be used to engage in activities that are intended to support or defeat the enactment of legislation before the Congress or Virginia General Assembly, or any local legislative body, or to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any federal, state or local government, except in presentation to the executive branch of any State or local government itself.  No portion of these funds can be used to support any personnel engaged in these activities.  These prohibitions include any activity to advocate or promote any proposed, pending or future Federal, State or local tax increase, or any proposed, pending or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control.

• Trafficking Victims Protection Act of 2000 (22 U.S.C. 7104(G)), amended by 2 C.F.R. Part 175: The Trafficking Victims Protection Act of 2000 authorizes termination of financial assistance provided to a private entity, without penalty to the Federal government, if the recipient or subrecipient engages in certain activities related to trafficking in persons. SAMHSA may unilaterally terminate this award, without penalty, if a private entity recipient, or a private entity subrecipient, or their employees:
• Engage in severe forms of trafficking in persons during the period that the award is in effect.
• Procure a commercial sex act during the period that the award is in effect; or,
• Use forced labor in the performance of the award or subawards under the award. The text of the full award term is available at 2 C.F.R. 175.15(b). See http://www.gpo.gov/fdsys/pkg/CFR-2012-title2-vol1/pdf/CFR-2012-title2-vol1-sec175-15.pdf

• Accessibility Provisions: Recipients and Subrecipient of Federal Financial Assistance (FFA) from HHS must administer their programs in compliance with Federal civil rights law. This means that recipients and Subrecipient of HHS funds must ensure equal access to their programs without regard to a person’s race, color, national origin, disability, age, and in some circumstances, sex and religion. This includes ensuring your programs are accessible to persons with limited English proficiency.

The HHS Office for Civil Rights also provides guidance on complying with civil rights laws enforced by HHS. Please see: http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html

Recipients and Subrecipient of FFA also have specific legal obligations for serving qualified individuals with disabilities. Please see- http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under Federal civil rights laws at https://www.hhs.gov/civil- rights/index.html

or call 1-800-368-1019 or TDD 1-800- 537-7697.

Also note that it is an HHS Departmental goal to ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations. For further guidance on providing culturally and linguistically appropriate services, recipients and Subrecipient should review the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=6.

• Executive Order 13410: Promoting Quality and Efficient Health Care: This Executive Order promotes efficient delivery of quality health care using health information technology, transparency regarding health care quality and price, and incentives to promote the widespread adoption of health information technology and quality of care. Accordingly, all recipients and Subrecipient that electronically exchange patient level health information to external entities where national standards exist must:

a) Use recognized health information interoperability standards at the time of any HIT system

update, acquisition, or implementation, in all relevant information technology systems supported, in whole or in part, through their federally funded agreement/contract with DBHDS. Please consult www.healthit.gov for more information, and

b) Use Electronic Health Record systems (EHRs) that are certified by agencies authorized by

the Office of the National Coordinator for Health Information Technology (ONC), or that will be certified during the life of the grant. For additional information contact: Jim Kretz, at 240-276-1755 or Jim.Kretz@samhsa.hhs.gov.

• Travel: Funds used to attend meetings, conferences or implement the activities of this grant must not exceed the lodging rates and per diem for Federal travel and Meal/Incidental expenses provided by the General Services Administration.  These rates vary by jurisdiction. 

• English Language: All communication between the Pass-Through Agency and the Subrecipient must be in the English language and must utilize the terms of U.S. dollars.  Information may be translated into other languages.  Where there is inconsistency in meaning between the English language and other languages, the English language meaning shall prevail.

• Intangible Property Rights: Pursuant to 2 CFR 200.315 and 45 CFR 75.322:
• Title to intangible property (as defined in the Definitions Section of this Exhibit) acquired under a federal award vest upon acquisition in the non-Federal entity.  The non-federal entity must use that property for the originally authorized purpose and must not encumber the property without approval of the federal awarding agency (SAMHSA). When no longer needed for the originally authorized purpose, disposition of the intangible property must occur in accordance with the provisions in 2 CFR 200.313(e) and 45 CFR 75.320(e). 
• The non-federal entity may copyright any work that is subject to copyright and was developed, or for which ownership was acquired, under a federal award.  The awarding agency reserves a royalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for Federal purposes and to authorize others to do so. 
• The Non-Federal entity is subject to applicable regulations governing patents and inventions, including government-wide regulations issued by the Department of Commerce at 37 CFR Part 401.
• The federal government has the right to: 1) Obtain, reproduce, publish, or otherwise use the data produced under a Federal Award; and 2) Authorize others to receive, reproduce, publish, or otherwise use such data for Federal purposes.
• Freedom of Information Act:
• In response to a Freedom of Information Act (FOIA) request for research data relating to published research findings produced under a Federal award that were used by the Federal Government in developing an agency action that has the force and effect of law, the HHS awarding agency must request, and the non-Federal entity must provide, within a reasonable time, the research data so that they can be made available to the public through the procedures established under the FOIA. If the HHS awarding agency obtains the research data solely in response to a FOIA request, the HHS awarding agency may charge the requester a reasonable fee equaling the full incremental cost of obtaining the research data. This fee should reflect costs incurred by the Federal agency and the non-Federal entity. This fee is in addition to any fees the HHS awarding agency may assess under the FOIA (5 U.S.C. 552(a)(4)(A)).
• Published research findings means when:

(i) Research findings are published in a peer-reviewed scientific or technical journal; or

(ii) A Federal agency publicly and officially cites the research findings in support of an agency action that has the force and effect of law. “Used by the Federal Government in developing an agency action that has the force and effect of law” is defined as when an agency publicly and officially cites the research findings in support of an agency action that has the force and effect of law.

• Research data means the recorded factual material commonly accepted in the scientific community as necessary to validate research findings, but not any of the following: Preliminary analyses, drafts of scientific papers, plans for future research, peer reviews, or communications with colleagues. This “recorded” material excludes physical objects (e.g., laboratory samples). Research data also do not include:

(i) Trade secrets, commercial information, materials necessary to be held confidential       

by a researcher until they are published, or similar information which is protected under law; and

(ii) Personnel and medical information and similar information the disclosure of  

      which would constitute a clearly unwarranted invasion of personal privacy, such as    

      information that could be used to identify a particular person in research study.

      f)    The requirements set forth in paragraph (E)(1) of this part do not apply to commercial    

             organizations.

The Pass-Through Agency reserves the irrevocable right to utilize any Intangible Property described above, royalty-free, for the completion of the terms of this Grant and any associated agreement.

• National Historical Preservation Act and Executive Order 13287, Preserve America: The Subrecipient must comply with this federal legislation and executive order.

• Welfare-to-Work: The Subrecipient is encouraged to hire welfare recipients and to provide additional needed training and mentoring as needed.

• Applicable Laws and Courts: Awards of federal funds from DBHDS shall be governed in all respects by the laws of the Commonwealth of Virginia and any litigation with respect thereto shall be brought in the courts of the Commonwealth.  The Subrecipient shall comply with all applicable federal, state and local laws, rules and regulations.

• Immigration Reform and Control Act of 1986: The Subrecipient certifies that the Subrecipient does not and shall not knowingly employ an unauthorized alien as defined in the federal Immigration Reform and Control Act of 1986.

• Construction Purchases: SAMHSA grant funds may not be used for the purchase or construction of any building or structure to house any part of the program (Applicants may request up to $5,000 for renovations and alterations of existing facilities, if necessary and appropriate to the project).

• Residential or Outpatient Treatment: SAMHSA grant funds may not be used to provide residential or outpatient treatment services when the facility has not yet been acquired, sited, approved, and met all requirements for human habitation and services provision. (Expansion or enhancement of existing residential services is permissible).

• Inpatient Services: SAMHSA grant funds may not be used to provide inpatient treatment or hospital-based detoxification services. Residential services are not considered to be inpatient or hospital-based services.

• Direct Payments to Individuals: SAMHSA grant funds may not be used to make direct payments to individuals to enter treatment or continue to participate in prevention or treatment services.  Note: A recipient or treatment or prevention provider may provide up to $30 in non-cash incentives to individuals to participate in required data collection follow-up and other treatment or prevention services. 

• Meals: Meals are allowable so long as they are part of conferences or allowable non-local travel and do not exceed the per diem reimbursement rate allowed for the jurisdiction by the General Services Administration. Grant funds may be used for light snacks, not to exceed $3.00 per person per day.

• Sterile Needles or Syringes: Funds may not be used to provide sterile needles or syringes for the hypodermic injection of any illegal drug. Provided, that such limitation does not apply to the use of funds for elements of a program other than making such purchases if the relevant State or local health department, in consultation with the Centers for Disease Control and Prevention, determines that the State or local jurisdiction, as applicable, is experiencing, or is at risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use, and such program is operating in accordance with state and local law.

• Compliance with Federal Regulations/Statute/Policy: The Subrecipient agrees to enforce, administer, and comply with any applicable federal regulations, statutes, or policies that are not otherwise mentioned including 2 C.F.R. § 200, 45 C.F.R. § 75, the Health and Human Services Grants Policy Statement, or any other source.

1. Treasury Grants

1. Grant Oversight: The CSBs and the Department are legally and financially responsible for all aspects of this award including funds provided to sub-recipients, in accordance with 2 CFR 200.331 – 200.333, Sub-recipient monitoring and management.

• Acceptance of the Terms of an Award: By drawing or otherwise obtaining funds, the Subrecipient acknowledges acceptance of the terms and conditions of the award and is obligated to perform in accordance with the requirements of the award. If the Subrecipient cannot accept the terms, the Subrecipient should notify the Program contact at DBHDS prior to the agreement. Once the agreement is signed by the Subrecipient, the contents are binding on the Subrecipient unless and until modified by a revised agreement signed by DBHDS.

• Certification Statement: By invoicing DBHDS for funds, the Subrecipient certifies that proper financial management controls and accounting systems, to include personnel policies and procedures, have been established to adequately administer Federal awards and drawdown funds. Recipients of Coronavirus State and Local Recovery Funds, and their subrecipients, must comply with all terms and conditions of their awards, including: (a) requirements of the authorizing statutes and implementing regulations for the program under which the award is funded; (b) applicable requirements or limitations in appropriations acts; and (c) any requirements specific to the particular award specified in program policy and guidance.

• Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards: The agreement issued is subject to the administrative requirements, cost principles, and audit requirements that govern Federal monies associated with this award, as applicable, in the Uniform Guidance 2 CFR Part 200.

• Award Expectations: The eligibility and program requirements originally outlined in the Federal Guidance issued because of the American Rescue Plan Act 2021 must continue to be adhered to as the funded project is implemented. Recipients must comply with the performance goals, milestones, outcomes, and performance data collection as determined by DBHDS. Additional terms and/or conditions may be applied to this award if outstanding financial or programmatic compliance issues are identified by or amended guidance is provided by the US Department of Treasury and/or Commonwealth of Virginia Department of Planning & Budget. Subrecipients must comply with the Scope of Services of this agreement as outlined in the Performance Contract.
   
• Flow down of requirements to sub-recipients: The grantee, as the awardee organization, is legally and financially responsible for all aspects of this award including funds provided to sub-recipients, in accordance with 2 CFR 200.331-332 – Subrecipient monitoring and management.

• Risk Assessment: The responsible federal agency may perform an administrative review of the Subrecipient organization’s financial management system. If the review discloses material weaknesses or other financial management concerns, grant funding may be restricted in accordance with 2 CFR 200.206, as applicable. DBHDS reviews and determines the risk associated with its subrecipients. As part of the risk assessment process, DBHDS may perform an administrative review of the Subrecipient’s financial management system.

• Improper Payments: Any expenditure by the Subrecipient under the terms of this Agreement which is found by auditors, investigators, and other authorized representatives of DBHDS, the Commonwealth of Virginia,  the U.S. Government Accountability Office or the Comptroller General of the United States, or any other federal agency to be improper, unallowable, in violation of federal or state law or the terms of the this Agreement, or involving any fraudulent, deceptive, or misleading representations or activities of the Subrecipient, shall become Subrecipient’s liability, to be paid by Subrecipient from funds other than those provided by DBHDS under this Agreement or any other agreements between DBHDS and the Subrecipient. This provision shall survive the expiration or termination of this Agreement.

• Limitations on Expenditures: Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to the Effective Date of this agreement, or following the end of the Period of Performance.    DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are:
   1) Reasonable and necessary to carry out the agreed upon Scope of Services in Section III and Attachment C of this Agreement,
  2) Documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and
  3) Incurred in accordance with all applicable requirements for the expenditure of funds payable under this agreement.

1. Treatment of Property and Equipment: If the Program permits the Subrecipient or entities that receive funding from the Subrecipient to purchase real property or equipment with grant funds, the Program retains a residual financial interest, enabling the Program to recover the assets or determine final disposition. This will be accomplished on a case-by-case basis, according to the federal guidelines in accordance with 2 CFR 200.313.

1. Program Income: Program income accrued under this grant award must be reported to the Recipient and must be used to further the objectives of the grant project and only for allowable costs.

1. Financial Management: The Subrecipient shall maintain a financial management system and financial records and shall administer funds received pursuant to this agreement in accordance with all applicable federal and state requirements, including without limitation:
2. the Uniform Guidance, 2 C.F.R. Part 200.
3. State and Local Fiscal Recovery Funds – Compliance and Reporting Guidance Ver 1.1 dated June 24, 2021
4. The Subrecipient shall adopt such additional financial management procedures as may from time to time be prescribed by DBHDS if required by applicable laws, regulations or guidelines from its federal and state government funding sources.  Subrecipient shall maintain detailed, itemized documentation and records of all income received and expenses incurred pursuant to this Agreement.

1. Audit of Financial Records: The Subrecipient shall comply with the audit and reporting requirements defined by the Federal Office of Management and Budget (OMB) 2 CFR 200 (Audits of States, Local, Governments and Non-Profit organizations) as applicable. The Subrecipient will, if total Federal funds expended are $1,000,000 or more a year, have a single or program specific financial statement audit conducted for the annual period in compliance with the General Accounting Office audit standards (2 CFR 200 Subpart F – Audit Requirements). 

If total federal funds expended are less than $1,000,000 for a year the Subrecipient is exempt from federal audit requirements (2 CFR 200-501(d)), but the Subrecipient’s records must be available to the Pass-Through Agency and appropriate officials of HHS, SAMHSA, the U.S. Government Accountability Office and the Comptroller General of the United States, and it must still have a financial audit performed for that year by an independent Certified Public Accountant.  Further, the subrecipient shall complete the certification letter included in Exhibit F (B) disclosing that they are not subject to the single audit requirement. 

Should an audit by authorized state or federal official result in disallowance of amounts previously paid to the Subrecipient, the Subrecipient shall reimburse the Pass-Through Agency upon demand.

Pursuant to 2 CFR 200.334, the Subrecipient shall retain all books, records, and other relevant documents for three (3) years from the end of the calendar year in which the grant period terminates. In the event that any litigation, claim, or audit is initiated prior to the expiration of the 3-year period, all records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken.  DBHDS, its authorized agents, and/or federal or state auditors shall have full access to and the right to examine any of said materials during said period.

1. Accounting Records and Disclosures: The Subrecipient must maintain records which adequately identify the source and application of funds provided for financially assisted activities, including awards and authorizations, obligations, unobligated balances, assets, liabilities, outlays or expenditures, and income. The Subrecipient should expect that the Primary Recipient or responsible federal agency may conduct a financial compliance audit and on-site program review of this project as outlined in paragraph (11).

1. Standards for Documentation of Personnel Expenses: The Subrecipient shall comply with 2 CFR 200.430 Compensation-Personal Services and 2 CFR 200.431 Compensation-Fringe Benefits as required by the Federal Office of Management and Budget (OMB) Circular 2 CFR 200 (Cost Principles for State, Local and Indian Tribal Government).  Per Standards for Documentation of Personnel Expenses 2 CFR 200.430(i) in accordance with Department of Labor regulations implementing the Fair Labor Standards Act (FLSA) (29 CFR Part 516), charges for the salaries and wages of nonexempt employees, in addition to the supporting documentation described in this section (2 CFR 200.430(i)(3)), must also be supported by records

1. Non-Supplant: Federal award funds must supplement, not replace (supplant) nonfederal funds. Applicants or award recipients and subrecipients may be required to demonstrate and document that a reduction in non-federal resources occurred for reasons other than the receipt of expected receipt of federal funds.

1. Unallowable Costs: All costs incurred prior to the award issue date and costs not consistent with the allowable activities under the guidance for the Coronavirus State and Local Fiscal Recovery Funds, 31 CFR 35, and 2 CFR 200 Subpart E – Cost Principles, are not allowable under this award.

1. Executive Pay: Pursuant to Executive Order and effective January 1, 2024, the amount of direct salary to Executive Level II of the Federal Executive Pay scales restricted to $221,900.

1. Intent to Utilize Funding to Enter into a Procurement/Contractual Relationship:
   If the Subrecipient utilizes any of these funds to contract for any goods or services, the Subrecipient must ensure that the resultant contract complies with the terms of Appendix II, 2 CFR 200 which governs the contractual provisions for non-federal entity contracts under federal awards issued by the US Department of Treasury.

• Ad Hoc Submissions: Throughout the project period, the responsible federal agency or DBHDS may determine that a grant or Subrecipient Funding Agreement requires submission of additional information beyond the standard deliverables. This information may include, but is not limited to the following:
• Payroll
• Purchase Orders
• Contract documentation
• Proof of Project implementation

• Conflicts of Interest Policy: Subrecipients must establish written policies and procedures to prevent employees, consultants, and others (including family, business, or other ties) involved in grant-supported activities, from involvement in actual or perceived conflicts of interest. The policies and procedures must:
  • Address conditions under which outside activities, relationships, or financial interest are proper or improper;
  • Provide for advance disclosure of outside activities, relationships, or financial interest to a responsible organizational official;
  • Include a process for notification and review by the responsible official of potential or actual violations of the standards; and
  • Specify the nature of penalties that may be imposed for violations.

• Administrative and National Policy Requirements: Public policy requirements are requirements with a broader national purpose than that of the Federal sponsoring program or award that an applicant/recipient/subrecipient must adhere to as a prerequisite to and/or condition of an award. Public policy requirements are established by statute, regulation, or Executive order. In some cases, they relate to general activities, such as preservation of the environment, while, in other cases they are integral to the purposes of the award-supported activities. An application funded with the release of federal funds through a grant award does not constitute or imply compliance with federal statute and regulations. Funded organizations are responsible for ensuring that their activities comply with all applicable federal regulations.
   
• Marijuana Restriction: Grant funds may not be used, directly or indirectly, to purchase, prescribe, or provide marijuana or treatment using marijuana. Treatment in this context includes the treatment of opioid use disorder. Grant funds also cannot be provided to any individual who or organization that provides or permits marijuana use for the purposes of treating substance use or mental disorders. See, e.g., 2 C.F.R. 200.300(a) (requiring HHS to “ensure that Federal funding is expended in full accordance with U.S. statutory requirements.”); 21 U.S.C. § 812(c) (10) and 841 (prohibiting the possession, manufacture, sale, purchase or distribution of marijuana). This prohibition does not apply to those providing such treatment in the context of clinical research permitted by the Drug Enforcement Agency and under an FDA-approved investigational new drug application where the article being evaluated is marijuana or a constituent thereof that is otherwise a banned controlled substance under federal law.

• Confidentiality of Alcohol and Drug Abuse Patient Record: The regulations (42 CFR 2) are applicable to any information about alcohol and other drug abuse patients obtained by a “program” (42 CFR 2.11), if the program is federally assisted in any manner (42 CFR 2.12(b)). Accordingly, all project patient records are confidential and may be disclosed and used only in accordance with 42 CFR Part 2. The recipient and/or subrecipient is responsible for assuring compliance with these regulations and principles, including responsibility for assuring the security and confidentiality of all electronically transmitted patient material.

• Drug-Free Workplace: During the performance of this agreement, the Subrecipient agrees to 1) provide a drug-free workplace for the Subrecipient’s employees; 2) post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the Subrecipient’s workplace and specifying the actions that will be taken against employees for violations of such prohibition; 3) state in all solicitations or advertisements for employees placed by or on behalf of the Subrecipient that the Subrecipient maintains a drug-free workplace; and 4) include the provisions of the foregoing clauses in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

• Promotional Items: Pursuant to 2 CFR 200.421(e), Federal funding awarded under Coronavirus State and Local Recovery Funds may not be used for Promotional Items. Promotional items include but are not limited to clothing and commemorative items such as pens, mugs/cups, folders/folios, lanyards, and conference bags.

• SAM and UEI Requirements: This award is subject to requirements as set forth in 2 CFR 25 – Universal Identifier And System For Award Management.  This includes the following:
   
  A. Requirement for SAM: Unless exempted from this requirement under 2 CFR 25.110, the Subrecipient must maintain its information in SAM, until the final financial report required under this agreement or receive the final payment, whichever is later. The information must be reviewed and updated at least annually after the initial registration, and more frequently if required by changes in the information or the addition of another award term.

B. Requirement for Unique Entity Identifier (UEI) if you are authorized to make subawards under this award, you: Must notify potential subrecipients that no governmental organization, foreign public entity, domestic or foreign nonprofit organization, or Federal agency serving as a subrecipient may receive a subaward unless the entity has provided its unique entity identifier; and

May not make a subaward to a governmental organization, foreign public entity, domestic or foreign nonprofit organization, or Federal agency serving as a subrecipient, unless the entity has provided its unique entity identifier.

• Mandatory Disclosures: Consistent with 2 CFR 200.113, the Subrecipient must disclose in a timely manner, in writing to the US Department of Treasury and the primary recipient, all information related to violations, or suspected violations, of Federal criminal law involving fraud, bribery, waste, abuse, or gratuity violations potentially affecting the Federal award. Subrecipients must disclose, in a timely manner, in writing to the prime recipient (pass through entity) and the US Department of Treasury, all information related to violations, or suspected violations, of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award.  

Failure to make required disclosures can result in any of the remedies described in 45 CFR 200.339 -Remedies for Noncompliance, including suspension or debarment (see 2 CFR parts 180 & 376 and 31 U.S.C. 3321). The Subrecipient will notify DBHDS when violations are reported to the federal government within three business days. 

• Lobbying Restrictions:  Pursuant to 2 CFR 200.450, no portion of these funds may be used to engage in activities that are intended to support or defeat the enactment of legislation before the Congress or Virginia General Assembly, or any local legislative body, or to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any federal, state or local government, except in presentation to the executive branch of any State or local government itself.  No portion of these funds can be used to support any personnel engaged in these activities.  These prohibitions include any activity to advocate or promote any proposed, pending or future Federal, State or local tax increase, or any proposed, pending or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control.
   
• Trafficking Victims Protection Act of 2000 (22 U.S.C. 7104(G)) amended by 2 C.F.R. Part 175:
  The Trafficking Victims Protection Act of 2000 authorizes termination of financial assistance provided to a private entity, without penalty to the Federal government, if the recipient or subrecipient engages in certain activities related to trafficking in persons. SAMHSA may unilaterally terminate this award, without penalty, if a private entity recipient, or a private entity subrecipient, or their employees:
  a) Engage in severe forms of trafficking in persons during the period of time that the award is in effect;
  b) Procure a commercial sex act during the period of time that the award is in effect; or,

c) Use forced labor in the performance of the award or subawards under the award.

       d) The text of the full award term is available at 2 C.F.R. 175.15(b).

• Accessibility Provisions: Recipients and subrecipients of Federal Financial Assistance (FFA) from the Coronavirus State and Local Recovery Fund are required to administer their programs in compliance with Federal civil rights law implemented by US Department of Treasury as codified in 31 CFR part 22 and 31 CFR part 23.
  
  These requirements include ensuring that entities receiving Federal financial assistance from the Treasury do not deny benefits or services, or otherwise discriminate on the basis of race, color, national origin (including limited English proficiency), disability, age, or sex (including sexual orientation and gender identity), in accordance with the following authorities: Title VI of the Civil Rights Act of 1964 (Title VI) Public Law 88-352, 42 U.S.C. 2000d-1 et seq., and the Department’s implementing regulations, 31 CFR part 22; Section 504 of the Rehabilitation Act of 1973 (Section 504), Public Law 93-112, as amended by Public Law 93-516, 29 U.S.C. 794; Title IX of the Education Amendments of 1972 (Title IX), 20 U.S.C. 1681 et seq., and the Department’s implementing regulations, 31 CFR part 28; Age Discrimination Act of 1975, Public Law 94-135, 42 U.S.C. 6101 et seq., and the Department implementing regulations at 31 CFR part 23.
   
• Executive Order 13410: Promoting Quality and Efficient Health Care: This Executive Order promotes efficient delivery of quality health care through the use of health information technology, transparency regarding health care quality and price, and incentives to promote the widespread adoption of health information technology and quality of care. Accordingly, all recipients and subrecipients that electronically exchange patient level health information to external entities where national standards exist must:
   a) Use recognized health information interoperability standards at the time of any HIT system update, acquisition, or implementation, in all relevant information technology systems supported, in whole or in part, through this agreement/contract. Please consult www.healthit.gov for more information, and

b) Use Electronic Health Record systems (EHRs) that are certified by agencies authorized by the Office of the National Coordinator for Health Information Technology (ONC), or that will be certified during the life of the grant. For additional information contact: Jim Kretz, at 240-276-1755 or Jim.Kretz@samhsa.hhs.gov.

• Travel: Funds used to attend meetings, conferences or implement the activities of this grant must not exceed the lodging rates and per diem for Federal travel and Meal/Incidental expenses provided by the General Services Administration.  These rates vary by jurisdiction. 

• English Language: All communication between the Pass-Through Agency and the Subrecipient must be in the English language and must utilize the terms of U.S. dollars.  Information may be translated into other languages.  Where there is inconsistency in meaning between the English language and other languages, the English             language meaning shall prevail.

• Intangible Property Rights Pursuant to 2 CFR 200.315:
• Title to intangible property (as defined in the Definitions Section of this Agreement) acquired under a Federal award vest upon acquisition in the non-Federal entity.  The non-Federal entity must use that property for the originally authorized purpose and must not encumber the property without approval of the Federal awarding agency (SAMHSA). When no longer needed for the originally authorized purpose, disposition of the intangible property must occur in accordance with the provisions in 2 CFR 200.313(e).
• The non-Federal entity may copyright any work that is subject to copyright and was developed, or for which ownership was acquired, under a federal award.  The awarding agency reserves a royalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for Federal purposes and to authorize others to do so.

 
The Non-Federal entity is subject to applicable regulations governing patents and inventions, including government-wide regulations issued by the Department of Commerce at 37 CFR Part 401.

• The Federal Government has the right to: 1) Obtain, reproduce, publish, or otherwise use the data produced under a Federal Award; and 2) Authorize others to receive, reproduce, publish, or otherwise use such data for Federal purposes.

• Freedom of Information Act:

1) In response to a Freedom of Information Act (FOIA) request for research data relating to published research findings produced under a Federal award that were used by the Federal Government in developing an agency action that has the force and effect of law, the HHS awarding agency must request, and the non-Federal entity must provide, within a reasonable time, the research data so that they can be made available to the public through the procedures established under the FOIA. If the HHS awarding agency obtains the research data solely in response to a FOIA request, the HHS awarding agency may charge the requester a reasonable fee equaling the full incremental cost of obtaining the research data. This fee should reflect costs incurred by the Federal agency and the non-Federal entity. This fee is in addition to any fees the HHS awarding agency may assess under the FOIA (5 U.S.C. 552(a)(4)(A)).

2) Published research findings means when: (i) Research findings are published in a peer-reviewed scientific or technical journal; or(ii) A Federal agency publicly and officially cites the research findings in support of an agency action that has the force and effect of law. “Used by the Federal Government in developing an agency action that has the force and effect of law” is defined as when an agency publicly and officially cites the research findings in support of an agency action that has the force and effect of law.

3) Research data means the recorded factual material commonly accepted in the scientific community as necessary to validate research findings, but not any of the following: Preliminary analyses, drafts of scientific papers, plans for future research, peer reviews, or communications with colleagues. This “recorded” material excludes physical objects (e.g., laboratory samples). Research data also do not include:(i) Trade secrets, commercial information, materials necessary to be held confidential by a researcher until they are published, or similar information which is protected under law; and(ii) Personnel and medical information and similar information the disclosure of which would constitute a clearly unwarranted invasion of personal privacy, such as information that could be used to identify a particular person in a research study.

The requirements set forth in paragraph (E)(1) of this part do not apply to commercial organizations. The Pass-Through Agency reserves the irrevocable right to utilize any Intangible Property described above, royalty-free, for the completion of the terms of this Grant and Agreement.

• National Historical Preservation Act and Executive Order 13287, Preserve America: The Subrecipient must comply with this federal legislation and executive order.

• Welfare-to-Work: The Subrecipient is encouraged to hire welfare recipients and to provide additional needed training and mentoring as needed.

• Applicable Laws and Courts: This agreement shall be governed in all respects by the laws of the Commonwealth of Virginia and any litigation with respect thereto shall be brought in the courts of the Commonwealth. The Subrecipient shall comply with all applicable federal, state and local laws, rules and regulations.

• Immigration Reform and Control Act of 1986: By entering into a written agreement with the Commonwealth of Virginia, the Subrecipient certifies that the Subrecipient does not, and shall not during the performance of the agreement for goods and/or services in the Commonwealth, knowingly employ an unauthorized alien as defined in the federal Immigration Reform and Control Act of 1986.

•  Construction Purchases: Coronavirus State and Local Recovery Funds may not be used for the purchase or construction of any building or structure to house any part of the program (Applicants may request up to $5,000 for renovations and alterations of existing facilities, if necessary and appropriate to the project).

• Meals: Meals are allowable so long as they are part of conferences or allowable non-local travel and do not exceed the per diem reimbursement rate allowed for the jurisdiction by the General Services Administration.  Grant funds may be used for light snacks, not to exceed $3.00 per person per day.

• Sterile Needles or Syringes: Funds may not be used to provide sterile needles or syringes for the hypodermic injection of any illegal drug. Provided, that such limitation does not apply to the use of funds for elements of a program other than making such purchases if the relevant State or local health department, in consultation with the Centers for Disease Control and Prevention, determines that the State or local jurisdiction, as applicable, is experiencing, or is at risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use, and such program is operating in accordance with state and local law.

• Compliance with Federal Regulations/Statute/Policy: The Subrecipient agrees to enforce, administer, and comply with any applicable federal regulations, statutes, or policies that are not otherwise mentioned in this agreement including 2 C.F.R. § 200, or any other source.

              V.          Federal Grant Specific Requirements

There are additional requirements to the grants included in Section IV of this Exhibit that are not universal to all grants that DBHDS administers.  Included below, by grant name, is a list of the grant specific requirements as required by federal statute, regulation, and policy. Use this link for Allowable Recovery Support Services Expenditures through the SUBG and the MHBG.

1. SAMHSA GRANTS
2. State Opioid Response Grant (SUD Federal Opioid Response)

Pursuant to the Notice of Award received by DBHDS and the Notice of Funding Opportunity Announcement (TI-24-008) associated with the State Opioid Response Grant, the following are requirements of the funding distributed to the Subrecipient from this grant.

1. Restrictions on Expenditures: State Opioid Response Grant funds may not be used to:      
2. Pay for services that can be supported through other accessible sources of funding such as other federal discretionary and formula grant funds, e.g. HHS (CDC, CMS, HRSA, and SAMHSA), DOJ (OJP/BJA) and non-federal funds, 3rd party insurance and sliding scale self-pay among others.
3. Pay for a grant or subaward to any agency which would deny any eligible client, patient, or individual access to their program because of their use of Food and Drug Administration (FDA)-approved medications for the treatment of substance use disorders.
4. Provide incentives to any health care professional for receipt of any type of professional training development.
5. Make direct payments to individuals to enter treatment or continue to participate in prevention or treatment services (See U.S.C. § 1320a-7b).
6. Funds may not be used to make direct payments to individuals to enter treatment or continue to participate in prevention or treatment services (See 42 U.S.C. § 1320a-7b).   
7. A recipient or treatment or prevention provider may provide up to $30 noncash incentive to individuals to participate in required data collection follow-up. This amount may be paid for participation in each required follow-up interview. For programs including contingency management as a component of the treatment program, clients may not receive contingencies totaling more than $75 per budget period. The incentive amounts may be subject to change.  SOR funds cannot be utilized for Contingency management without an approval from DBHDS.   All subrecipients receiving funding to support contingency management must have a written policy and procedures that outline the intention and goals regarding contingency management, and step-by- step instructions that explains how to implement the policy. 
8. Expenditure Guidelines:
   1. Grant funds:
9. For treatment and recovery support services grant funds shall only be utilized to provide services to individuals that specifically address opioid or stimulant misuse issues. If either an opioid or stimulant misuse problem (history) exists concurrently with other substance use, all substance use issues may be addressed. Individuals who have no history of or no current issues with opioids or stimulants misuse shall not receive treatment or recovery services with SOR grant funds.
10. Shall be used to fund services and practices that have a demonstrated evidence-base, and that are appropriate for the population(s) of focus.
11. If medications for the treatment of opioid use disorder (MOUD) are made available to those diagnosed with opioid use disorder (OUD), they shall include FDA-approved treatments such as: methadone, buprenorphine products, including single-entity buprenorphine products, buprenorphine/naloxone tablets, films, buccal preparations, long-acting injectable buprenorphine products, and injectable extended-release naltrexone.
12.  May only fund FDA approved products.

• Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or more than 40 days after the appropriate Award Period included in section IV.

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable under any associated agreement.

• Closeout:  Final payment request(s) must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until 40 days after the end of the Period of Performance to pay for unliquidated obligations.

Any funds remaining unexpended and unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any funds distributed to the Subrecipient by the pass-through entity that remain unexpended by 40 days after the end of the Period of Performance shall be returned to DBHDS.  The Subrecipient will send these funds to DBHDS by no later than the end of the 75^th day after the end of the Performance Period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal Subrecipient awards from DBHDS.

The Subrecipient agrees, to the extent permitted by law, that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to this Agreement. DBHDS understands that CSB is a political subdivision of the Commonwealth of Virginia and is legally prohibited from entering hold harmless and indemnification provisions. Local governments in Virginia have sovereign immunity from tort suits and cannot waive or contract away their immunity or assume the liability of another absent specific statutory authority. Subrecipient’s obligations to DBHDS under this agreement shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS. Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS. This provision shall survive the expiration or termination of this agreement.

2.  Substance Abuse Prevention and Treatment Block Grant (SUD FBG)

Pursuant to the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) Funding Agreement and relevant federal statutes, the following are requirements of the funding distributed to the Subrecipient.

1. Restrictions on Expenditures: No SAPTBG funds may not be used for any of the following purposes:
   1. To provide inpatient hospital services.
   1. To make cash payments to intended recipients of health services.
   1. To purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling with DBHDS, Federal Grants Manager approval) any building or other facility, or purchase major medical equipment as defined in the Defined Terms section of this Exhibit.
   1. To satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of federal funds; or
   1. To provide financial assistance to any entity other than a public or non-profit entity.
   1. To provide individuals with hypodermic needles or syringes so that such individuals may use illegal drugs, unless the Surgeon General of the Public Health Service determines that a demonstration needle exchange program would be effective in reducing drug abuse and the risk that the public will become infected with the etiologic agent for acquired immune deficiency syndrome.
2. Grant Guidelines:
3. In the case of an individual for whom grant funds are expended to provide inpatient hospital services, as outlined above (A.a.), the Subrecipient shall not incur costs that are in excess of the comparable daily rate provided for community-based, non-hospital, residential programs of treatment for substance abuse (42 US Code § 300x-31(b)(2)).
4. No entity receiving SAPTBG funding may participate in any form of discrimination on the basis of age as defined under the Age Discrimination Act of 1975 (42 US Code § 6101), on the basis of handicap as defined under section 504 of the Rehabilitation Act of 1973 (29 US Code § 794), on the basis of sex as defined under Title IX of the Education Amendments of 1972 (20 US Code § 1681) or on the basis of race, color, or national origin as defined under Title VI of the Civil Rights Act of 1964 (42 US Code § 2000) (42 US Code § 300x-57(a)(1)).
5. No person shall on the ground of sex, or on the ground of religion, be excluded from participation in, be denied the benefits of, or be subject to discrimination under, any program or activity funded in whole or in part with funds made available under section 300x or 300x-21 of title 42 US Code (42 US Code § 300x-57(a)(2)). 
6. This funding source is designated to plan, implement, and evaluate activities that prevent or treat substance use disorder, including to fund priority substance use disorder treatment and support services for individuals without insurance or for whom coverage is terminated for short periods of time.  Further these funds can be utilized to fund those priority treatment and support services that demonstrate success in improving outcomes and/or supporting recovery that are not covered by Medicaid, Medicare, or private insurance, fund primary prevention by providing universal, selective, and indicated prevention activities and services for persons not identified as needing treatment, and collecting performance and outcome data to determine the ongoing effectiveness of behavioral health promotion, treatment, and recovery support services. To the extent possible, other funding sources must be utilized first except where prohibited by law or regulation. Substance Abuse Block Grant funding must, however, be the payor of last resort when providing treatment services to pregnant women, women with children, children, and individuals with Tuberculosis or HIV pursuant to 45 CFR 96.124, 127, and 128.
7. Target and priority populations are pregnant and parenting women and intravenous (IV) drug users.  In providing treatment services to these target and priority populations, providers must offer treatment in order of population preference as outlined in 45 CFR 96.131 (a) which is as follows:
   1. Pregnant injecting drug users.
   1. Pregnant substance abusers.
   1. Injecting drug users.
   1. All others
8. Allowable SAPTBG services include: Healthcare Home/Physical Health (General and specialized outpatient medical services, Acute Primary care, General Health Screens, Tests and Immunizations, Comprehensive Care Management, Care coordination and Health Promotion, Comprehensive Transitional Care, Individual and Family Support, Referral to Community Services), Prevention and Promotion (Including Promotion, such as Screening, Brief Intervention and Referral to Treatment, Brief Motivational Interviews, Screening and Brief Intervention for Tobacco Cessation, Parent Training, Facilitated Referrals, Relapse Prevention/Wellness Recovery Support, Warm Line); Engagement Services (including Assessment, Specialized Evaluations (Psychological and Neurological), Service Planning (including crisis planning), Consumer/Family Education, Outreach); Outpatient Services (including Individual evidenced based therapies, Group therapy, Family therapy, Multi-family therapy, Consultation to Caregivers); Medication Services (including Medication management, Pharmacotherapy including MAT; Laboratory services); Community Rehabilitative Support (including Parent/Caregiver Support, Skill building (social, daily living, cognitive), Case management, Behavior management, Supported employment, Recovery housing, Therapeutic mentoring, Traditional healing services); Recovery Supports (including Peer Support, Recovery Support Coaching, Recovery Support Center Services, Supports for Self-Directed Care); and Other Habilitative Supports (including Respite; Supported Education; Transportation; Assisted living services; Recreational services; Trained behavioral health interpreters; Interactive communication technology devices); Intensive Support Services (including Substance abuse intensive outpatient; Partial hospital; Intensive home based services; Multi-systemic therapy; Intensive Case Management); Out of Home Residential Services (including Crisis residential/stabilization, Clinically Managed 24 Hour Care (SA), Clinically Managed Medium Intensity Care (SA), Adult Substance Abuse Residential, Adult Mental Health Residential, Youth Substance Abuse Residential Services, Children’s Residential Mental Health Services, Therapeutic foster care); and Acute Intensive Services (including Mobile crisis, Peer based crisis services, Urgent care, 23 hr. observation bed, Medically Monitored Intensive Inpatient (SA), 24/7 crisis hotline services).

• Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or more than 40 days after the appropriate Award Period included in its Exhibit D, Exhibit G, or Notice of Award.

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award, 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable under any associated agreement.

• Closeout: Final payment request(s) must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until 40 days after the end of the Period of Performance to pay for unliquidated obligations.

Any funds remaining unexpended and unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any funds distributed to the Subrecipient by the pass-through entity that remain unexpended by 40 days after the end of the Period of Performance shall be returned to DBHDS.  The Subrecipient will send these funds to DBHDS by no later than the end of the 75th day after the end of the Performance Period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal

Subrecipient awards from DBHDS.

The Subrecipient agrees that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to a program funded by this grant.  Subrecipient’s obligations to DBHDS under this Exhibit shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS.  Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS.  This provision shall survive the expiration or termination of any associated agreement.

3.  Community Mental Health Services Block Grant (MH FBG)

Pursuant to the Community Mental Health Services Block Grant (CMHSBG) Funding Agreement and relevant federal statutes, the following are requirements of the funding distributed to the Subrecipient.

1. Restrictions on Expenditures: CMHSBG funds may not be used for any of the following purposes:
2. To provide inpatient services.
3. To make cash payments to intended recipients of health services.
4. To purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling with DBHDS, Federal Grants Manager approval) any building or other facility or purchase major medical equipment (as defined in the Definitions section of this Exhibit).
5. To satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of federal funds; or
6. To provide financial assistance to any entity other than a public or non-profit entity. (42 US Code § 300x-5(a))

                         b.   Grant Guidelines:

1. No entity receiving CMHSBG funding may participate in any form of discrimination on the basis of age as defined under the Age Discrimination Act of 1975 (42 US Code § 6101), on the basis of handicap as defined under section 504 of the Rehabilitation Act of 1973 (29 US Code § 794), on the basis of sex as defined under Title IX of the Education Amendments of 1972 (20 US Code § 1681) or on the basis of race, color, or national origin as defined under Title VI of the Civil Rights Act of 1964 (42 US Code § 2000) (42 US Code § 300x-57(a)(1)).
2. No person shall on the ground of sex, or on the ground of religion, be excluded from participation in, be denied the benefits of, or be subject to discrimination under, any program or activity funded in whole or in part with funds made available under section 300x or 300x-21 of title 42 US Code (42 US Code § 300x-57(a)(2)). 
3. The Subrecipient must provide the services through appropriate, qualified community programs, which may include community mental health centers, child mental-health programs, psychosocial rehabilitation programs, mental health peer-support programs, and mental-health primary consumer-directed programs.  Services may be provided through community mental health centers only if the centers provide: 1) Services principally to individuals residing in a defined geographic area (hereafter referred to as a “service area”); 2) Outpatient services, including specialized outpatient services for children with a Serious Emotional Disturbance (SED), the elderly, individuals with a Serious Mental Illness (SMI), and residents of the service areas of the center who have been discharged from inpatient treatment at a mental health facility; 3) 24-hour-a-day emergency care services; 4) Day treatment or other partial hospitalization services, or psychosocial rehabilitation services; 5) Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of such admission; 6) Services within the limits of the capacities of the centers, to any individual residing or employed in the service area of the center regardless of ability to pay; and 7) Services that are accessible promptly, as appropriate, and in a manner which preserves human dignity and assures continuity of high quality care (42 US Code § 300x-2(c)). 
4. Treatment and competency restoration services may be provided to individuals with a serious mental illness or serious emotional disturbance who are involved with the criminal justice system or during incarceration.
5. Medicaid and private insurance, if available, must be used first.

• Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or more than 40 days after the appropriate Award Period included in section IV.

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable under any associated agreement.

• Closeout:  Final payment request(s) must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until 40 days after the end of the Period of Performance to pay for unliquidated obligations.

Any funds remaining unexpended and unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any funds distributed to the Subrecipient by the pass-through entity that remain unexpended by 40 days after the end of the Period of Performance shall be returned to DBHDS.  The Subrecipient will send these funds to DBHDS by no later than the end of the 75th day after the end of the Performance Period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal Subrecipient awards from DBHDS.

The Subrecipient agrees, to the extent permitted by law, that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to this Agreement. DBHDS understands that CSB is a political subdivision of the Commonwealth of Virginia and is legally prohibited from entering hold harmless and indemnification provisions. Local governments in Virginia have sovereign immunity from tort suits and cannot waive or contract away their immunity or assume the liability of another absent specific statutory authority. Subrecipient’s obligations to DBHDS under this agreement shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS. Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS. This provision shall survive the expiration or termination of this agreement.

4.  Projects for Assistance in Transition from Homelessness (PATH)

Pursuant to the Notice of Award received by DBHDS, Notice of Funding Opportunity Announcement (SM-24-F2), and relevant statutes associated with the Project for Assistance in Transition from Homelessness (PATH) Grant, the following are requirements of the funding distributed to the Subrecipient.

1. Restrictions on Expenditures: PATH funds may not be used for any of the following purposes:
   1. To support emergency shelters or construction of housing facilities.
   1. For inpatient psychiatric treatment costs or inpatient substance use disorder treatment costs; or
   1. To make cash payments to intended recipients of mental health or substance use disorder services (42 U.S. Code § 290cc-22(g)).
   1. For lease arrangements in association with the proposed project utilizing PATH funds beyond the project period nor may the portion of the space leased with PATH funds be used for purposes not supported by the grant.
2. Grant Guidelines:
   1. All funds shall be used for the purpose of providing the following:
3. Outreach services including the prioritization of eligible veterans.
4. Screening and diagnostic treatment services.
5. Habilitation and rehabilitation services.
6. Community mental health services.
7. Alcohol or drug treatment services.
8. Staff training including the training of individuals who work in shelters, mental health clinics, substance abuse programs, and other organizations serving eligible individuals.
9. Support for the training and certification of provider staff in the SSI/SSDI Outreach, Access, and Recovery (SOAR) model, designed to increase access to disability income benefits for eligible individuals who are experiencing or at risk of homelessness.
10.  
11. Case management services including:
    1. Preparing a plan for the provision of community mental health services to the eligible homeless individual involved and reviewing such plan not less than once every three months.
    1. Helping in obtaining and coordinating social and maintenance support services for eligible individuals, including services related to daily living activities, peer support, personal financial planning, transportation, and obtaining identification and other essential documents.
    1. Providing recovery support services such as job training, educational services, and relevant housing services, including use of peer providers to assure that these services are successfully accessed by eligible individuals.
    1. Helping in obtaining and coordinating income support services, housing assistance, food stamps, and supplemental social security income benefits.
    1. Providing representative payee services in accordance with section 1631(a)(2) of the Social Security Act if the eligible individuals are receiving aid under title XVI of such act and if the applicant is designated by the Secretary to provide such services.
    1. Referring eligible individuals for such other services as may be appropriate.
    1. Supportive and supervisory services in residential settings including shelters, group homes, recovery housing, supported apartments and other residential settings specifically serving those living with SMI or COD. 
    1. Housing services, as specified in Section 522(b)(10) of the PHS Act, as amended, including: Minor renovation, expansion, and repair of housing (as defined in the Definitions section of this Exhibit).
    1. Planning of housing.
    1. Technical assistance in applying for housing assistance.
    1. Improving the coordination of housing services.
    1. Security deposits.
    1. The costs associated with matching eligible homeless individuals with appropriate housing situations.
    1. One-time rental payments to prevent eviction.
    1. All funds shall only be utilized for providing the services outlined above to individuals who:
12. Are suffering from a serious mental illness; or
13. Are suffering from a serious mental illness and from a substance use disorder; and
14. Are homeless or at imminent risk of becoming homeless (42 U.S. Code § 290cc-22(a)).
    1. Funding may not be allocated to an entity that:
       1. Has a policy of excluding individuals from mental health services due to the existence or suspicion of a substance use disorder; or
       1. Has a policy of excluding individuals from substance use disorder services due to the existence or suspicion of mental illness (42 U.S. Code § 290cc-22(e)).
    1. Match amounts agreed to with DBHDS may be:
15. Cash.
16. In-kind contributions, that are fairly evaluated, including plant, equipment, or services.
17. Amounts provided by the federal government or services assisted or subsidized to any significant extent by the Federal Government, shall not be included in determining the amount of match (42 U.S. Code § 290cc-23(b)).
    1. Subrecipient may not discriminate on the basis of age under the Age Discrimination Act of 1975 (42 U.S. Code § 6101 et seq.), on the basis of handicap under section 504 of the Rehabilitation Act of 1973 (29 U.S. Code § 794), on the basis of sex under Title IX of the Education Amendments of 1972 (20 U.S. Code § 1681 et seq.), or on the basis of race, color, or national origin under Title VI of the Civil Rights Act of 1964 (42 U.S. Code § 2000d et seq.)(42 U.S. Code § 290cc-33(a)(1)).

• The Subrecipient shall not exclude from participation in, deny benefits to, or discriminate against any individuals that are otherwise eligible to participate in any program or activity funded from the PATH grant (42 U.S. Code § 290cc-33(a)(2)).

1. Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or following one year after the end of the appropriate Award Period provided in section IV. 

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable under any associated agreement.

• Closeout:  Final payment request(s) must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until 40 days after the end of the Period of Performance to pay for remaining allowable costs.

Any funds remaining unexpended and unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any funds distributed to the Subrecipient by the pass-through entity that remain unexpended by 40 days after the end of the Period of Performance shall be returned to DBHDS.  The Subrecipient will send these funds to DBHDS by no later than the end of the 75^th day after the end of the Performance Period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Benjamin.wakefield@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal Subrecipient awards from DBHDS.

The Subrecipient agrees, to the extent permitted by law, that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to this Agreement. DBHDS understands that CSB is a political subdivision of the Commonwealth of Virginia and is legally prohibited from entering into hold harmless and indemnification provisions. Local governments in Virginia have sovereign immunity from tort suits and cannot waive or contract away their immunity or assume the liability of another absent specific statutory authority. Subrecipient’s obligations to DBHDS under this agreement shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS. Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS. This provision shall survive the expiration or termination of this agreement.

5.  Screening Brief Intervention and Referral to Treatment Grant

Pursuant to the Notice of Award received by DBHDS and the Notice of Funding Opportunity Announcement (NOFO) (TI-24-010) associated with the FY 2024 Screening, Brief Intervention and Referral to Treatment Grant, the following are requirements of the funding distributed to the Subrecipient because of this agreement.

1. Restrictions on Expenditures: Screening Brief Intervention and Referral to Treatment Grant funds may not be used for any of the following purposes: None for this grant.

• Grant Guidelines:
• Funds shall be used to fund services and practices that have a demonstrated evidence-base, and that are appropriate for the population(s) of focus.  An evidence-based practice refers to approaches to prevention or treatment that are validated by some form of documented research evidence.
• All patients must be screened for substance use.  Such screening will be conducted by the Subrecipient or subcontractors of Subrecipient (“Subcontractors”).  The Subrecipient or Subcontractors are also encouraged to screen for risk of suicide as well.  If a patient screens positive for drug misuse, the Subrecipient or Subcontractors’ staff will conduct a brief assessment to ascertain specific type(s) of drug(s) used, consumption level, and impact on functions of daily living to best determine level of severity and refer patients to specialty providers who can determine which specific type of treatment is needed.  Subrecipients and Subcontractors with robust mental health services available must screen and assess clients for the presence of co-occurring serious mental illness and SUD and use the information obtained from the screening and assessment to develop appropriate treatment approaches for the persons identified as having such co-occurring disorders.  In their interventions with children, Subrecipients or Subcontractors must also incorporate education for parents about the dangers of use of, and methods of, discouraging substance use.
• Subrecipients or Subcontractors, as applicable, must utilize third party reimbursements and other revenue realized from the provision of services to the extent possible and use SAMHSA grant funds only for services to individuals who are not covered by public or commercial health insurance programs, individuals for whom coverage has been formally determined to be unaffordable, or for services that are not sufficiently covered by an individual’s health insurance plan.  Subrecipients or Subcontractors, as applicable, are also expected to facilitate the health insurance application and enrollment process for eligible uninsured clients.  Subrecipients or Subcontractors, as applicable, should also consider other systems from which a potential service recipient may be eligible for services (for example, the Veterans Health Administration or senior services), if appropriate for and desired by that individual to meet his/her needs.  In addition, Subrecipients or Subcontractors, as applicable, are required to implement policies and procedures that ensure other sources of funding are utilized first when available for the individual.
• All SAMHSA recipients are required to collect and report certain data so that SAMHSA can meet its obligations under the Government Performance and Results (GPRA) Modernization Act of 2010. Recipients are required to submit data via SAMHSA’s Performance Accountability and Reporting System (SPARS); and access will be provided upon notification of award.

• Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or following 40 days after the end of the Award Period included in section IV.

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable.

• Closeout:  Final payment request(s) must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until 40 days after the end of the Period of Performance to pay for unliquidated obligations.

Any funds remaining unexpended and unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any funds distributed to the Subrecipient by the pass-through entity that remain unexpended by 40 days after the end of the Period of Performance shall be returned to DBHDS.  The Subrecipient will send these funds to DBHDS by no later than the end of the 75^th day after the end of the Performance Period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal Subrecipient awards from DBHDS.

The Subrecipient agrees, to the extent permitted by law, that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to this Agreement. DBHDS understands that CSB is a political subdivision of the Commonwealth of Virginia and is legally prohibited from entering hold harmless and indemnification provisions. Local governments in Virginia have sovereign immunity from tort suits and cannot waive or contract away their immunity or assume the liability of another absent specific statutory authority. Subrecipient’s obligations to DBHDS under this agreement shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS. Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS. This provision shall survive the expiration or termination of this agreement.

6.  Strategic Prevention Framework – Partnerships for Success Grant

Pursuant to the Notice of Award received by DBHDS and the Notice of Funding Opportunity Announcement (NOFO) (SP-23-003) associated with the FY 2024 Strategic Prevention Framework – Partnerships for Success Grant, the following are requirements of the funding distributed to the Subrecipient because of this agreement.

• Restrictions on Expenditures: Screening Brief Intervention and Referral to Treatment Grant funds may not be used for any of the following purposes:
  • Pay for the purchase or construction of any building or structure to house any part of the program.
  • Provide inpatient treatment or hospital-based detoxification services. Residential services are not considered to be inpatient or hospital-based services.
  • Pay for housing other than recovery housing which includes application fees and security deposits.
  • Make direct payments to individuals to enter treatment or continue to participate in prevention or treatment services (See 42 U.S.C. § 1320a-7b).

• Grant Guidelines:
  • Subrecipients must use the grant money to fund comprehensive, data-driven substance disorder use prevention strategies to continue to accomplish the following goals:
    • Prevent the onset and reduce the progression of substance use disorder.
    • Reduce substance use disorder-related problems.
    • Strengthen prevention capacity/infrastructure at the state, tribal, and community levels.
    • Leverage, redirect and align state/tribal-wide funding streams and resources for prevention.

• Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or following 40 days after the end of the Award Period included in section IV.

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable.

• Closeout:  Final payment request(s) must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until 40 days after the end of the Period of Performance to pay for unliquidated obligations.

Any funds remaining unexpended and unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any funds distributed to the Subrecipient by the pass-through entity that remain unexpended by 40 days after the end of the Period of Performance shall be returned to DBHDS.  The Subrecipient will send these funds to DBHDS by no later than the end of the 75^th day after the end of the Performance Period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal Subrecipient awards from DBHDS.

The Subrecipient agrees, to the extent permitted by law, that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to this Agreement. DBHDS understands that CSB is a political subdivision of the Commonwealth of Virginia and is legally prohibited from entering hold harmless and indemnification provisions. Local governments in Virginia have sovereign immunity from tort suits and cannot waive or contract away their immunity or assume the liability of another absent specific statutory authority. Subrecipient’s obligations to DBHDS under this agreement shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS. Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS. This provision shall survive the expiration or termination of this agreement.

1. Treasury Grants
2. State and Local Fiscal Recover Fund Grant: Pursuant to the Interim Final Rule issued by US Department of Treasury pertaining to Coronavirus State and Local Recovery Funds, SLFRF Compliance and Reporting Guidance Ver 2.1 dated November 15, 2021, and 31 CFR 35(A), the following are requirements of the funding distributed to the Subrecipient:
3. Restrictions on Expenditures: State and Local Fiscal Recovery Fund Grant funds may not be used to:         
4. Pay Funds shall not be used to make a deposit to a pension fund. Treasury’s Interim Final Rule defines a “deposit” as an extraordinary contribution to a pension fund for the purpose of reducing an accrued, unfunded liability. While pension deposits are prohibited, recipients may use funds for routine payroll contributions for employees whose wages and salaries are an eligible use of funds.
5. Funds shall not be used towards funding debt service, legal settlements or judgments, and / or deposits to rainy day funds or financial reserves.
6. Expenditure Guidelines:

Grant funds: Shall be used to pay for services and practices that have a demonstrated evidence-base, which are inclusive of: mental health treatment, substance misuse treatment, other behavioral health services, hotlines or warmlines, crisis intervention, overdose prevention, infectious disease prevention, and services or outreach to promote access to physical or behavioral health primary care and preventative medicine.

• Limitations on Reimbursements:  Subrecipient shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided prior to or after the appropriate Award Period included in section IV. 

DBHDS shall only reimburse or otherwise compensate the Subrecipient for documented expenditures incurred during this period that are: 1) reasonable and necessary to carry out the agreed upon scope of service outlined in Exhibit D, Exhibit G, or Notice of Award 2) documented by contracts or other evidence of liability consistent with established DBHDS and Subrecipient procedures; and 3) incurred in accordance with all applicable requirements for the expenditure of funds payable under this agreement.

• Closeout:  Final payment request(s) under any associated Agreement must be received by DBHDS no later than thirty (30) days after the end of the Period of Performance referenced in the Exhibit D, Exhibit G, or Notice of Award.  No payment request will be accepted by DBHDS after this date without authorization from DBHDS.  The Subrecipient may continue to expend retained funds until the end of the Period of Performance to pay for remaining allowable costs unless otherwise instructed in their subaward document by DBHDS.

Any funds remaining unobligated at the end of the Period of Performance shall be returned to DBHDS within 30 days of the end of the Period of Performance.  Any unexpended funds remaining at the end of the Period of Performance or, available at the end of a liquidation period for obligations incurred if allowed by the subaward document, will be returned to DBHDS within 30 days of the end of the relevant period.  Unexpended funds should be returned in the form of a check made payable to the Treasurer of Virginia and sent to:

DBHDS

PO Box 1797

Richmond, VA 23218-1797

C/O Eric Billings

Funds for this grant may also be returned via an electronic ACH payment to DBHDS’ Truist Bank account.  The account information and DBHDS’ EIN is as follows:

Account Number: 201141795720002

Routing Number: 061000104

EIN: 546001731

Name and Address of Bank:

Truist Bank

214 North Tryon Street

Charlotte, NC 28202

If the ACH method is utilized, the Subrecipient shall provide email notification of their intention to provide payment electronically to:

Eric.Billings@dbhds.virginia.gov

Failure to return unexpended funds in a prompt manner may result in a denial of future federal Subrecipient awards from DBHDS.

The Subrecipient agrees, to the extent permitted by law, that acceptance of final payment from DBHDS will constitute an agreement by the Subrecipient to release and forever discharge DBHDS, its agents, employees, representatives, affiliates, successors and assigns from any and all claims, demands, damages, liabilities, actions, causes of action or suits of any nature whatsoever, which Subrecipient has at the time of acceptance of final payment or may thereafter have, arising out of or in any way relating to any and all injuries and damages of any kind as a result of or in any way relating to this Agreement. DBHDS understands that CSB is a political subdivision of the Commonwealth of Virginia and is legally prohibited from entering into hold harmless and indemnification provisions. Local governments in Virginia have sovereign immunity from tort suits and cannot waive or contract away their immunity or assume the liability of another absent specific statutory authority. Subrecipient’s obligations to DBHDS under this agreement shall not terminate until all closeout requirements are completed to the satisfaction of DBHDS. Such requirements shall include, without limitation, submitting final reports to DBHDS and providing any closeout-related information requested by DBHDS by the deadlines specified by DBHDS. This provision shall survive the expiration or termination of this agreement.

            VI.          Charitable Choice

The CSB assures that it is and will continue to be in full compliance with the applicable provisions of 45 CFR Part 54, Charitable Choice Regulations, and 45 CFR Part 87, Equal Treatment for Faith- Based Organizations Regulations, in its receipt and use of federal Mental Health Services and SABG funds and federal funds for Projects for Assistance in Transitions from Homelessness programs. Both regulations prohibit discrimination against religious organizations, provide for the ability of religious organizations to maintain their religious character, and prohibit religious organizations from using federal funds to finance inherently religious activities.

          VII.          List of Federal Grants

The federal grants that DBHDS passes-through to the CSB and the required identifying information that should be used to categorize and track these funds are found in the DBHDS grants management system.

Assurance of Compliance

TITLE VI OF THE CIVIL RIGHTS ACT OF 1964

Under the Paperwork Reduction Act of 1995, as amended, and 5 C.F.R. § 1320.5(b)(2)(i), persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0945-0008. In lieu of completing this hard copy form and mailing it in, the Applicant may provide this assurance via the U.S. Department of Health and Human Services’ Assurance of Compliance online portal at https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf.

ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504

OF THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972,

THE AGE DISCRIMINATION ACT OF 1975, SECTION 1557 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, AND FEDERAL CONSCIENCE AND NONDISCRIMINATION LAWS

The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts or other Federal financial assistance from the U.S. Department of Health and Human Services.

THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:

1. Title VI of the Civil Rights Act of 1964, as amended (codified at 42 U.S.C. § 2000d et seq.), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin (including limited English proficiency) be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
2. Section 504 of the Rehabilitation Act of 1973, as amended (codified at 29 U.S.C. § 794), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified individual with a disability in the United States shall, solely by reason of their disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
3. Title IX of the Education Amendments of 1972, as amended (codified at 20 U.S.C. § 1681 et seq.), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45C.F.R. Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex (including pregnancy, sexual orientation, and gender identity), be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Department.
4. The Age Discrimination Act of 1975, as amended (codified at 42 U.S.C. § 6101 et seq.), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United

States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.

• Section 1557 of the Patient Protection and Affordable Care Act, as amended (codified at 42 U.S.C. §

18116), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 92), to the end that, in accordance with Section 1557 and the Regulation, no person in the United States shall, on the ground of race, color, national origin (including limited English proficiency), age, disability, or sex (including pregnancy, sexual orientation, and gender identity) be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity for which the Applicant receives Federal financial assistance from the Department.

As applicable, the Church Amendments, as amended (codified at 42 U.S.C. § 300a-7), the Coats-Snowe

Amendment (codified at 42 U.S.C. § 238n), the Weldon Amendment (e.g., Consolidated Appropriations Act,

2022, Pub. L. No. 117-103, Div. H, Title V § 507(d), 136 Stat 49, 496 (Mar. 15, 2022)) as extended by the

Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023, Pub. L. No. 117-180, Div. A, §

101(8) (Sep. 30, 2022); , Section1553 of the Patient Protection and Affordable Care Act, as amended (codified at

42 U.S.C. § 18113), and Section1303(b)(4) of the Patient Protection and Affordable Care Act, as amended (codified at 42 U.S.C. § 18023(b)(4)), and45 C.F.R. Part 88, to the extent that the rights of conscience are protected and associated discrimination and coercion are prohibited, in any program or activity for which the Applicant receives Federal financial assistance .Consistent with applicable court orders, the version of Part 88 in effect as of [October 20, 2022] is found at 76 Fed. Reg. 9968-9977 (Feb. 23, 2011).

The Applicant agrees that compliance with this assurance constitutes a material condition of continued receipt of Federal financial assistance, and that it is binding upon the Applicant, its successors, transferees, and assignees for the period during which such assistance is provided.

If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek judicial enforcement of this assurance.       

The CSB and the Department agree to comply with the requirements set forth in the Settlement Agreement for United States v. Commonwealth of Virginia, Civil Action No. 3:12cv00059-JAG, entered by the U.S. District Court for the Eastern District of Virginia on August 23, 2012 [Section IX.A, p. 36], and the subsequent Permanent Injunction in the same case, filed on January 15, 2025, between the U.S. Department of Justice (DOJ) and the Commonwealth of Virginia. This includes the terms of the Permanent Injunction, as well as the compliance indicators agreed to by the parties and filed with the Court on January 14, 2020.

Sections identified in text or brackets refer to sections in the agreement requirements that apply to the target population defined in section III.B of the Agreement: individuals with developmental disabilities who currently reside in training centers, (ii) meet criteria for the DD Waiver waiting list, including those currently receiving DD Waiver services, or (iii) reside in a nursing home or an intermediate care facility (ICF).

To support Virginia’s efforts to ensure all people with DD and their families have access to Medicaid information, the CSB will post a message for individuals with DD and their families related to the DMAS document titled “Help in Any Language” to the CSB website and provide the information through other means, as needed, or requested by individuals with DD and their families who are seeking services. This document can be accessed at https://dmas.virginia.gov/media/2852/language-taglines-for-dmas.pdf or by contacting DBHDS or DMAS.

1. Case Managers or Support Coordinators shall provide anyone interested in accessing DD Waiver

 Services with a DBHDS provided resource guide (i.e. the Individual and Family Support Program (IFSP) First Steps Document) that contains information including but not limited to case management eligibility and services, family supports- including the IFSP Funding Program, family and peer supports, and information on the My Life, My Community Website, information on how to access REACH services, and information on where to access general information. [section III.C.2. a-f, p. 1]. 

• Case management services, defined in section III.C.5.b, shall be provided to all individuals receiving

Medicaid Home and Community-Based Waiver services under the Agreement by case managers or support coordinators who are not directly providing or supervising the provision of Waiver services to those individuals [section III.C.5.c, p. 8].

•  For individuals receiving case management services pursuant to the Agreement, the individual’s case

manager or support coordinator shall meet with the individual face-to-face on a regular basis and shall

conduct regular visits to the individual’s residence, as dictated by the individual’s needs [section V.F.1, page 26].

1. At these face-to-face meetings, the case manager or support coordinator shall: observe the individual and the individual’s environment to assess for previously unidentified risks, injuries, needs, or other changes in status; assess the status of previously identified risks, injuries, needs, or other changes in status; assess whether the individual’s individual support plan (ISP) is being implemented appropriately and remains appropriate for the individual; and ascertain whether supports and services are being implemented consistent with the individual’s strengths and preferences and in the most integrated setting appropriate to the individual’s needs.
2. The case manager or support coordinator shall document in the ISP the performance of these observations and assessments and any findings, including any changes in status or significant events that have occurred since the last face-to-face meeting.
3. If any of these observations or assessments identifies an unidentified or inadequately addressed risk, injury, need, or change in status, a deficiency in the individual’s support plan or its implementation, or a discrepancy between the implementation of supports and services and the individual’s strengths and preferences, then the case manager or support coordinator shall report and document the issue in accordance with Department  policies and regulations, convene the individual’s service planning team to address it, and document its resolution.

•  DBHDS shall develop and make available training for CSB case managers and leadership staff on

how to assess change in status and that ISPs are implemented appropriately. DBHDS shall provide a tool with elements for the case managers to utilize during face-to-face visits to assure that changes in status as well as ISP are implemented appropriately and documented.

1. CSB shall ensure that all case managers and case management leadership complete the training that helps to explain how to identify change in status and that elements of the ISP are implemented appropriately prior to using the On-Site Visit Tool. The CSB shall deliver the contents of the DBHDS training through support coordinator supervisors or designated trainers to ensure case managers understand the definitions of a change in status or needs and the elements of appropriately implemented services, as well as how to apply and document observations and needed actions.
2. CSB shall ensure that all case managers use the DBHDS On-Site Visit Tool during one face-to-face visit each quarter for individuals with Targeted Case Management and at one face-to-face visit per month for individuals with Enhanced Case Management to assess at whether or not each person receiving services under the waiver experienced a change in status and to assess whether or not the ISP was implemented appropriately. The completed On-Site Visit Tool and from the visit that will be avialable to  DBHDS within 30 days of completion. [MC1] [EW2] 

•  Using the process developed jointly by the Department and Virginia Association of Community Services  

Boards (VACSB) Data Management Committee (DMC), the CSB shall report the number, type, and   frequency of case manager or support coordinator contacts with individuals receiving case management services [section V.F.4, p. 27].

•  Key indicators – The CSB shall report key indicators[MC3] [EW4] , selected from relevant domains in section V.D.3 on page 24, from the case manager’s or support coordinator’s face-to-face visits and observations and assessments [section V.F.5, p 27].  Reporting in WaMS shall include the provision of data and actions related to DBHDS defined elements regarding a change in status or needs and the elements of appropriately implemented services in a format, frequency, and method determined by DBHDS [section III.C.5.b.i.].

•  Enhanced Case Management (ECM) Face-to-Face Visits – The individual’s case manager or support coordinator shall meet with the individual face-to-face at

least every calendar month,[WE5]  and at least one such visit every two months must be in the individual’s place of residence, for any individuals who [section V.F.3, pages 26 and 27]:

1. Receive services from providers having conditional or provisional licenses; 
2. Have more intensive behavioral or medical needs as defined by the Supports Intensity Scale category representing the highest level of risk to individuals
3. Have an interruption of service greater than 30 days;
4. Encounter the crisis system for a serious crisis or for multiple less serious crises within a three-month period;
5. Have transitioned from a training center within the previous 12 months; or 
6. Reside in congregate settings of five or more individuals. Refer to Enhanced Case Management Criteria Instructions and Guidance and the Case Management Operational Guidelines issued by the Department.

The status of any individual receiving Enhanced Case Management (ECM) may be reviewed after 90 days to determine whether continued ECM support is necessary. This review must be documented in the individual’s record and must include a description of the individual’s status at the time of the decision, along with justification for the reason(s) continued ECM support is not required.[WE6] 

  The[WE7]  Case Manager or Support Coordinator (SC) shall provide each individual receiving Developmental Disabilities (DD) Waiver services, and the Substitute Decision-Maker (SDM), if applicable, with a choice of qualified service providers. This choice shall be presented prior to any discussion of service options.

The SC shall furnish the DBHDS Service Selection Guide to the individual and, where applicable, the SDM. The guide shall be provided in either electronic or printed format prior to the presentation of provider options.

Provider options shall be based on the individual’s expressed preferences and shall include, but not be limited to, community non-waiver services and resources, Community Services Board (CSB) providers, and non-CSB waiver providers.

The SC shall document the individual’s and, if applicable, the SDM’s provider selection using the Virginia Informed Choice Form. This form shall be completed within the Waiver Management System (WaMS) for all referrals to the Regional Support Team (RST) [section III.C.5.c, p. 8].

The CSB SC shall complete the Virginia Informed Choice Form to document both provider and SC selection upon initiation of a new service request; when a change occurs in provider, service, or service setting; when the individual expresses dissatisfaction with a current service or provider; and no less than once annually.

 The CSB will document the selected Support Coordinator’s name on the Virginia Informed Choice form to indicate individuals, and as applicable Substitute Decision-Maker’s, choice of the assigned SC.

• Support Coordinator Quality Review (SCQR) – The CSB shall complete the Support Coordinator Quality Review process for a statistically     

      significant sample size as outlined in the Support Coordinator Quality Review Process.

1. DBHDS shall annually pull a statistically significant stratified sample of individuals receiving HCBS

waiver and send this to the CSB to be utilized to complete the review. 

• Each year, the CSB shall complete the number of Support Coordinator Quality Reviews and provide data to DBHDS as outlined by the process. 
• DBHDS shall analyze the data submitted to determine the following elements are met:
  • The CSB offered each person the choice of case manager/provider
  • The case manager assesses risk, and risk mitigation plans are in place
  • The case manager assesses whether the person’s status or needs for services and supports have changed and the plan has been modified as needed.
  • The case manager assists in developing the person’s ISP that addresses all of the individual’s risks, identified needs and preferences.
  • The ISP includes specific and measurable outcomes, including evidence that employment goals have been discussed and developed, when applicable.
  • The ISP was developed with professionals and nonprofessionals who provide individualized supports, as well as the individual being served and other persons important to the individual being served.
  • The ISP includes the necessary services and supports to achieve the outcomes such as medical, social, education, transportation, housing, nutritional, therapeutic, behavioral, psychiatric, nursing, personal care, respite, and other services necessary.
  • Individuals have been offered choice of providers for each service.
  • The case manager completes face-to-face assessments that the individual’s ISP is being implemented appropriately and remains appropriate to the individual by meeting their health and safety needs and integration preferences.
  • The CSB has in place and the case manager has utilized where necessary, established strategies for solving conflict or disagreement within the process of developing or revising ISPs, and addressing changes in the individual’s needs, including, but not limited to, reconvening the planning team as necessary to meet the individuals’ needs.
• DBHDS shall review the data submitted and complete a semi-annual report that includes a review of data from the Support Coordinator Quality Reviews and provide this information to the CSB. To assure consistency between reviewers, DBHDS shall complete an inter-rater reliability process.
• If two or more records do not meet 86% compliance for two consecutive quarters, the CSB shall receive technical assistance provided by DBHDS. As requested by DBHDS, the CSB will submit a performance improvement plan when two or more indicators ( Item 9c above) are found to be below 60% during any year reviewed.
• The CSB shall cooperate with DBHDS and facilitate its completion of on-site annual retrospective reviews at the CSB to validate findings of the CSB Support Coordinator Quality Review to provide technical assistance for any areas needing improvement. 

•  Education about Integrated Community Options – Case managers or support coordinators shall offer education about integrated community options   

        to any individuals living outside of their own or their families’ homes and, if relevant, to their

        authorized representatives or guardians [section III.D.7, p. 14]. Case managers shall offer this

        education at least annually through the completion of the Virginia Informed Choice form and at the following times:

1. At enrollment in a DD Waiver
2. When there is a request for a change in Waiver service provider(s)
3. When an individual is dissatisfied with a current Waiver service provider, 
4. When a new service is requested
5. When an individual wants to move to a new location, or
6. When a regional support team referral is made as required by the Virginia Informed Choice Form

1.  Co-occurring Mental Health conditions or engaging in challenging behaviors for individuals receiving case management services identified to have co-occurring mental  

health conditions or engaging in challenging behaviors, the individual’s case manager or support coordinator shall assure that effective community based behavioral health and/or behavioral supports and services are identified and accessed where appropriate and available.

1. If the case manager or support coordinator incurs capacity issues related to accessing needed behavioral support services in their designated Region, every attempt to secure supports should be made to include adding the individual to several provider waitlists (e.g., based upon individualized needs, this may be inclusive of psychotherapy, psychiatry, counseling, applied behavior analysis/positive behavior support providers, etc.) and following up with these providers quarterly to determine waitlist status. [SA. Provision: III.C.6.a.i-iii Filing reference: 7.14, 7.18]
2. DBHDS will provide the practice guidelines and a training program for case managers regarding the minimum elements that constitute an adequately designed behavioral program, as provided under Therapeutic Consultation waiver services, and what can be observed to determine whether the plan is appropriately implemented.  The CSB shall ensure that all case managers and case management leadership complete the training such that case managers are aware of the practice guidelines for behavior support plans and of key elements that can be observed to determine whether the plan is appropriately implemented. [SA. Provision: III.C.6.a.i-iii Filing reference: 7.16, 7.20]

1.  The CSB shall identify children and adults who are at risk for crisis through the standardized 

on-site visit tool or through the utilization of the crisis elements contained in the tool at intake, and  

if the individual is identified as at risk for crisis or hospitalization, shall refer the individual to 

REACH.  [SA. Provision: III.C.6.a.i-iii Filing reference: 7.2]

1.  Enhanced Case Management – For individuals who receive enhanced case management, the case manager or support  

coordinator shall utilize the standardized on-site visit tool during monthly visits; for individuals

that receive targeted case management, the case manager or support coordinator shall use the

standardized on-site visit tool during quarterly visits.  Any individual that is identified as at risk

for crisis shall be referred to REACH. [S.A. Provision: III.C.6.a.i-iii Filing reference: 7.3] This tool can be adapted to electronic health records when all elements of the standardized format are included.

1.  The CSB shall ensure that CSB Executive Directors, Developmental Disability Directors, case  

management or support coordination supervisors, case managers or support coordinators, and intake workers participate in training on how to identify children and adults who are at risk for going into crisis. 

1. CSBs shall ensure that training on identifying risk of crisis for intake workers and case managers (or support coordinators) shall occur within 6 months of hire.    [S.A. Provision: III.C.6.a.i-iii   Filing reference: 7.5]

1. The CSB shall provide data on implementation of the crisis elements as requested by DBHDS when

it is determined that an individual with a developmental disability has been hospitalized and has not been referred to the REACH program.  

1. The CSB shall provide to DBHDS upon request copies of the on-site visit tool, or documentation of utilization of the elements contained within the tool during a crisis screening, for quality review purposes to ensure the tool is being implemented as designed and is appropriately identifying people at risk of crisis. [S.A. Provision: III.C.6.a.i-iii Filing reference: 7.6]
2. DBHDS shall develop a training for the CSB to utilize when training staff on assessing an individual’s risk of crisis/hospitalization.
3. DBHDS shall initiate a quality review process to include requesting documentation for anyone psychiatrically hospitalized who was not referred to the REACH program and either actively receiving case management during the time frame or for whom an intake was completed prior to hospitalization.  The CSB shall promptly, but within no more than 5 business days, provide the information requested.
4. DBHDS shall request information to verify presence of DD diagnosis for persons who are psychiatrically hospitalized and are not known to the REACH program.  The CSB shall promptly, within  5 business days, provide the information requested.  [S.A. Provision: III.C.6.b.ii.A Filing references 8.6, 8.7]

1.  CSB Case manager shall work with the REACH program to identify a community residence  

within 30 days of admission to the program including making a referral to the RST when the system    

has been challenged to find an appropriate provider within this timeframe.

1. If a waiver eligible individual is psychiatrically hospitalized, is a guest at a REACH Crisis Therapeutic Home (CTH), or is residing at an Adult Transition Home and requires a waiver to obtain a community residence, the CSB shall submit an emergency waiver slot request.  [S.A. Provision III.C.6.b.ii.A Filing reference 10.2]

1.  CSB emergency services shall be available 24 hours per day and seven days per week, staffed      

with clinical professionals who shall be able to assess crises by phone, assist callers in identifying and connecting with local services, and, where necessary, dispatch at least one mobile crisis team member adequately trained to address the crisis for individuals with developmental disabilities [section III.C.6.b.i.A, p. 9].

1. The mobile crisis team shall be dispatched from the Regional Education Assessment Crisis Services Habilitation (REACH) program that is staffed 24 hours per day and seven days per week by qualified persons able to assess and assist individuals and their families during crisis situations and that has mobile crisis teams to address crisis situations and offer services and support on site to individuals and their families within one hour in urban areas and two hours in rural areas as measured by the average annual response time [section III.C.6.b.ii, pages 9 and 10].
2. All Emergency services staff and their supervisors shall complete the REACH training, created and made available by DBHDS, that is part of the emergency services training curriculum.
3. DBHDS shall create and update a REACH training for emergency staff and make it available through the agency training website.
4. CSB emergency services shall notify the REACH program of any individual suspected of having a developmental disability who is experiencing a crisis and seeking emergency services as soon as possible, preferably prior to the initiation of a preadmission screening evaluation in order to allow REACH and emergency services to appropriately divert the individual from admission to psychiatric inpatient services when possible.
5.  
6. If the CSB has an individual receiving services in the REACH CTH program with no plan for discharge to a community residence and a length of stay that shall soon exceed 30 concurrent days, the CSB Executive Director or his or her designee shall provide a weekly update describing efforts to achieve an appropriate discharge for the individual to the Department’s Assistant Commissioner of Developmental Services or his/her designee.
7. DBHDS shall notify the CSB Executive Director or designee when it is aware of a person at the REACH CTH who is nearing a 30-day concurrent stay.

1. Comply with State Board Policy 1044 (SYS) 12-1 Employment First [section III.C.7.b, p. 11]. This

policy supports identifying community-based employment in integrated work settings as the first and priority service option offered by case managers or support coordinators to individuals receiving day support or employment services.

1. CSB case managers shall take the on-line case management training modules and review the case management manual within 30 days of hire.
2. CSB case managers shall initiate meaningful employment conversations with individuals starting at the age of 14 until the age of retirement (65).
3. CSB case managers shall discuss employment with all individuals, including those with intense medical or behavioral support needs, as part of their ISP planning processes.
4. CSB case managers shall document goals for or toward employment for all individuals 18-64 or the specific reasons that employment is not being pursued or considered.
5. DBHDS shall maintain training and tools for case managers regarding meaningful conversation about employment, including for people with complex medical and behavioral support needs.  The CSB shall utilize this training, the SC Employment Module, with its staff and document its completion within 30 days of hire.

1. CSB case managers or support coordinators shall liaise with the Department’s regional community

resource consultants regarding responsibilities as detailed in the Performance Contract [section III.E.1, p.  14].

1. Case managers or support coordinators shall participate in discharge planning with individuals’

personal support teams (PSTs) for individuals in training centers and children in ICF/IIDs for whom the CSB is the case management CSB, pursuant to § 37.2-505 and § 37.2-837 of the Code that requires the CSB to

develop discharge plans in collaboration with training centers [section IV.B.6, p. 16].

•  In developing discharge plans, CSB case managers or support coordinators, in collaboration with

facility PSTs, shall provide to individuals and, where applicable, their authorized representatives,

specific options for types of community residences, services, and supports based on the discharge

plan and the opportunity to discuss and meaningfully consider these options [section IV.B.9, p. 17].  

•  CSB case managers or support coordinators and PSTs shall coordinate with specific types of

community providers identified in discharge to provide individuals, their families, and, where applicable,

their authorized representatives with opportunities to speak with those providers, visit community

residences (including, where feasible, for overnight visits) and programs, and facilitate conversations

and meetings with individuals currently living in the community and their families before being asked to

make choices regarding options [section IV.B.9.b, p. 17]. 

•  CSB case managers or support coordinators and PSTs shall assist individuals and, where applicable,    

their authorized representatives in choosing providers after providing the opportunities described in subsection 13 above and ensure that providers are timely identified and engaged in preparing for individuals’ transitions [section IV.B.9.c, p.17].  Case managers or support coordinators shall provide information to the Department about barriers to discharge for aggregation and analysis by the Department for ongoing quality improvement, discharge planning, and development of community-based services [IV.B.14, p. 19].  

•  In coordination with the Department’s Post Move Monitor, the CSB shall conduct post- move   

monitoring visits within 30, 60, and 90 days following an individual’s movement from a training  center to a community setting [section IV.C.3, p.19]. The CSB shall provide information obtained in these post move monitoring visits to the Department within seven business days after the visit.

• If a CSB provides day support or residential services to individuals in the target population, the CSB

shall implement risk management and quality improvement processes, including establishment of   uniform risk triggers and thresholds that enable it to adequately address harms and risks of harms,   

including any physical injury, whether caused by abuse, neglect, or accidental causes [section V.C.1, p. 22].

•  Using the protocol and the real-time, web-based incident reporting system implemented by the

Department, the CSB shall report any suspected or alleged incidents of abuse or neglect as defined

in § 37.2-100 of the Code, serious injuries as defined in 12 VAC 35- 115-30 of the Rules and

Regulations to Assure the Rights of Individuals Receiving Services from Providers Licensed, Funded, or Operated by the Department of Behavioral Health and Developmental Services or deaths to the Department within 24 hours of becoming aware of them [section V.C.2, p. 22].

• CSBs shall participate with the Department to collect and analyze reliable data about individuals 

Receiving services under this Agreement from each of the following areas:

1. safety and freedom from harm
2. physical, mental, and behavioral
3. avoiding crises       
4. choice and self-determination 
5. community inclusion, health and well-being
6. access to services
7. provider capacity
8. stability [section V.D.3, pgs. 24 & 25]

• CSBs shall participate in the regional quality council established by the Department that is responsible for

assessing relevant data, identifying trends, and recommending responsive actions in its region [section V.D.5.a, p.    25].

29.)  CSB’s shall review and provide annual feedback on the Quality Review Team (QRT) End of Year Report.

30.)  CSBs shall participate in DBHDS initiatives that ensure the reliability and validity of data submitted to the

Department. Participation may include reviews of sampled data, the comparison of data across DBHDS and CSB systems, and the involvement of operational staff to include information technology. Meeting frequency shall be semi-annually, but not more than monthly depending on the support needed. 

31.) CSBs shall provide access to the Independent Reviewer to assess compliance with this Agreement. The

 Independent Reviewer shall exercise his access in a manner that is reasonable and not unduly burdensome to   

 the operation of the CSB and that has minimal impact on programs or services to individuals receiving   

 services under the Agreement [section VI.H, p. 30 and 31]

 32.)     CSBs shall participate with the Department and any third-party vendors in the implementation of the   National Core Indicators (NCI) Surveys and Quality Service Reviews (QSRs) for selected individuals     receiving services under the Agreement. This includes informing individuals and authorized    representatives about their selection for participation in the NCI individual surveys or QSRs; providing   the access and information requested by the vendor, including health records, in a timely manner.   assisting with any individual specific follow up activities; and completing NCI surveys [section V.I, p. 28]. 

During FY22 the QSR process will be accelerated and will require the CSB to fully participate in the completion of QSR implementation twice during a nine-month period.  This will ensure that the

Commonwealth can show a complete improvement cycle intended by the QSR process by June 30, 2022.  The attached GANTT details the schedule for the QSR reviews of 100% of providers, including support coordinators, for two review cycles.

 The CSB shall cooperate with the Department and any designated third-party vendors in the implementation of the National Core Indicators (NCI) Surveys and Quality Service Reviews (QSRs) for individuals selected to participate under the Agreement. Such cooperation shall include: (i) notifying individuals and their authorized representatives of their selection for participation in NCI individual surveys or QSRs; (ii) providing timely access to requested information, including health records; (iii) assisting with individual-specific follow-up activities as necessary; and (iv) completing NCI surveys. [section V.I, p. 28].

33.)  The CSB shall notify the community resource consultant (CRC) and regional support team (RST) in the following circumstances using the RST referral form in the waiver management system (WaMS) application to enable the RST to monitor, track, and trend community integration and challenges that require further system development:  

1. within five calendar days of an individual being presented with any of the following residential options: an ICF, a nursing facility, a training center, or a group home/congregate setting with a licensed capacity of five beds or more;
2. if the CSB is having difficulty finding services within 30 calendar days after the individual’s enrollment in the waiver; or
3. immediately when an individual is displaced from his or her residential placement for a second time [sections III.D.6 and III.E, p. 14].

• DBHDS shall provide data to CSBs on their compliance with the RST referral and implementation 

process.

1. DBHDS shall provide information quarterly to the CSB on individuals who chose less integrated options due to the absence of something more integrated at the time of the RST review and semi-annually
2. DBHDS shall notify CSBs of new providers of more integrated services so that individuals who had to choose less integrated options can be made aware of these new services and supports.
3. CSBs shall offer more integrated options when identified by the CSB or provided by DBHDS.
4. CSBs shall accept technical assistance from DBHDS if the CSB is not meeting expectations.

•  Case managers or support coordinators shall collaborate with the CRC to ensure that person-centered

       planning and placement in the most integrated setting appropriate to the individual’s needs and consistent   

       with his or her informed choice occur [section III.E.1- 3, p. 14].

1. CSBs shall collaborate with DBHDS CRCs to explore community integrated options including working with providers to create innovative solutions for people.
2. The Department encourages the CSB to provide the Independent Reviewer with access to its services and records and to individuals receiving services from the CSB; however, access shall be given at the sole discretion of the CSB [section VI.G, p. 31].

•  Developmental Case Management Services
• Case managers or support coordinators employed or contracted by the CSB shall meet the knowledge, skills, and abilities qualifications in the Case Management Licensing Regulations, 12 VAC 35-105-1250. During its inspections, the Department’s Licensing Office may verify compliance as it reviews personnel records.
• Reviews of the individual support plan (ISP), including necessary assessment updates, shall be conducted with the individual quarterly or every 90 days and include modifications in the ISP when the individual’s status or needs and desires change.
• During its inspections, the Department’s Licensing Office may verify this as it reviews the ISPs including those from a sample identified by the CSB of individuals who discontinued case management services.
• The CSB shall ensure that all information about each individual, including the ISP and VIDES, is imported from the CSB’s electronic health record (EHR) or through WaMS direct entry (see 36.e.)  to the Department on or prior to the effective date of the ISP through an electronic exchange mechanism mutually agreed upon by the CSB and the Department into the electronic waiver management system (WaMS). CSBs must continue to provide the information to provider agencies in a timely manner to prevent any interruption in an individual’s services.
• If the CSB is unable to submit via the data exchange process, it shall enter this data directly through WaMS, when the individual is entered the first time for services, or when his or her living situation changes, her or his ISP is reviewed annually, or whenever changes occur, including the individual’s Race and the following information:

• Case managers or support coordinators and other CSB staff shall comply with the SIS^® Administration Process and any changes in the process within 30 calendar days of notification of the changes.
• Case managers or support coordinators shall notify the Department’s service authorization staff that an individual has been terminated from all DD waiver services within 10 business days of termination.
• Case managers or support coordinators shall assist with initiating services within 30 calendar days of         

 waiver enrollment and shall submit Request to Retain Slot forms as required by the Department. All  

 written denial notifications to the individual, and family/caregiver, as appropriate, shall be accompanied  

 by the standard appeal rights (12VAC30-110).

1. Case managers or support coordinators shall complete the level of care tool for individuals requesting DD Waiver services within 60 calendar days of application for individuals expected to present for services within one year.
2. Case managers or support coordinators shall comply with the DD waitlist process, DD waitlist review process and slot assignment process and implement any recommendations or changes in the processes within 30 calendar days of written notice from the Department.
3. Targeted Technical Assistance
   1. The CSB shall participate in technical assistance as determined by the Case Management Steering Committee. Technical assistance may be comprised of virtual or on-site meetings, trainings, and record reviews related to underperformance in any of the following areas monitored by the committee: Regional Support Team referrals, Support Coordination Quality Review results, Individual Support Plan entry completion, and case management contact data.
   1. DBHDS shall provide a written request that contains specific steps and timeframes necessary to complete the targeted technical assistance process.
   1. The CSB shall accommodate technical assistance when recommended within 45 days of the written request.
   1. CSB failure to participate in technical assistance as recommended or demonstrate improvement within 12 months may result in further actions under Exhibit I of this contract.
4. CSB Quality Improvement Committees will review annually the DMAS-DBHDS Quality Review Team’s End of Year report on the status of the performance measures included in the DD HCBS Waivers’ Quality Improvement Strategy with accompanying recommendations to the DBHDS Quality Improvement Committee.  CSB documentation of these reviews and resultant CSB-specific quality improvement activities will be reported to DBHDS within 30 days of receiving the report.

39.) Support Coordination Training Requirements

 [MC1]1.     On site visit tool (OSVT)

30-day deadline for submitting documents in WAMS is creating significant challenges. Support Coordinators already manage high caseloads and multiple time-sensitive tasks.Tracking and monitoring compliance with the 30-day requirement will be difficult for QA, particularly because: WAMS does not currently provide easily accessible alerts or automated tracking features. Manual monitoring increases administrative burden and risk of oversight. Overall, the deadline may reduce accuracy and quality of documentation, and it creates a risk of noncompliance despite support cooordinators has already completed the task of completing OSVT in the EHR. 

 [EW2]Information is needed in a timely manner for the DBHDS behavioral and nursing offices to complete activities tied to the Permanent Injunction. We will explore options for sending PDFs/attachments from EHRs into the EDW and/or WaMS to determine if there are any possibilities to ease efforts.

 [MC3]I think this should have been key indicators of visits through the data exchange because we do not enter our monthly contacts in WaMS other than uploading the OSVT.  Key indicators, for example, being FF, location, etc. I’ll continue to review this but as far as meeting this reporting we do so through the data exchange.

 [EW4]Agree that this is met through established face-to-face contact data sent through the data exchange and the uploading of the OSVT.

 [WE5]New addition following QI strategy

 [WE6]New addition following QI strategy

 [WE7]This is based on new forms/process that just closed on Town Hall.

 [WE8]Needs to be updated/developed.

Appendix C: Management of Unexpended State Funds

Purpose

The purpose of this Appendix is to establish standardized limits, approval requirements, and oversight responsibilities for the accumulation and use of unexpended state funds by Community Services Boards (CSBs) and Regional Programs administered by a Regional fiscal agent.

Unexpended balance refers to funds allocated or awarded to a CSB that are not spent or paid out by the CSB during a fiscal year or other appropriation term. 

For the purposes of this Appendix the definition for Unexpended, Unspent and Carry Over funds is the same.

Section 1: CSB Unspent Balance Requirements

1.2 State General Funds

1.        Regional Program Funds                  

Unexpended regional program funds may be managed by the fiscal agent and participating CSBs, and in accordance with Appendix F: Regional Program Operations of Addendum I Administrative Requirements and Processes and Procedures, and that provided:

1. All uses are approved collectively by participating CSBs in their established Memorandum of Agreement (MOA).
2. Uses comply with allowable purposes or an alternative use proposed by the region, in line with the appropriation act and authorized by DBHDS.
3. Procedures for managing regional funds are documented in the regional program’s Memorandum of Agreement (MOA) and align with this Appendix and the current performance contract.

Balances may be:

1. Prorated to individual CSBs for local use as outlined in original plan from the Department. Meaning, funds are divided among the individual CSBs. Each CSB gets its own share based on a formula. It can be based on population, need, or another prorated method- based on an agreed upon methodology to deliver the service in that region through the prior agreed upon plan unless circumstances have changed and the methodology needs to change. The money is then used locally by each CSB according to the plan approved by Department.
2. Allocated collectively for regional initiatives. Means, instead of part of the regional funds going to each CSB separately, the funds are pooled together. The combined amount is used for projects or initiatives that benefit the entire region, not just a single CSB. Decisions about use are made at the regional level rather than by individual CSBs.
3. Managed by the fiscal agent as agreed by all participating CSBs.

2.        Non-Regional Funds:

Funds allocated to an individual CSB to develop a program service within the operational scope of that individual CSB.  Unexpended General Fund balances awarded to individual CSBs are managed by the CSB and in compliance with requirements outlined in Section 2.

Section 2: Allowable Uses of Unspent State Fund Balances

Consistent with the intent of the Grants to Localities item in the Appropriation Act, Board Policy 6005(FIN)94-2,  and §§ 37.2-500 or 37.2-601 of the Code of Virginia:

1. CSBs may use unspent balances of state funds only for mental health, developmental, and substance use disorder services purposes.
2. Any other uses are prohibited and constitute a violation of the CSB’s performance contract.
3. Categories:
4. Restricted – Limited to the permissible purpose.
5. Unrestricted –Funds are used solely for allowable mental health, developmental, or substance use disorder service purposes consistent with the Appropriation Act and applicable Code of Virginia provisions. Unrestricted balances will be monitored by the Department.
6.  
7. Repayment Obligation

Funds used for disallowed, unauthorized or out-of-scope activities must be repaid immediately to the Department or the Department shall reduce future disbursements to offset amount(s) owed. It is the expectation of the Department that CSBs request technical assistance if uncertain of permissible use of funding.

Section 3: Collective Uses of Unspent State Fund Balances

A group of CSBs may pool unspent balances to address one-time issues or needs that are more effectively or efficiently addressed collectively. CSBs shall share these written plans with the Department for review.

• Pooled restricted funds must adhere to original restrictions.
• All uses must comply with principles and procedures in this Appendix.

Section 4: Carryforward Limits

1. Individual CSBs: May carry forward from previous fiscal year(s)up to 25% of the total state appropriation allocated for the current fiscal year. DBHDS shall provide timely notification regarding the individual funding line items within a defined funding category which exceed the 25% cap and work collaboratively with the CSBs regarding the funding line items that should be paused in order to spend down those funds which exceed the 25% cap.
2. Regional Programs: May carry forward from previous fiscal year(s) up to 25% of the total state appropriation allocated for  the  current fiscal year. DBHDS shall provide timely notification regarding the individual funding line items within a defined funding category which exceed the 25% cap and work collaboratively with the CSBs regarding which funding line items should be paused in order to spend down those funds which exceed the 25% cap.
3. The 25% carryforward limitation shall apply only to restricted state fund balances.
4.  
5. There shall be no percentage cap on the carryforward of unrestricted (non-restricted) state fund balances. Unrestricted state funds may be carried forward without limitation, provided that:

Funds are used solely for allowable mental health, developmental, or substance use disorder service purposes consistent with the Appropriation Act, Board Policy 6005(FIN)94-2, and §§ 37.2-500 or 37.2-601of the Code of Virginia.

• Monthly reporting regarding the above will be provided by DBHDS to CSBs until such time as funding line item in questions is below the 25% threshold.  At which point, funding will resume at the original dispensation.

Section 5: Exception Process

CSBs and Regional Programs may request exceptions to percentage limits for documented, one-time, or strategic uses, including:

1. Capital projects
2. Time-limited investments
3. Infrastructure, technology, or security enhancements
4. Transitional program requirements
5. Urgent needs identified by the Department
6. Funds distributed in the last two quarters of the fiscal year

Capital Project Exception

Amounts reserved for approved capital projects shall be excluded from carryforward calculations if:

1. Approved by the CSB board  and follows Appendix F: Regional Program Operations of Addendum I Administrative Requirements and Processes and Procedures.
2. Documented in a specific exhibit as capital with standardized language provided by the Department
3. Funds are designated for purchase, construction, renovation, or replacement of land/buildings; purchase/replacement of capital equipment or facility-related machinery; or purchase of information technology system equipment or software.

Department Authority:

The Department may approve, modify, or deny exception requests and provide timely communication to CSBs. Requests must include:

1. A clearly stated decision
2. Detailed justification for the decision
3. Cost estimate
4. Timeline
5. Explanation of why expenditure cannot be accommodated within standard limits.
6. Any proposed alternatives or adjustments which might result in approval if the request has been denied
7.  
8. Department Responsibilities:
9. Responses to CSB requests for capital project exceptions will be provided to the CSB within 2 weeks  of receipt .  CSBs reserves the right to appeal anydecision or escalate if a response is not timely.  The appeal process begins with working with the Deputy Commissioner of Community. If a timely agreeable resolution is not achieved the CSB reserves the right to appeal to the Commissioner of DBHDS within 90 days of receipt of the response.  Responses will include:
10. A clearly stated decision
11. A detailed justification for the decision
12. Any proposed alternatives or adjustments which might result in approval if the request has been denied
13.  

Section 6: Reporting Requirements

CSBs and Regional Programs shall report all unexpended balances, proposed carryforwards, and exception requests in the format required in mid-year and end-of-year performance contract reporting.

Section 7: Carryforward Balances Oversight

The Department shall review all carryforward requests above 25% to assess:

1. Progress toward expenditure
2. Compliance with intended use
3. Overall program service performance
4. Emerging risks or delays

CSBs and Regional Programs shall provide updated expenditure reports using a jointly developed template provided by DBHDS at a cadence that is mutually agreed upon. Section 8: Effective Period of Restrictions

Restricted state funds remain restricted as originally appropriated. After the biennium, any unexpended restricted funds shall remain restricted for permissible purposes.

The Department may request accounting of accumulated restricted fund. The Department may direct CSBs to repurpose or reallocate funds within existing programs, services or projects, based on need and with appropriate authority from the General Assembly where required.

Section 9: Department Responsibilities

Allocations of State Funds

Per State Board Policy 6005 and §§ 37.2-509 or 37.2-611 of the Code of Virginia, the Department shall allocate funds in Grants to Localities without applying estimated year-end balances to next year’s awards and in accordance with procedures established by the Department and performance contracts. Allocations of state-controlled funds to the CSBs shall be determined by the Department, after careful consideration of all of the factors noted in the current Board Policy and Code and providing sufficient notification to CSB before implementing any reduction of state-controlled funds

Review of Unspent Balances

• The Department may require CSBs to report any unspent funds from the previous year. If a CSB’s unspent funds are above allowed limits, the Department may pause current‑year payments. If performance data shows ongoing low program service performance and high unspent balances, the Department may also withhold current‑year funds. The Department may create additional requirements for how unspent funds are identified, used, reported, or redistributed.
•  
• The Department will work with CSBs to resolve compliance issues. It will provide guidance on what is allowed and not allowed use of unspent funds, including a timely review and approval process, and will offer technical assistance when needed.
•  
• Reinstatement: DBHDS may reinstate payments to CSBs within the current fiscal year if it determines that withholding such payments results in a material operational impact. Material operational impact includes, but is not limited to, disruptions to service delivery, staffing, compliance requirements, or continuity of care. DBHDS will provide written notification of any decision to reinstate payments, including the effective date and any applicable term.

Applicable Exhibits/Addendums

• Appendix C Implementation Guide (TO BE DEVELOPED JOINTLY)
• Exhibit G: Community Services Boards Master Programs Services Requirements
• Appendix F: Regional Program Operations of Addendum I Administrative Requirements and Processes and Procedures Addendum I: Carryforward Reporting Template (electronic form)
• Addendum I: Exception Request Form (electronic form)
•  
•  
•  
• BOILER PLATE
•  
• The funds identified in this Exhibit are designated and approved as Capital Project funds in accordance with Appendix C: Management of Unexpended State Funds. These funds are restricted solely to the capital purpose described. Amounts designated and approved as Capital Project funds shall be excluded from the calculation of the 25% restricted state fund carryforward limitation for the applicable fiscal year(s).

State and Federal Indirect Cost Rate Policy

Version 2.0

Effective Date: July 1, 2026

Contents

Federal Indirect Cost Rate. 2

Definitions. 2

Federal Negotiated Indirect Cost Rate (NICRA) 2

DBHDS State Indirect Cost Rate. 3

State Indirect Cost Rate Definitions. 3

Individual Program Services (Non- Regional) 3

Regional Administrative Indirect Cost Rate. 3

Where to Find Current Rates. 4

Version History. 4

Federal Indirect Cost Rate

The Office of Management and Budget (OMB) updated grant guidance effective October 1, 2024, allowing:

• An increase in the allowable indirect cost rate from 10% to 15% of Modified Total Direct Costs (MTDC).
• An increase in the MTDC subaward ceiling from $25,000 to $50,000.
• An increase in the threshold for equipment from $5,000 to $10,000.
• The revised rate can only be claimed on costs incurred after Oct. 1, 2024

Community Services Boards (CSBs) with a negotiated Indirect Cost Rate above 15% from their cognizant federal agency shall be honored by DBHDS.

Definitions

Indirect Costs:  Includes costs incurred for a common or joint purpose benefiting more than one cost objective (e.g., accounting, HR, procurement, administration).

Modified Total Direct Cost (MTDC) Includes all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $50,000 of each subaward (regardless of the period of performance of the subawards under the award).

MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs and the portion of each subaward in excess of $50,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs, and with the approval of the cognizant agency for indirect costs.

Federal Negotiated Indirect Cost Rate (NICRA)

Pass-through entities  (PTE) must accept all federally negotiated indirect cost rates for subrecipients per 2 CFR § 200.332(b)(4). The pass-through entity must not require the use of the de minimis indirect cost rate (current 15%) if the subrecipient has an approved indirect cost rate negotiated with the Federal Government. (§ 200.332 Requirements for pass-through entities)

DBHDS State Indirect Cost Rate (IDCR)

The indirect cost rate in Virginia varies by organization and funding source. Rates for state agencies are often set by the Virginia Department of Planning and Budget (DPB). DBHDS does not have a DPB-established rate; therefore, DBHDS Executive Leadership must establish, review, and approve any changes.

State Indirect Cost Rate Definitions

Direct Administrative Costs: Includes costs directly related to program administration (e.g., salaries, fringe benefits, materials, supplies, contractual costs).

Indirect Costs: Includes Costs benefiting multiple programs within a CSB (e.g., administrative staff salaries, finance, quality, postage, security).

Program Services

• Effective July 1, 2026 the allowable individual program services (non-regional)  indirect cost rate will be set at 15%. Due to program-specific considerations, DBHDS may, under certain circumstances, apply a rate lower than 15%.
•  
• The Federal Negotiated Indirect Cost Rate (NICRA) is not applicable to state funds. Use of the Federal Negotiated Indirect Cost Rate (NICRA) for state general funds must be reviewed and approved through a contract agreement with the Department.

Regional Administrative Indirect Cost Rate

• Effective July 1, 2026 the Regional Administrative Indirect Cost Rate for state funding may be allocated directly to CSBs by DBHDS, through the Regional Fiscal Agent, who may retain a portion for administrative costs:
• Pass-through only: Up to 5% – For the purposes of this policy,  pass-through means for the purchase of services on behalf of individuals.  If the Regional Fiscal Agent is only passing the funding through to another CSB or service entity and does not enter into a contract or manage the program for which the funds are intended, the Regional Fiscal Agent may retain the allocation amount for Administrative Costs.  
• Subcontract management: Up to 7.5%  – If the Regional Fiscal Agent enters into a subcontract with another entity which will allow the third party to administer the service or program, the Regional Fiscal Agent may retain the allocation for Administrative Costs.
• Direct program administration: Up to 15% – If the Regional Fiscal Agent is directly administering the program or service for which the funds are intended, the Regional Fiscal Agent may retain the allocation for Administrative Costs.

The Federal Negotiated Indirect Cost Rate (NICRA) is not applicable to state funds. Use of the Federal Negotiated Indirect Cost Rate (NICRA) for state general funds must be reviewed and approved through a contract agreement with the Department.

Where to Find Current Rates

• Federal IDCR
• Code of Federal Regulations
• WebGrants: Navigate to People and Organizations → Organization Database → Organization Information → Federally-Approved Indirect Cost Rate.
• OEMS System of Record (SoR): CSB Lookup, column titled Indirect Cost Rate.
• DBHDS State Indirect Cost Rate (IDCR) – TBD

Version History

Purpose

The purpose of this Exhibit is to provide the CSB with the schedule and process for providing the community services performance contract and other required program and financial data to the Department. It also provides administrative performance requirements and processes specific to this Exhibit. 

Contract No. P1636.3

                                                                I.      Administrative Performance Requirements

The CSB shall meet these administrative performance requirements in submitting its performance contract, contract revisions, and mid-year and end-of-the-fiscal year performance contract reports and required program service data through the reporting mechanism established by the Department.

1. The performance contract and any revisions submitted by the CSB shall be:
   1. Complete all required information is displayed in the correct places and all required Exhibits, including applicable signature pages, are included.
   1. Consistent with Letter of Notification allocations or figures subsequently revised by or negotiated with the Department.
   1. Prepared in accordance with instructions by the Department.
   1. Received by the due dates listed in this Exhibit. If the CSB does not meet these performance contract requirements, the Department may delay future payments of state and federal funds until satisfactory performance is achieved.
2. Mid-year and end-of-the-fiscal year performance contract reports submitted by the CSB shall be:
   1. Complete, all required information is displayed in the correct places, all required data are included in the reports, and any other required information not included in reports are submitted.
   1. Consistent with the state and federal grant funds allocations in the Letter of Notification or figures subsequently revised by or negotiated with the Department.
   1. Prepared in accordance with instructions provided by the Department.
   1. All related funding, expense, and cost data are consistent, and correct within a report, and errors identified are corrected; and
   1. Received by the due dates listed in this Exhibit  
3. If the CSB does not meet these requirements for its mid-year and end-of-the-fiscal year reports, the Department may delay future payments until satisfactory performance is achieved. The Department may impose one-time reductions of state funds apportioned for CSB administrative expenses on a CSB for its failure to meet the requirements in its end-of-the-fiscal year report may have a one percent reduction not to exceed $15,000 unless an extension has been granted by the Department.
4. If the CSB fails to meet other reporting requirements in this Exhibit, the Department may delay payments until satisfactory performance is achieved.
5. If the Department is at fault for the CSB not submitting timely reports, no penalty shall be applied to CSB.  
6. If the Department negotiates a performance improvement plan or corrective action plan with a CSB because of unacceptable data quality, and the CSB fails to satisfy the requirements by the end of the contract term, the Department may impose a one-time one percent reduction not to exceed a total of $15,000 of state funds apportioned for CSB administrative expenses and other applicable noncompliance penalties.
7. The CSB shall not allocate or transfer a one-time reduction of state funds apportioned for administrative expenses to direct service or program costs.

• Process for Obtaining an Extension of the End-of-the-Fiscal Year Report Due Date

1. Extension Request: The Department will grant an extension only in very exceptional situations such as a catastrophic information system failure, a key staff person’s unanticipated illness or accident, or a local emergency or disaster situation that makes it impossible to meet the due date.
   1. It is the responsibility of the CSB to obtain and confirm the Department’s approval of an extension of the due date within the time frames specified below. Failure of the CSB to fulfill this responsibility constitutes prima facie acceptance by the CSB of any resulting one-time reduction in state funds apportioned for administrative expenses.
   1. As soon as CSB staff becomes aware that it cannot submit the end-of-the-fiscal year report by the due date to the Department, the executive director must inform the Office of Management Services (OMS) through the performancecontractsupport@dbhds.virginia.gov email mailbox that it is requesting an extension of this due date. This request should be submitted as soon as possible and describe completely the reason(s) and need for the extension and state the date on which the report will be received by the Department.
   1. The request for an extension must be received in the OMS no later than 5:00 p.m. on the fourth business day before the due date through the performancecontractsupport@dbhds.virginia.gov email mailbox.  
   1. The OMS will act on all requests for due date extensions that are received in accordance with this process and will notify the requesting CSB of the status of their requests within 2 business of receipt of the request.

                                                                         II.        CSB Payment Disbursement Schedule  

Table of Contents

1. Introduction………………………………………………………………………………………………… 2
2. Measure Development…………………………………………………………………………………… 2
3. Technical Assistance…………………………………………………………………………………….. 2
4. Performance Monitoring………………………………………………………………………………… 2
   1. Performance Improvement Plan (PIP)……………………………………………………………. 2
   1. Corrective Action Plan (CAP)……………………………………………………………………… 2
5. Performance Measures………………………………………………………………………………….. 3
6. Suicide Screening Measure…………………………………………………………………………. 3
7. Same Day Access Measures………………………………………………………………………… 3
8. SUD Engagement Measure (Block Grant SAMSHA/DBHDS Requirement)…………… 3
9. DLA-20 Measure……………………………………………………………………………………… 3
10. Additional Expectations and Elements Being Monitored……………………………………….. 3
11. Outpatient Primary Care Screening and Monitoring……………………………………………… 4
    1. Primary Care Screening……………………………………………………………………………… 4
    1. Antipsychotic Metabolic Screening………………………………………………………………. 4
12. Outpatient Services…………………………………………………………………………………… 4
13. Service Members, Veterans, and Families (SMVF)…………………………………………… 4
14. Peer and Family Support Services………………………………………………………………… 5

I.          Introduction

The Department, the Community Services Boards and Behavioral Health Authority (CSB) are committed to a collaborative continuous quality improvement (CQI) process aimed at improving the quality, transparency, accessibility, consistency, integration, and responsiveness of services across the Commonwealth pursuant to Code

§37.2-508(C) and §37.2-608(C). Exhibit B establishes the CQI framework through which CSBs, providing community behavioral health services, and the Department engage in the CQI processes that are established to track progress towards meeting established benchmarks, identify barriers to achievement, and understand and address root causes that impacts progress. For the purposes of this Exhibit, “benchmark” is defined as the measure target for achievement that is established by the Department in collaboration with CSB.

II.          Measure Development

The establishment of benchmarks is a collaborative process with the CSBs and exists as part of the

III.          Technical Assistance

An opportunity for technical assistance exists when a CSB requires support in meeting an established goal. The following graduated response will be employed to support the CSB to achievement.

Technical Assistance (TA)

For the purposes of this Exhibit, technical assistance (TA) is defined as targeted, collaborative support provided

by the Department to CSBs for the purposes of improving performance on the core measures outlined in Section V of this exhibit. The Department may initiate the process for its provision of TA when a CSB’s performance does not meet the benchmark. Upon receipt of Department notification of the requirement for CSB participation in TA, the CSB shall respond to the Department within 10 business days to confirm receipt and establish next steps.

Additionally, TA may be requested by the CSB at any time. A CSB may request TA from the Department by completing the Exhibit B TA Request form. The Department shall respond to the CSB request for TA within 10 business days to confirm receipt and establish next steps.

The Department will work to address CSB-raised concerns or identified Department data issues as part of the technical assistance process.

IV.          Performance Monitoring

1.      Performance Improvement Plan (PIP)

Develop a Performance Improvement Plan (PIP). For the purposes of this Exhibit, a PIP is defined as a written, collaborative agreement between the Department and the CSB that identifies specific action steps required to support the CSB in meeting identified benchmarks for core performance measures as outlined in Section V of this exhibit. A PIP will not be entered into until at least 6 months of TA has been provided in order to allow for the review of at least 2consecutive reporting periods , or as otherwise established by the Department.

2.      Corrective Action Plan (CAP)

In the event PIP implementation does not result in improvement regarding core performance measures pursuant to Section V of this exhibit; the Department may seek other remedies as outlined in the Compliance and Remediation section of the performance contract such as initiating a CAP. For the purpose of this Exhibit, a CAP is defined as a written plan to address lack of achievements with identified benchmarks for

core performance measures outlined in Section V of this exhibit. If the CSB refuses to participate in the TA and/or PIP process, a CAP will be initiated by the Department. If the CSB disagrees with the CAP they shall utilize the Compliance and Remediation of the performance contract.

V.          Performance Measures

CSB Core Performance Measures: The CSB and Department agree to use the CSB Core Performance Measures, developed by the Department in collaboration with the VACSB Data Management, Quality Leadership, and/ Quality and Outcomes Committees (Q&O) to monitor outcome and performance measures for the CSBs and improve the performance on measures where the CSB falls below the benchmark. These performance measures include:

A.    1. Suicide Screening Measure

Percent of individuals ages six and older that receive Columbia Suicide Severity Rating Scale screening within 30 days before or 5 days after a new MH or SUD case has been opened.

Benchmark: The CSB shall conduct a Columbia Suicide Severity Rating Scale screening for at least 86 percent of individuals with a new MH or SUD case opening.

B.     2. Same Day Access Measures

ISERV Definition: The percentage of consumers with comprehensive needs assessment provided within 10 business days of first contact as well as the mean number of days from the first contact. DBHDS and CSB will collaborate to determine how to collect this information in FY26.

Benchmark: CSB and DBHDS will work together to establish by the end SFY27

Appointment[MN1]  Kept: Percentage of new consumers with comprehensive needs assessment who keep and attend a follow up appointment within 30 days.

Benchmark: At least 70 percent of the individuals seen in SDA who are determined to need a follow-up service will return to attend that service within 30 calendar days of the SDA assessment.

C.    3. SUD Engagement Measure (Block Grant SAMSHA/DBHDS Requirement)

Percentage of individuals 13 years or older with a new/existing admission to CSB services as a result of a new SUD diagnosis who initiate services within 14 days of diagnosis and attend at least two follow up SUD services within 30 days.

Benchmark: The CSB shall have at least 65% of SUD clients engage in treatment per this definition of engagement.

D.    4. DLA-20 Measure to be replaced by the WHODAS in FY27[MN2] [KP3] [MN4] 

The percentage of individuals receiving STEP-VA services assessed using the WHODAS who demonstrate improvement in their WHODAS  score over a 6-month period.

Benchmark: CSB and DBHDS will work together to establish by end of SFY27

VI.          Additional Expectations and Elements Being Monitored

The data elements and expectations of this section are active expectations regarding CSB operations and implementation. The Department in collaboration with the VACSB Data Management, Quality Leadership, and Quality and Outcomes Committees will monitor outcome and performance measures in this section.

A.    Outpatient Primary Care Screening and Monitoring

1.      Primary Care Screening

Measures – The percentage of Adults with a SMI diagnosis and children with SED, engaged in MH CM and/or  and Psychiatry services, who receive an annual primary care screening to include height, weight and therefore, BMI.

Benchmark – CSB and DBHDS will work together to establish by end of SFY27.

Outcomes – To provide yearly primary care screening to identify and provide related care coordination to ensure access to needed physical health care to reduce the number of individuals with serious mental illness (SMI), known to be at higher risk for poor physical health outcomes largely due to unidentified chronic conditions.

Monitoring– CSB must report the screen completion as required by DBHDS.

2.      Antipsychotic Metabolic Screening

Measures – The percentage of individuals, receiving STEP-VA services, over the age of 3 years old, receiving antipsychotic medications prescribed by a CSB, who have undergone metabolic screenings within 1 year of identification and comply with recommended metabolic screening schedule (at least annually)

Benchmark – CSB and DBHDS will work together to establish by end of SFY27

Outcomes – To provide screening in order to identify and provide related care coordination to ensure access needed to physical health care as well as additional information for psychiatric providers.

Individuals with serious mental illness (SMI) or serious emotional disturbance (SED) are known to be at higher risk for poor physical health outcomes.

Monitoring – CSB must report the screen completion as required by DBHDS

B.     Outpatient Services[MN5] [KP6] [MN7] [KP8] 

Outpatient services are foundational services for any behavioral health system. Outpatient services may include diagnosis and evaluation, screening and intake, counseling, psychotherapy, behavior management, psychiatry, psychological testing and assessment, laboratory, and ancillary services.

Measures – Percent of CSB Outpatient provider staff that have received the required 8 hours of trauma focused training within the first year of employment and 4 hours in each subsequent year or until 40 hours of trauma-focused training can be demonstrated

Benchmark – Benchmark is 95% of above-mentioned staff.

Monitoring: Provide training data regarding required trauma training yearly in July when completing evidence-based practice survey.

C.     Service Members, Veterans, and Families (SMVF)

1. Training Measures – Percent of CSB Direct Services Staff that receive military cultural competency training within 90 days of hire and every 3 years of employment thereafter.

Benchmark – 95% of CSB staff delivering direct services to the SMVF population

2.      Identifying SMVF members

Measures- At admission, health records in all program areas will contain a valid entry for the Military Status demographic variable.

Benchmark– The CSB shall ensure the Benchmark of 90% of individuals will have a valid entry at admission for MH/SUD services.

• DBHDS has the ability to pull data from the Columbia Suicide Screening responses and trends for this particular subgroup; measure language and benchmarking are the same as in bullet A above. 

D.     Peer and Family Support Services

1. Peer FTEs (STEP-VA Funded)Measure: Total number of Peer Support Services FTE offering peer support services in mental health and/or substance use treatment settings funded by STEP-VA allocations.Benchmark: Year 1 will allow for monitoring and benchmarking.

2.      Peer FTEs (Total)

• Measure: Total number of Peer Support Services FTE offering peer support services in CSB/BHA from all funding sources.
  • Benchmark: Year 1 will allow for monitoring and benchmarking

3.      Peer Certification and Registration

• Measure: Peer Supporters will obtain certification within 15 months of hire and be registered within 18 months of hire (from the Board of Counseling)
  • Benchmark: There is not a benchmark at this time as FY24 is the first year collecting this information.DBHDS and the CSBwill revisit setting a benchmark by the end of SFY27.

Attachment 1[CN9] 

 [MN1]Justification:  This provides clarification as there are two SDA measures; as written prior, it separated the measures out, which was unclear when they are both interconnected.

 [MN2]Katie, please check measure language. 

 [KP3]Measure language in this section is correct.

 [MN4]Justification: DLA is being replaced by WHODAS in FY27.  General clarification.

 [MN5]I need to ask Carly to send me Exhibit G next.  In the meantime Katie, please reach out to Katharine about Primary Screening language and adding “at risk of SED” and ensuring that the and/or measurement language is correct between all documents before we edit Exhibit G. 

We will also leave the regional services as is in Exhibit G as not to make too many noticeable changes, despite it already being in D.

 [KP6]Sorry in advance for a complicated response…

The current measure language for PC Screening does not include “at risk of SED” in the definition itself so this language here is technically correct. That being said, the “at risk of SED” language IS in the numerator/denominator for the measure, but the numerator/denominator are not included here in the PC.

The “MH CM and Psychiatry Services” is correct here too, but needs to be fixed in Exhibit G, as I think Ex G says “and/or”. The language around this in the numerator/demonimator is also incorrect because it says “OR”.

Basically, the language in this section is accurate and current – the inconsistency lies in our own documentation. The numerator/denominator in our own documentation needs corrected, and Exhibit G needs corrected. In the meantime, I will check with Katharine regarding the inclusion or exclusion of “at risk of SED”… we will want to ensure our numerator/denominator are consistent with the definition provided here.

 [MN7]Katie commented to adding caseload caps as per redesign to OP in Exhibit G; we are not in a place of finalizing policy yet to add this to the PC

Katie commented to adding number of staff trained in each EBP to OP in Exhibit G.  I believe that the EBP survey is approved by the survey committee, and what we want to capture can vary- so I would not add that here.

 [KP8]I think I had added that after you and I had a convo once and we didn’t want to forget it! We will hold off on that for now, but I’ll keep it in my notes in case that changes in a future year.

 [CN9]This will be removed as requested by Committee

Table of Contents

Purpose…………………………………………………………………………………………………………………. 3

Notification of Award…………………………………………………………………………………………………………………. 3

Billing And Payment Terms and Conditions…………………………………………………………………………………………………………………. 3

Use of Funds…………………………………………………………………………………………………………………. 3

Limitations on Reimbursements…………………………………………………………………………………………………………………. 3

Reporting Requirements…………………………………………………………………………………………………………………. 3

Monitoring, Review, and Audit…………………………………………………………………………………………………………………. 3

Technical Assistance…………………………………………………………………………………………………………………. 3

Other Terms and Conditions…………………………………………………………………………………………………………………. 3

Federal Funded Program Services…………………………………………………………………………………………………………………. 4

1. Children’s Mental Health Block Grant……………………………………………………………………………………………….. 4
   1. Assertive Community Treatment (ACT) Program Services……………………………………………………………………………………………….. 4
   1. Project Link Program……………………………………………………………………………………………….. 7
   1. State Opioid Response Program Services (SOR)                                                                                                                   8
   1. Regional Suicide Prevention Initiative……………………………………………………………………………………………… 11
   1. Supplemental Substance Abuse Block Grant Funded Program Services – (Prevention and Treatment)                12
   1. Substance Use Prevention, Treatment and Recovery Block Grant (SUPTR) Prevention Set Aside Services    13

State Funded Program Services……………………………………………………………………………………………………………….. 16

1. Auxiliary Grant in Supportive Housing Program (AGSH)……………………………………………………………………………………………… 16
   1. Children’s Mental Health Initiative (MHI) Funds……………………………………………………………………………………………… 18
   1. Permanent Supportive Housing (PSH)……………………………………………………………………………………………… 20
   1. Forensic Services………………………………………………………………………………………………. 21

11.5     Adult Competency to Stand Trial Restoration (MH Adult Outpatient Competency Restoration

Services)……………………………………………………………………………………………………………….. 23

1. Gambling Prevention……………………………………………………………………………………………… 24
   1. Mental Health Services in Juvenile Detention Centers……………………………………………………………………………………………… 25

11.12. System Transformation of Excellence and Performance (STEP – VA)……………………………………………………………………………………………………………. 33

• Primary Care Screening and Monitoring……………………………………………………………………………………………….. 35
• Same Day Access (SDA)……………………………………………………………………………………………….. 35
• Service Members, Veterans, and Families (SMVF)                                                                                                               36

Other Program Services……………………………………………………………………………………………………………….. 38

1. Mental Health Crisis Response and Child Psychiatry Funding –Regional Program Services

Children’s Residential Crisis Stabilization Units (CRCSU)……………………………………………………………………………………………………………. 39

1. Children’s Residential Crisis Stabilization Unit………………………………………………………………………………………………… 39
   1. Child Psychiatry and Children’s Crisis Response- Regional Funding (CRCSU)……………………………………………………………………………………………….. 43
   1. Case Management Services Training……………………………………………………………………………………………… 45
   1. Developmental Case Management Services Organization……………………………………………………………………………………………… 45
   1. Regional Programs……………………………………………………………………………………………… 45

CSB Code Mandated Services……………………………………………………………………………………………………………….. 46

ATTACHMENT 1- Program Services – State General Funding Line Items……………………………………………………………………………………………………………….. 48

Purpose

The Community Services Board or Behavioral Health Authority (the “CSB”) shall comply with certain program service requirements for those community services it provides and the Department of Behavioral Health and Developmental Services (“DBHDS” or ” Department”) funds under this Exhibit G (the “Exhibit”). All terms, provisions and agreements set forth in the most current version of the Community Services Performance Contract remain in effect, except to the extent expressly modified herein. If the terms set forth in this Exhibit are inconsistent with the most current version of the Community Services Performance Contract, the terms set forth in this Exhibit shall apply.

Notification of Award

For program services under this Exhibit, the Department’s Fiscal Services and Grants Management Office (the “FSGMO”) and Budget Development Office works with the program offices to provide notification of federal and state grant awards, and baseline funding allocations to the CSB prior to funding disbursement and/or reimbursement. The notice will provide applicable federal and state grant specific information such as: award amounts, period of performance, reconciliation and close out.

See ATTACHMENT 1 of this Exhibit for additional information regarding all state funded program services.

Billing And Payment Terms and Conditions

CSB shall comply with Section 9 of the performance contract.

Indirect Cost Rate

CSB shall comply with the most current version of the DBHDS State and Federal Indirect Cost Rate Policy unless otherwise contractually negotiated.

Regional Program Procedures

CSB shall comply with the Regional Program Procedures unless otherwise contractually negotiated.

Use of Funds

Funds provided under this agreement shall not be used for any purpose other than as described herein and/or outlined in Exhibit F: Federal Grant Requirements, and other federal and state laws or regulations.

CSB agrees that if it does not fully implement, maintain, or meet established terms and conditions as established herein or as subsequently modified by agreement of the Parties, the Department shall be able to recover part or all the disbursed funds as allowable under the terms and conditions of the performance contract.

Limitations on Reimbursements

CSB shall not be reimbursed or otherwise compensated for any expenditures incurred or services provided following the end of the period of performance.

Reporting Requirements

CSB shall comply and collaborate with the Department regarding all standard and additional reporting requirements pursuant to but not limited to the Reporting and Data Quality Requirements of the performance contract, established data processes and procedures, Exhibit E: Performance Contract Schedule and Process, this Exhibit, and by the Department as required by its funding authorities.

Monitoring, Review, and Audit

The Department may monitor and review the use of the funds, performance of the Program or Service, and

compliance with this agreement, which may include onsite visits to assess the CSB’s governance, management and operations, and review relevant financial and other records and materials. In addition, the Department may conduct audits, including onsite audits, at any time during the term of this agreement with advance notification to the CSB.

Technical Assistance

The CSB and the Department shall work in partnership to address technical assistance needs to provide the program services herein.

Other Terms and Conditions

This exhibit may be amended pursuant to Section 5 of the performance contract.

Federal Funded Program Services

This section describes certain program services that have a primary funding source of federal funds but there may also be other sources of funding provided by the Department for these services.

10.1          Children’s Mental Health Block Grant Scope of Services and Deliverables

Children’s Mental Health Block Grant funds are to be used to reduce states’ reliance on hospitalization and develop effective community-based mental health services for children with Serious Emotional Disturbance (SED). Children with SED includes persons up to age 18 who have a diagnosable behavioral, mental, or emotional issue (as defined by the DSM). The state MHBG allotments are used to support community programs, expanded children’s services, home-based crisis intervention, school-based support services, family and parenting support/education, and outreach to special populations

The purpose of these funds is to provide community-based services to youth (up to age 18), who have serious emotional disturbance with the goal of keeping youth in the community and reducing reliance on out-of-home placements. Services may include assessments and evaluations, outpatient or office-based treatment, case management, community-based crisis services, intensive community-based supports, community-based home services, and special populations of youth with SED such as juvenile justice, child welfare, and/other under-served populations. Services cannot be used for residential or inpatient care.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall use the Children’s Mental Health Block Grant funds to reduce states’ reliance on hospitalization and develop effective community-based mental health services for children with Serious Emotional Disturbance (SED). Children with SED includes persons up to age 18 who have a diagnosable behavioral, mental, or emotional issue (as defined by the DSM). This condition results in a functional impairment that substantially interferes with, or limits, a

child’s role or functioning in family, school, or community activities.

• The CSB shall comply with the additional uses or restrictions for this grant pursuant to Exhibit F of the performance contract.

• The Department Responsibilities: The Department agrees to comply with the following requirements. The Department will periodically review case files through regional consultant block grant reviews to ensure funds are being spent accordingly.

10.2.        Assertive Community Treatment (ACT) Program Services Scope of Services and Deliverables

Assertive Community Treatment (ACT) provides long term needed treatment, rehabilitation, and support services to identified individuals with severe and persistent mental illness especially those who have severe symptoms that are not effectively remedied by available treatments or who because of reasons related to their mental illness resist or avoid involvement with mental health services in the community. ACT services are offered to outpatients outside of clinic, hospital, or program office settings for individuals who are best served in the community.

ACT is a highly coordinated set of services offered by a group of medical, behavioral health, peer recovery support providers and rehabilitation professionals in the community who work as a team to meet the complex needs of individuals with severe and persistent mental illness. An individual who is appropriate for ACT requires this comprehensive, coordinated approach as opposed to participating in services across multiple, disconnected providers, to minimize risk of hospitalization, homelessness, substance use, victimization, and incarceration. An ACT team provides person-centered services addressing the breadth of individuals’ needs and is oriented around individuals’ personal goals. A fundamental charge of ACT is to be the first line (and generally sole provider) of all the services that an individual receiving ACT needs. Being the single point of responsibility necessitates a higher frequency and intensity of community-based contacts between the team and individual, and a very low individual-to-staff ratio. ACT services are flexible; teams offer personalized levels of care for all individuals participating in ACT, adjusting service levels to reflect needs as they change over time.

An ACT team assists individuals in advancing toward personal goals with a focus on enhancing community integration and regaining valued roles (e.g. worker, daughter, resident, spouse, tenant, or friend). Because an ACT team often works with individuals who may demonstrate passive or active resistance to participation in services, an ACT team must carry out thoughtfully planned assertive engagement techniques including rapport-building strategies, facilitating the individual in meeting basic needs, and motivational interviewing interventions. The team uses these techniques to identify and focus on individuals’ life goals and motivations to change. Likewise, it is the team’s responsibility to monitor individuals’ mental status and provide needed supports in a manner consistent with their level of need and functioning. The ACT team delivers all services according to a recovery-based philosophy of care. Individuals receiving ACT should also be engaged in a shared decision-making model, assistance with accessing medication, medication education, and assistance in medication to support skills in taking medication with greater independence. The team promotes self-determination, respects the person participating in ACT as an individual in their own right, and engages registered peer recovery specialists to promote hope that recovery from mental illness and regaining meaningful roles and relationships in the community are possible.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall design and implement its ACT program in accordance with requirements in the Department’s Licensing Regulations for ACT in 12 VAC 35-105-1360 through 1410, Department of Medical Assistance Services Regulations and Provider Manual Appendix E, and in accordance with best practice as outlined in the Tool Measurement of Assertive Community Treatment (TMACT). The final ratings of a TMACT review are used to set the reimbursement rate with DMAS.
      1. The CSB shall reserve any restricted state mental health funds earmarked for ACT that remain unspent only for ACT program services unless otherwise authorized by the Department in writing.
      1. The CSB shall prioritize admission to ACT for adults with serious mental illnesses who are currently residing in state hospitals, have histories of frequent use of state or local psychiatric inpatient services, or are homeless.
      1. The CSB shall participate in ACT fidelity monitoring (TMACT review) every 12-18 months and assist Department staff as requested with any case-level utilization review activities, making records of individuals receiving ACT services available and providing access to individuals receiving ACT services for interviews.
      1. The CSB shall follow the Tool for Measurement of ACT (TMACT) review process.

• CSB ACT staff shall participate in ACT network meetings with other ACT teams as requested by the Department.
  • New ACT programs shall obtain and provide documentation of individual team-level training and technical assistance at least quarterly for the first two years of operation from recognized experts approved by the Department.
    • Each new ACT team staff shall successfully complete an introductory ACT 101 training. The Department recommends the University of North Carolina’s Institute for Best Practices (or an equivalent training as approved by DBHDS) within the first 120 calendar days of the team member’s date of hire.
    • For each year of employment thereafter, each ACT team member (excluding the program assistant) shall receive an additional three hours of training in an area that is fitting with their area of expertise and role within the team. This additional training may be in the form of locally provided training, online workshops, or regional or national conferences. The CSB shall maintain documentation of completed training activities.
  • The Department Responsibilities: The Department agrees to comply with the following requirements.
    • The Department shall monitor ACT implementation progress of new ACT programs through quarterly reports submitted to the Department’s Office of Adult Community Behavioral Health by the CSB. This will be a 2-year monitoring process for new ACT programs.
    • The Department shall monitor ACT fidelity using the Tool for Measurement of Assertive Community Treatment (TMACT).
    • The Department shall provide the process for the Tool for Measurement of ACT (TMACT) review.
    • The Department shall provide the data collection and additional reporting database, submission due dates, and reporting protocols to the CSB. DBHDS will provide advance notification to the CSB regarding data collection and additional reporting database, submission due dates, and reporting protocols in sufficient time to allow for compliance.
  • Reporting Requirements: The CSB and the DBHDS will work in collaboration to provide a standardized mechanism for ACT teams to track

outcomes, which can then guide their own performance initiatives.Pregnant Women and Women with Dependent Children Services  

10.3.        Scopes and Deliverable Services

The Substance Use Prevention, Treatment, and Recovery Block Grant (SUBG) has numerous

requirements for services for the Pregnant Women and Women with Dependent Children (PPW). Per CFR, Title 45, Subtitle A, Subchapter A, Part 96, Subpart L, 596.124 Certain allocations mandate that all programs providing such services will treat the family as a unit and therefore will admit both women and their children into treatment services, if appropriate. Community Services Board, at a minimum, treatment programs receiving funding for such services also provide or arrange for the provision of the following services to pregnant women and women with dependent children, including women who are attempting to regain custody of their children.

A.    The CSB Responsibilities

1. The CSB shall admit pregnant women into services within 48 hours of request and provide interim services (per SUBG) if unable to provide services; and notify the Department’s designee, Women’s Services, and Specialty Population Manager within in 48 hours.
   1. The CSB shall adhere to the following federal guidelines for the PPW population and utilize the federal set-a-side and state general funds to provide or refer to the following services:

1. primary medical care for women, including referral for prenatal care and, while the women are receiving such services, childcare.
   1. Refer the children of women enrolled in services to primary pediatric care, including immunization, for their children.
      1. Gender-specific substance use treatment and other therapeutic interventions for women which may address issues of relationships, sexual and physical abuse and parenting, and childcare while the women are receiving these services.
      1. Therapeutic interventions for children in the custody of women in treatment which
      1. may, among other things, address their developmental needs, their issues of sexual and physical abuse, and neglect; and sufficient case management and transportation to ensure women attend treatment appointments.
      1. Collaboration with local birthing hospitals per VA Code 32.1-127 B6 for individuals who deliver Substance Exposed Infants (SEIs) and coordinate discharge planning.

B.     The Department Responsibilities

1. The Department shall monitor the utilization of the federal and state general funds for the PPW population.
   1. The Department shall be responsible for conducting physical site visits and federal block grant reviews biennially and can increase in frequency based upon the technical needs of the CSB.

10.4          Project Link Program

Scope of Services and Deliverables

Project LINK is a specialized program that provides intensive case management, home visiting, treatment, prevention, and recovery services as well as linkage to said services for women of childbearing age (14-44 years old), pregnant, and parenting women impacted by substance use disorders or co-occurring disorders.                  The CSB is responsible for maintaining a Project LINK supervisor to manage the requirements of the program. Additionally, each site is responsible for collaboration with birthing hospitals to coordinate discharge planning with individuals who deliver Substance Exposed Infants (SEI) per VA Code 32.127.B6. Each program is responsible for advisory meetings with agencies in its catchment, to integrate and coordinate additional service needs with community stakeholders.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall work collaboratively with the DBHDS Addiction Wellness and Recovery Services (AWRS)  Women’s Services Coordinator and Specialty Population Manager to fulfill the SUBG Woman set aside requirement.
   1. The program will provide the Evidence-Based Program (EBP) Nurturing Program for Families in Substance Abuse Treatment and Recovery and a trauma program such as Seeking Safety, Beyond Trauma, Trauma Recovery and Empowerment Model, or Eye Movement Desensitization and Reprocessing (EMDR).
   1. Submit Project LINK Service Delivery and Outcomes at Discharge, narrative, and financial reports bi-annually.
2. The Department Responsibilities: The Department agrees to comply with the following requirements.
   1. Provide oversight and monitor the Project LINK program to ensure the scope and deliverables are met as well as provide technical assistance as required.

• Communicate in a timely manner about changes to the program and funding allocations
  • Facilitate quarterly Project LINK Managers and Directors meeting as well as virtual and onsite program visits.
• Reporting Requirements: The CSB shall electronically submit all required Project LINK reports per the following schedule below.

10.5.        State Opioid Response Program Services (SOR)

SOR Prevention Program – The SOR grant was awarded to Virginia to combat the opioid epidemic and build upon programs started with State Targeted Response R/OPT-R and SOR. The purpose of the SOR program is to address the public health crisis caused by escalating opioid misuse, opioid use disorder (OUD), and opioid-related overdose across the nation. States and territories are expected to use the resources to: increase access to U.S. Food and Drug Administration (FDA)-approved medications for the treatment of opioid use disorder (MOUD); support the continuum of prevention, harm reduction, treatment, and recovery support services for OUD and other concurrent substance use disorders; and support the continuum of care for stimulant misuse and use disorders, including those involving cocaine and methamphetamine.

The SOR prevention grant awards support the implementation of effective strategies identified by the Virginia Evidence-Based Outcomes Workgroup. The categories of approved strategies include: coalition development, heightening community awareness/education, supply reduction/environmental, tracking and monitoring, and community education as part of harm reduction efforts. A portion of SOR Prevention funds are approved for the ACEs Project and Prevention Mini Wellness Grants .

1.      Adverse Childhood Experiences (ACEs) Project Scope of Services and Deliverables

SOR Prevention grant funds for the Adverse Childhood Experiences (ACEs) Project must be used

to fund prevention strategies that have a demonstrated evidence-base, and that are appropriate for the population(s) of focus.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall work collaboratively with DBHDS and OMNI Institute technical assistance team to fulfill requirements of the grant. This collaboration includes responding to information requests in a timely fashion, entering data in the Performance Based Prevention System (PBPS), submitting reports by established deadlines.

• CSB understands that SOR prevention funds are restricted and shall be used only for approved SOR prevention strategies (from the CSB’s approved SOR Logic Model).
  • CSB understands that changes to the budget (greater than a variance of 25 percent among approved budget items) and/or requests for additional funding must be sent via an email to the SOR Prevention Coordinator.
  • The Department Responsibilities: The Department agrees to comply with the following requirements.
    • The Department shall adhere to SOR grant guidelines established by the Substance Abuse and Mental Health Services Administration (SAMHSA), including reporting on statewide and CSB-specific data, accomplishments, and challenges.
    • The Department’s Behavioral Health Wellness Consultant/ACEs Lead shall maintain regular monthly communication with the CSB and monitor SOR ACEs Project performance.
    • The Department, particularly the SOR Prevention Coordinator and ACEs Lead, will respond to inquiries in a timely manner, fulfill requests for training and share regular updates regarding the grant. Every effort will be made to provide at least two weeks lead time prior to report deadlines.
    • The Department will provide a budget template for annual budget submission.

2.      SOR Prevention Program – Prevention Mini Wellness Grants

3.      Scope of Services and Deliverables

A portion of SOR Prevention funds were approved for the Prevention Mini Wellness Grants . Prevention Mini Wellness

-Grants provide CSB an award of funds to perform equity-oriented activities and programing throughout their agency and community. Funds can be used in innovative ways to meet the professional development and community needs of the populations being served. Grants recognize that minority communities may require interventions tailored to their unique needs. Grants should explicitly work to address the needs of marginalized populations.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall use the SOR Prevention grant funds for Prevention Mini Wellness Grants to fund strategies that have a demonstrated evidence-base and are appropriate for the population(s) of focus.
   1. The CSB shall work collaboratively with DBHDS and the Human Services Program Consultant, to complete all approved objectives from the application. This collaboration includes participating in a mid-grant check-in, completing a final grant report.
   1. The Department Responsibilities: The Department agrees to comply with the following requirements.
      1. The Department shall adhere to SOR grant guidelines established by the Substance Abuse and Mental Health Services Administration (SAMHSA), including reporting on statewide and CSB-specific data, accomplishments, and challenges.
      1. The Department’s  Human Services Program Consultant will perform a mid-grant check-in and will provide the format and collect the final grant report.

4.      SOR – Treatment and Recovery Services Scope of Services and Deliverables

1. Develop and provide opioid misuse prevention, treatment, and recovery support services for the purposes of addressing the opioid and stimulant misuse and overdose crisis.
2. Implement service delivery models that enable the full spectrum of treatment and recovery support services facilitating positive treatment outcomes.
3. Implement community recovery support services such as peer supports, and recovery coaches.
4. Increase the number of Opioid Treatment Programs (OTP). Expand Medication-Assisted Treatment (MAT) for justice-involved individuals.
5. Create pathways for new treatment and recovery providers/organizations. Increase treatment for pregnant and post-partum women.
6. Support Peer Support Services in emergency departments.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall comply with the Department’s approved budget plan for services.
   1. The CSB may employ SA MAT treatment personnel and recovery personnel
   1. The CSB may provide treatment and recovery services to include drug/medical supplies, drug screens, lab work, medical services, residential treatment, childcare services, client transportation, contingency management, recruitment services and treatment materials, employment resources, recovery wellness planning resources, overdose prevention and response materials, and temporary recovery housing.
   1. The CSB shall collect SAMSHA Unified Performance Reporting Tool (SUPRT) data for each person receiving services at intake, discharge, and 6-month time points. This data must be submitted to OMNI Institute within five business days of survey completion.
   1. All the SUPRT must be submitted to Omni  Institute within five (5) business days of survey completion.
   1. CSB receiving treatment or recovery funding under the SOR grant must complete a treatment or recovery Quarterly Survey every quarter of the grant.
   1. The Quarterly Survey must be submitted to OMNI Institute within two weeks of request by Omni Institute.
   1. The Department Responsibilities: The Department agrees to comply with the following requirements.
      1. The Department shall be responsible for submitting required reporting to SAMHSA in accordance with the SOR Notice of Award.
      1. The Department shall conduct physical and/or virtual site visits or program audit on a bi-annual basis, or more frequently, if necessary. Each site visit will be documented in a written report submitted to the Director of Addiction Recovery and Wellness Supports  .
      1. The SOR team will provide quarterly reports to CSB.
   1. Reporting Requirements: The CSB shall submit the Quarterly Treatment and Recovery Reporting Surveys through the online survey link that will be provided by Omni Institute each quarter. All surveys must be submitted no later than the following dates:

Quarter 4

October 15

The CSB shall collect SUPRT data for each person receiving services at intake, discharge, and 6-month time points. This data must be submitted to OMNI Institute within five business days of survey completion.

10.6.        Regional Suicide Prevention Initiative Scope of Services and Deliverables

To increase capacity to address suicide prevention and promote mental health wellness, the

Department funding for regional suicide prevention plans that implement evidenced based initiatives and strategies that promote a comprehensive approach to suicide prevention across the lifespan in the Commonwealth.

The regional or sub regional initiatives are intended to extend the reach and impact of suicide prevention efforts, afford greater access to suicide prevention resources by affected communities, and leverage and reduce costs for individual localities related to training or other suicide prevention action strategies.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall provide an action plan that includes (but not limited to) the following strategies and activities:
      1. mental health wellness and suicide prevention trainings based on community need and capacity to provide.
      1. activities for September Suicide Prevention Awareness Month and May Mental Health Awareness Month.
      1. identification of anticipated measurable outcomes.
      1. a logic model; and
      1. a budget and budget narrative.
      1. These funds shall be used only for the implementation of the Regional Suicide Prevention Initiative described in the Regional Suicide Prevention plan (and or supplement plan) approved by the Department.
      1. Any restricted state funds that remain unexpended or unencumbered at the end of the fiscal year may be carried over to the following year to be used only for Regional Suicide Prevention Initiative expenses authorized by the Department in consultation with the participating regional CSB.
      1. Any federal funds that remain unexpended or unencumbered by the end of the Performance Period the CSB must contact the Department at least 30 days prior to the end of the Performance Period to discuss permissible purposes to expend or encumber those funds.
   1. The Department Responsibilities: The Department agrees to comply with the following requirement.
      1. The Department shall monitor Regional Suicide Prevention Initiative program implementation progress through a semi-annual report and annual report submitted by the Regional Suicide Prevention Initiative Lead CSB, other data gathering and analysis, periodic visits to the region to meet with Regional Suicide Prevention Initiative partners, and other written and oral communications with Regional Suicide Prevention Initiative team members.
      1. The Department may adjust the CSB’s allocation of continued state funds for the Regional Suicide Prevention Initiative based on the CSB’s compliance with its responsibilities, including the requirements for maximizing resources from other sources.

• The Department will provide guidelines for the annual plan and a template for the semi-annual and annual report for the CSB to use.

C.    Reporting Requirements:

1. Mental Health First Aid and Suicide Prevention activities shall be included in each CSB’s Prevention data system.
   1. The Regional Suicide Prevention Initiative CSB shall submit its quarterly report to the Department per the schedule below.

10.7.        Supplemental Substance Abuse Block Grant Funded Program Services – (Prevention and Treatment)

Scope of Services and Deliverables

This allocation provides supplemental funding to support additional allowable uses of Substance Use Prevention, Treatment and Recovery Services (SUPTRS) Block Grant funding. This funding source is designated to plan, implement, and evaluate activities that prevent or treat substance use disorder. The priorities for the use of these funds include: the funding of substance use disorder treatment and support services for the uninsured or for whom coverage is terminated for short periods of time; the treatment and support services that demonstrate success in improving outcomes and/or supporting recovery that are not covered by Medicaid, Medicare, or private insurance; primary prevention by providing universal, selective, and indicated prevention activities; prevention services for persons not identified as needing treatment; and the collection of performance and outcome data to determine the ongoing effectiveness of behavioral health promotion, treatment, and recovery support services.

SUPTRS funds are to be the funds of last resort: Medicaid and private insurance, if available, must be used first. Target and priority populations are pregnant and parenting women, and intravenous (IV) drug users, to include those in need of interim services.

Any treatment services provided with SABG funds must follow treatment preferences established in 45 CFR 96.131(a):

1. Pregnant injecting drug users
2. Pregnant substance abusers
3. Injecting drug users
4. All others

Complete details of allowable services can be found in Exhibit F of the performance contract.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements
   1. The CSB shall prioritize SUPTRS priority populations including the uninsured, pregnant women and women with dependent children, and people who inject drugs
      1. The CSB shall follow all other federal requirements pursuant to Exhibit F.

• The Department Responsibilities: The CSB agrees to comply with the following requirements. The Department shall monitor uses of these supplemental funds in the same manner it monitors uses of SUPTRS treatment and recovery base funding, including SAMHSA measures and on-site or virtual reviews. These funds will be monitored as part of existing review processes.

10.8.        Substance Use Prevention, Treatment and Recovery Block Grant (SUPTR) Prevention Set Aside Services

Scope of Services and Deliverables

Access to Substance Abuse Treatment for Opioid Use Disorder (OUD)The CSB shall ensure that individuals requesting treatment for opioid use disorder drug abuse, including prescription pain medications, regardless of the route of administration, receive rapid access to appropriate treatment services, as defined in 45 CFR § 96.126, within 14 days of making the request for treatment or 120 days after making the request if the CSB has no capacity to admit the individual on the date of the request and within 48 hours of the request it makes interim services, as defined in 45 CFR § 96.121, available until the individual is admitted.

The SUPTRS BG Prevention Set aside is intended to prevent Substance Use Disorders (SUD) by implementing an array of strategies including information dissemination, education, alternatives, problem ID and referral, community capacity building and environmental approaches that target individuals, communities and the environment, guided by the Strategic Prevention Framework (SPF) planning model.

The CSB shall use the Institute of Medicine (IOM) model to identify target populations based on levels of risk: universal, selective, and indicated. The CSB shall utilize the Center for Substance Abuse Prevention (CSAP)s evidenced- based strategies: information dissemination, education and skill building, alternatives, problem identification and referral, community-based process, and environmental approaches. Community-based process/coalitions and environmental approaches that impact the population as a whole are keys to achieving successful outcomes and are Department priorities.

Substance abuse prevention services may not be delivered to persons who have substance use disorders to prevent continued substance use as mandated by the federal Substance Abuse Block grant.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.

1.      General Capacity Requirements

Each CSB shall work collaboratively with the  DBHDS  Community BH Division team and the OMNI Institute technical assistance team to fulfill requirements of the grant. This collaboration includes responding to information requests in a timely fashion, entering data in the Performance Based Prevention System (PBPS), submitting reports by established deadlines.

1. Each CSB must complete an evaluation plan, in collaboration with the OMNI Institute technical assistance team, which is revised and approved annually and includes:
   1. A logic model which includes all the required priority strategies all CSBs must implement and any discretionary strategies the CSB has elected to implement.
      1. A measurement plan documenting how all required metrics will be tracked and reported.

• All prevention programs, practices, and strategies must be evidence-based or evidence-informed and approved by the DBHDS Community BH Division team. Only strategies that align with the state-identified priorities and/or the CSB’s logic model outcomes will be approved.
  • Each CSB must maintain a license(s) for the Performance-Based Prevention System (PBPS) and record all implemented strategies in the PBPS. The resources to support this have been added to the CSB base allocation.
    • Each CSB must maintain a minimum of 1 FTE Prevention Lead position. This position leads and ensures compliance and implementation of all Prevention priority strategies.
    • Prevention funding should be used for prevention staff to attend at least one national prevention-related conference per year. Any national conferences outside of the NPN Prevention Research Conference, NATCON, CADCA National or Mid-Year Conferences must have prior DBHDS approval. Each CSB receives $3000 in their base allocation to help support this capacity building effort.
    • Submit an annual budget for SUPTR Prevention Set Aside utilizing DBHDS’ template.
    • CSBs must enter all report data into PBPS by the 15th of the month for the month prior.

2.      Counter Tools

1. The CSB shall conduct store audits of and merchant education with 100 percent of tobacco/nicotine retailers in its service area over a two-year period. Any retailer to be found in violation in the previous year is to be given priority for merchant education.
   1. The CSB also must maintain and update a list of tobacco/nicotine retailers in its catchment area over the two-year period.
      1. Data must be entered into the Counter Tools and PBPS systems.
      1. The CSB base allocation includes $10,000 for these strategies.
      1. Tobacco education programs for youth with the goal of reducing prevalence of use are not to be identified as SYNAR activities.

3.      ACEs Trainings

1. All CSBs should ensure there are at least 1ACE Interface presenter or Master Trainer either on staff or available to them through their community partners.
   1. All CSBs must conduct at least 6 ACEs trainings annually that focus on either/or the implications of early childhood adversity, resilience, or healing centered relationships. These can all be reported as ACEs trainings.
      1. All ACEs training data (including number of trainings held and number of people trained) must be reported in PBPS.
      1. CSBs which are designated as Self-Healing Communities and are receiving additional funding to address ACEs must complete all items noted above and the following:
         1. Submit a quarterly narrative report on all ACEs strategies and measures.
         1. Engage in a local Trauma-Informed Community Network (TICN) or other trauma-centered coalition

4.      Community Coalition Development

1. The CSB shall support or lead at least one community coalition and be involved in a minimum of 6-10 coalition meetings a year.
   1. The CSB should maintain membership in CADCA and/or CCoVA each year.
      1. The CSB and its associated coalition should ensure youth engagement in the coalition either as a sub-group of the coalition or a separate youth coalition.
      1. The CSB should maintain a social media presence to publicize prevention/coalition activities and messaging (Facebook page, Instagram, website, etc.) Websites should be updated monthly at a minimum and social media bi-weekly to ensure information and resources remain relevant and engages the community.

• Every 2 years, each CSB must complete a coalition readiness assessment and an assessment of representation in the coalition of the following 12 sectors: youth; parents; businesses; media; school; youth-serving organizations; law enforcement; religious/fraternal organizations; civic and volunteer organizations; healthcare professionals; state, local and tribal governments; and other organizations involved in reducing illicit substance use.

5.      Mental Health First Aid

1. Each CSB must have at least one staff trained to deliver MHFA courses.
   1. Each CSB trained MHFA trainer must provide a minimum of 3 Youth and/or Adult MHFA trainings annually to the population catchment area to maintain certification. (Example: Two CSB trained staff can co-facilitate and provide 3 trainings per year.) Residents of other catchment areas may attend, but the primary target audience needs to be the CSB’s catchment area.
      1. Ensure a minimum of 45 community participants are trained annually in MHFA (across all trainers at the CSB; no minimum number per trainer.
      1. If a CSB receives more than 3 requests for MHFA training, they may use RSPI funds to contract with another provider if they are unable to fulfill this community need due to staff capacity. CSBs are still responsible for capturing evaluation data from these trainings and entering them in the data system. An MOU must be established with the subcontractor that indicates the CSB be allowed to capture the data from the training, including number participants and, when appropriate, evaluation forms.

6.      Suicide Prevention

1. CSBs will have at least one staff member trained in at least one suicide prevention training on the approved list below to contribute to suicide prevention training efforts in their region.
   1. Applied Suicide Intervention Skills Training (ASIST) (in-person only)
      1. safeTALK (in-person only)
         1. QPR (Question, Persuade, Refer)
         1. The ASK Workshop
         1. More than Sad, Talk Saves Lives, L.E.T.S. or other suicide prevention training developed by the American Foundation for Suicide Prevention (virtual or in-person)
         1. Any other training listed in the Suicide Prevention Resource Center’s Best Practice Registry (Best Practices Registry)
         1. One-hour or more Lock and Talk Training listed in the Lock and Talk website portal
      1. Each CSB must take the lead on providing 3 suicide prevention trainings in their catchment area or Region.
      1. Each CSB must train a minimum of 45 participants in suicide prevention trainings.
      1. CSBs are encouraged to partner with other CSBs in their region to fulfill the training needs of their community and ensure the minimum number or participants required to hold a course is met.
      1. CSBs may subcontract with a certified trainer should the request for the delivery of suicide prevention training exceed the CSB’s staff capacity. An MOU must be established with the subcontractor that indicates the CSB be allowed to capture data from the training including number of participants and, when appropriate, evaluation forms.
      1. CSBs will actively promote trainings via their websites, social media and in-person events and community networks

• CSBs will assist community members who are seeking suicide prevention training with accessing training. CSBs will take lead on coordinating a training for groups interested in suicide prevention training within their catchment.
  • The Department Responsibilities: The Department agrees to comply with the following requirements.
    • The Department shall adhere to SABG Prevention Set Aside, grant guidelines established by the Substance Abuse and Mental Health Services Administration (SAMHSA), including reporting on statewide and CSB-specific data, accomplishments and challenges.
    • The Department’s SABG Prevention Set Aside Behavioral Health Wellness Consultants shall maintain regular communication with the CSB, monitor performance through reporting, and provide technical assistance to the CSB upon request.
    • The Department will work with the CSB to mutually agree on annual site visit dates.
    • The Department, particularly the SABG Prevention Set Aside Behavioral Health Wellness Consultants will respond to inquiries in a timely fashion, fulfill requests for training and share regular updates regarding the grant.
    • Every effort will be made to provide at least two weeks lead time prior to report deadlines by DBHDS in partnership with OMNI Institute federal reporting contractor.
    • The Department will provide a budget template for annual budget submission
  • Reporting Requirements: All data is reported into the Prevention data system and must be submitted by the 15th of the month for the month prior.

10.9.   Adult Mental Health Block Grant

The Community Mental Health Services Block Grant (MHBG) program’s objective is to support the grantees in carrying out plans for providing comprehensive community mental health services. The target populations served under this grant are adults with serious mental illness (SMI). This includes persons ages 18 and older who have a diagnosable behavioral, mental, or emotional condition—as defined by the Psychiatric Association’s Diagnostic and Statistical Manual (DSM), where their condition substantially interferes with, or limits, one or more major life activities (ex. basic daily living, accessing community resources).

A.    CSB Responsibilities: The CSB agrees to comply with the following requirements.

1. The CSB shall use the funds Mental Health Block Grant funds to reduce states’ reliance on hospitalization and develop effective community-based mental health services for adults with serious mental illness (SMI).
   1. The CSB shall follow the state performance measurement requirements.
      1. The CSB shall follow all other federal requirements pursuant to Exhibit F.

B.     Department Responsibilities:

1. The Department shall monitor the use of MHBG funds by means of on-site reviews at least every two years.
   1. The Department shall provide technical assistance as deemed necessary or upon request to ensure the state performance measurement requirements are met.

State Funded Program Services

This section describes certain program services with a primary funding source of state general funds but there may also be other sources of funding provided by the Department for the services provided.

11.1.        Auxiliary Grant in Supportive Housing Program (AGSH) Scope of Services and Deliverables

Section 37.2-421.1 of the Code of Virginia provides that DBHDS may enter into an agreement for the provision of supportive housing for individuals receiving auxiliary grants pursuant to §51.5-160 with any provider licensed to provide mental health community support services, intensive community treatment, programs of assertive community treatment, supportive in-home services, or supervised living residential services. The Auxiliary Grant (AG) funds shall not be disbursed directly to the CSB or DBHDS. The Department for Aging and Rehabilitative Services (DARS) shall maintain administrative oversight of the Auxiliary Grant program, including the payment of AG funds from DSS to individuals in the program.

1. The CSB Responsibilities: The CSB shall comply with the following requirements pursuant.
   1. For everyone served by the provider under this agreement, the provider shall ensure the following basic services:
      1. the development of an individualized supportive housing service plan (“ISP”).
      1. access to skills training.
      1. assistance with accessing available community-based services and supports.
      1. initial identification and ongoing review of the level of care needs; and
      1. ongoing monitoring of services described in the individual’s ISP.
      1. Assist AGSH recipients with securing and maintaining lease-based rental housing. This residential setting shall be the least restrictive and most integrated setting practicable for the individual that:
         1. complies with federal habitability standards.
         1. provides cooking and bathroom facilities in each unit.
         1. affords dignity and privacy to the individual; and
         1. includes rights of tenancy pursuant to the Virginia Residential Landlord and Tenant Act (§55-248.2 et seq.).
         1. provides rental levels that leave sufficient funds for other necessary living expenses, and
         1. the provider shall not admit or retain recipients who require ongoing, onsite, 24-hour supervision and care or recipients who have any of the conditions or care needs described in subsection D of §63.2-1805.
      1. The provider is expected to be full census (based on approved budget) within 12 months of operation and to maintain census of no less than 90% thereafter.
      1. Request approval, in writing, of DBHDS for an AGSH recipient to live with a roommate freely chosen by the individual.
      1. Adhere to all components of the AGSH Provider Operating Guidance.
      1. Licensing/Certification Requirements:
         1. The CSB shall maintain all relevant DBHDS licenses in good standing. Provide documentation of licensure status for relevant services to the Department for Aging and Rehabilitative Services (DARS) at initial certification and annually thereafter.
         1. The CBS shall maintain annual certification with DARS in accordance with §51.5-160 Section D.

B.     The Department Responsibilities:

1. DBHDS or its designee shall conduct annual inspections to determine whether the provider is following the requirements of this agreement. DBHDS will provide 30 days written notice for routine annual inspections. DBHDS may also conduct inspections at any time without notice.
   1. DBHDS will work with the Provider to develop and implement AGSH data reporting requirements including data elements, formats, timelines and reporting deadlines.

• Pursuant to §37.2-421.1 Section C., DBHDS may revoke this agreement if it determines that the provider has violated the terms of the agreement or any federal or state law or regulation.
  • Reporting Requirements: The CSB shall collect and report recipient level identifying information and outcome data at least quarterly no later than the 15th day following the end of the month (i.e., October 15th, January 15th, April 15th, and July 15th) and provide to DBHDS as requested.

11.2.        Children’s Mental Health Initiative (MHI) Funds Scope of Services and Deliverables

The Mental Health Initiative (MHI) Fund was established by the General Assembly in FY 2000 to

create a dedicated source of funding for mental health and substance abuse services for children and adolescents with serious emotional disturbances, at risk for serious emotional disturbance, and/or with co-occurring disorders with priority placed on those children who, absent services, are at-risk for removal from the home due to placement by a local department of social services, admission to a congregate care facility or acute care psychiatric hospital or crisis stabilization facility, commitment to the Department of Juvenile Justice, or parental custody relinquishment.

These services have the purpose of keeping children in their homes and communities and preserving families whenever possible.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. MHI funds must be used exclusively to serve currently unserved children and adolescents or provide additional services to underserved children and adolescents with serious emotional disturbances, at risk for serious emotional disturbance, and/or with co-occurring disorders with priority placed on those children who, absent services, are at-risk for removal from the home due to placement by a local department of social services, admission to a congregate care facility or acute care psychiatric hospital or crisis stabilization facility, commitment to the Department of Juvenile Justice, or parental custody relinquishment. These funds shall be used exclusively for children and adolescents, not mandated for services under the Children’s Services Act. Underserved refers to populations which are disadvantaged because of their ability to pay, ability to access care, or other disparities for reasons of race, religion, language group, sexual orientation or social status.
      1. Children and adolescents must be under 18 years of age at the time services are initiated. MHI funds can be used to bridge the gap between the child and adolescent and adult service

systems, if the service was initiated before the adolescent’s 18th birthday. Services used to bridge the gap can only be used for up to one (1) year. MHI funds cannot be used to initiate new services once an adolescent turns 18 years of age.

• MHI funds must be used to purchase services which will be used to keep the child or adolescent in the least restrictive environment and living in the community.
  • CSBs may use MHI funds to support personnel used to provide services to children and families. Each service provided shall be linked to an individualized service plan for an individual child and submit the required program and financial data reports in the format established by the Department.
    • MHI funds should not be used when another payer source is available.
    • Services must be based on the individual needs of the child or adolescent and must be included in an individualized services plan. Services must be child-centered, family focused, and community-based. The participation of families is integral in the planning of these services.

• CSBs must develop policies and procedures for accessing MHI funds for appropriate children and adolescents
  • The CSBs shall develop a Mental Health Initiative funding plan in collaboration with the local Family and Assessment Planning Teams and/or Community Policy and Management Team. The funding plan shall be approved by the Community Policy and Management Teams of the localities. The CSB should seek input and guidance in the formulation of the protocol from other FAPT and CPMT member agencies. A copy of the plan shall be kept on file at the CSB.
    • The MHI Fund Protocol shall at minimum:
      • Clearly articulate the target population to be served within the serious emotional disturbance, at risk for serious emotional disturbance, and/or with co-occurring disorders, non-CSA mandated population.
      • Establish defined protocols and procedures for accessing services, ensuring that all key stakeholder agencies have a method to link into services.
      • Clearly articulate the kinds or types of services to be provided; and
      • Provide for a mechanism for regular review and reporting of MHI expenditures.
      • Includes effective date and reviewed or updated dates as appropriate.
      • Includes acknowledgment that the protocol has been approved by the Community Policy and Management Teams.
    • Types of services that these funds may be used for include but are not limited to: crisis intervention and stabilization, outpatient, intensive in-home, intensive care coordination, case management, Family Support Partners, evidence-based practices, therapeutic day treatment, alternative day support (including specialized after school and summer camp, behavior aide, or other wrap-around services), and, supervised family support services.
    • All expenditures shall be linked to an individualized service plan for an individual child. Expenditures may be for something that is needed by more than one child, providing it can be linked to the individualized service plan of each child.
    • CSBs may use MHI funds to support personnel used to provide services to children and families. For example, the funds may be used to create a position dedicated to serving the non-CSA mandated population of children in the community; however, as stated above, each service provided should be linked to an individualized service plan for an individual child.
    • MHI funds may not be used for residential care services, partial or full hospitalizations, or for CSA sum sufficient populations. MHI funding may not be used to purchase vehicles, furniture, computers, or to provide training.
    • The CSB may carry-forward a balance in the MHI fund during the biennium in which the funds were distributed.

• The Department Responsibilities: The Department shall establish a mechanism for regular review and reporting of MHI Fund expenditures including monitoring unspent balances.

C.    Reporting Requirements:

All services shall be linked to an individualized service plan for an individual child in accordance with applicable business rules and HL7 interface specifications, including the use of the MHI Client Transaction Type. Expenditures may be for something that is needed by more than one child, providing it can be linked to the individualized service plan of each child.

1. The CSB shall submit the required program and financial data reports in the format established by the Department.
   1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time to allow for compliance.

11.3.        Permanent Supportive Housing (PSH) Scope of Services and Deliverables

1. The CSB Responsibilities: If the CSB receives state mental health funds for PSH for adults with serious mental illness and/or pregnant or parenting women with substance use disorder, it shall fulfill these requirements:
   1. Comply with requirements in the Virginia Department of Behavioral Health and Developmental Services Permanent Supportive Housing Program Operating Manual and any subsequent additions or revisions to the requirements agreed to by the participating parties. If the implementation of the program is not meeting its projected implementation schedule, the CSB shall provide a written explanation to and seek technical assistance from the Office of Community Housing in the Department.
      1. Ensure that individuals receiving PSH have access to an array of clinical and

rehabilitative services and supports based on the individual’s choice, needs, and preferences and that these services and supports are closely coordinated with the housing-related resources and services funded through the PSH initiative.

• Assist Department staff as requested with any case-level utilization review activities, making records of individuals receiving PSH available and providing access to individuals receiving PSH for interviews.
  • Comply with requirements related to the implementation of the Virginia Low-Income Housing Tax Credit (LIHTC) Qualified Allocation Plan First Leasing Preference.
  • Reserve any current restricted state mental health funds for PSH that remain unspent at the end of the fiscal year to be used only for PSH activities in subsequent fiscal years as authorized by the Department.
  • Participate in PSH training and technical assistance in coordination with the Community Housing and any designated training and technical assistance providers.
  • Ensure twelve-month housing stability of PSH tenants of no less than 85%
  • Reporting Requirements: Track and report the expenditure of restricted state mental health PSH funds separately in the implementation status reports required in subsection f below. Based on these reports, the Department may adjust the amount of state funds on a quarterly basis up to the amount of the total allocation to the CSB. The CSB shall include applicable information about individuals receiving PSH services and the services they receive.
    • CSB shall submit data about individuals following guidance provided by the Office of

Community Housing

• The CSB shall submit the required program and financial data reports in the format established by the Department.
  • The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time to allow for compliance and in accordance with Section 6 of this Exhibit.

11.4.        Forensic Services

Scope Services and Deliverables

1. The CSB Responsibilities: The CSB shall comply with the following requirements:
   1. The CSB shall designate appropriate staff to the roles of Forensic Admissions Coordinator, Adult Outpatient Restoration Coordinator, and NGRI Coordinator to collaborate with the local courts, the forensic staff of state facilities, and the Department. The CSB shall notify the

Department’s Office of Forensic Services of the name, title, and contact information of these designees and shall inform the Director of any changes in these designations. The CSB shall ensure that designated staff completes all recommended training identified by the Department.

• The Code of Virginia requires that court-ordered forensic evaluations of competency to stand trial and mental state at the time of the offense, and restoration treatment be performed on an outpatient basis unless the results of an outpatient evaluation indicate that hospitalization is necessary or if the defendant is already in DBHDS custody under certain legal statuses. The CSB shall consult with their local courts and the Forensic Coordinator at the designated DBHDS hospital as needed in placement decisions for individuals with a forensic status, based upon evaluation of the individual’s clinical condition, age, need for a maximum security, and other relevant factors.
  • Adult forensic evaluations should be completed by forensic evaluators with the requisite training and education as required by the Code and the Department. Evaluations of competency to stand trial (§ 19.2-169.1) and mental state at the time of the offense (§§ 19.2-168.1, 19.2-169.5) must be completed by an evaluator who is currently on the List of Qualified Evaluators maintained by the Department. Only if the CSB employs qualified forensic evaluators will it be eligible to perform forensic evaluations ordered by local courts. To the greatest extent possible, the CSB will assist the courts in identifying qualified forensic evaluators to perform adult outpatient forensic evaluations, if such assistance is requested by the courts.
    • Upon receipt of a court order pursuant to § 16.1-356 of the Code of Virginia, the CSB shall provide or arrange for the provision of a juvenile competency evaluation by a qualified forensic evaluator.
    • Upon receipt of a court order pursuant to § 16.1-357, the CSB shall submit the court order to the DBHDS Juvenile Justice Program Supervisor. The Supervisor will determine if the restoration will be provided by DBHDS Juvenile Justice Program or the CSB.
    • Upon receipt of a court order for the provision of adult outpatient competency restoration services pursuant to § 19.2-169.2 of the Code of Virginia, the CSB shall provide or arrange for the provision of services to restore the individual to competency to stand trial. These services shall be delivered in the community where the individual is currently located, or in a local or regional jail, juvenile detention center (when a juvenile is being tried as an adult), Department of Corrections facility, or in another location suitable for the delivery of the restoration

services when determined to be appropriate. These services may include treatment and restoration services, case management, assessment services, the provision of medications and medication management services, and other services that may be needed by the individual in order to restore them to competency and to prevent their admission to a state hospital.

• Upon written notification from a DBHDS facility that an individual has been hospitalized pursuant to § 19.2-169.1 (competency evaluation), § 19.2-169.2 (competency restoration), § 19.2-169.3 (unrestorable incompetent), § 19.2-169.5 & 168.1 (mental status at the time of the offense evaluation), or § 19.2-169.6 (emergency treatment from jail), the CSB shall provide discharge planning in accordance with the provisions of the Collaborative Discharge Requirements for Community Services Boards and State Hospitals: Adult & Geriatric.
  • The CSB shall provide follow-up care and discharge planning coordination to patients returning from a state facility to local or regional jails or juvenile detention centers. The CSB shall work with jail mental health and correctional staff to assist with reentry planning from the jail back to the community.
    • The CSB shall provide discharge planning for persons found not guilty by reason of insanity who are being treated in DBHDS facilities pursuant to § 19.2-182.2 through § 19.2 -182.7, and

§ 19.2-182.11 of the Code of Virginia, and in accordance with the Department’s NGRI Manual: Guidelines for Management of Individuals Acquitted Not Guilty by Reason of Insanity (February 2023) and the provisions of the Collaborative Discharge Requirements for Community Services Boards and State Hospitals: Adult & Geriatric.

1. Upon written notification from DBHDS that an individual found Not Guilty by Reason of Insanity has been placed onto outpatient temporary custody status pursuant to § 19.2-182.2, the CSB shall initiate contact with the individual as soon as possible for the purpose of making referrals to CSB services and other providers as needed, as well as to assess and provide feedback to the Department on the individual’s progress. The CSB will provide NGRI coordination and supervision while the individual completes the outpatient temporary custody evaluation process and will work jointly with the Department to develop conditional or unconditional release plans as required by Code.
   1. The CSB will review and sign an NGRI acquitter’s Risk Management Plan for Escorted Community, Unescorted Community, Conditional Release, and Unconditional Release in accordance with the timelines outlined in the Department’s NGRI Manual: Guidelines for Management of Individuals Acquitted Not Guilty by Reason of Insanity (February 2023) and the Collaborative Discharge Requirements for Community Services Boards and State Hospitals: Adult & Geriatric.
      1. The CSB will implement and monitor compliance with court-ordered Conditional Release Plans (CRPs) for persons found Not Guilty by Reason of Insanity and released with conditions pursuant to § 19.2-182.2 through § 19.2 -182.7, and § 19.2-182.11 of the Code of Virginia. The CSB is responsible for providing the Office of Forensic Services copies of any written correspondence and court orders issued for NGRI acquitters in the community.

B.     Reporting Requirements

Not Guilty by Reason of Insanity (NGRI):

1. The CSB shall supply information to the Office of Forensic Services for individuals adjudicated not guilty by reason of insanity (NGRI), as required under § 37.2-508 or § 37.2-608 of the Code and as permitted under 45 CFR §§ 164.506 (c) (1) and (3), 164.512 (d), and 164.512 (k) (6) (ii).
   1. The CSB shall submit written reports to the court for individuals adjudicated Not Guilty by Reason of Insanity (NGRI), documenting the person’s progress and adjustment in the community. Pursuant to § 19.2-182.7 these reports shall be submitted no less frequently than

every six months from the date of release and are required for the duration of conditional release. The CSB shall also provide to the Department’s Office of Forensic Services written monthly reports on the person’s progress and adjustment in the community for their first 12 continuous months in the community following discharge to conditional release.

11.5  Adult Competency to Stand Trial Restoration (MH Adult Outpatient Competency Restoration Services)

Scope of Service and Deliverables

The CSB shall coordinate the provision of Adult Outpatient Competency Restoration and Outcome Evaluation Services to any individual so ordered who is currently residing in their service area or who is in custody in a local or regional jail or state correctional facility within the boundaries of their service area.

A.    The CSB Responsibilities:

1. Upon receipt of a court order for Adult Outpatient Competency Restoration services pursuant to Virginia Code §19.2-169.2, the CSB shall provide Adult Outpatient Restoration Services, including initial restoration assessment, restoration services, and restoration case management services as defined in the DBHDS Definitions for Adult Outpatient Restoration Services.
   1. As soon as possible following receipt of the court order, the CSB shall determine the location of the defendant and outreach the court or attorneys to gather all necessary collateral documentation (such as the initial competency evaluation, prior treatment records, charging documents or warrants, police reports or other collateral information specific to the criminal charges). If the defendant is not presently residing in the CSB’s catchment area, the CSB is responsible for ensuring that the court amends the order and appoints the appropriate CSB based on the defendant’s location.
   1. At the conclusion of restoration services, the CSB shall arrange for an outcome competency to stand trial evaluation by a licensed clinical psychologist or psychiatrist who has the requisite forensic training and experience prescribed by the Code of Virginia.
   1. The CSB shall transmit a cover letter issued from the CSB to the court and attorneys at the conclusion of restoration services, outlining the findings of the outcome evaluator and including a copy of the outcome evaluation if it was coordinated by the CSB.
   1. The CSB shall provide the DBHDS Office of Forensic Services electronic copies of the court order, outcome evaluation, and CSB cover letter to the court, along with the DBHDS Adult Outpatient Competency Restoration Services Report within 60 days of the conclusion of services.
   1. Upon receiving confirmation from the Office of Forensic Services that all of the required documentation is complete, the CSB shall submit its claim for payment using the Departments grants management system and claims reimbursement process.
   1. The CSB shall use the Departments grants management system support mailbox webgrants@dbhds.virginia.gov for any WebGrants technical assistance and training as needed.

B.     The Department Responsibilities:

1. The Department shall provide technical assistance and case consultation upon request to the CSB related to Adult Outpatient Competency Restoration cases.
   1. The Department shall notify the CSB when available funding has been exhausted.
   1. The Department shall provide WebGrants training and technical assistance as needed to the CSBs.
   1. The Department shall ensure timely review and approval of CSB reimbursement claims pursuant to the claim’s reimbursement process.

C.    Payment Terms:

1. The Department shall provide the CSB payment for the provision of Adult Outpatient

Restoration Services, including restoration assessment, restoration services, and restoration case management, as defined in the DBHDS Definitions for Adult Outpatient Restoration Services, Revised 1/24/2025.

• The Department shall disperse payment to the CSB for outcome competency evaluations coordinated and paid for by the CSB at the conclusion of restoration services. The Department will issue payments according to the DBHDS Adult Outpatient Competency Restoration Payment Guidelines, Revised 1/24/2025.
  • Funds will be paid out to the CSB on a reimbursement basis only through WebGrants. The CSB will submit invoices for reimbursement based on actual services provided during the period of performance. Payment is contingent on the availability of funds.
  • The Department may, at its reasonable discretion, modify payment dates or amounts, or terminate this agreement and provide advance notification of any such changes in writing and work collaboratively with CSB/BHA when possible, regarding any changes to this Agreement.
  • The CSB shall ensure that all reimbursement requests are supported by actual expenses that further the Adult Outpatient Competency Restoration program. The CSB shall be reimbursed up to the approved amount for these costs. The CSB shall maintain records of these expenses in the event of future audits.

11.6.        Gambling Prevention

Scope of Service and Deliverables

The Problem Gambling Treatment and Support Fund (9039) via the Community BH Division, Problem Gambling Prevention Program intends to prevent and minimize harm from the expansion of legalized gambling by implementing the Strategic (SPF) planning model. CSB’s will

continue to utilize data collected and research to identify and implement strategies to prevent problem gambling. Making data driven decisions to determine and revise priorities and select evidence-based strategies based upon the priorities identified.

To increase capacity to address problem gambling prevention the Department also provides funding for CSB level problem gambling prevention data collection, capacity building, and strategy implementation.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall provide a proposed budget.
   1. These funds shall be used only for the implementation of the Problem Gambling Prevention Services described herein. Funding may be used to hire or maintain staff working on problem gambling prevention (PGP), provide stipends, travel related to PGP services, incentives for data collection, promotion/awareness items, and membership and attendance to organizations whose mission includes the mitigation of gambling problems.
   1. Participate in surveys by coordinating collection of data for your CSB catchment area on gambling and gaming behaviors.
   1. Each CSB that receives problem gambling prevention funding will participate in conducting the Young Adult Survey, a PG Community Readiness Assessment, and Environmental Scan, and will ensure a minimum of two (2) different strategies to prevent problem gambling will be included in your CSB logic model. Those CSB’s receiving enough funding to pay for at least a half time staff will need to implement at least 3 strategies. This may include:
      1. Information dissemination.
      1. Education.

• Alternative strategies.
  • Environmental
  • Community-Based Process; and/or
  • Problem Identification and Referral
  • The CSB shall continue to build capacity in their CSB by assigning at least one person to oversee the problem gambling prevention work and share information about problem gambling with their communities. This includes attending and participating in all DBHDS Community BH Division  sponsored problem gambling trainings and webinars
  • The CSB may either hire or maintain a current part time staff person, add hours on to a current part time position in the organization, or adjust a current employee’s workload to allow for time to lead and ensure compliance and implementation of all problem gambling prevention activities.
  • Any restricted state Problem Gambling Treatment and Support funds that remain unexpended or unencumbered at the end of the fiscal year may be carried over to the following year to be used only for Problem Gambling Prevention strategy expenses authorized by the Department.
  • If you have a casino or racino in your catchment area, continue to build relationships with those businesses and coordinate prevention and responsible gambling services for those facilities.
• The Department Responsibilities: The Department agrees to comply with the following requirements.
  • The Department shall monitor Problem Gambling Prevention Services program implementation progress through a quarterly report submitted by the CSB Problem Gambling Prevention Services Lead, other data gathering and analysis, periodic on-site or virtual visits to meet with the CSB Problem Gambling Prevention Services staff, and other written and oral communications with CSB Problem Gambling Prevention Services team members.
  • The Department may adjust the CSB’s allocation of continued state funds for the Problem Gambling Prevention Services based on the CSB’s compliance with its responsibilities, including the requirements for maximizing resources from other sources
  • The Department will respond to inquiries in a timely fashion, fulfill requests for training and share regular updates regarding the grant.
  • Every effort will be made to provide reporting forms at least two weeks prior to report deadlines by DBHDS and in accordance with Section 6 of this Exhibit.
  • The Department will provide a template for the plan and quarterly report for the CSB to use.
• Reporting Requirements: The CSB shall track and account for its state Problem Gambling Treatment and Support Fund as restricted problem gambling prevention State funds, reporting expenditures of those funds separately in its quarterly reports.

Submit a quarterly report on problem gambling prevention activities to the DBHDS Problem Gambling Prevention Coordinator (due by the 15th of October, January, April, and July and in accordance with Section 6 of this Exhibit.

11.7.        Mental Health Services in Juvenile Detention Centers Scope of Services and Deliverables

The Mental Health in Juvenile Detention Fund was established to create a dedicated source of funding for mental health services for youth detained in juvenile detention centers.

A CSB’s primary role in a juvenile detention center is providing short-term mental health and substance use disorder services to youth detained in the center with mental illnesses or mental illnesses and co-occurring substance use disorders. As part of this role, a CSB also consults with juvenile detention center staff on the needs and treatment of youth. This may include case consultation with detention center staff. Since the youth have been court ordered to the center, they are under the jurisdiction of the center for care. A CSB provides consultation and behavioral health services in support of the centers care of youth and should establish and maintain positive, open, and professional communication with center staff in the interest of providing the best care to the youth.

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall provide mental health and substance use services to youth detained in the juvenile detention center, this may include youth who are pre-adjudicated, youth who are post-adjudicated, youth who are post-dispositional, and youth who are in a community placement program. Since most youth have short lengths of stay, clinical services in juvenile detention should be designed to provide short term mental health and substance use services. At times, a youth may have a long length of stay and the CSB should be prepared to provide services as needed. Below are examples of core services a CSB typically provides with this funding to most of the youth it serves in juvenile detention centers:
      1. Case management,
      1. Consumer Monitoring,
      1. Assessment and Evaluation,
      1. Crisis Services
      1. Medical Services, or
      1. Individual or group therapy when appropriate (coded as outpatient services)
      1. The CSB shall provide discharge planning for community-based services for youth with identified behavioral health and/or substance use issues who return to the community.
      1. The CSB shall document provided mental health and substance use services while a youth is in detention in the CSBs electronic health record (EHR).
      1. The CSB shall have a Memorandum of Understanding (MOU), a Memorandum of Agreement (MOA), or contract with the juvenile detention center in which the CSB provides services. The MOU, MOA, or contract shall outline the roles and responsibilities of each entity, outline a plan for continued services if there is a vacancy, a dispute resolution process as well as outline a plan for regular communication between the CSB and Juvenile Detention Center. MOU/MOA and contracts shall be reviewed bi-annually.
      1. The CSB shall notify the Office of Child and Family Services of any significant staffing changes or vacancies that cannot be filled within 90 days.

• The Department Responsibilities: The Department agrees to comply with the following requirements.

The Department shall establish a mechanism for regular review of reporting Mental Health in Juvenile Detention fund expenditures, data, and MOUs/MOAs or contracts to include a process by the Office of Child and Family Services.

C.     Reporting Requirements:

1. The CSB shall account for and report the receipt and expenditure of these restricted funds separately.
   1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in compliance with Section 6 of this Exhibit.
      1. The CSB biennially, shall provide a copy of a signed MOU/MOA or contract to the Department.

11.7          State Regional Discharge Assistance Program (RDAP – MH Regional DAP) Scope of Services and Deliverables

The Department and the CSB agree to implement the following requirements for management and

utilization of all current state regional discharge assistance program (RDAP) funds to enhance monitoring of and financial accountability for RDAP funding, decrease the number of individuals on state hospital extraordinary barriers to discharge lists (EBLs), and return the greatest number of individuals with long lengths of state hospital stays to their communities.

A.     The CSB Responsibilities:

1. The CSB shall comply with the current Discharge Assistance Program Manual issued by the Department.
   1. The CSB, through the RMG and RUMCT on which it participates, shall ensure that other funds such as Medicaid payments are used to offset the costs of approved IDAPPs to the greatest extent possible so that state RDAP funds can be used to implement additional IDAPPs to reduce EBLs.
   1. All state RDAP funds allocated within the region shall be managed by the regional management group (RMG) and the regional utilization management and consultation team (RUMCT) on which the CSB participates.
   1. On behalf of the CSBs in the region, the regional manager funded by the Department and employed by a participating CSB shall assure accurate and timely entry and reporting of all relevant IDAPP and expenditure data in the DBHDS DAP Portal.
   1. If the CSB has unspent funds they may be utilized subsequent years to support one-time IDAPPS. Any other use of funds must be reviewed and approved by DBHDS in accordance with the DAP manual.

B.     The Department Responsibilities:

1. The Department shall work with the VACSB, representative CSBs, and regional managers to develop clear and consistent criteria for identification of individuals who would be eligible for individualized discharge assistance program plans (IDAPPs) and acceptable uses of state RDAP funds and standard terminology that all CSBs and regions shall use for collecting and reporting data about individuals, services, funds, expenditures, and costs.
   1. The Department may conduct utilization reviews of the CSB or region at any time to confirm the effective utilization of state RDAP funds and the implementation of all approved ongoing and one-time IDAPPs.
   1. Annually DBHDS will revise allocations to the Regional Fiscal Agent CSB based on previous year’s use of funds to assure all needs are met statewide.

• Reporting Requirements: The regional Manager shall assure accurate and timely data entry of IDAPPS and expenditures monthly into the DAP Portal. Reports on allocation, use and expenditures shall be available to both DBHDS and the Regional offices in the DAP portal at any time.

11.8        Housing Flexible Funding Program (State Rental Assistance Program) (790 Funds DD SRAP) Scope of Services and Deliverables

Individuals with developmental disabilities face numerous financial barriers to making the initial

transition to integrated, independent housing and to maintaining this housing. Most adults with developmental disabilities have income below 30% of the area median income. Those who have Medicaid or Supplemental Security Income must meet strict asset limits that prevent them from saving enough to cover one-time, upfront expenses to rent housing or to cover expenses that, if not paid, could jeopardize their housing stability.

The Flexible Funding Program enables adults with developmental disabilities to overcome financial barriers to making initial transitions to integrated, independent housing and to maintaining housing stability. Six Community Services Boards administer the Program in their respective DBHDS regions. Program operations include:

1. making Flexible Funding applications and program materials available to support coordinators in the region
   1. providing technical assistance to support coordinators on the program requirements and application process
   1. reviewing and adjudicating Flexible Funding applications in accordance with the Flexible Funding 2.0 Guidelines (“the Guidelines”)
   1. authorizing and processing payment or reimbursement for approved goods and services in accordance with the Flexible Funding 2.0 Guidelines (“the Guidelines”)
   1. tracking and reporting per person and aggregated program expenditures in the Flexible Funding workbook provided by DBHDS in accordance with the Flexible Funding 2.0 Guidelines (“the Guidelines”).

1. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CSB shall designate a Flexible Funding program administrator and a fiscal administrator who are responsible for program implementation. The program administrator and fiscal administrator may be the same staff person or different staff people. The CSB shall provide contact information for each administrator (including name, title, address, email and phone number) to the DBHDS Office of Community Housing.
   1. The CSB shall ensure it can access the DBHDS cloud-based electronic file sharing system which contains program materials required to administer the Program.
   1. The CSB shall implement strategies to pay time-sensitive expenses such as, but not limited to holding fees, security deposits and moving company charges as soon as possible. Strategies may include issuing promissory notes, notifying vendors that applicants’ Flexible Funding requests have been approved, or identifying third parties that can front payment of expenditures immediately and request reimbursement from Flexible Funding.
   1. The CSB shall submit programmatic and financial reports in accordance with the Guidelines using the Flexible Funding workbook provided by DBHDS.
   1. The CSB shall maintain program and financial records in accordance with the Guidelines.

• The CSB shall direct all communication regarding Flexible Funding applications and decisions to the support coordinator identified on the application. If the CSB denies an application in whole or in part, the program administrator must inform the support coordinator in writing and must offer appeal rights in accordance with the Guidelines. Support coordinators are responsible for informing applicants about the status of their applications.
  • The CSB shall review and adjudicate requests for reasonable accommodations within the program in accordance with the Guidelines.
  • The CSB has the option to delegate the review and adjudication of Flexible Funding applications to a single point of contact within each local CSB within the region. The CSB can approve and issue reimbursements to local CSBs that approve their own applications and make payments in accordance with the Guidelines.
  • The CSB shall provide periodic trainings for support coordinators in the region regarding the Guidelines and the application process.
  • Administrative costs include, but are not limited to, Flexible Funding program personnel salaries and benefits, rent, utilities, telephone/Internet service, equipment, supplies, and travel.
• The Department Responsibilities: The Department agrees to comply with the following requirements.
  • The Department shall develop and issue Guidelines for administering the Program to the CSB.
  • The Department shall issue Program Memoranda to the CSB to clarify the guidelines as needed. If there is a conflict between the Guidelines and a Program Memorandum, the Program Memorandum shall prevail.
  • The Department shall provide the CSB access to its cloud-based file sharing system, which shall contain program materials required to administer the Program.
  • The Department shall provide the CSB training and technical assistance with completing program reports, reviewing applications, and interpreting program guidelines.
  • The Department shall process appeal requests from applicants or their designated representatives in accordance with the Guidelines.
  • The Department shall monitor the CSB in accordance with Section J of this Agreement.
  • The Department shall distribute additional funding allocations for the Program to the CSB.

C.    Performance Outcome Measures:

1. 90% of all Flexible Funding applications submitted within the fiscal year are reviewed and adjudicated within 10 days of receiving completed applications.
   1. 90% of all Flexible Funding applications submitted within the fiscal year are approved in accordance with the maximum funding caps identified in the Guidelines.

D.    Reporting Requirements:

The CSB will provide the following reports to DBHDS OCH:

1. A quarterly expense report that summarizes the balance at the beginning of the quarter, expenditures for the reporting quarter and the year to date, and the balance at the end of the quarter. The report will reflect this information for each line item, including but not limited to program expenditures and administrative expenditures. This report will also identify the number of discrete persons served each quarter.
   1. A completed program status report that details information about approved applications disbursed during the current reporting quarter and previous quarters/fiscal years.

• The CSB will submit quarterly expenses and program status reports in a DBHDS-provided Excel workbook that is hosted on a DBHDS-approved, cloud-based storage system by the 30th of the month following the end of the 1st, 2nd and 3rd quarter. The CSB may submit the quarterly expense and program status report for the 4th quarter (e.g., the end of the fiscal year) within 45 days of the end of the quarter.

11.9.     Substance Abuse Residential Purchase of Services (SARPOS -SGF) Scope of Services

SARPOS funds may be used for residential settings, programs, or services that “meet the intent” of providing services that support recovery. SARPOS funds have traditionally been made available to support community-based residential medically managed/monitored withdrawal, contracted residential, transitional living programs, and other residential services that support recovery. SARPOS funding is not intended to be long term. If being used to support transitional services, there should be a plan related to how the individual will be able to maintain housing after the supports are removed.

SARPOS funding is prioritized for priority populations- pregnant substance use, injecting substance use, other opioid use populations. SARPOS fund shall be used for treatment and support services for substance use disorders, including individuals with acquired brain injury and co-occurring substance use disorders. Funded services shall focus on recovery models and the use of best practices.

1. SARPOS funds have traditionally been made available to support community-based residential medically managed/monitored withdrawal, contracted residential, transitional living programs, and other residential services that support recovery.
2. Funds may be used for short term. If funding is being used to support transitional housing a plan should exist for maintaining housing post the use of SARPOS funds.
3. Funding may also be used to provide services that support recovery in the community setting to include transportation to or from treatment, and medical appointment when there are no other means of transportation available, the purchase of training, registration, courses, licenses, certification, etc. that leads to financial recovery/ability to gain skills for specific trade/employment, items needed to maintain or gain employment include work uniforms, glasses, etc.
4. Additionally, the purchase of tools and types of equipment, i.e. barber clippers, work tools, safety glasses, hard hats, etc. required to begin employment if there is no other funding source may be obtained.
5. Payment for medications needed while in a residential setting or for medications needed for medication assisted treatment (MAT) while in medically managed detoxification or other residential care if no other revenue sources are available.
6. Non-MAT psychiatric care for those clients working toward application for Medicaid. Funds of last resort.
7. SARPOS funds may be used for individuals in need of residential settings, programs, or

services that “meet the intent” of providing services that support recovery for persons with SUDs and persons with co-occurring MH and SUDs if the funds are addressing the SUD. (e.g., half-way house, Oxford House).

• SARPOS funds may also be used to address barriers an individual may experience to entering residential services or to mitigate factors that might impede continued residential services. Examples include:

1. Funds for transportation to or from the residential services, if no other means of transportation is available.
   1. Purchase of clothing or personal hygiene products that may be needed while in residential services if no other resource is available.
   1. Payment for a brief stay in a motel if the individual does not have a safe residence while awaiting a bed in a residential setting.
   1. Payment for medications needed while in a residential setting or for medications needed for medication assisted treatment (MAT) while in medically managed detoxification or other residential care if no other revenue sources are available.
   1. Payment for children to reside with their mother while she participates in residential treatment, if no other revenue sources are available.
2. SARPOS funds should not be substituted for other funds dedicated to these purposes. CSBs are encouraged to first explore utilization of other funds available for residential services (e.g. transformation funds for crisis stabilization, SA diversion funds, co-occurring disorders funds). CSBs can use other SA state general funds or SA federal funds for SUD residential needs in addition to SARPOS funds if the funds are not in an earmarked restricted category.
3. The CSB Responsibilities: To implement the SARPOS funds, the CSB agrees to comply with the following requirements.
   1. CSBs should develop memorandums of agreement/contracts with community providers for residential services that follow all Federal and state laws and regulations concerning confidentiality, human rights, and SAPTBG requirements, including data collection. The CSB is responsible for ensuring that contracted providers are adhering to these requirements.
   1. Where possible, CSBs are encouraged to engage, in collective and regional negotiation with potential vendors for the most cost effective and highest quality care for individuals.
   1. The CSB must provide and document care coordination services and discharge for individuals funded via SARPOS, if applicable. The residential service provider must also collaborate with the CSB in discharge planning and appropriate transition back into the community, including the need for treatment or other services at a different level of care.
4. The Department Responsibilities: To implement the SARPOS funds, the Department agrees to comply with the following requirements.
   1. Monitor use of these funds to assure that they are being used to support evidence-based treatment/recovery supports and will not permit use of these funds for non-evidence-based approaches, and review services during Programming Monitoring and Oversight (PMO) and Department review visits.
   1. Support the effective implementation of the program through technical assistance to develop implementation plans, address implementation challenges, and modify performance targets to address emerging issues.
   1. The Department shall provide technical assistance when requested.
   1. The Department reserves the rights to recover unexpended SARPOS funds and to reallocate those funds to CSBs that have documented the need for additional substance abuse residential purchase of services funds.

11.10 Substance Use Medication Assisted Treatment (SUD MAT)

Scope of Services: This allocation provides supplemental funding to support the ongoing effort to decrease substance use and the overdose rates throughout the Commonwealth. These funds must be prioritized for individuals who are not covered by insurance; however, can be used for those who are under insured. These are state general funds for the current state fiscal year.

The designated uses for these funds are:

Long-acting, injectable prescription drug treatment regimens for individuals within the community who need medication assisted treatment.

Non-narcotic, non-addictive prescription drug treatment regimens to (i.e., manage withdrawal Long-acting, injectable prescription drug treatment regimens for individuals who need medication assisted treatment while (i) on probation, (ii) incarcerated, or (iii) upon their release to the community. This is to include those with current or recent criminal justice involvement (within the last 12 months).

Non-narcotic, non-addictive prescription drug treatment regimens to (i.e., manage withdrawal symptoms, reduce drug cravings, help prevent relapse, treat co-occurring disorders (e.g., depressive or anxiety disorders).

Non-drug treatment regimens to include IOP, residential, partial hospitalization, social detox, etc.) for individuals who are not clinically able or for other reasons related to treatment barriers to participate in buprenorphine or methadone-based drug treatment regimens.

1. The CSB Responsibilities: the CSB agrees to comply with the following requirements.

The CSB shall utilize the funding to expand MAT and MAT support services to uninsured and under insured SU consumers as stated above.

B.     The Department Responsibilities:

1. The Department shall continue to monitor use of the MAT funds.
   1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time to allow for compliance and in accordance with.

C.    Reporting Requirements:

1. The CSB shall provide financial reporting for the utilization of the MAT and its supportive services.
   1. The CSB shall submit the required program and financial data reports in the format established by the Department.

11.11.     HIV/EIS/Harm Reduction Scope of Services

This funding is to support the ongoing effort to reduce the risks, harm, and negative consequences

associated with drug use, to include programs and interventions that are not abstinence based but are aimed at reducing the transmission of HIV and other communicable diseases and improving the health outcomes of individuals at risk.

The designated uses for these funds are:

1. Prevention, treatment, and peer staff that provide services to those with HIV, at risk of developing communicable diseases, or at risk for developing substance use.
2. Prevention Service to include education and outreach programs to raise awareness about HIV transmission and prevention, distribution of condoms and other safer sex supplies, and PrEP (pre-exposure prophylaxis) services for high-risk individuals.
3. Harm Reduction Strategies to include support of CHR sites and services that reduces the spread of HIV among people who inject drugs, and access to opioid substitution therapy (e.g., methadone) to help individuals reduce or eliminate drug use.
4. Testing and Counseling such as confidential HIV testing services, including rapid testing options, and pre-and post-test counseling to provide support and information about HIV and its implications.
5. Linkage to Care such as referral services to connect individuals with medical care, including antiretroviral therapy (ART) for those who are HIV-positive, and support for navigating healthcare systems and accessing necessary services.
6. FDA approved Drug Test Strips which encourages safer drug use.
7. Supportive mental health and substance use treatment services, and peer support programs that provide social support and shared experiences.
8. Community Engagement such as advocacy.
9. The CSB Responsibilities: the CSB agrees to comply with the following requirements.

The CSB shall utilize funding to support HIV/EIS/Harm reduction services to the uninsured and under insured SUD population as stated above.

B.     The Department Responsibilities:

1. The Department shall continue to monitor use of the HIV/EIS funds.
   1. The Department shall review communicate in a timely fashion with each CSB/BHA about changes to the programming and where funding needs may be assessed and readdressed.

C.    Reporting Requirements:

1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time and in compliance with Section 6 of this Exhibit.
   1. The CSB shall provide financial reporting for the utilization of the HIV/EIS and its supportive services.
   1. The CSB shall submit the required program and financial data reports in the format established by the Department.

11.12.   System Transformation of Excellence and Performance (STEP – VA) Scope of Services

STEP-VA is an initiative designed to improve the community behavioral health services available to all Virginians. All CSBs in Virginia are statutorily required to provide all STEP-VA services. These

services include Same Day Access, Primary Care Screening, Outpatient Services, Crisis Services, Peer and Family Support Services, Psychiatric Rehabilitation, Veterans Services, and Case Management and Care Coordination. the Department anticipates fewer admissions to state and private hospitals,

decreased emergency room visits, and reduced involvement of individuals with behavioral health disorders in the criminal justice system as STEP-VA has been implemented across the

Commonwealth. Peer and Family Support Services, Psychiatric Rehabilitation, Case Management and Care Coordination performance expectation are outlined in Exhibits D as the Department works with CSBs to establish program requirements and benchmark.

1.      For all steps of STEP-VA

1. All CSB will establish a quality management program and continuous quality improvement plan to assess the access, quality, efficiency of resources, behavioral healthcare provider training, and patient outcomes of those individuals receiving outpatient services through the CSB. This may include improvement or expansion of existing services, the development of new services, or enhanced coordination and referral process to not directly provided by the CSB.

b.      The Department agrees to comply with the following requirements

1. Determine the need for site visits based on monitoring, particularly if the Programs are not accomplishing its missions, and/or meeting its goals as described in this document. Based on this identified need and regular on-going scheduled site-visits:
   1. Conduct in-person or virtual visits/check-ins with the CSB program leadership to ensure compliance with the scope and requirements of services; and to review outcomes, which include challenges and successes of the programs.

2.     Outpatient Services

Scope of Services and Deliverables

Outpatient services are foundational services for any behavioral health system. Outpatient services may include diagnosis and evaluation, screening and intake, counseling, psychotherapy, behavior management, psychiatry, psychological testing and assessment, laboratory and ancillary services. As one of the required services for STEP-VA, the purpose of the Outpatient Services step is to ensure the provision of high quality, evidence-based, trauma-informed, culturally competent, accessible behavioral health services that addresses a broad range of diagnoses and considers an

individual’s course of illness across the lifespan from childhood to adulthood.

A. The CSB Responsibilities: The CSB agrees to comply with the following requirements.

1. The CSB will offer evidence based and best practices as part of their programming and implementation of Outpatient Services to the adults, children and families in the community.
2. The CSB/BHA shall increase capacity and community access to Children’s Outpatient services.
3. The individual will receive a service with a high quality CSB outpatient provider or a referral to a non-CSB outpatient behavioral health service within 30 business days of the completed Comprehensive Needs Assessment, if clinically indicated. The quality of outpatient behavioral health services is the key component of this step.
4. CSB shall establish expertise in the treatment of trauma related conditions.
5. CSB should provide a minimum for outpatient behavioral healthcare providers of 8 hours of trauma focused training in treatment modalities to serve adults, children/adolescents and their families within the first year of employment and 4 hours in each subsequent years or until 40 hours of trauma-focused treatment can be demonstrated.
6. Provide training data regarding required trauma training yearly in August when completing federal Block Grant reporting (Evidence Based Practice Survey) sent by DBHDS.
7. STEP Virginia requires that each CSB offer, at a minimum, the following Evidence Based Practices for psychotherapy: Cognitive Behavioral Therapy (CBT) and Motivational

Interviewing (MI) and the following EBP’s for Psychiatry: Medication Management and Long-Acting Injectable Psychotropic Medications.

• STEP Virginia requires each CSB also utilize at least one EBP which meets the needs identified by the locality’s community needs assessment : Acceptance and Commitment Therapy, Collaborative Assessment and Management of Suicidality (CAMS), Cognitive Behavioral Intervention for Trauma in Schools (CBITS), Dialectical Behavior Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), Functional Family Therapy (FFT), Hi-Fidelity Wraparound (HFW), Integrated Treatment for Co-Occurring Disorders, Living in Balance, Medication Assisted Treatment (MAT), Moral Resonation Therapy, Motivational Enhancement Therapy, Multi-Systemic Family Therapy (MFT), Parent Child Interaction Therapy (PCIT), Screening, Brief Intervention, and Referral to Treatment (SBIRT), Seeking Safety, Solution Focused Brief Therapy, Trauma Focused CBT (TF-CBT), Effective but underutilized medications for SUD treatment.

3.     Primary Care Screening and Monitoring Scope of Services and Deliverables

Individuals with SMI or SED, populations primarily served by the CSB, are known to be at higher

risk for poor physical health outcomes largely due to unidentified chronic conditions. Therefore, it is important for behavioral health staff to provide related care coordination to ensure access to needed physical health care.

1. Any child diagnosed with a serious emotional disturbance, or any adult diagnosed with a serious mental illness and receiving MH CM and Psychiatry services will be provided or referred for a primary care screening on a yearly basis.
2. These clients are required to be provided with a yearly primary care screening to include, at minimum, height, weight, blood pressure, and BMI. This screening may be done by the CSB, or the individual may be referred to a primary care provider to have this screening completed.
3. If the screening is done by a primary care provider, the CSB is responsible for the

screening results to be entered in the patient’s CSB electronic health record. The CSB will actively support this connection and coordinate care with physical health care providers for all service recipients.

• On an annual basis, CSB shall screen and monitor for metabolic syndrome (following the American Diabetes Association guidelines) any individual receiving STEP-VA services over age 3, with a diagnosis of SMI prescribed an antipsychotic medication by a CSB prescriber,
• Individuals with SMI, a population primarily served by the CSB, are known to be at higher risk for poor physical health outcomes largely due to unidentified chronic conditions.
• For the population includes all individuals over age 3 who receive psychiatric medical services by the CSB. CSB must report the screen completion and monitoring completion in the regular submissions of EHR data to DBHDS.

4.      Same Day Access (SDA)

Scope of Services and Deliverables

SDA serves children adolescents, and adults seeking behavioral health services. Military status will be considered, and appropriate services and referrals made based on that status. CSB’s have flexibility to adopt two versions of Same Day Access, depending on the needs of their community and staffing.

1. An individual may walk into or contact a CSB to request mental health or substance use

disorder services and receive a comprehensive clinical behavioral health assessment from a licensed or license-eligible clinician the same day. Based on the results of the comprehensive assessment, if the individual is determined to need services, the individual will receive an appointment for face-to-face or other direct services within 30 business days of the completed CNA.

• SDA can also provide a mental health and substance use risk screening and triage to individuals at the time the individual first contacts the CSB/BHA for services. The screening and triage may be completed in person, by telephone, or via telehealth, and will include, at a minimum, the presenting need and a screening for risk of harm to self or others, and for risk of accidental overdose. Appointments are not necessary for this initial screening. Individuals determined to be at high risk will be seen for a full assessment within 24 hours; individuals in an active crisis will be routed to Emergency Services immediately. Individuals determined to be at low or moderate risk will be seen for assessment within 10 business days. Based on the results of the comprehensive assessment, if the individual is determined to need services offered by the CSB, the individual will receive an appointment for face-to-face or other direct services in the program offered by the CSB within 30 calendar days, sooner if indicated by clinical circumstances.

The Comprehensive Needs Assessment must still contain all elements outlined in Policy 12VAC25-105-650 of the Virginia Administrative Code. The Comprehensive Needs Assessment must be completed by a LMHP or LMHP-E. The Comprehensive Needs Assessment should identify which CSB services will best meet the needs identified and should describe how the appropriate criteria are met for the receiving services. The first service or visit with the receiving program should take place within 30 calendar days of the initial date of contact.

• SDA emphasizes engagement of the individual, uses concurrent EHR documentation during the delivery of services, implements techniques to reduce appointment no shows, and uses centralized scheduling.

Reporting Requirements

1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time to allow for compliance and in accordance with Section 6 of this Exhibit.
2. The CSB shall report the date of each SDA comprehensive assessment, whether the assessment determined that the individual needed services offered by the CSB, and the date of the first service offered at the CSB for all individuals seeking mental health or substance use disorder services from the CSB.

5.      Service Members, Veterans, and Families (SMVF) Scope of Services and Deliverables

As one of the nine required services for System Transformation Excellence and Performance (STEP-VA), the purpose of the Service Members Veterans and Families (SMVF) step is to ensure SMVF receive needed mental health, substance abuse, and supportive services in the most efficient and effective manner available. Services shall be high quality, evidence-based, trauma-informed, culturally competent, and accessible. Per the Code of Virginia, CSB core services, as of

July 1, 2021, shall include mental health services for members of the armed forces located 50 miles or more from a military treatment facility and veterans located 40 miles or more from a Veterans Health Administration medical facility.

A.    CSB Responsibilities

1. All CSBs shall ensure they have clinician(s) who specialize in treatment for post-traumatic stress disorder and other forms of trauma including from military and/or combat service including military sexual trauma and substance use disorders.
   1. CSBs shall ensure behavioral health services including but not limited to MH, SUD, Co-Occurring and Youth/Adolescents. Clinical services for this population shall align with federal clinical guidelines from Veterans Affairs and Department of Defense which can be found at https://www.healthquality.va.gov.
   1. CSBs shall identify and refer SMVF seeking services to internal providers that have been trained in military cultural competency (MCC); provide resource information pertaining to Military Treatment Facilities (MTFs), Veterans Health Administration (VHA) facilities, and Virginia Department of Veterans Services (DVS) offer coordination of services with agencies indicated above.
   1. As it pertains to those CSB’s who implement Regional STEP VA Services for Service Members, Veterans, and Families (SMVF) the CSB shall:
      1. Ensure that the Program is implemented as a regional program and is not specific to the physical location of the program.
      1. Ensure the participating CSBs in the region develop a Memorandum of Understanding (MOU) outlining the mission, vision, and goals of the regional partnerships to support the Program and provide this to the Department upon request.
      1. Offer evidence based and best practices as part of their programming and implementation.
      1. Support at least 1.0 FTE Regional Navigator SMVF position to provide dedicated capacity at the regional level to support regional and state level SMVF initiatives; support the connectedness of SMVF system needs across regional, state, and federal level; serve as a resource to CSBs in the region in meeting SMVF metrics; oversee regional training and capacity-building funds, liaise with relevant partners at the state and federal levels, and participate in regional and state SMVF initiatives focused on suicide prevention at the intersection of SMVF populations
      1. Support a Regional Navigator to form and support cross referral and training partnerships with regional Department of Veterans Services, Military Treatment Facilities, and Veterans Health Administration facilities and serve on SMVF work groups to enhance regional services and partnerships (e.g. Governor’s Challenge teams, etc.) and support and grow best practices within the region and individual CSBs in their region
      1. Support regional goals to implement, enhance, and promote the goals of Lock and Talk at the intersection of the SMVF population including but not limited to regional planning and capacity building, lethal means safety, social media campaigns, and other activities.
      1. The CSB shall support regional training and capacity building in the region in service to SMVF, specifically:

1. ensuring access to clinical training for CSB providers to increase the availability for citizens to evidence-based, trauma-focused therapy such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR).
   1. Supporting workforce training (for CSB direct services staff) on military culture and resources available to Service Members and their Families (SMVF); and
      1. Providing educational materials and outreach activities to support clinical needs of SMVF, as needed.

B.     The Department Responsibilities:

1. Conduct in-person or virtual visits/check-ins at least every two years with the designated CSB leadership to ensure compliance with the scope and requirements of services.
   1. Determine the need for additional site visits (virtual or in-person) based on the monitoring of the four key SMVF metrics, for CSBs not reaching SMVF performance measurement goals.
   1. Establish a process to provide feedback to CSB regarding performance measurement goals outcomes.
   1. Provide technical assistance to regional navigators and/or CSB leadership responsible for SMVF performance metrics to assist in reaching the desired outcomes.

C.    Reporting Requirements:

1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time to allow for compliance and time to allow for compliance and in accordance with Section 6 of this Exhibit.
   1. The CSB shall submit the required program and financial data reports in the format established by the Department.

6.     STEP-VA Ancillary (936) – Restricted (MH SGF BASELINE)

Background: The purpose of this funding is to support the CSB in its efforts to modernize information technology infrastructure regarding data, business analytics, and critical operating systems including financial management systems. These funds shall be used to invest in infrastructure resources that will enhance the CSB’s ability to comply with ongoing and evolving data sharing, fiscal, and reporting requirements between DBHDS and the CSB.

A.    The CSB Responsibilities

1. Investment in infrastructure that enhances the CSB’s ability to collect, manage, and/or analyze data, to meet data sharing requirements with DBHDS.
   1. Perform critical business functions such as financial management improvements.
   1. Investment may be in human capital with IT/Data Management expertise or in technology that enhances data capture and management, financial management, or other critical management needs.
2. Reporting Requirements: The CSB shall account for these funds in compliance with reporting requirements of the most recent version of the community services performance contract.

Other Program Services

This section includes certain program services initiatives CSB may engage in with the Department such as, but not limited to regional programs, pilot and other projects,

12.1.        Mental Health Crisis Response and Child Psychiatry Funding –Regional Program Services Children’s Residential Crisis Stabilization Units (CRCSU)

Scope of Services and Deliverables

Children’s Residential Crisis Stabilization Units (CRCSU) are a crucial part of the community-based continuum of care in Virginia. The expectations outlined in this document support the strategic vision of DBHDS to provide access to quality, person-centered services and supports in the least restrictive setting, and that exemplify clinical and management best practices for CRCSUs. CRCSUs should demonstrate consistent utilization, evidence-based clinical programming, and efficient operations.

CRCSUs provide treatment for individuals requiring less restrictive environments than inpatient care for managing their behavioral health crises.

1.   Children’s Residential Crisis Stabilization Unit

1. Staffing:
   1. The CRCSU staffing plan will be reviewed by the CSB clinical director at least quarterly to determine staffing needs and to ensure that staffing patterns meet the needs of the individuals served.
      1. Reviews are to ensure that staffing plans maximize the unit’s ability to take admissions 24 hours a day seven (7) days a week. The CRCSU will follow the Service Description and Staffing as defined in Part VIII Crisis Services in Chapter 105 Rules and Regulations for Licensing Providers by The Department of Behavioral Health and Developmental Services.
      1. The CRCSU will include family members, relatives and/or fictive kin in the therapeutic process and/or family support partners, unless it is not deemed clinically appropriate.
      1. The CRCSU will have a well-defined written plan for psychiatric coverage. The plan must address contingency planning for vacations, illnesses, and other extended absences of the primary psychiatric providers. Plans will be reviewed and updated as needed. Plans will be consistent with licensing and DMAS regulations.
      1. The CRCSU will have a well-defined written plan for nursing and/or clinical staff coverage. The plan must address contingency planning for vacations, vacancies, illnesses, and other extended staff absences. Plans will be reviewed and updated as needed. Plans will be consistent with licensing and DMAS regulations.
      1. The CRCSU will have a well-defined written plan for staffing all provider coverage during weather related events and other natural and man-made disasters or public health emergencies. Plans will be reviewed and updated as needed.
      1. CRCSU will have access to a Licensed Mental Health Professional (LMHP) or Licensed Mental Health Professional Eligible (LMHP-E) on-site during business hours and after hours, as needed, for 24/7 assessments.

b.                Admission and Discharge Process:

1. Individuals considered for admission should not have reached their 18^th birthday prior to admission.
   1. The CRCSU shall review and streamline their current admission process to allow for admissions 24 hours a day seven (7) days a week. CSB admission process shall not require a physician’s order or any signature during the referral/pre-admission process. Medical screenings shall not be required and shall be conducted at the nursing assessment at time of admission and ongoing as needed. The CRCSU shall develop well-defined written policies and procedures for reviewing requests for admission. The CRCSU will maintain written documentation of all requests and denials that include clinical information that

could be used for inclusion or exclusion criteria. Admission denials must be reviewed by the LMHP or CSU Director within 72 hours of the denial decision.

• The CSU shall agree to the following exclusionary criteria:
  • The individual’s psychiatric condition is of such severity that it can only be safely treated in an inpatient setting due to violent aggression or other anticipated need for physical restraint, seclusion or other controls.
    • This may include: individuals demonstrating evidence of active suicidal behavior. Individuals with current violent felony charges pending. Individuals demonstrating evidence of current assaultive or violent behavior that poses a risk to peers in the program or CRCSU staff. Individuals demonstrating sexually inappropriate behavior, such as sexually touching another child who is significantly older or younger that is not considered developmentally normal, within the last 12 months. Individuals with repetitive fire starter within the last 12 months.
      • The individual’s medical condition is such that it can only be safely treated in a medical hospital as deemed by a physician which may include individuals deemed to have medical needs that exceed the capacity of the program.
      • The CSB shall limit medical denials to be consistent with the following resources: Criteria for Medical Assessment Prior to Admission to a Psychiatric Hospital, Inpatient Psychiatric or Crisis Stabilization Unit (EFFECTIVE NOVEMBER 5, 2018 (virginia.gov). The CSB shall follow the Exclusion Criteria listed on page 4 in this document. DMAS Appendix G language-The individual is not appropriate for this service if there is a presence of any condition of sufficient severity to require acute psychiatric inpatient, medical, or surgical care. The individual does not voluntarily consent to admission except for temporary detention orders pursuant to §37.2-800 et. seq. and §16.1-335 et seq. of the Code of Virginia. This may include individuals that are unable or unwilling to participate in the programmatic requirements to ensure safety of staff and residents of the program. Individuals unable or unwilling to participate with the goals set out in individualized service plan (ISP). Individuals who demonstrate or report inability to function in a group setting without causing significant disruption to others and are not able to participate in alternative programming.
      • The individual can be safely maintained and effectively participate in a less intensive level of care. This may include individuals whose needs can be better met through other services such as individuals with a primary diagnosis of substance use disorder with current active use, individuals with ID/DD diagnosis better served by REACH programming.
      • The request for service authorization is being pursued to address a primary issue of housing need, including individuals who were in some form of housing placement prior to admission to the CRCSU and are not currently allowed to return and do not meet medical necessity criteria
      • Admission does not meet medical necessity criteria and is being used solely as an alternative to incarceration.
• Individuals admitted to the CRCSU should be at risk of serious emotional disturbance or seriously emotionally disturbed. The CRCSU shall accept and admit at least 60% of referrals made.
• The CRCSU shall develop well-defined written policies and procedures for accepting step-downs from the Commonwealth Center for Children and Adolescents.

• The CRCSU will follow discharge planning requirements as cited in the DBHDS licensing regulations 12VAC35-105-1880
• CRCSUs will assess the integrated care needs of individuals upon admission and establish a plan for care coordination and discharge that addresses the individual’s specialized care needs consistent with licensing and DMAS medical necessity
• The CSB shall admit and continue to serve youth regardless of Medicaid status or Medicaid ability/willingness to pay if the admission and services provided are consistent with your program description.

c.                  Programming

1. The CRCSU will have a well-defined written schedule of clinical programming that covers at least eight (8) hours of services per day (exclusive of meals and breaks), seven

(7) days a week. Programming will be trauma informed, appropriate for individuals receiving crisis services, and whenever possible will incorporate evidence-based and best practices.

• Programming must be flexible in content and in mode of delivery to meet the needs of individuals in the unit at any point in time.
  • The CRCSU will always maintain appropriate program coverage. The unit will have a written transition staffing plan(s) for changes in capacity.
    • The CRCSU manager, director, or designee shall implement a review process to evaluate both current and closed records for completeness, accuracy, and timeliness of entries. (12VAC35-105- 920)
    • Programming will contain a mix of services to include but not limited to clinical, psycho educational, psychosocial, relaxation, and physical health.
    • Alternate programming must be available for individuals unable to participate in the scheduled programming due to their emotional or behavioral dysregulation.
    • The CRCSU manager, director, or designee shall outline how each service offers a structured program of individualized interventions and care designed to meet the individuals’ physical and emotional needs; provide protection, guidance and supervision; and meets the objectives of any required individualized services plan. The CRCSU will provide scheduled recreational activities to include but not limited to art, music, pet therapy, exercise, and yoga, acupuncture, etc.

d.                Resources:

1. The CRCSU will develop a well-defined written process for building collaborative relationships with private and state facilities, emergency services staff, CSB clinical staff, schools, Family and Assessment Planning Teams (FAPT) and local emergency departments in their catchment area. Ideally, these collaborative relationships will facilitate the flow of referrals to the CRCSU for diversion and step down from a hospital setting and to transition an individual from a CRCSU to a higher level of care. This process will be documented in the CRCSUs policies and procedures.
   1. The CRCSU will participate in meetings in collaboration with DBHDS and other CRCSUs at least quarterly
2. The CSB Responsibilities: The CSB agrees to comply with the following requirements.
   1. The CRCSU will comply with all DBHDS licensing requirements.
   1. The CRCSU will provide data as per the provided DBHDS standardized spreadsheet for the CRCSU on a quarterly basis until such time this request is discontinued upon full operation of the retrieval of data from the Crisis Data Platform. Data request will be in accordance with Section 6 of this Exhibit.

• The CRCSU will be responsible for following the DBHDS process for providing the bed registry data metrics into the DBHDS crisis data platform as per the DBHDS Bed Registry Standards and in accordance with Section 6 of this Exhibit.
  • CRCSUs shall be considered regional programs and is not specific to the physical location of the program. The CSBs in the Region will revise the Memorandum of Understanding (MOU) governing the Regional CRCSU and provide this to the Department upon request.
  • The CRCSU will offer evidence based and best practices as part of their programming and have an implementation/ongoing quality improvement for these in the context of the applicable regulations. The CRCSU shall develop a written plan to maintain utilization at 75% averaged over a year and submit to DBHDS annually, Crisis Services Coordinator with ongoing revisions as needed.
  • The CRCSU will develop a written plan to ensure the CRCSUs remain open, accessible, and available always as an integral part of DBHDSs community-based crisis services.
  • The CRCSU will develop a written plan to accept individuals accepting step-downs from Commonwealth Center for Children and Adolescents.
  • The CSB shall meet the reporting requirements required in the Reporting Requirements and Data Quality of the most current version of the Community Services Performance Contract.
• The Department Responsibilities: The Department agrees to comply with the following requirements.
  • The Department shall provide Technical Assistance (TA), to include but not limited to: networking meetings, training, and site visits to the CSB upon request or if the staff determines based on yearly monitoring visits that the project is not accomplishing its mission or meeting its goals as described above.
  • The Department will initiate Performance Improvement Plans (PIP) after Technical Assistance has been provided and a CRCSU continues to not meet established benchmarks and goals. The purpose of the PIP is to have a period of collaborative improvement.
  • The Department will initiate Corrective Action Plans (CAP) if benchmarks and goals continue to not be met after TA and PIPs. on the procedures outlined above.
  • The Department shall determine need for site visits based on monitoring that the CRCSU is not accomplishing its mission or meeting its goals as described in this document. The CRCSU will construct a corrective action plan for units not meeting their goals and collaborate with the CRCSU to implement the plan.
  • The Department shall monitor data to ensure data submitted through reports meets the expectations as outlined in this document and in the CRCSU written plans.
  • The Department shall schedule quarterly meetings with the CRCSU points of contact.

C.    Reporting Requirements for Children’s Residential Crisis Stabilization Unit

1. Annually submit as part of the yearly programmatic monitoring a plan to DBHDS to streamline the admission process to allow for 24 hours a day, 7 day a week admission.
   1. The CSB shall submit the required program and financial data reports in the format established by the Department.
   1. The Department shall provide the data collection and reporting database, submission due dates, and reporting protocols to the CSB in sufficient time to allow for compliance and in accordance with Section 6 of this Exhibit.

• CRCSU will provide additional data points (developed in accordance with Section 6 of this Exhibit) as requested to DBHDS Office of Crisis Services, no later than the 15^th of the month following the reporting month.
  • Providing data, as per the provided DBHDS standardized spreadsheet, for the CRCSU on a quarterly basis until such time this request is discontinued upon full operation of the retrieval of data from the Crisis Data Platform.
  • Crisis Stabilization Units (CSUs) will be required to input bed registry information into the DBHDS crisis data platform to maintain accurate, real-time tracking of bed availability and enhance crisis system coordination.as per the DBHDS Bed Registry Standards per Code of Virginia (Chapter 3, Article 1, 37.2-308.1)

2.      Child Psychiatry and Children’s Crisis Response- Regional Funding (CRCSU) Scope of Services and Deliverables

The funds are provided to the CSB as the regional fiscal agent to fund other CSBs in the designated region, other regional programs, or private providers if necessary to provide Child Psychiatry and Children’s Crisis Response services.

A.    The CSB Responsibilities

1. Child Psychiatry and Crisis Response the regional fiscal agent shall require a Memorandum of Understanding (MOU), a Memorandum of Agreement (MOA), or a contract with all CSBs in their region if Child Psychiatry and Crisis Clinician Services are to be provided by individual boards. The MOU or MOA shall outline the roles, responsibilities of the regional fiscal agent and each board receiving funding, funding amounts, data and outcomes to be shared with the regional fiscal agent, and how children can access child psychiatry and crisis clinician services. The MOU, MOA, or contract shall be developed by the CSB providing the services, reviewed by the regional fiscal agent, and executed once agreed upon.
   1. If the CSB fiscal agent is providing regional Child Psychiatry and Crisis Clinician Services, then the regional fiscal agent shall develop the MOU, MOA, or contract to be reviewed by each CSB in the region and executed once agreed upon. Each CSB shall have access to a board-certified Child and Adolescent Psychiatrist who can provide assessment, diagnosis, treatment and dispensing and monitoring of medications to youth and adolescents involved with the community services board.
   1. The CSB may hire a psychiatric nurse practitioner due to the workforce shortage of child and adolescent psychiatrists or contract within the region to have access.
   1. The psychiatrist’s role may also include consultation with other children’s health care providers in the health planning region such as general practitioners, pediatricians, nurse practitioners, and community service boards’ staff, to increase their expertise in the prevention, diagnosis, and treatment of children with mental health disorders.
   1. CSBs must include, in the MOA/MOU, a description on how the CSB creates new or enhances existing community-based crisis response services in their health planning region, including, but not limited to mobile crisis response and community stabilization services, with the goal of diverting children from inpatient psychiatric hospitalization to less restrictive services in or near their communities.
   1. Funds cannot be used to fund emergency services pre-screener positions if their role is to function as an emergency services clinician.
2. The CSB Responsibilities: In order to implement the CSB Fiscal Agent agrees to comply with the following requirements.

1. The Regional Fiscal Agent shall notify the department of any staffing issues for these services such as a reduction in staffing or an extended vacancy.
   1. The Regional Fiscal Agent shall consult with the Office of Crisis Services about any changes to the services allocation.
   1. The CSB may charge an administrative cost in accordance with DBHDS State and Federal Indirect Cost Rate Policy and DBHDS Regional Program Procedures when the role the CSB is serving for the region.
   1. The Regional Fiscal Agent shall receive monthly Child Psychiatry reports from each CSB which include: the hours of service provided by the child psychiatrist, the number of children served, and consultation hours with other health providers. This shall occur when the Regional Fiscal Agent is passing the funding to another CSB within the region to manage the responsibility of providing psychiatric services.
   1. The Regional Fiscal Agent shall provide the executed MOU, MOA, or contract with each CSB to the Department’s Office of Crisis Services for its review.
2. The Department Responsibilities: The Department agrees to comply with the following requirements.
   1. The Department shall distribute the funds in the regular semi-monthly electronic funds transfers, beginning with the July 1 payment of each state fiscal year.
   1. The Department shall establish a mechanism for regular review of reporting Child Psychiatry Services through the Child Psychiatry and Children’s Crisis Response Funding expenditures, data, and MOUs/MOAs to include a process by the Office of Services and will regularly share this data with the CSB’s for proactive programming.
   1. The Department will annually review Child Psychiatry and Children’s crisis response spending.
   1. The Department shall provide Technical Assistance (TA) as needed to the CSB’s.

D.    Reporting Requirements: For Regional Fiscal Agent for Child Psychiatry and Crisis Response Responsibilities.

1. The CSB shall account for and report the receipt and expenditure of these performance contract restricted funds separately.
   1. The CSB shall provide a copy of a signed MOU/MOA to the Department.
   1. The CSB should notify the department of staffing issues for these programs, such as a reduction in staffing or an extended vacancy.

• The CSB may carry-forward a balance in the Child Psychiatry and Children’s Crisis Response Fund during the biennium in which the funds were distributed.

12.2.        Case Management Services Training

The CSB shall ensure that all direct and contract staff that provide case management services have completed the case management curriculum developed by the Department and that all new case management staff complete it within 30 days of employment. The CSB shall ensure that developmental disability case managers or support coordinators complete the ISP training modules developed by the Department within 60 days of their availability on the Department’s web site or within 30 days of employment for new developmental disability case management or support coordination staff.

12.3.        Developmental Case Management Services Organization

The CSB shall structure its developmental case management or support coordination services so that a case manager or support coordinator does not provide a DD Waiver service other than services facilitation and a case management or support coordination service to the same individual. This will ensure the independence of services from case management or service coordination and avoid perceptions of undue case management or support coordination influence on service choices by an individual.

12.4.        Regional Programs

The CSB shall manage or participate in the management of, account for, and report on regional programs in accordance with the Regional Program Operating Principles and the Regional Program Procedures. The CSB agrees to participate in any utilization review or management activities conducted by the Department involving services provided through a regional program.

ATTACHMENT 1- Program Services – State General Funding Line Items Background

This section provides funding details related to Community Mental Health Services, Substance Abuse Prevention and Treatment, and Developmental Disabilities 790 (grants to localities) and 720 (central office) state general funding allocations per the CSB’s letter of notification (LON) of funding. The funds are to be utilized by Community Services Boards in Virginia to deliver services to vulnerable populations through programs as indicated in the tables below and within the guidelines associated with award documentation. CSB shall use this document to cross-reference various program service funding sources, appropriation language and any additional requirements that may be found in its LON, Exhibits D, Exhibit G or other Exhibits that are part of the most current version of the community services performance contract.

Fund Types: All fund types associated with CSB funding allocations are provided in DBHDS’s grants management system (WebGrants).

General Funds (790 Grants to localities) – These are funds are appropriated from Virginia taxpayers provided by the General Assembly for state functions. These funds make up the majority of DBHDS budget and are disbursed through the DBDHS established warrant payment schedule. Majority of general funds are found in WebGrants as part of baseline funding see tables below for details.

Special/Non-General Funds (720 Central Office Funding) – These are funds that the agencies can raise through revenue collection and DBHDS has the authority to allocate funding as need for special projects and other initiatives. (Ex: 988 Fund, Hospital Insurance Revenue, and Problem Gambling Fund).

ADDENDUM IADMINISTRATIVE REQUIREMENTS AND PROCESSES AND PROCEDURES

                                                                            Table of Contents                                                                                         

I. Background. 2

II. CSB Requirements. 2

A.      Financial Management Requirements, Policies, and Procedures 2

B.       Procurement Requirements, Policies, and Procedures 3

C.       Reimbursement Requirements, Policies, and Procedures 4

D.      Human Resource Management Requirements, Policies, and Procedures 4

E.       Comprehensive State Planning. 5

F.       Interagency Relationships 5

III. The Department Requirements. 7

A.      Comprehensive State Planning. 7

B.       Administrative Fee. 7

C.       Department Review.. 7

D.      Complaint Follow-up. 7

E.       Information Technology. 7

Appendix A:  CSB and Board of Directors Organization and Operations. 9

A.       CSB Organization. 9

B.       Board Bylaws 9

C.       CSB Name/Appointment Changes 9

D.       BOD Member Job Description. 9

E.       BOD Member Training. 9

F.       BOD Policies 9

G.       FOIA Compliance. 9

H.       Meeting Frequency. 9

I.    Reporting Fraud. 10

J.        Employment of a CSB Executive Director or Behavioral Health Authority (BHA) Chief Executive Officer (CEO) Position. 10

Appendix B: Disaster Response and Emergency Service Preparedness Requirements. 11

Appendix C: Unspent Balances Principles and Procedures. 12

Appendix D: User Acceptance Testing Process. 15

Appendix E: Administrative Requirements for Accounts Receivables. 17

Appendix F:  Regional Program Procedures. 19

I. Background

The Administrative Requirements and Processes and Procedures include statutory, regulatory, policy, process and procedures and other requirements that are not expected to change frequently. The CSB and the Department shall comply with these requirements and processes and procedures. This document is incorporated into and made a part of the Community Services Performance Contract (PC) by reference.  The Department will work with the CSBs regarding any substantive changes to this document, with the exception of changes in statutory, regulatory, policy, or other requirements.

The provisions of this agreement apply to all CSBs, Chapter 5 Section 37.2-100 defines the four types of CSB organizational structure and Chapter 6 Section 37.2-601 further defines the organizational structure of a Behavioral Health Authority (BHA). As such, the precise application of these provisions will vary across the different organizational types. All CSBs are required to meet the provisions herein, but some CSBs may meet said provisions by their nature as subsections of a local government or similar. This agreement does not, in any way, seek to contradict or otherwise be in opposition to local government policy/procedure as it applies to any of the subject matter discussed.

An illustrative example: All CSBs are required to have an annual audit. Operational CSBs must conduct this audit by contracting with an appropriate third party. Administrative Policy CSBs may satisfy this requirement by ensuring the CSB is included appropriately in the required annual audit conducted by the local governing body.

II. CSB Requirements

A.    Financial Management Requirements, Policies, and Procedures

CSB’s financial management and accounting system shall operate and produce financial statements and reports in accordance with Generally Accepted Accounting Principles, compliance with requirements of Governmental Accounting Standards Board (GASB), and Code of Federal Regulations, 2 CFR Part 200. 

1. Accounting:  CSBs shall account for all service and administrative expenses accurately and submit timely reports to the Department to document these expenses.

• Annual Independent Audit: CSBs shall obtain an independent annual audit conducted by certified public accountants. 
  • Audited financial statements shall be prepared in accordance with generally accepted accounting principles (GAAP) and compliance with Code of Federal Regulations, 2 CFR Part 200. 
  • Copies of the audit and the accompanying management letter shall be provided to the Office of Budget and Financial Reporting in the Department and to each local government that established the CSB. 
  • Deficiencies and exceptions noted in an audit or management letter shall be resolved or corrected in a timely manner defined more precisely through discussions between the CSB and the Department.
  • For a CSB that is included in the annual audit of its local government. 
• Copies of the applicable portions of the accompanying management letter shall be provided to the Office of Budget and Financial Reporting in the Department.
• Deficiencies and exceptions noted in a management letter shall be resolved or corrected in a timely manner defined more precisely through discussions between the CSB, the local government entity and the Department.
• Federal Audit Requirements:  When the Department issues subawards of federal grants to a CSB, the CSB shall satisfy all federal government audit requirements.
• Subcontractor Audits:  The CSB shall obtain, review, and take any necessary actions on audits of any subcontractors that provide services that are procured under the Virginia Public Procurement Act and included in a CSB’s performance contract.  The CSB shall provide copies of these audits to the Office of Budget and Financial Reporting in the Department.
• Bonding: CSB employees with financial responsibilities shall be bonded in accordance with local financial management policies.
• Fiscal Policies and Procedures:  A CSB’s written fiscal policies and procedures shall conform to applicable local government policy or, in absence of local governing requirements, State Board policies and Departmental Policies and procedures.
• Additional Financial Management Requirements: The CSB shall comply with the following requirements, as applicable.
• CSBs may not use the same Certified Public Accountant (CPA) for both production of their annual financial statements and execution of their independent audit.
• Operating CSBs and the BHA shall rebid their CPA audit contracts at least every five (5) years once the current CPA contracts expire. CSB’s will ensure their contract with the audit firm gives them the right to rebid annual audit services if the firm is more than 60 days late for two consecutive years.
• All CSB bank accounts shall be reconciled monthly, with the appropriate segregation of duties, and a designated staff person not involved in preparing the reconciliation shall approve it.
• A contract administrator shall be identified for each contract for the purchase of services entered into by the CSB, and every contract shall be signed, with the appropriate segregation of duties by a designated staff person, and each other party to the contract, where applicable.
• A designated staff person shall approve and document each write-off of account receivables for services to individuals. The CSB shall maintain an accounts receivable aging schedule, and debt that is deemed to be uncollectable shall be written off periodically. The CSB shall maintain a system of internal controls including separation of duties to safeguard accounts receivable assets. A designated staff person who does not enter or process the CSB’s payroll shall certify each payroll.
• Documentation for all expenditures must adhere to the respective fund requirements for both state and federal funding sources.
• The CSB shall maintain an accurate list of fixed assets as defined by the state and federal policies.
• Access to the CSB’s information system shall be controlled and properly documented. Access shall be terminated in a timely manner when a staff member is no longer employed by the CSB to ensure security of confidential information about individuals receiving services and compliance with the Health Insurance Portability and Accountability Act of 1996 and associated federal or state regulations.
• The CSB shall assess operating reserves at least monthly to ensure it maintains an operating reserve of funds sufficient to cover at least two months of personnel and operating expenses and ensure that the CSB’s financial position is sound.
• At any point during the term of this contract, if it determines that its operating reserve is less than two months, the CSB shall notify the the Department within 10 business days of the determination and work with the Department to develop a corrective action plan to increase the reserve to at least two months in a reasonable agreed upon timeframe.

B.           Procurement Requirements, Policies, and Procedures

CSBs shall have written procurement policies and procedures that comply with the Virginia Public Procurement Act.

C.           Reimbursement Requirements, Policies, and Procedures

1. Reimbursement System:  Each CSB’s reimbursement system shall comply with § 37.2-504 and § 37.2-511 or § 37.2-605 and § 37.2-612 and with § 20-61 of the Code of Virginia and State Board Policy 6002 (FIN) 86-14.  Its operation shall be described in organizational charts identifying all staff positions, flow charts, and specific job descriptions (as they relate to reimbursement policy/process) for all personnel involved in the reimbursement system.

• Policies and Procedures:  Written fee collection policies and procedures shall be adequate to maximize fees from individuals and responsible third-party payers.

• Schedule of Charges:  A schedule of charges shall exist for all services that are included in the CSB’s performance contract, shall be related reasonably to the cost of the services, and shall be applicable to all recipients of the services.

• Ability to Pay:  A method, approved by a CSB’s board of directors that complies with applicable state and federal regulations shall be used to evaluate the ability of each individual to pay fees for the services he or she receives.

• Medicaid and Medicare Regulations:  CSBs shall comply with applicable federal and state Medicaid and Medicare regulations, policies, procedures, and provider agreements.  Medicaid non-compliance issues identified by Department staff will be communicated to the Department of Medical Assistance Services.

D.           Human Resource Management Requirements, Policies, and Procedures

1. Statutory Requirements:  The CSB shall operate a human resource management program that complies with state and federal statutes, regulations, and policies. 
2. Policies and Procedures:  If the CSB is not otherwise required to adhere to local government human resource management requirements, policies, and procedures, written human resource management policies and procedures shall include a classification plan and uniform employee pay plan and, at a minimum, shall address:

1. nature of employment;
2. equal employment opportunity;
3. recruitment and selection;
4. criminal background and reference check requirements;
5. classification and compensation, including a uniform employee pay plan;
6. employment medical examinations (e.g., TB);
7. nepotism (employment of relatives);
8. probationary period;
9. initial employee orientation;
10. transfer and promotion;
11. termination, layoff, and resignation;
12. benefits, including types and amounts of leave, holidays, and health, disability, and other insurances;
13. hours of work;
14. outside employment;
15. professional conduct;
16. employee ethics;
17. compliance with state Human Rights Regulations and the CSB’s local human rights policies and procedures;
18. HIPAA compliance and privacy protection;
19. compliance with the Americans with Disabilities Act;
20. compliance with Immigration Reform and Control Act of 1986;
21. conflicts of interests and compliance with the Conflict of Interests Act;
22. compliance with Fair Labor Standards Act, including exempt status, overtime, and compensatory leave;
23. drug-free workplace and drug testing;
24. maintenance of a positive and respectful workplace environment;
25. prevention of sexual harassment;
26. prevention of workplace violence;
27. whistleblower protections;
28. smoking;
29. computer, internet, email, and other electronic equipment usage;
30. progressive discipline (standards of conduct);
31. employee performance evaluation;
32. employee grievances;
33. travel reimbursement and on-the-job expenses;
34. employee to executive director and board of directors contact protocol; and
35. communication with stakeholders, media, and government officials.

• Job Descriptions

A CSB shall have written, up-to-date job descriptions for all positions. 

Job descriptions shall include identified essential functions, explicit responsibilities, and qualification statements, expressed in terms of knowledge, skills, and abilities as well as business necessity and bona fide occupational qualifications or requirements.

• Grievance Procedure

A CSB’s grievance procedure shall satisfy §15.2-1507 of the Code of Virginia.

• Uniform Pay Plan

A CSB shall adopt a uniform pay plan in accordance with §15.2-1506 of the Code of Virginiaand the Equal Pay Act of 1963.

E.     Comprehensive State Planning

1. General Planning:  The CSB shall participate in collaborative local and regional service and management information systems planning with state facilities, otherCSBs, other public and private human services agencies, and the Department, as appropriate.  In accordance with § 37.2-504 or § 37.2-605 of the Code of Virginia, the CSB shall provide input into long-range planning activities that are conducted by the Department.

• Participation in State Facility Planning Activities

The CSB shall participate in collaborative planning activities with the Department to the greatest extent possible regarding the future role and structure of the state facilities.

F.     Interagency Relationships

Pursuant to the case management requirements of § 37.2-500 or § 37.2-601 of the Code of Virginia, the CSB shall, to the extent practicable, develop and maintain linkages with other community and state agencies and facilities that are needed to assure that individuals it serves are able to access treatment, training, rehabilitative, and habilitative mental health, developmental, or substance abuse services and supports identified in their individualized services plans.  The CSB shall comply with § 37.2-504 or § 37.2-605 of the Code of Virginia regarding interagency agreements.

The CSB also shall develop and maintain, in conjunction with the courts having jurisdiction in the cities or counties served by the CSB, cooperative linkages that are needed to carry out the provisions of § 37.2-805 through § 37.2-821 and related sections of the Code of Virginiapertaining to the involuntary admission process.

The CSB shall develop and maintain the necessary linkages, protocols, and interagency agreements to effect the provisions of the Comprehensive Services Act for At-Risk Youth and Families (§ 2.2-5200 through § 2.2-5214 of the Code of Virginia) that relate to services that it provides.  Nothing in this provision shall be construed as requiring the CSB to provide services related to this act in the absence of sufficient funds and interagency agreements.

III. The Department Requirements

A.    Comprehensive State Planning

The Department shall conduct long-range planning activities related to state facility and community services, including the preparation and dissemination of the Comprehensive State Plan required by § 37.2-315 of the Code of Virginia.

B.     Administrative Fee

The Department shall partner with the CSBs to establish administrative fee policies and procedures.

C.    Department Review

While it does not conduct routine reviews of the entirety of a CSB’s administrative activities, the Department may conduct a review in response to significant deficiencies, irregularities, or problems identified in the CSB’s independent annual audit or management letter or in response to complaints or information that it receives.

If Departmental review identifies compliance deficiencies, CSBs will submit formal plans of correction to the appropriate Office of Administrative Services in the Department within 45 days of receipt of official reports of reviews.  Minor compliance issues shall be corrected within 45 days of submitting a plan.  Action to correct major compliance issues shall be initiated within 45 days and completed within 180 days of submitting a plan, unless, following discussion with the CSB, the Department grants an extension.

Additional information about departmental review of various administrative functions is available in the Technical Manual.

D.    Complaint Follow-up

In response to complaints from constituents or other entities related to CSB financial, procurement, reimbursement, or human resource policy, the Department will forward those complaints to the Board, the local government or local governing body for resolution. If resolution is not attained within a reasonable period, DBHDS may conduct a review of these policies, departments, and activities, within the extent allowable by state law, to seek resolution.

E.     Information Technology

The Department shall operate and provide technical assistance and support, to the extent practicable, to the CSB about any/all systems through which operational or service-level data are exchanged and will comply with State Board Policies 1030.

1. Pursuant to § 37.2-504 and § 37.2-605 of theCode of Virginia, the Department shall implement procedures to protect the confidentiality of data accessed or received in accordance with the performance contract. 

• The Department shall ensure that any software application that it issues to the CSB for reporting purposes associated with the performance contract has been field tested in accordance with Appendix D by a reasonable number of CSBs to assure compatibility and functionality with the major IT systems used by CSBs, is operational, and is provided to the CSB sufficiently in advance of reporting deadlines to allow it to install and run the software application. 

• The Department shall collaborate with the VACSB DMC in the implementation of any new data management or data warehousing systems to ensure appropriate interoperability and workflow management.

• DBHDS will develop and provide essential training to support new hires and current CSB Executive Director, Chief Executive Officer, and Chief Financial Officer annually as it relates to their role and responsibilities with DBHDS.

Appendix E: Administrative Requirements for Accounts Receivables

Background

1. CSB Responsibilities
2. Before the end of the first quarter of FY27, the established small workgroup comprised of Chief Executive Officers (CFO) and Executive Directors (ED) and DBHDS representatives shall meet to revise the current language in this section with key performance indicators that take in consideration but not limited to the following:
3. Clean Claim Rate (CCR)
4. Days in Accounts Receivable (A/R)
5. Initial Denial Rate
6. Monitoring A/R aging
7. Final Denial Write-offs
8. Net collection rates
9. Eligibility conversion rate

• CSB shall develop and implement systems that are adequate to properly account for and report their client receivables.
• CSB shall establish and implement receivable collection policy that includes procedures for billing, re-billing, processing denials and write offs. Such procedures should address the frequency of billing, monitoring of denials and frequency of re-billing such denials of client receivables.

1. CSB shall write off client receivable accounts when all collection procedures have been exhausted and categories of such write offs need to be defined in their receivable policy.
2. CSB shall collect minimum prescribed information from clients including their insurance information that aids in collecting receivables.

1. CSB shall strive to consistently pursue client receivables collect its client receivables including Medicaid, Medicare, and third-party insurers and limit the percentage of receivables over 120 days (excluding self-pay) to 15% or less of the total AR (excluding self-pay) unless actively collecting on those accounts.

• Department Responsibilities
• Before the end of the first quarter of FY27, Department shall convene meeting with the established small workgroup comprised of CFOs and EDs to revise the current language in this section with key performance indicators that take in consideration but not limited to the following: Clean Claim Rate (CCR)
• Days in Accounts Receivable (A/R)
• Initial Denial Rate
• Monitoring A/R aging
• Final Denial Write-offs
• Net collection rates
• Eligibility conversion rate

• The Department shall attend the established VACSB State Steering Committee meetings that address issues around collecting receivables.
• The Department shall attend VARO (Virginia Association of Reimbursement Officers) conference that address issues around collecting receivables.
• The Department shall consult with the CSB Executive Director and/or Chief Executive Officer in advance of sharing data with the General Assembly, Behavioral Health Commission, JLARC or posting on any public facing dashboards.
• Reporting Requirements

CSB shall report total client receivables, including accounts aged 30 days, 31-60 days, 61-90 days, 91-120, 120 days and over, by payor type, to DBHDS Finance on a quarterly basis within 30 days of the close of the quarter using the established DBHDS report template.  CSB shall send the reports to  sharon.wilson@dbhds.virginia.gov

Appendix F:  Regional Program Operations Operating Principles

A regional program can be a highly effective way to allocate and manage resources, coordinate the delivery and manage the utilization of high cost or low incidence services, and promote the development of services where economies of scale and effort could assist in the diversion of individuals from admission to state facilities. 

A regional program is funded by the Department through the community services board or behavioral health authority, hereafter referred to as the CSB, and operated explicitly to provide services to individuals who receive services from the CSBs participating in the program.  A regional program may be managed by the participating CSBs or by one CSB, have single or multiple service sites, and provide one or more types of service.  A regional program also may include self contained, single purpose programs (e.g., providing one type of core service, usually residential) operated by one CSB for the benefit of other CSBs or programs contracted by one CSB that serve individuals from other CSBs.

Each individual receiving services provided through a regional program must be identified as being served by a particular CSB.  That CSB will be responsible for contracting for and reporting on the individuals that it serves and the services that it provides; and each individual will access services through and have his or her individualized services plan managed by that particular CSB. 

Regional Program Operating Principles

The regional program operating principles provide guidance for CSBs to implement and manage identified regional programs and to account for services provided by the programs.  The principles also provide guidance for the Department to monitor regional programs on a more consistent basis. 

1. Regional Program Funding:  Depending on the design of a regional program, the Department may disburse state and/or federal funds for a regional program to each participating CSB or to one CSB that operates a regional program or agrees to serve as the fiscal agent for a regional program.  All regional programs shall be included in the performance contract and reflected in required reports. 
   1. If the Department disburses regional program funds to each participating CSB, each participating CSB shall follow existing performance contract and report requirements and procedures for that portion of the regional program funded by that CSB.
   1. If the Department disburses regional program funds to a CSB that operates a regional program on behalf of the other CSBs in a region, the operating CSB shall follow existing performance contract and report requirements and procedures, as if the regional program were its own program.
   1. If the Department disburses regional program funds to a CSB that has agreed to serve as the fiscal agent (fiscal agent CSB) for the regional program, disbursements will be based on, accomplished through, and documented by appropriate procedures, developed and implemented by the region.
   1. When funds are disbursed to a fiscal agent CSB, each participating CSB shall identify, track, and report regional program funds that it receives and spends as funds for that regional program.  Each participating CSB, including the fiscal agent CSB, shall reflect in its financial and program reports only its share of the regional program, in terms of individuals served, services provided, funds received, expenses made, and costs of the services.  Any monitoring and reporting of andaccountability for the fiscal agent CSB’s handling of state or federal funds for a regional program shall be accomplished through the performance contract and reports.  Alternately, if the participating CSBs elect, each CSB may perform these functions for its share of the regional program.
   1. When funds are disbursed to a fiscal agent CSB that pays a contract agency to deliver regional program services, the fiscal agent CSB and participating CSBs may elect to establish an arrangement in which the fiscal agent CSB reports all of the funds and expenditures in the fiscal report while the participating CSBs and the fiscal agent CSB report information about the program service delivery.  Alternately, if the participating CSBs elect, the fiscal agent CSB may admit the individuals served by other participating CSBs and, for purposes of this regional program, treat those individuals as its own for documentation and reporting purposes.
2. Regional programs should receive the same state funding increases as regular CSB grant- funded activities, such as the salary increases for community services provided from time to time by the General Assembly in the Appropriation Act.
   1.  
3. Financial Reporting:  All funds, expenses, and costs for a regional program shall be reported to the Department only once; they may be reported by individual CSBs, the CSB that serves as the fiscal agent, or both, depending on how the regional program is designed and operates.  For example, the fiscal agent CSB might report the revenues and expenses for a regional program provided by a contract agency, and a CSB that refers individuals it serves to that regional program may report the service and cost information related to those individuals.

• Consumer Reporting:  Each individual who receives services through a regional program shall be reported to the Department only once for a particular service.  However, an individual who receives services from more than one CSB should be reported by each CSB that provides a service to that individual.  For example, if an individual receives outpatient mental health services from one CSB and residential crisis stabilization services from a second CSB operating that program on behalf of a region, the individual would be admitted to each CSB and each CSB would report information about the individual and the service it provided to the individual.

• Service Reporting:  Each service provided by a regional program shall be reported only once, either by the CSB providing or contracting for the service or the CSB that referred individuals it served to the regional program operated or contracted by another CSB or by the region.

• Contracted Regional Programs:  When the case management CSB refers an individual to a regional program that is operated by a contract agency and paid for by the regional program’s fiscal agent CSB, the case management CSB shall report the service and cost information, and  funding and expense information. Alternately, if the participating CSBs elect, the fiscal agent CSB could admit the individual for this service and report information about the individual receiving services, services, costs, funds, and expenses itself; in this situation, the case management CSB would report nothing about this service.

• Transfers of Resources Among CSBs:  CSBs may transfer state, local, and federal funds to each other to pay for services that they purchase from each other.

• Regional Administrative and Management Expenses: CSBs and the Department have provider and local or state authority roles that involve non-direct services tasks such as utilization management and regional authorization committees.  These roles incur additional administrative and management expenses for the programs.  CSBs shall report these expenses as part of their costs of delivering regional services.  The Department shall factor in and accept reasonable administrative and management expenses as allowable costs in regional programs in accordance with the DBHDS Federal and State Indirect Cost Rate Policy.

• Local Supplements:  If a CSB participating in a regional program supplements the allocation of state and/or federal funds received by the CSB operating that program through transferring resources to the operating CSB, the participating CSB shall show the transfer as an expense on financial forms but not as a cost on service forms in its performance contract and reports.  Then, the participating CSB will avoid displaying an unrealistically low service cost in its reports for the regional program and double counting individuals served by and service units delivered in the regional program, since the operating CSB already reports this information.

1. Balances:  Unexpended balances of current or previous fiscal year regional program funds should not be retained by the participating CSBs to which the regional fiscal agent CSB or the Department disbursed the funds, unless this is approved by the region for purposes that are consistent with the legislative intent of the Appropriation Act item that provided the funds.  Otherwise, the balances should be available for redistribution during the fiscal year among participating CSBs to ensure maximum utilization of these funds.  CSBs shall follow Appendix C of this Addendum. Each region shall establish procedures for monitoring expenditures of regional program funds. and redistributing those unexpended balances to ensure that uses of those funds are consistent with the legislative intent of the Appropriation Act item that provided the funds.

1. Issue Resolution:  Regional program funding issues, such as the amount, sources, or adequacy of funding for the program, the distribution of state allocations for the regional program among participating CSBs, and financial participation of each CSB whose individuals receive services from the regional program, should be resolved at the regional level among CSBs participating in the program, with the Department providing information or assistance as needed or required.

Regional Program Models [NjC(1] 

The following models have been developed for CSBs and the Department to use in designing, implementing, operating, monitoring, and evaluating regional programs.  These models are paradigms that could be altered by mutual agreement among the CSBs and the Department as regional circumstances warrant.  However, to the greatest extent possible, CSBs and the Department shall adhere to these models to support and reinforce more consistent approaches to the operation, management, monitoring, and evaluation of regional programs.  CSBs should review these models and, in consultation with the Department, implement the applicable provisions of the model or models best suited to their particular circumstances, so that the operations of any regional program will be congruent with one of these models.

1.  Operating CSB-Funded Regional Program Model

1. The CSB that operates a regional program receives state and/or federal from the Department for the program.  The operating CSB provides the services, projects the total funding and cost for the regional program in its performance contract and contract revision(s), and reports all data on total actual individuals served, units of service(s) delivered, Community Consumer Submission 3 (CCS 3) extracts and reports funding, expenses, costs, and static capacities in its CARS.  Other CSBs, which refer individuals to the regional program for services, project and report nothing for the regional program in their contracts for the program service or financial data. , CARS reports, or CCS 3 extracts.
2. The operating CSB admits individuals receiving services from the regional program to the applicable program area (all MH, DV, or SA services) and develops individualized services plans (ISPs) for them for service(s) provided by the regional program.  When individuals complete receiving all services from the regional program, they are discharged from the applicable program area by the operating CSB, unless they are receiving other services in that program area from that operating CSB.  If individuals are also receiving services from the operating CSB in another program area, the CSB admits them to that program area.  The operating CSB provides appropriate information about the services provided and other clinical information to the CSB that referred the individual to the regional program for clinical record keeping purposes at the referring CSB.
3. The operating CSB is responsible for ensuring that all data is accurately maintained in that the appropriate information about individuals and services in the regional program is entered into its information system, so that the information can be extracted by the CCS 3 and reported in the CCS 3 and applicable CARS reports.  Thus, for performance contract and reporting purposes, on individuals receiving services from a regional program operated by that CSB. are reported by that operating CSB. 
4. Each of the other CSBs with individuals receiving services from this regional program admits those individuals to the applicable program area and provides a service, such as case management, consumer monitoring, or another appropriate service, but not in service(s) provided by the regional program.  Thus, individuals receiving services from a regional program will appear in the data reporting CCS 3 extracts for two CSBs, but not for the same services.
5. If the other CSBs with individuals receiving services from this regional program provide additional funds to the operating CSB to supplement the funds that the operating CSB receives from the Department for the regional program, the other CSBs show the revenues and expenses for this supplement on the financial forms in their performance contracts, contract revisions, and reports.  However, the other CSBs do not show any services provided, individuals served, or costs for the regional program’s services on the service forms in their contracts, revisions, or reports.  Thes other CSBs include an explanation on the Financial Comments page of the difference between the expenses on the financial forms and the costs on the service forms.  The operating CSB shows the services provided, individuals served, and total costs (including costs supported by supplements from the other CSBs) for the regional program’s services on its service forms, but it does not show any revenues or expenses associated with the supplements on the financial pages in its contract, contract revision(s), and reports.  The operating CSB includes an explanation of the difference between the expenses on the financial forms and the costs on the service forms on the Financial Comments page.
6. All of the CSBs, to the extent practicable, determine individual CSB allocations of the state and/or federal and sometimes other funds received from the Department, based on service utilization or an agreed upon formula in collaboration with the Department.
7. Regional programs should receive the same state funding increases as regular CSB grant- funded activities, such as the salary increases for community services provided from time to time by the General Assembly in the Appropriation Act.
8. This model also could be adapted by a region to handle its LIPOS services, if one CSB receives all of the LIPOS funds, admits all of the individuals receiving LIPOS services, and pays all of the LIPOS providers.  Participating CSBs should negotiate this adaptation with the Department.

2.  All Participating CSBs-Funded Regional Program Model

1. Each CSB that participates and receives state and/or federal sometimes other funds from the Department for the regional program,  Each participating CSB may supplement this amount with other funds available to it if the funds received from the Department are not sufficient to cover the regional program’s expenses.  Each participating CSB uses those funds to purchase services from the regional program for the individuals it serves, projects the funding and cost for the regional program in its performance contract and reports actual individuals served and units of service(s) delivered, funding, expenses, costs, and static capacities in its performance contract reports (CARS) only for the individuals it serves.
2. The regional program operated by one of the participating CSBs functions like a contract agency provider.  All of the individual, service, static capacity, funding, expense, and cost information for the whole program is maintained separately and is not included in the contract, contract revision(s), program and financial reports (CARS), and CCS 3 extracts of the CSB operating the program.  The participating CSBs, including the CSB operating the program, include only the parts of this information that apply to the individuals it serves in their contracts, contract revisions, reports, and extracts.  The regional program is licensed by the Department, when applicable, and develops and maintains individualized services plans (ISPs) for individuals that it serves.
3. Each participating CSB admits individuals receiving services from the regional program to the applicable program area (all MH, DV, or SA services) for the services provided by the regional program.  The services provided by the regional program are listed in the ISPs maintained by the participating CSBs for these individuals.  When individuals complete receiving all services from the regional program, they are discharged from the applicable program area by the participating CSB, unless they continue to receive other services in that program area from that participating CSB.  The regional program provides appropriate information about the services provided and other clinical information to the CSB that referred the individual to the program, as any contract agency would provide such information to the contracting CSB.
4. Each participating CSB, including the CSB operating the regional program, ensures that the appropriate information about the individuals it serves and their services is entered into its information system, so that the information can be extracted by the CCS 3 and reported in the CCS 3 submissions and applicable CARS reports for that participating CSB.
5. Regional programs should receive the same state funding increases as regular CSB grant- funded activities, such as the salary increases for community services provided from time to time by the General Assembly in the Appropriation Act.

3.  Fiscal Agent CSB-Funded Regional Program Model

1. One CSB receives state and/or federal sometimes other funds from the Department and acts as the fiscal agent for a regional program.  The Department disburses the regional allocation to the fiscal agent CSB on behalf of all CSBs participating in the regional program.
2. The fiscal agent CSB, in collaboration with the other participating CSBs, develops agreed-upon procedures that describe how the CSBs implement the regional program and jointly manage the use of these funds on a regional basis.  The procedures also establish and describe how unused funds can be reallocated among the participating CSBs to ensure the greatest possible utilization of the funds.  These procedures should be documented in a regional memorandum of agreement (MOA) that is available for review by the Department.  
3. The fiscal agent CSB receives the semi-monthly payments of funds from the Department for the regional program.  The fiscal agent CSB disburses the regional program funds to individual CSBs, including itself when applicable, in accordance with the procedures in paragraph 2.  The fiscal agent CSB displays such disbursements on a Transfer In/Out line of the applicable resources page in its final performance contract revision and its reports.  The other CSBs

receiving the transferred funds show the receipt of these funds on the same line.  CSBs provide more detailed information about these transfers on the Financial Comments pages of contract revisions and reports.

• Each CSB implementing a regional program accounts for and reports the funds and expenses associated with the program in its final performance contract revision and CARS reports.  The fiscal agent CSB displays the total amount of the allocation as funding and all Transfers Out in its financial CARS reports, but it only displays in its reports the expenses for any regional program that it implements.
• As an alternative to items 1 through 4 above for certin programs, such as the Discharge Assistance Program, and with the concurrence of the Department, instead of one CSB acting as a fiscal agent, all CSBs participating in that program establish a regional mechanism for managing the use of the regional program funds.  The CSBs decide through this regional management mechanism how the total amount of funds for the program should be allocated among them on some logical basis (e.g., approved regional discharge assistance program ISPs).  The region informs the Department of the allocations, and the Department adjusts the allocation of each participating CSB and disburses these allocations directly to the participating CSBs.  Those CSBs agree to monitor and adjust allocations among themselves during the fiscal year through this regional management mechanism to ensure the complete utilization of these regional program funds, in accordance with the MOA in item 2 above.
• Each CSB implementing a regional program ensures that appropriate information about the individuals it serves and their services is entered into its information system., so that the CCS 3 can extract the information and report it in the CCS 3 submissions and applicable CARS reports.
• Regional programs should receive the same state funding increases as regular CSB grant- funded activities, such as the salary increases for community services provided from time to time by the General Assembly in the Appropriation Act.

A variation of this model, the Fiscal Agent CSB-Funded Regional Local Inpatient POS Program Model, can be used to implement and manage regional local acute psychiatric inpatient bed purchases.

3.a.  Fiscal Agent CSB-Funded Regional Local Inpatient POS Program Model

1. One CSB agrees to act as the fiscal agent for the regional Local Inpatient Purchase of Services (LIPOS) program.  The Department disburses the regional LIPOS allocation to the fiscal agent CSB on behalf of all of the CSBs participating in the regional LIPOS program.
2. The fiscal agent CSB, in collaboration with all of the participating CSBs and with consultation from the Department, develops procedures that describe how the CSBs will implement the regional LIPOS program and jointly manage the use of these funds on a regional basis.  The procedures include regional utilization management mechanisms, such as regional authorization committees (RACs) and regional procurements of beds through contracts with private providers.  Such contracts may reserve blocks of beds for use by the region or purchase beds or bed days on an as available basis.  The procedures also establish and describe how unused funds can be reallocated among the participating CSBs to ensure the greatest possible utilization of the funds.  These procedures should be documented in a regional memorandum of agreement (MOA) that is available for review by the Department.

• The fiscal agent CSB receives the semi-monthly payments of funds from the Department for the regional LIPOS program.  The fiscal agent CSB disburses regional LIPOS funds to individual CSBs or uses such funds itself to pay for the costs of local inpatient hospitalizations that have been approved by a regional review and authorization body established by and described in the MOA in item 2 of this section.  The fiscal agent CSB displays such disbursements on a Transfer In/Out line of the mental health resources page in its final performance contract revision and reports, and the CSB receiving the transferred funds shows the receipt of these funds on the same line.  CSBs provide more detailed information about these transfers on the Financial Comments page of contract revisions and reports. 
• The CSB that purchases local inpatient services accounts for and reports the funds and expenses associated with its LIPOS in its final performance contract revision and financial reports.  The fiscal agent CSB displays the total amount of the allocation as funds and all Transfers Out in its CARS reports, but it displays in its reports only the expenses for its own LIPOS.  
• The CSB that purchases the local inpatient services ensures that appropriate information about individuals, services, and costs is entered into its management information system, so that the CCS 3 can extract the information and report it in the CCS 3 submissions and applicable CARS reports.
• Regional programs should receive the same state funding increases as regular CSB grant- funded activities, such as the salary increases for community services provided from time to time by the General Assembly in the Appropriation Act. 

4.  Fiscal Agent CSB-Funded Contract Agency Regional Program Model

1. One CSB receives state and/or federal sometimes other funds from the Department and acts as the fiscal agent for a regional program that is contracted by this fiscal agent CSB to a public or private agency.  The Department disburses the regional allocation to the fiscal agent CSB on behalf of all CSB participating in the contracted regional program.

• The fiscal agent CSB contracts with and provides set monthly payments to a regional program provided by a public or private contract agency on behalf of all of the CSB participating in this regional program.  The contract may purchase a pre-set amount of specified services from the contract agency and pay the agency a predetermined cost, whether or not the participating CSBs use the services.

• Each participating CSB referring one of the individuals it serves to this contracted regional program admits the individual, enrolls him in the regional program service, and refers him to the contract agency.  The contract agency provides information to the referring (case management) CSB, and that CSB maintains information about the individual and the service units in its information system, where the CCS 3 can extract the information.

• The fiscal agent CSB provides program cost information to each referring CSB, based on its use of the regional program, and the referring CSB enters this information in the cost column of the program services form (pages AP-1 through AP-4) but does not enter any funding or expenditure information in its performance contract report (CARS).  The fiscal agent CSB enters the funding and expenditure information associated with the regional program on the financial forms in its performance contract report, but it enters cost information on the program services form only for the individuals that it referred to the regional program.  Each CSB will explain the differences between the financial and program service forms in its performance contract report on the Financial Comments page.  The Department will reconcile the differences among the participating CSBs’ reports using these comments.  Because of the difficulty in calculating the program cost information for each participating CSB, program cost information would only need to be included in end of the fiscal year performance contract (CARS) reports.

• All of the participating CSBs, to the extent practicable, determine individual CSB allocations of the state and sometimes other funds received from the Department, based on service utilization or an agreed-upon formula in collaboration with the Department.

• Regional programs should receive the same state funding increases as regular CSB grant-funded activities, such as the salary increases for community services provided from time to time by the General Assembly in the Appropriation Act.

This model also could be adapted by a region to handle its LIPOS services, if one CSB acts as the fiscal agent and pays all of the LIPOS providers.  This adaptation should be negotiated with the Department by the participating CSBs.

Regional Program Procedures

A regional program is funded by the Department through the community services board or behavioral health authority, hereafter referred to as the CSB and operated explicitly to provide services to individuals who receive services from the CSBs participating in the program.

1.   Purpose

The CSB may collaborate and act in concert with other CSBs or with other CSBs and state hospitals or training centers, hereafter referred to as state facilities, to operate regional programs, provide or purchase services on a regional basis, conduct regional utilization management, or engage in regional quality improvement efforts.  Regional programs include but limited to regional discharge assistance programs (RDAP), local inpatient purchases of services (LIPOS), and other programs such as residential or ambulatory crisis stabilization programs.  These procedures apply to all regional programs.  While this appendix replaces earlier regional memoranda of agreement (MOAs), CSBs, state facilities, private providers participating in the regional partnership, and other parties may still need to develop MOAs to implement specific policies or procedures to operate regional or sub-regional programs or activities.  Also, an MOA must be developed if a regional program intends to establish a peer review committee (e.g., a regional utilization review and consultation team) whose records and reviews would be privileged under § 8.01-581.16 of the Code of Virginia.  When the CSB receives state and/or federal funds from the Department for identified regional programs or activities, it shall adhere to the applicable parts of these procedures, which are subject to all applicable provisions of the community services performance contract.  In the event of a conflict between any regional program procedures and any provisions of the contract, provisions of the contract shall prevail.

2.   Regional Management Group (RMG)

1. The participating CSBs and/or state facilities shall establish an RMG.  The executive director of each participating CSB and the director of each participating state facility shall each serve on or appoint one member of the RMG.  The RMG shall manage the regional program and coordinate the use of funding provided for the regional program, review the provision of services offered through the regional program, coordinate and monitor the effective utilization of the services and resources provided through the regional program, and perform other duties that the members mutually agree to carry out.  An RMG may deal with more than one regional program.
2. Although not members of the RMG, designated staff in the Central Office of the Department shall have access to all documents maintained or used by this group, pursuant to applicable provisions of the performance contract, and may attend and participate in all meetings or other activities of this group.
3. In order to carry out its duties, the RMG may authorize the employment of one or more regional managers to be paid from funds provided for a regional program and to be employed by a participating CSB.  The RMG shall specify the job duties and responsibilities for and supervise the regional manager or managers.

3.   Regional Utilization Review and Consultation Team (RURCT)

a.   The RMG shall establish a RURCT pursuant to § 8.01-581.16 of the Code of Virginia to, where applicable:

1. review the implementation of the individualized services plans (ISPs) or individualized Discharge Assistance Program plans (IDAPPs) developed through the regional program to ensure that the services are the most appropriate, effective, and efficient services that meet the clinical needs of the individual receiving services and report the results of these reviews to the RMG;
2. review individuals who have been on the state facility extraordinary barriers to discharge list for more than 30 days to identify or develop community services and funding appropriate to their clinical needs and report the results of these reviews and subsequent related actions to the RMG;
3. review, at the request of the case management CSB, other individuals who have been determined by state facility treatment teams to be clinically ready for discharge and identify community services and resources that may be available to meet their needs;
4. facilitate, at the request of the case management CSB, resolution of individual situations that are preventing an individual’s timely discharge from a state facility or a private provider participating in the regional partnership or an individual’s continued tenure in the community;
5. identify opportunities for two or more CSBs to work together to develop programs or placements that would permit individuals to be discharged from state facilities or private providers participating in the regional partnership more expeditiously;
6. promote the most efficient use of scarce and costly services; and
7. carry out other duties or perform other functions assigned by the RMG.
8. The RURCT shall consist of representatives from participating CSBs in the region, participating state facilities, private providers participating in the regional partnership, and others who may be appointed by the RMG, such as the regional manager(s) employed pursuant to section II.C.  The positions of the representatives who serve on this team shall be identified in local documentation.
9. The RURCT shall meet monthly or more frequently, when necessary, for example, depending upon census issues or the number of cases to be reviewed.  Minutes shall be recorded at each meeting.  Only members of the team and other persons who are identified by the team as essential to the review of an individual’s case, including the individual’s treatment team and staff directly involved in the provision of services to the individual, may attend meetings.  All proceedings, minutes, records, and reports and any information discussed at these meetings shall be maintained confidential and privileged, as provided in § 8.01-581.17 of the Code of Virginia.
10. For the regional program, the RURCT or another group designated by the RMG shall maintain current information to identify and track individuals served and services provided through the regional program.  This information may be maintained in participating CSB information systems or in a regional data base.  For example, for the RDAP, this information shall include the individual’s name, social security number or other unique identifier, other unique statewide identifier, legal status, case management CSB, state hospital of origin, discharge date, state re-hospitalization date (if applicable), and the cost of the IDAPP.  This team shall maintain automated or paper copies of records for each RDAP-funded IDAPP.  Changes in responsibilities of the case management CSB, defined in the core services taxonomy, and the transfer of RDAP funds shall be reported to the Offices of Grants Management and Mental Health Services in the Department as soon as these changes or transfers are known or at least monthly.
11. For RDAP, the RURCT shall conduct utilization reviews of ISPs as frequently as needed to ensure continued appropriateness of services and compliance with approved IDAPPs and reviews of quarterly utilization and financial reports and events related to the individual such as re-hospitalization, as appropriate.  This utilization review process may result in revisions of IDAPPs or adjustment to or redistribution of RDAP funds.  This provision does not supersede utilization review and audit processes conducted by the Department pursuant to the performance contract.
12. Although not members of the RURCT, designated staff in the Central Office of the Department shall have access to all documents, including ISPs or IDAPPs, maintained or used by this body, pursuant to applicable provisions of the performance contract, and may attend and participate in all meetings as non-voting members and in other activities of this team.

4.   Operating Procedures for Regional Programs:  These operating procedures establish the parameters for allocating resources for and monitoring continuity of services provided to individuals receiving regional program services.  Some of the procedures apply to regional programs generally; others apply to particular regional programs, although they may be able to be adapted to other regional programs.

1. Funding for a regional program shall be provided and distributed by the Department to participating CSBs or to a CSB on behalf of the region through their community services performance contracts in accordance with the conditions specified the contract, often in an Exhibit D.
2. Each participating CSB or a CSB on behalf of the region shall receive semi-monthly payments of state funds from the Department for the regional program through its community services performance contract, as long as it satisfies the requirements of this appendix and the performance contract, based upon its total base allocation of previously allotted and approved regional program funds.
3. Participating CSBs and state facilities shall develop agreed-upon procedures that describe how they will implement a regional program and jointly manage the use of regional program funds on a regional basis.  These procedures shall be reduced to writing and provided to the Department upon request.
4. Regional program funds may be used to support the activities of the RMG and RURCT.
5. Within the allocation of funds for the regional program, funds may be expended for any combinations of services and supports that assure that the needs of individuals are met in community settings.  ISPs or IDAPPs must be updated and submitted, as revisions occur or substitute plans are required, to the RMG for approval according to procedures approved by the RMG.
6. Regional program funds used to support ISPs or IDAPPs shall be identified on a fiscal year basis.  Amounts may be adjusted by the RMG to reflect the actual costs of care based on the regional program’s experience or as deemed appropriate through a regional management and utilization review process.
7. The CSB responsible for implementing an individual’s regional program ISP or IDAPP shall account for and report the funds and expenses associated with the regional program ISP or IDAPP in its community services performance contract and in its quarterly performance contract reports submitted through to the Department.
8. The CSB responsible for implementing an individual’s regional program ISP or IDAPP shall ensure that the appropriate information about that individual and his or her services is entered into its management information system so that the information can be through reports to the Department.
9. The participating CSBs may use regional program funds to establish and provide regional or sub-regional services when this is possible and would result in increased cost effectiveness and clinical effectiveness.
10. Operation of a RDAP is governed by the Discharge Assistance Program Manual issued by the Department and provisions of Exhibit C of the performance contract. 

 5.   General Terms and Conditions

1. CSBs, the Department, and any other parties participating in a regional program agree that they shall comply with all applicable provisions of state and federal law and regulations in implementing any regional programs to which these procedures apply.  The CSB and the Department shall comply with or fulfill all provisions or requirements, duties, roles, or responsibilities in the current community services performance contract in their implementation of any regional programs pursuant to these procedures. 
2. Nothing in these procedures shall be construed as authority for the CSB, the Department, or any other participating parties to make commitments that will bind them beyond the scope of these procedures.
3. Nothing in these procedures is intended to, nor does it create any claim or right on behalf of any individual to any services or benefits from the CSB or the Department.

6.         Project Management

1. The Department shall be responsible for the allocation of regional program state and federal funds and the overall management of the regional program at the state level.
2. The RMG shall be responsible for overall management of the regional program and coordination of the use of funding provided for the regional program in accordance with these procedures.
3. The CSB shall be responsible for managing regional program funds it receives in accordance with these regional program procedures.
4. Payments generated from third party and other sources for any regional program shall be used by the region or CSB to offset the costs of the regional program.  The CSB shall collect and utilize all available funds from other appropriate specific sources before using state and federal funds to ensure the most effective use of these state and federal funds.  These other sources include Medicare; Medicaid-fee-for service, targeted case management payments, rehabilitation payments, and ID waiver payments; other third-party payors; auxiliary grants; SSI, SSDI, and direct payments by individuals; payments or contributions of other resources from other agencies, such as social services or health departments; and other state, local, or Department funding sources.
5. The Department may conduct on-going utilization review and analyze utilization and financial information, and events related to individuals served, such as re-hospitalization, to ensure the continued appropriateness of services and to monitor the outcomes of the regional program.  The utilization review process may result in adjustment to or reallocation of state general and federal funding allocations for the regional program.

 [NjC(1]Put in the Admin P&P document

Exhibit I: IT SECURITY AND COMPLIANCE

As the healthcare technology landscape continues to evolve, it is important for all healthcare operations to responsibly leverage new technology to improve patient care and business operations.

DBHDS recognizes that CSBs are healthcare entities subject to various federal and state regulation including but not limited to HIPAA and 42 CFR Part 2. To support compliance with these regulations, the Department and CSBs will establish a collaborative workgroup by the end of the first quarter of the 2027 fiscal year. The workgroup will develop IT Security and Compliance protocols to protect sensitive healthcare data and protect both parties from unnecessary data security risk.

The below, baseline requirements exist today. The workgroup may identify more requirements for this section to be included in future agreements.

Background

The Department expects all CSBs to comply with the IT Security and Artificial Intelligence requirements outlined in this section. These requirements align with current Commonwealth of Virginia Executive Orders, as well as applicable state and federal laws and regulations.

The Parties acknowledge that security standards will continue to evolve, and updates may be required as future versions of standards are released. DBHDS will monitor security and reporting initiatives related to the overall security posture and will coordinate with CSBs in a timely manner to implement evolving controls and address new security requirements.

Scope

The Department, as a healthcare oversight agency, is required to ensure IT Security and Compliance for all systems owned and operated by the Department. Further, the Department is required to ensure all data entering IT systems owned and operated by the Department, via integration or other means, do not pose avoidable risks to data security.

CSBs are responsible for the compliance of their business and data systems in accordance with federal and state laws and regulations. The Department does not oversee or bear any responsibility for a CSB’s use of security controls, artificial intelligence tools, tools, processes and workflows that do not impact data or IT systems owned or operated by the department.

IT Security and Compliance
Regardless of other provisions in this agreement, each CSB must comply with State Code § 2.2-5514, “Prohibited products and services and required incident reporting.”

Access Control for Department Systems

CSBs are responsible for managing the access their employees receive to Department owned or operated systems if such access is granted based upon an individual’s business needs associated with the CSB. The aforementioned workgroup will develop processes and procedures for cataloging all DBHDS systems to which CSB users have access as well as the process CSBs will use to notify DBHDS of the occurrence of, or need for access suspension. CSBs will be responsible for maintaining documentation of their users’ access to DBHDS systems and must notify the established DBHDS IT points of contact in a timely manner when access changes are needed, access is no longer required, personnel are terminated, or a breach occurs.

Artificial Intelligence (AI)
The Commonwealth of Virginia recognizes the value of Artificial Intelligence (AI) technologies and has implemented guardrails to protect the privacy, security, and confidentiality of Commonwealth applications and data.

The VITA Policy Standards for the Utilization of Artificial Intelligence by the Commonwealth of Virginia govern the Department’s use of these tools and may govern interactions between the parties in cases involving sensitive information.

Finally, under no circumstances will an unauthorized AI tool have access to DBHDS systems directly or indirectly via access to CSB systems. This is to maintain compliance with the VITA Enterprise Architecture Standard (EA225) which requires compliance with all applicable solution business requirements, including design/architecture, availability/performance, capacity, continuity, integration/interoperability, technology, and security requirements outlined in the standard.