Memorandum of Understanding (MOU)

Circle of Care for Families and Children of Passaic County

(if multiple Medicaid Numbers, please indicate what service(s) is associated with each number)

This Memorandum of Understanding (MOU) serves to define the roles and responsibilities of Circle of Care for Families and Children of Passaic County (COC) and (PROVIDER) as we work in partnership to provide services to children and families served through the New Jersey Children’s System of Care (CSOC

from PROVIDER for youth and families enrolled with and authorized by COC. This agreement is effective upon the signing of both parties and continues ongoing unless terminated as per the section named “Termination.” This agreement will apply to all services authorized for a youth or family member under the youth’s approved Individual Service Plan (ISP) and/or Family Crisis Plan (FCP) developed by the Child and Family Team (CFT) and documented and authorized by COC. Signing of the MOU with COC does not guarantee referrals to PROVIDER.

The term “CLINICIAN” refers to those individuals who deliver direct authorized services to youth and families.

The term “PROVIDER” refers to an agency that employs, contracts with or oversees and/or supervises CLINICIANS.

COC is committed to providing the highest quality of services by upholding the Wraparound values of New Jersey’s Children’s System of Care (CSOC These values define our commitment to the community that our services are family driven, community-based, strength-based, culturally diverse, individualized, and easily accessible. Our goal is to keep youth at home, in school, and in the community. Our mission is to foster a partnership between families and communities by finding or developing sustainable resources that will allow the family to function in a healthy manner. As one of our partners in the delivery of services, PROVIDER will share our commitment to maintain the fidelity of the Wraparound model and demonstrate these values through all of your work with the youth and families we serve.

In compliance with New Jersey’s Department of Children and Families (DCF) policy, COC honors the no eject/no reject approach to service. Enrollment is maintained for all youth and families referred to COC until defined outcomes or transition criteria are met. Families always maintain their right to select providers of their choice at any time. As one of our partners in the delivery of services, PROVIDER will share our commitment to this policy through all of your work with the youth and families we serve.

1) COC has the responsibility of developing an Individual Service Plan (ISP) for youth enrolled in COC through the Child Family Team (CFT) process. The ISP serves as the authorizing document for service delivery for a particular youth or family member. COC will send a Service Request Form to PROVIDER, which confirms service authorization.

2) COC will coordinate CFT meetings with all CFT members, including CLINICIANS. CFT meetings are held every 60–90 days, although at times they are held more often to respond to the particular needs of a youth or family.

3) COC will contact CLINICIANS a minimum of once per month by telephone or other audio/visual means to monitor strategies on the ISP.

4) In the event that concerns or challenges are identified that cannot be resolved via the CFT process and may impede service delivery by CLINICIAN, COC will contact PROVIDER for resolution as soon as possible.

5) COC will inform PROVIDERS of relevant staff changes promptly.

6) COC will provide advanced notice of bi-annual Administrator Meetings and Provider Resource Fairs.

7) COC will offer biannual IIC/BA trainings.

a) No services shall be procured or subcontracted to any outside agency.

b) PROVIDER meets all applicable current local, state and federal requirements or standards set forth by any appropriate local, state or federal entity or licensing authority.

c) PROVIDER is in good standing with New Jersey state and federal government agencies, departments, divisions, or bureaus.

d) PROVIDER has and will maintain an active license with appropriate licensing authorities for all applicable services being provided to families and youth of COC.

e) CLINICIANS have and will maintain an active license with appropriate licensing authorities for all applicable services being provided to families and youth of COC.

f) All CLINICIANS providing IIC services must have an LAC, LPC, LSW orLCSW and possess the necessary skills and experience to render authorized services. Individuals with only an MA, MSW or LCAD without a dual license cannot provide IIC services.

g) All CLINICIANS are supervised as required by their respective licensure bodies and professional ethical standards and best practices.

h) If at any time, PROVIDER’S or CLINICIANS’ applicable license to provide services is revoked or suspended, PROVIDER will notify COC immediately so that services can be terminated.

i) COC accepts no responsibility for license monitoring, expirations or suspensions. It is the sole responsibility of PROVIDER to ensure all clinicians providing IIC services maintain an active professional license.

j) PROVIDER will make available any documentation as requested by COC (i.e. proof of insurance, licensure, etc within 7 business days of request.

2) PROVIDER has comprehensive general and professional malpractice liability, property damage and automobileliability insurance (if providing transportation to families or youth), in the amount of at least $1,000,000/$3,000,000. PROVIDER will have COC listed as a certificate holder. PROVIDER shall be continuously insured during the term of business with COC.

a) PROVIDER will notify COC at any time if insurance coverage is cancelled or suspended and will cease providing services with families/youth until coverage is reinstated.

b) COC bears no responsibility for monitoring insurance coverage, coverage limits or expirations. It is the sole responsibility of each PROVIDER to keep track of Liability Insurance.

3)   PROVIDER has a policy/process in place to ensure that all staff that transport youth will have a valid driver’s license, safe driving record and adequate automobile insurance.

a)       COC bears no responsibility for monitoring driver’s licenses, driving records, car insurance coverage, coverage limits or expirations.

4) PROVIDER has a policy in place to ensure that all staff having direct contact with youth have completed, at aminimum, criminal background checks, and if required by law, a Child Abuse Registry Index check. All changes indirect contact staff and the criminal background/Child Abuse Registry Index should be monitored by PROVIDER.

a) COC bears no responsibility for monitoring criminal background or Child Abuse Registry Index reports.

5)       PROVIDER will add their agency information, to the Passaic Resource Net (PRN),  including PROVIDER’s active staff list and keep this information current for referrals.

a)       Passaic Resource Net can be found at http://www.passaicresourcenet.org/

b)       New PROVIDERS will submit the universal staff roster as an Excel or CSV document to info@njresourcenet.org within 72 business hours of signing this MOU or enter the information manually through PRN, via the PROVIDER Dashboard > Agency Staff

c)        Existing PROVIDERS will maintain staff list current, updating clinician availability for new referrals each week, to ensure accuracy.

6) PROVIDER will respond to any communication from COC Community Resource Department within 72 business

7) PROVIDER will attend “Provider Administrator Meeting” at minimum once per year.

8) PROVIDE will ensure at least one IIC/BA attends COC’s biannual PROVIDER Trainings offered by COC

9) PROVIDER will return initial calls from COC seeking availability of services within 24 hours.

10) Upon receiving referral, PROVIDER will reach out to the authorized family within 24 hours.

a) If PROVIDER is unable to contact the family within 72 hours, PROVIDER will notify the Care Manager.

11) PROVIDER will notify COC Community Resource Department and assigned Care Manger of staff changes.

a) PROVIDER will not reassign CLINICIANS directly with the family. All changes in assigned CLINICIANS will go through the CFT team process.

12 CLINICIAN will participate as a member of the Child and Family Team:

a) CLINICIANS will speak to Care Manager via telephone or other audio/visual means, at minimum once per month to provide updates related to strategies on the ISP.

b) CLINICIANS will attend CFT meetings every 60 – 90 days or more often to respond to the particular needs of a youth or family.

c) If CLINICIAN is unable to attend the CFT meeting in person, CLINICIAN will attend CFT via phone or video conferencing. If CLINICIAN is unable to attend CFT meeting via telephone conferencing, CLINICIAN will send written documentation to be shared during CFT meeting or PROVIDER will send appropriate representative.

d) CLINICIAN will not have discussions with the family about out of home treatment or flex funding outside of the CFT process.

e) Services will not by reauthorized with CLINICIANS who do not participate in or provide information as requested for CFT meetings.

13) In the event COC authorizes a Biopsychosocial Evaluation, CLINICIAN will complete and submit assessment within 21 days of authorization start date in the electronic CSA Medical Record, as indicated by CSOC guidelines.

a) CLINICIAN will submit initial treatment plans (IIC/IIH Treatment Plans, Behavior Assistant Treatment Plans) into the electronic CSA Medical Record within 21 days of authorization of service.

b) CLINICIAN will update treatment plan for each reauthorization, within 7 days of authorization of service.

c) CLINICIAN will review treatment plans and updates with the youth and/or family and CFT. The PROVIDER, youth, and family shall sign the documents indicating receipt and agreement with the treatment plan.

d) IIC Treatment Plans will be submitted via the “Treatment Plan Tab” or will be uploaded in the “DOC Tab” in the youth’s electronic CSA Medical Record.

e) IIC will submit or update BA ISP within 7 days authorization of service. BA Treatment Plans will follow BA ISP Template attached as Appendix 1. BA ISP will be uploaded to the “DOC Tab” in the youth’s electronic CSA Medical Record. BA will not begin services with a youth/family until the BA ISP has been submitted.

15) CLINICIAN will not use authorized hours of service for time spent completing documentation. CLINICIAN will

only use authorized hours of service for face to face sessions with youth/family.

16) CLINICIAN will submit session progress notes for each visit into the electronic CSA Medical Record within 72 hours of visit. 

17)  While the youth is the “identified client” CLINICIANS will include caregivers and family members in treatment as appropriate.

1) During the term of this Agreement and thereafter, PROVIDER and COC shall ensure that they and their directors, officers, employees, contractors, and agents (“personnel”) hold all information about the child and family in the strictest confidence and in accordance with state and federal laws, including but not limited to HIPAA.

a) PROVIDER attests and affirms it will:

i. As a Covered Entity, will abide by all requirements under HIPAA.

ii. Not use or disclose Protected Health Information (PHI) other than as permitted or required by this agreement or as required by law.

iii. Use appropriate safeguards to prevent use or disclosure of PHI other than as provided by this Agreement.

iv. Mitigate, to the extent practical, any harmful effect that is known to PROVIDER of a use or disclosure of PHI by PROVIDER in violation of the requirements of this Agreement.

v. Report to COC any use or disclosure of the PHI not permitted under HIPAA.

vi. Ensure that any agent, including subcontractor, to whom it provides PHI received from, or created or received by PROVIDER on behalf of COC, agrees to the same restrictions and conditions that apply throughout this Agreement to PROVIDER with respect to such information.

2) PROVIDER reports, assessments, and treatment plans are to be made available to the youth and family, upon written request, in compliance with HIPAA guidelines.

3) Confidential information pertaining to youth and families will be sent via encrypted email.

1) COC will not be responsible for payment of Medicaid eligible services provided to Medicaid eligible recipients. PROVIDER will bill Medicaid directly.

2) PROVIDER agrees to accept payments from Medicaid as defined by the Medicaid Fee Schedule as payment in full. Medicaid regulations prohibit COC from providing any additional reimbursement.

3) PROVIDER will clarify Medicaid eligibility of the youth referred for service before providing any service. COC is not financially responsible for any services provided when a referred youth does not have active Medicaid.

4) COC does not provide reimbursement to CLINICIANS for attendance at CFT meetings, mileage/travel time, no shows, cancellations, documentation (i.e., time spent completing progress notes, treatment plans, etc, or emails to COC/families/other providers. Payment for time is factored into the Medicaid rate for all Rehab Option services.

1) PROVIDER agrees that for any service rendered and billed for, a progress note will be submitted along with the invoice when Provider is unable to enter the note into CSA Medical Record. All services that are able to be entered into CSA Medical Record are expected to appear in the youth’s electronic record.

2) PROVIDER agrees to provide required invoice packets that include:

Session notes 1500 Health Claim Form completed and signed DCF’s Intensive In-Community Service Delivery Encounter Form

3) PROVIDER agrees to submit invoices broken down by unique youth.

4) PROVIDER will complete the Provider Rate Sheet with services and related fees for non-reimbursable Medicaid/Flexible Funded Services offered.

5) COC reserves the right to deny payment on any invoices for Flex Funded services not received within 90 days of the service delivery date. COC agrees to pay PROVIDER within 30 days of the receipt of a completed invoice.

6) PROVIDER is expected at any point to abide by *Special Instructions* as outlined by NJ Department of Children & Families along with Medicaid. (For example: COVID-19 service delivery changes

In New Jersey, any person having reasonable cause to believe a youth has been subjected to abuse and neglect or acts of abuse should immediately report this information to the State Central Registry (SCR If the youth is in immediate danger, call 911 as well as 1-877 NJ ABUSE (1-877-652-2873). A concerned caller does not need proof to report an allegation of child abuse and can make the report anonymously. Statutes concerning child abuse can be found under Title 9. Children--Juvenile and Domestic Relations Courts. Any person knowingly violating the provisions of this act including the failure to report an act of child abuse having reasonable cause to believe that an act of child abuse has been committed, is a disorderly person.

COC is committed to providing quality services to children and families. As a method of ensuring quality services, COC evaluates the services offered through PROVIDER. These evaluations are accomplished in a number of ways, including but not limited to, youth and family surveys, quality assurance calls to families and care manager feedback. If these evaluations result in any dissatisfactory outcomes, COC may take the following actions:

1) Initiate a meeting to review feedback and discuss performance improvement goals. PROVIDER will meet with COC within thirty days of dissatisfactory report.

2) Require CLINICIAN for whom dissatisfactory reports are received to attend COC provided IIC/BA training.

COC also welcomes ongoing feedback from the providers on our care management services.

As part of our commitment to offer quality services, COC strives to provide culturally competent services to children and their families. PROVIDER shall offer culturally competent training to their staff, offer bi-lingual services where needed, engage in regular agency self-assessment of culturally competent policies and practices, and ensure that services are sensitive and responsive to the cultural needs of the families we serve.

1) Termination for Cause – Upon COC’s knowledge of a material breach of this Agreement, breach of federal or state rules and regulations or recognized standards of care by PROVIDER, COC, in its sole discretion, shall either:

a) Provide an opportunity for PROVIDER to cure the breach by detailing the specific steps taken by PROVIDER to mitigate.

b) Terminate this Agreement if PROVIDER does not cure the breach or end the violation within the time specified by COC.

c) Immediately terminate this Agreement if PROVIDER has breached a material term of this Agreement and cure is not possible.

2) Termination without Cause – Either party may terminate this Agreement for any reason with thirty days written notice. Upon receiving written notice, COC will notify the family receiving services from your agency and the CFT to inform their will be a change in services. The CFT will then meet to revise the youth’s ISP to reflect termination of services from PROVIDER.

3) In the event of failure of PROVIDER to comply with any provision of this Agreement, COC reserves the right to terminate this Agreement upon five days written notice.

If there are any modifications to this Agreement, PROVIDER will be notified in writing. Modification may be effective immediately.

This Agreement cannot be assigned, delegated or transferred by either party without written consent of both parties.

I acknowledge and understand that Circle of Care for Families and Children of Passaic County and its employees, trustees and agents are not responsible for any personal injury or property damages that may occur during a client’s participation in any services that have been provided by my organization and which have been authorized and/or referred to my organization by Circle of Care for Families and Children of Passaic County.

Signature of COC Community Relations and Resource Development Director