Contract 952-M1 Collection Service Requirements Department of Family and Protective Services (DFPS)

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1 The services and requirements referenced in this attachment are specific to DFPS and are in addition to and may include the services as outlined in Part A and Attachment D. A. Eligible Population 1. DFPS shall use the Contract for drug testing a client population. 2. The Contractor shall contact the DFPS Caseworker, and not the client for any reason. 3. DFPS will determine eligible client population prior to Contractor referrals. 4. Any individual referred to the laboratory with a payment authorization, Form 2054, is eligible and must be provided services by the Contractor. 5. Any individual referred to the Contractor with a valid service authorization, Form 2054, is eligible and must be provided services by the Contractor. 6. Collection sites require photo IDs to verify the person is the same as on the Collection sites should not provide services if the referred individual s identity cannot be verified. This is to the benefit of DFPS also so that a different person does not go to provide a sample for the intended CPS client. B. Client Characteristics Clients referred to the Contractor for drug testing services may be involuntary or reluctant clients. The majority of the clients are adults over the age of 18, but in some cases clients may be under 18 and sent for laboratory testing with consent. The majority of the clients referred for drug testing services will be: 1. Parents involved in open Child Protective Services' cases 2. Children in open Child Protective Services' cases, to include foster children and children being placed for adoption; 3. Any family member or kinship caregivers being assessed for a voluntary placement of children involved in Child Protective Services' cases. C. Service Authorization and Referral Process 1. Following Contract execution, the Contractor must have a signed and approved Service Authorization, Form 2054 prior to providing service or product provision. 2. The Contractor must retain a copy of each Service Authorization, Form 2054 in their files. 3. The dates listed on the Service Authorization, Form 2054 must include the date(s) of collection with a maximum request of two (2) units per form per client per week. 4. One unit equals one complete test. 5. DFPS may require direct observation in some cases. 6. Authorization for direct observation will be noted in "Comment" area on the Service Authorization, Form D. Urinalysis Laboratory Analysis DFPS will purchase urinalysis testing for the following substances as indicated in Table 1, 2, 3 and 4: Table 1: Standard Urinalysis Testing Name of Substance Initial Screening Level Confirmation Level Amphetamines 1000 ng/ml 500 ng/ml Barbiturates 300 ng/ml 200 ng/ml Benzodiazepines (Zanax, Valium, Ativan, etc.) 300 ng/ml 200 ng/ml Page 1 of 7

2 Cocaine Metabolites 300 ng/ml 150 ng/ml Marijuana Metabolites 20 ng/ml 10 ng/ml Opiates 300 ng/ml 300 ng/ml Proproxyphene 300 ng/ml 200 ng/ml Phencyclidine (PCP) 25 ng/ml 25 ng/ml Table 2: Ala Carte Urinalysis Testing Name of Substance Initial Screening Level Confirmation Level Bath Salts (substituted 10 ng/ml 10 ng/ml Synthetic Cathinones) EtG/EtS Alcohol* 500 ng/ml 500 ng/ml Oxycodones 100 ng/ml 100 ng/ml Synthetic Marijuana/ Cannabinoids 10 ng/ml 10 ng/ml (K2/Spice/etc.) Rohypnol 300 ng/ml 200 ng/ml *EtG/EtS Alcohol test: Automated Analyzer is an Olympus E. Hair Strand Laboratory Analysis DFPS will purchase laboratory hair strand testing for the following substances at the levels indicated in Table 2: Table 3: Hair Strand Testing Name of Substance Initial Screening Level Confirmation Level Amphetamines 500 pg/mg 500 pg/mg Cocaine Metabolites 500 pg/mg 500 pg/mg Methamphetamines 500 pg/mg 500 pg/mg Marijuana Metabolites 1 pg/mg 0.3 pg/mg Opiates (includes Heroin pg/mg 300 pg/mg MAM, 6-Monoacetylmorphine) Phencyclidine (PCP) 300 pg/mg 300 pg/mg F. DFPS Training and Support Table 4: Ala Carte Hair Strand Testing Name of Substance Initial Screening Level Confirmation Level 300 pg/mg 300 pg/mg Methadone 1. Contractor must have a dedicated customer service representative plus a trained back-up individual to serve the state of Texas. These customer service representatives must be available from 8:00 a.m. to 5:00 p.m. Central Standard Time. The laboratory must have the customer service representative's phone system separate from voice mail. Respondent shall provide a toll free number. Page 2 of 7

3 2. The Contractor will provide DFPS staff with training to include: a. Reasonable Suspicion b. How to Read and Interpret Test Results c. At least two (2) times per year, provide updates on any new drug screening services available including new testing techniques and procedures. d. Information on drug testing windows of detection for Urinalysis versus Hair Strand, versus Oral swabs. e. Any other drug related issues as requested. f. Training may be presented on-site and/or through webinar or web-based training format as agreed upon by the customer and the Contractor(s). G. Required Reports 1. Test Results MRO is defined by the Federal Health and Human Services Administration as "A person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results." 2. Negative The laboratory will report negative or "diluted" test results within 24 hours after receipt of a specimen by the laboratory. 3. Positive Positive test results will be reported within 72 hours after receipt by the laboratory. 4. Analytical Results Report a. Minimum Required Information All results shall be reported in an analytical Results Report that provides: 1) A comprehensive list of substances tested 2) Levels at which the tests were screened and confirmed, if applicable b. Where to Send The Results Report shall be available via a website or submitted to the DFPS caseworker. c. Accessibility of Report The Results Report for any test performed by a laboratory must be accessible to DFPS upon request for a minimum of twelve (12) months following the laboratory drug test. 5. Statistical Summary Report a. Frequency of Report Statistical summary reports will be provided monthly by DFPS region. b. Where to Send The statistical summary report will be mailed, ed or faxed to: 1) The DFPS Substance Abuse Specialist; and 2) The DFPS Contract Manager for the DFPS region Page 3 of 7

4 c. Minimum Required Information The summary shall contain only the following information: 1) Number of specimens received for testing 2) Number of specimens confirmed positive for each type of drug tested 3) Number of specimens for which a test was not performed d. Limits to Prevent ID of Client 1) Summary reports shall not contain personal identifying information or other data from which it is reasonably likely that information about individuals' tests can be readily inferred. 2) If necessary, in order to prevent disclosure of such data, the laboratory shall not send such a report until data is sufficiently aggregated to make such an inference unlikely. 3) In any reporting period in which a report is withheld for this reason or because no testing was conducted, the laboratory shall so inform the CPS Substance Abuse Specialist for that DFPS Region consortium in writing. 6. Client Specific Report Contractor shall provide DFPS with a quantitative report of drug use on any DFPS client upon request H. DFPS Invoicing Process No payment will be made by DFPS without the submission of correct invoices. Invoices must be submitted on a monthly basis, and must be received at the designated DFPS contract office. 1. Instructions for Invoicing DFPS a. Contractor s staff responsible for preparing invoices will receive instructions on the specifics of invoicing DFPS. b. The format for invoicing DFPS is determined by the DFPS Contract Manager. c. Invoice Process Selected Contractor will: 1) Access the Pre-Bill Access the pre-bill either electronically or a pre-bill will be mailed to Contractor. 2) Submit Pre-Bill as Invoice Submittal of claims either by directly data entering the information into the DFPS Invoice system, or by submitting a signed and dated Department pre-bill, reflecting services authorized and delivered. 3) Invoice Attachments a) Form 4116X, State of Texas Purchase Voucher Submit a signed Form 4116X, State of Texas Purchase Voucher. b) Form 2016, Delivered Services Input For anyone served, but not listed on pre-bill. Separate Form 2016, Delivered Services Input is required for each month when a resubmitted or supplemental claim is being made. c) Other Supporting Documentation Submit any other supporting documentation requested by DFPS. 4) Due Date Page 4 of 7

5 a) Submittal of claims either by directly data entering the information into the DFPS Invoice system, or by submitting a signed and dated Department pre-bill, reflecting services authorized and delivered data by the 15th of each month. b) Failure to submit invoices on time may be considered a contract compliance issue and be used in evaluating whether to renew or terminate the Contract. I. Court Related Services 1. Due to the potential weight of drug testing results on the outcome of a Child Protective Services case, in rare occasions Laboratory employees may be required to testify in court hearings. 2. The Contractor must allow any of its employees to provide relevant information in representation for the Contractor when requested by DFPS in any of the following situations: a. Judicial Hearings b. Court Depositions c. Administrative Reviews 3. Any of the above services may require: a. In-Person Testimony provided by the Contractor MRO or Expert witness b. Teleconferencing Testimony provided by the Contractor MRO or Expert witness c. A Full Litigation Package d. A Partial Litigation Package; or e. A Court Deposition provided by the Contractor MRO or Expert witness at the court house nearest to, or most convenient for the Contractor. 4. The Contractor must provide court related services when requested by DFPS. 5. When the Contractor is required to provide court related services, DFPS will provide Service Authorization, Form 2054 prior to any court related service provision, authorizing the appropriate compensation for the court related services, with the exception of the "partial litigation package," which shall be made available to DFPS at no charge as a record keeping requirement. J. Price Schedule for Court Related Services Reference the Mandatory Price Sheet All pricing to include travel costs Type of Testimony Unit of Service Full Litigation Packet 1 Completed Packet Expert Testimony in Person 1 Hour Expert Testimony via Telecommunications 1 Hour * Extensive Travel includes travel that necessitates a trip to a location overnight. Note: MRO charges related to court services will be invoiced separately by the MRO under contract. K. Required Record Keeping 1. Client Records a. The Contractor must maintain individual client records for a minimum of twelve (12) months from the date of the clients' first referral for drug testing. b. These records shall be made available to DFPS upon request. c. At a minimum, each case record must include, but is not limited to, the following: 1) The Service Authorization, Form 2054; Page 5 of 7

6 2) The Result Report from each test conducted for the client. 2. Litigation Package Requirements a. The Contractor must provide a Partial Litigation Package upon request by DFPS at no additional cost. b. The Contractor must also provide, upon request, a Full Litigation Package. c. Both Litigation Packages shall be available to DFPS for any specimen for up to fifteen (15) months following the specimen test. d. The following information must be included in the Litigation Packages: Full Litigation Package: 1) Copy of Air bill (Fed Ex or other) 2) Affidavit for business records 3) Laboratory Qualification Statement, including: a) Copy of the Federal Register with lab listed b) Personal Qualification Statement, including: 1) Copy of Curriculum Vitae for Lab Director 2) Copy of Non-Federal Chain of Custody Form (TRF) 3) Copy of Hair Pouch or Urine Cup with the donor initials 4) Copy of Preparation Worksheet (appropriate page only) 5) Batch Review Checklist 6) Batch internal hair or urine testing work list 7) Copy of Initial Testing Batch Internal Chain of Custody Document 8) Copy of EIA worksheet (drug screening results) 9) Copy of appropriate Quality Control log (blind Quality Control, daily or monthly quality control data, or other) 10) Copy of Internal Chain of Custody confirmation 11) worksheet (if confirmation performed) GC/MS results, including: a) Turning data b) Standards, controls, and blanks c) Data review/final results summary d) Data Pack (sample RIC's, SIMs and results) e) Copy of external chain of custody (if confirmation sent out); f) Copy of final report and preliminary reports sent g) Explanatory notes EIA and GC/MS h) Copy of appropriate GC/MS method i) Additional material by request Partial Litigation Package for Hair Strand Specimen a. Affidavit for business records b. Laboratory Qualification Statement, including: 1) Copy of the Federal Register with lab listed c. Personal Qualification Statement, including: 1) Copy of Curriculum Vitae for Lab Director a) Copy of Non-Federal Chain of Custody Form (TRF) b) Copy of Hair Pouch with donor initials c) Copy of Preparation Worksheet (appropriate page only) d) Batch Review Checklist e) Batch internal hair testing work list f) Copy of Initial Testing Batch Internal Chain of Custody Document Page 6 of 7

7 g) Copy of EIA worksheet (drug screening results) h) Copy of appropriate quality control log (blind quality control, daily or monthly quality control data, or other) i) Copy of Internal Chain of Custody confirmation worksheet (if confirmation performed) GC/MS results, including: 1) Turning data; 2) standards, controls, & blanks; 3) data review/final results summary; 4) Data Pak (sample RIC's, SIMs and results); and 5) Copy of final report and/or preliminary reports sent. Partial Litigation Package for Urine Specimen a. Affidavit for business records b. Laboratory Qualification Statement, including: 1) Copy of the Federal Register with lab listed c. Personal Qualification Statement, including: 1) Copy of Curriculum Vitae for Lab Director; d. Drug Testing Custody and Control Form, including: 1) A copy of the original custody and Control form for each test performed 2) A signed report generated by the laboratory e. Initial Screen Documents, including: 1) A copy of the initial screening batch work list 2) Instrument data and chain of custody documentation for all specimens and aliquots contained in the batch 3) An initial result f. Data includes calibration, applicable controls and patient data. L. Service Provider Records Contractor must maintain provider personnel files. At a minimum, the file must include but is not limited to: a. Copy of current professional license(s) b. Copy of the Laboratory's current Federal HHS (SAMHSA) licensure Page 7 of 7