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Docusign Envelope ID:98DDF151-695D-4983-9047-F1D75C21E335 <br /> 6. EW Clinicians reserve the right to refuse clinical services after a clinical assessment if the <br /> clinician in their professional judgment feels that client: <br /> a. Would not benefit from clinical services; <br /> b. Does not meet criteria; <br /> C. Does not currently have capacity for progress in an individual therapeutic setting due <br /> to cognitive functioning and limitations and/or medical needs are beyond what the <br /> facility can manage; or <br /> d. Needs higher medication management as evidenced by unmanaged severe mental <br /> health symptoms impeding ability to engage in treatment <br /> 7. EW will bill for all sessions in accordance with the fee for service payment arrangement <br /> attached to this contract. <br /> 8. EW and SMPD MHU may share treatment plan records. EW may share weekly to biweekly <br /> with SMPD MHU staff and community mental health providers via phone or email updates of <br /> the participant's engagement in treatment and if progressing or regressing. SMPD MHU will <br /> work with EW to ensure appropriate authorizations are in place pursuant to HIPAA and 42 <br /> CFR Part 2 to enable such information sharing. <br /> 9. SMPD MHU clients will be seen by a licensed clinician while engaged in EW services who <br /> will hold one of the following licensures: LMFT,LPC,LMFT-A,LMSW,LCDC A/I or LPC- <br /> Associate. Any clinician who is currently licensed under supervision will also provide <br /> credentials of their clinical supervisor and agree to maintain supervision while providing <br /> services to SMPD MHU clients. <br /> PAYMENT FOR BEHAVIORAL HEALTH SERVICES <br /> 1. SMPD MHU will assess whether the participant has insurance and/or the ability to pay. This <br /> program is intended for indigent, San Marcos residents. <br /> 2. If the participant does have insurance accepted by Evoke, the participant will be required to <br /> use that insurance to cover the cost. <br /> 3. If the participant: <br /> A) does not have insurance; <br /> B) has insurance but cannot pay the copay; or <br /> C) does not have the ability to pay out of pocket for treatment <br /> 4. Then the City will provide the financial support to cover the co-pay or full cost of treatment <br /> (whichever cannot be financially contributed by the participant) that the participant needs to <br /> comply with the requirements of the SMPD MHU. <br /> 5. EW will invoice the City monthly for all services by the tenth(10th)calendar day of the month. <br /> Invoices will be net 30 days. Invoices will be sent to cosmap@sannnarcostx.gov. <br /> 6. As indicated, SMPD MHU will issue an IRS form 1099. <br /> 7. EW reserves the right to terminate services if payment is not received within 30 calendar days <br /> of invoice date. <br /> 8. Based off of the Financial Assessment SMPD MHU clients who camlot pay for treatment out <br /> of pocket or cannot pay the co-pay with commercial insurance may qualify for a scholarship <br /> from Evoke Wellness to receive treatment at no cost to the City. The number of people that <br /> Evoke Wellness can provide scholarships for will be maximum 5 individuals per year. These <br /> individuals will be staffed with Evoke staff and evaluated by their staff to determine that they <br /> meet criteria for their treatment services before this decision is made. <br />