Common use of ADDITIONAL GRANT INFORMATION Clause in Contracts

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 Health and Human Services Commission The Montrose Center Xxxxx Ita Associate Commissioner Xxx X. Xxxxxxx Executive Director Date of execution: July 20, 2020 Date of execution: July 17, 2020 The following attachments to System Agency Contract No. HHS000663700051 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700196 Health and Human Services Commission The Montrose Nexus Recovery Center Xxxxx Ita Associate Xxxxxx Name: Xxxxxxx Xxxxxx Assoc. Commissioner Xxx X. Xxxxxxx IDD/BH Date of execution: _July 21, 2020 Title: Executive Director Director/CEO Date of execution: July 20, 2020 Date of execution: July 1721, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700196 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054B08TI08354-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700125 Health and Human Services Commission The Montrose Bluebonnet Trails Community MHMR Center Xxxxx Ita Associate Xxxxxx Assoc. Commissioner Xxx X. Xxxxxxx IDD/BH Xxxxxx Xxxxxxxxxx Name: Title:Executive Director Date of execution: _July 2017, 2020 Date of execution: July 17, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700125 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Government Entity Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency HHSC Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substanceCO-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 NU62PS92459 Federal Award Date: 10/01/2019 12/11/2018 Name of Federal Awarding Agency: Department of Health Centers for Disease Control and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) Prevention CFDA Name and Number: 93.959 93.940 Awarding Official Contact Information: Xxxxxx X. Xxxxx, M.B.A Lead Grants Management Specialist Centers for Disease Control and Prevention Infectious Diseases Services Branch 0000 Xxxxxxxxxx Xxxx, XX X-00 Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact NumberXX 00000 Telephone: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx 0000 Signature Page for System Agency Contract NoFollows Department of State Health Services CONTRACT NO. HHS000663700051 Health and Human Services Commission The Montrose Center HHS000077800014 DSHS GRANTEE Name: Xxxxxx Xxxxxx Name: Xxxxx Ita Xxxxxxxxxx Title: Associate Commissioner Xxx X. Xxxxxxx Title: Executive Director Date of execution: July 20November 1, 2020 2019 Date of execution: July 17November 1, 2020 2019 The following attachments to System Agency Contract No. HHS000663700051 HHS000077800014 are hereby incorporated by reference: Attachment A - Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates - Budget Attachment C General Affirmations Attachment D - HHSC Uniform Terms and Conditions-Grantee Conditions – Grant Attachment D – Supplemental Conditions Attachment E Special Conditions Version 1.2 Attachment F - Federal Assurances and certifications Lobbying Form Attachment F - FFATA Certification Attachments Follow The following attachments to System Agency Contract No. HHS000077800014 are hereby incorporated by reference, as if physically attached: Attachment G – Data Use Agreement Version 8.5 (DUA) Attachment G-1 – DUA Security and Privacy Inquiry Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I - System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum HHS0000778 Attachment X XxxxxxxI - Grantee’s proposal for Solicitation No. HHS0006637 Attachments Follow Response ATTACHMENT A: A STATEMENT OF WORK TREATMENT I. GENERAL REQUIREMENTS FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to ALL GRANTEES All activities conducted under this Contract will support the target population at one or more goals and objectives of the following service typesNational HIV/levels of careSTD Strategy and the Texas HIV Plan. The below service types/levels goals of care the Texas HIV Plan are based on Texas Administrative Code (TAC) requirementsto increase HIV awareness among members of the public, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providerscommunity leaders, and American Society policy makers, increase access to HIV prevention efforts for communities and groups at highest risk, successfully diagnose all HIV infections, increase timely linkage to HIV-related treatment for those newly diagnosed with HIV, increase continuous participation in systems of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxxtreatment among people living with HIV, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.increase viral suppression among people living with HIV. Grantees for ALL activities funded under this award will:

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054B08TI010051-01 18 Federal Award Date: 10/01/2019 10/01/2017 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS000663700051 HHS000130500014 Health and Human Services Commission The Montrose Center Aliviane, Inc. Xxxxx Ita Associate Xxxxxx Name: Name: Xxxxxx Xxxxx Title: _Assoc. Commissioner Xxx X. Xxxxxxx Executive Director IDD/BH Date of execution: July 20_April 2, 2020 Title: Chief Executive Officer Date of execution: July 17April 1, 2020 The following attachments Documents are Hereby Attached to System Agency Contract No. HHS000663700051 are hereby incorporated by referenceHHS000130500014: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Budget Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Conditions Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment K Indirect Cost Rate Agreement The Following Documents are Hereby incorporated by Reference to System Agency Contract No. HHS000130500014 Attachment I System Agency Solicitation No. HHS0006637 HHS0001305 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 HHS0001305 Attachments Follow ATTACHMENT A: A STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.SOW)

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700038 Health and Human Services Commission The Montrose Center Turtle Creek Manor, Inc. Xxxxx Ita Associate Commissioner Xxx X. Xxxxxxx Executive Director Date of execution: July 2022, 2020 Name: Xxxx X. Xxxxxxxxx Title: Pres./CEO Date of execution: July 1722, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700038 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency HHSC Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substanceCO-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: Substance Abuse and Prevention Treatment (SAPT), 93.959 State Opioid Response (SOR), 93.788 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Federal Award Identification Number (XXXX): H79TI081729 Federal Award Date: 09/30/2018 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: State Opioid Response, 93.788 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is XxXxxxxx X. Browne, Grants Specialist, Contact Number: (000) 000-0000, Email: xxxxxxxx.xxxxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700092 Health and Human Services Commission The Montrose El Dorado Texas Community Service Center Xxxxx Ita Associate Xxxxxx Name: Xxxxxxx X. Xxxxxx Assoc. Commissioner Xxx X. Xxxxxxx Executive IDD/BH Title: Administrative Director Date of execution: _July 20, 2020 Date of execution: July 1720, 2020 The following attachments to System Agency Contract No. HHS000663700051 are hereby incorporated by referenceHHS000663700092 ARE HEREBY INCORPORATED BY REFERENCE: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Version 2.16.1 Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: A MEDICATION ASSISTED TREATMENT STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.WORK

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 NU62PS92459 Federal Award Date: 10/01/2019 12/11/2018 Name of Federal Awarding Agency: Department of Health Centers for Disease Control and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) Prevention CFDA Name and Number: 93.959 93.940 Awarding Official Contact Information: Xxxxxx X. Xxxxx, M.B.A Lead Grants Management Specialist Centers for Disease Control and Prevention Infectious Diseases Services Branch 0000 Xxxxxxxxxx Xxxx, XX X-00 Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact NumberXX 00000 Telephone: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx 0000 Signature Page for System Agency Contract NoFollows CONTRACT NO. HHS000663700051 Health and Human Services Commission The Montrose Center HHS000077800019 Name: Xxxxx Ita Associate Xxxxx DSHS GRANTEE Name: Xxxxxxxx Xxxx Title: Deputy Commissioner Xxx X. Xxxxxxx Executive Director Title: CEO Date of execution: July 20November 22, 2020 2019 Date of execution: July 17November 18, 2020 2019 The following attachments to System Agency Contract No. HHS000663700051 HHS000077800019 are hereby incorporated by reference: Attachment A - Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates - Budget Attachment C General Affirmations Attachment D - HHSC Uniform Terms and Conditions-Grantee Conditions – Grant Attachment D – Supplemental Conditions Attachment E Special Conditions Version 1.2 Attachment F - Federal Assurances and certifications Lobbying Form Attachment F - FFATA Certification Attachments Follow The following attachments to System Agency Contract No. HHS000077800019 are hereby incorporated by reference, as if physically attached: Attachment G – Data Use Agreement Version 8.5 (DUA) Attachment G-1 DUA Security and Privacy Inquiry Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I - System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum HHS0000778 Attachment X XxxxxxxI - Grantee’s proposal for Solicitation No. HHS0006637 Attachments Follow Response ATTACHMENT A: A STATEMENT OF WORK TREATMENT I. GENERAL REQUIREMENTS FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to ALL GRANTEES All activities conducted under this Contract will support the target population at one or more goals and objectives of the following service typesNational HIV/levels of careSTD Strategy and the Texas HIV Plan. The below service types/levels goals of care the Texas HIV Plan are based on Texas Administrative Code (TAC) requirementsto increase HIV awareness among members of the public, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providerscommunity leaders, and American Society policy makers, increase access to HIV prevention efforts for communities and groups at highest risk, successfully diagnose all HIV infections, increase timely linkage to HIV-related treatment for those newly diagnosed with HIV, increase continuous participation in systems of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxxtreatment among people living with HIV, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.increase viral suppression among people living with HIV. Grantees for ALL activities funded under this award will:

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency HHSC Contract No. HHS000663700051 HHS000663700179 Health and Human Services Commission The Montrose Center Serving Children and Adults in Need, Inc. Xxxxx Ita Associate Xxxxxx Assoc. Commissioner Xxx X. IDD/BH Xxxxx Xxxxxxx Chief Executive Director Officer Date of execution: July 2022, 2020 Date of execution: July 1722, 2020 The following attachments to System Agency HHSC Contract No. HHS000663700051 HHS000663700179 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency HHSC Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS YOUTH SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.PURPOSE

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency HHSC Contract No. HHS000663700051 HHS000663700105 Health and Human Services Commission The Montrose Center Longview Wellness Center, Inc. Xxxxx Ita Associate Xxxxxx Assoc. Commissioner Xxx X. Xxxxxxx IDD/BH Xxxx Xxxxx Chief Executive Director Officer Date of execution: July 20, 2020 Date of execution: July 1720, 2020 The following attachments to System Agency HHSC Contract No. HHS000663700051 HHS000663700105 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency HHSC Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS YOUTH SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.PURPOSE

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700008 Health and Human Services Commission The Montrose Center Turning Point, Inc. Xxxxx Ita Associate Xxxxxx Assoc. Commissioner Xxx X. Xxxxxxx IDD/BH Date of execution: _July 23, 2020 Xxxxx Xxxxxxxx Executive Director Date of execution: July 20, 2020 Date of execution: July 17, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700008 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700081 Health and Human Services Commission The Montrose Center Bee Cave Recovery Xxxxx Ita Associate Commissioner Xxx X. Xxxxxxx Date of execution: _July 20, 2020 Xxxxx Xxxxxxxx Executive Director Date of execution: July 20, 2020 Date of execution: July 17, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700081 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.

ADDITIONAL GRANT INFORMATION. Grantee Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): B08TI083054-01 NU50CK000501 Catalog of Federal Domestic Assistance (CFDA) Name and Number (list all that apply): Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) – 93.323 Federal Award Date: 10/01/2019 April 23, 2020 Name of Federal Awarding Agency: Department of Health Centers for Disease Control and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Prevention Awarding Official Contact Information: Xxxxxx XxxxxxxXxxxxxx Xxxxxxxx-Xxxx, Grants Management OfficerOfficer 0000 Xxxxxxx Xxxx – Mailstop TV2 Atlanta, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact NumberGA 00000-0000 Phone: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx 0000 Signature Page Follows Signature Page for System Agency Contract No. HHS000663700051 Health and Human Services Commission The Montrose Center Xxxxx Ita HHS000812700041 System Agency Grantee Signature Signature Xxxxxx Xxxxxx Associate Commissioner Xxx X. Xxxxxxx Executive Director Date of executionExecution: July 20October 28, 2020 2021 Xxxxx Xxxxxxxx City Manager Date of executionExecution: July 17October 28, 2020 2021 The following attachments to System Agency Contract No. HHS000663700051 HHS000812700041 are hereby incorporated by reference: Attachment A - Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates - Budget Attachment C General Affirmations Attachment D - Uniform Terms and Conditions-Grantee Conditions - Grant Attachment D - HHS Additional Provisions – Grant Funding Attachment E Special Conditions Version 1.2 - Federal Assurances Non-Construction Attachment F Federal Assurances and certifications - Certification Regarding Lobbying Attachment G - FFATA Attachment H - HHS Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting - Security and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Privacy Inquiry (SPI) Attachments Follow ATTACHMENT A: A STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE I. GRANTEE RESPONSIBILITIES Grantee shall provide substance use disorder treatment services to will perform activities as submitted in their DSHS-approved budget for this specific funding contract period. Only activities listed below are approved for this funding and any additional activities not listed in the target population at one or more of the following service types/levels of careapproved budget must be submitted for DSHS consideration and approval. The below service types/levels of care activities for this contract funding period are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.follows:

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency HHSC Contract No. HHS000663700051 HHS000663700097 Health and Human Services Commission The Montrose Center for Success and Independence, Inc. Xxxxx Ita Associate Xxxxxx Assoc. Commissioner Xxx X. Xxxxxxx IDD/BH Date of execution: _July 24, 2020 Xxxxxx Xxxxx Chief Executive Director Officer Date of execution: July 20, 2020 Date of execution: July 1723, 2020 The following attachments to System Agency HHSC Contract No. HHS000663700051 HHS000663700097 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency HHSC Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS YOUTH SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.PURPOSE

ADDITIONAL GRANT INFORMATION. Grantee Data Universal Numbering System (DUNS) Number: 58213893 Federal Award Identification Number (XXXX): B08TI083054B08TI083478-01 Catalog of Federal Domestic Assistance (CFDA) Name and Number (list all that apply): • Name – Number 93.959 Federal Award Date: 10/01/2019 02/02/2021 Federal Award Period: 10/01/2020-09/30/2022 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) Management Specialist Center for Substance Abuse Treatment xxxxx.xxxx@xxxxxx.xxx.xxx 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx 0000 Signature Page Follows Signature Page for System Agency Contract No. HHS000663700051 Health and Human Services Commission The Montrose Center HHS001081400001 HEALTH AND HUMAN SERVICES CITY OF LUBBOCK COMMISSION Xxxxx Ita Associate Commissioner Xxx X. Xxxxxxx Executive Director Xxxxxx SG Date of executionExecution: July 20September 11, 2020 2021 Xxxxxx Xxxx Mayor Date of executionExecution: July 17September 8, 2020 2021 The following attachments to System Agency Contract No. HHS000663700051 HHS001081400001 are hereby incorporated by reference: ATTACHMENT A - GENERAL STATEMENT OF WORK ATTACHMENT A-1 - YOUTH PREVENTION STATEMENT OF WORK ATTACHMENT A-2 - COMMUNITY COALITION PARTNERSHIP STATEMENT OF WORK ATTACHMENT A-3 - PREVENTION RESOURCE CENTERS STATEMENT OF WORK ATTACHMENT B – FISCAL REQUIREMENTS ATTACHMENT B-1 - APPROVED CATEGORICAL BUDGET ATTACHMENT C – DELIVERABLES & PERFORMANCE MEASURES ATTACHMENT D – HHSC UNIFORM TERMS & CONDITIONS GRANT V 2.16.1 ATTACHMENT E-- CONTRACT AFFIRMATIONS ATTACHMENT F -- HHSC ADDITIONAL PROVISIONS VERSION 1.0, SEPTEMBER 2021 Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F G – Federal Assurances and certifications Attachment G H– Data Use Agreement Version 8.5 Attachment H Fiscal I—Federal Funding Accountability funding accountability and Transparency Act transparency act (FFATAffata) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: A GENERAL STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.WORK

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency HHSC Contract No. HHS000663700051 HHS000663700278 Health and Human Services Commission The Montrose Center Phoenix Houses of Texas, Inc. Name: Xxxxx Ita Associate Xxxxxx Name: Xxxx Xxxxxx Title: Assoc. Commissioner Xxx X. Xxxxxxx Executive Director IDD/BH Title: President & CEO Date of execution: July 20_August 13, 2020 Date of execution: July 17August 13, 2020 The following attachments to System Agency HHSC Contract No. HHS000663700051 HHS000663700278 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency HHSC Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS YOUTH SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.PURPOSE

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700141 Health and Human Services Commission The Montrose Center Austin Recovery Inc. Name: Xxxxx Ita Associate Xxxxxx Name: Xxxxx Xxxxxxxx Title: Assoc. Commissioner Xxx X. Xxxxxxx Executive Director IDD/BH Title: CEO Date of execution: July August 20, 2020 Date of execution: July August 17, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700141 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 NU62PS92459 Federal Award Date: 10/01/2019 12/11/2018 Name of Federal Awarding Agency: Department of Health Centers for Disease Control and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) Prevention CFDA Name and Number: 93.959 93.940 Awarding Official Contact Information: Xxxxxx X. Xxxxx, M.B.A Lead Grants Management Specialist Centers for Disease Control and Prevention Infectious Diseases Services Branch 0000 Xxxxxxxxxx Xxxx, XX X-00 Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact NumberXX 00000 Telephone: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx 0000 Signature Page for System Agency Contract NoFollows CONTRACT NO. HHS000663700051 Health and Human Services Commission The Montrose Center HHS000077800010 DSHS GRANTEE Name: Xxxxxxxx Xxxx Name: Xxxxxx Xxxxx Ita Associate Title: Deputy Commissioner Xxx X. Xxxxxxx Executive Director Title: Sr. Director, Sponsored Programs Date of execution: July 20November 11, 2020 2019 Date of execution: July 17November 7, 2020 2019 The following attachments to System Agency Contract No. HHS000663700051 HHS000077800010 are hereby incorporated by reference: Attachment A - Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates - Budget Attachment C General Affirmations Attachment D - HHSC Uniform Terms and Conditions-Grantee Conditions – Grant Attachment D – Supplemental Conditions Attachment E Special Conditions Version 1.2 Attachment F - Federal Assurances and certifications Lobbying Form Attachment F - FFATA Certification Attachment G - Data Use Agreement Version 8.5 (DUA) Attachments Follow The following attachments to System Agency Contract No. HHS000077800010 are hereby incorporated by reference, as if physically attached: Attachment G-1 – DUA Security and Privacy Inquiry Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I - System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum HHS0000778 Attachment X XxxxxxxI - Grantee’s proposal for Solicitation No. HHS0006637 Attachments Follow Response ATTACHMENT A: A STATEMENT OF WORK TREATMENT I. GENERAL REQUIREMENTS FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to ALL GRANTEES All activities conducted under this Contract will support the target population at one or more goals and objectives of the following service typesNational HIV/levels of careSTD Strategy and the Texas HIV Plan. The below service types/levels goals of care the Texas HIV Plan are based on Texas Administrative Code (TAC) requirementsto increase HIV awareness among members of the public, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providerscommunity leaders, and American Society policy makers, increase access to HIV prevention efforts for communities and groups at highest risk, successfully diagnose all HIV infections, increase timely linkage to HIV-related treatment for those newly diagnosed with HIV, increase continuous participation in systems of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxxtreatment among people living with HIV, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.increase viral suppression among people living with HIV. Grantees for ALL activities funded under this award will:

ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 HHS000663700090 Health and Human Services Commission The Montrose Center Dallas Sigma Counseling Services, Inc. Xxxxx Ita Name: Xxxxxx Xxxx Associate Commissioner Xxx X. Xxxxxxx Executive Director Title: CEO Date of execution: _July 20, 2020 Date of execution: July 1720, 2020 The following attachments to System Agency Contract No. HHS000663700051 HHS000663700090 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.