HomeMy WebLinkAboutDoc 298 - Early Learning Div - IGA - MedicaidDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of June 5, 2013
Please see directions for completing this document on the next page.
DATE: May 23,2013
FROM: Hilllary Saraceno CFC/DCHS (541) 317-3178
TITLE OF AGENDA ITEM:
Consideration of Board signature on Document #2013-298, the Early Learning Division 2013-15
Medicaid Activities Intergovernmental Agreement between the State of Oregon, Early Learning
Division and Deschutes County.
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
This is an intergovernmental agreement for the 2013-15 biennium between the State of Oregon, Early
Learning Division and Deschutes County. This agreement describes the Healthy Start Medicaid
Administrative activities.
FISCAL IMPLICATIONS:
None. The 2013-14 Deschutes County Health Services, Early Learning Division proposed budget
includes a projection of$30,000 in Healthy Start Medicaid Activities revenue for the 2013-14 fiscal
year. Payment for all work performed under this Agreement shall be subject to the provisions of ORS
293.462. The maximum, not to exceed amount for the total cost ofproviding Medicaid administrative
activities under this Agreement is $175,000.
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of the Board of County Commissioners on Document #2013-298, the 2013-15
Healthy Start Medicaid Intergovernmental Agreement.
ATTENDANCE: Hillary Saraceno
DISTRIBUTION OF DOCUMENTS:
Return the original documents to Hillary Saraceno at Deschutes County Children & Families
Commission, 1130 NW Harriman, Suite A, Bend, OR 97701
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements. regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda. the Agenda Request Form is also required. If this form is not included with the document. the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes. and not directly to Legal Counsel. the
County Administrator or the Commissioners. In addition to submitting this form with your documents. please submit this form
electronically to the Board Secretary.)
Please complete all sections above the Official Review line.
Date: IMay 23, 201 ~ Department: ICFq
Type of Document: Intergovernmental Agreement
Goods and/or Services: This is an Intergovernmental Agreement for the 2013-15
biennium between the State of Oregon, Early Learning Division and Deschutes County.
This agreement describes the Healthy Start Medicaid Administrative activities.
Background & History: This two year agreement is the basis for claiming
reimbursement for Healthy Start services. The 2013-14 Deschutes County Health
Services, Early Learning Division proposed budget includes a projection of $30,000 in
Healthy Start Medicaid Activities revenue for the 2013-14 fiscal year (based on a six
month contract). Payment for all work performed under this Agreement shall be subject
to the provisions of ORS 293.462. The maximum, not to exceed amount for the total
cost of providing Medicaid administrative activities under this Agreement is $175,000.
Agreement Starting Date: Ruly 1, 201~ Ending Date: Rune 30, 201 ~
Annual Value or Total Payment: 1$175,000 (over the biennium)
D Insurance Certificate Received (check box)
Insurance Expiration Date: INIAl
Check all that apply:
D RFP, Solicitation or Bid Process
D Informal quotes «$150K)
[g] Exempt from RFP, Solicitation or Bid Process (specify see DCC §2.37)
Funding Source: (Included in current budget? [g] Yes D No
If No, has budget amendment been submitted? DYes D No
Is this a Grant Agreement providing revenue to the County? [g] Yes D No
5/28/2013
Special conditions attached to this grant: None
Deadlines for reporting to the grantor: Quarterly 45 days after the end of the quarter;
November, February, May & August.
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant-funded position so that this will be noted in the offer letter: 0 Yes 0 No
Contact information for the person responsible for grant compliance:
Name: Hilla Saraceno
Phone #: 541 317-3178
Departmental Contact and Title: Hillary Saraceno Phone #: (541)
317-3178
Department Director Approval: ~
Si nature
Distribution of Document: Please return all originals to Hillary Saraceno at CFC,
1130 NW Harriman, Ste. A, Bend OR 97701.
Official Review:
County Signature Required (check one): III BOCC 0 Department Director (if <$25K)
o Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. _____,)
Legal Review ~ O~ Date ... , '"$ / ' 0
Document Number 2013-298
5/28 /2013
-=~~~~~-I 2013-2015 COUNTY HEALTHY FAMILIES OREGON
THE EARLY LEARNING DIVISION
MEDICAID ADMINISTRATIVE ACTIVITIES
INTERGOVERNMENTAL AGREEMENT
"HEALTHY START AGREEMENT"
This Early Learning Division 2013-2015 County Healthy Families Oregon -Medicaid
Administrative Activities Intergovernmental Agreement (this "Agreement") is entered into by and
between the State of Oregon, (the "State") acting by and through its Early Learning Division
("AGENCY") and Deschutes County, a political subdivision of the State of Oregon ("COUNTY").
RECITALS
WHEREAS, under Title XIX of the Social Security Act (the "Act"), the federal government
and states share the cost of funding the Medicaid program, which provides medical assistance to
certain low-income individuals. Federal Financial Participation ("FFP") is the federal government's
share for states' Medicaid program expenditures. The State is required to share in the cost of
medical assistance expenditures, and the Act permits both state and local governments to
participate in the financing of the non-Federal portion of medical assistance expenditures ("State
Share"). States may claim FFP for providing administrative activities that are found to be
necessary by the Secretary of the U.S. Department of Health and Human Services (DHHS),
Centers for Medicare and Medicaid Services ("CMS") for proper and efficient administration of the
Title XIX Medicaid Oregon State Plan (the "State Medicaid Plan").
WHEREAS, the State Medicaid program is administered by the Oregon Health Authority
("OHA"), pursuant to ORS 409.010(3). OHA has an interagency agreement with AGENCY that
authorizes AGENCY to administer Medicaid administrative activities for purposes of the Healthy
Families Oregon programs authorized under ORS 417.795 (formerly known as the Healthy Start
Family Support Services Program). AGENCY desires to administer those Medicaid administrative
services, in part, through its Agreement with the COUNTY.
WHEREAS, ORS 417.795, authorizes AGENCY to establish Healthy Families Oregon
programs, as funding becomes available.
WHEREAS, COUNTY desires to receive funding from AGENCY to implement Health
Families Oregon programs to improve the wellness of children and families located within
COUNTY'S jurisdiction.
WHEREAS, consistent with the goals of the Healthy Families Oregon programs, AGENCY
and COUNTY, intend to improve health services access and availability for children and families
eligible for medical assistance under Medicaid who reside in the geographic areas served by the
COUNTY. Under the Agreement, COUNTY , through contracts with local providers ("Providers"),
who must be enrolled with the Oregon Health Authority, Department of Medical Assistance
Program ("DMAP") to provide Medicaid services, will perform Title XIX administrative activities.
COUNTY will utilize Providers to perform outreach, health care coordination, and other medical
assistance related to administrative activities that support the administration of the State Medicaid
Plan.
Agreement #DES 1315 Deschutes County Page 1 of 30
DC -2 13-2 9 8
:::EWED' THE EARLY LEARNING DIVISION
f_--.....;-..=!E;.;:.G=A.~""""_r.""":O ~,!;...;.NS!l;.;;;;;...---I2013-2015 COUNTY HEALTHY FAMILIES OREGON ....
MEDICAID ADMINISTRATIVE AC"nVITIES
INTERGOVERNMENTAL AGREEMENT
"HEALTHY START AGREEMENT"
This Early Learning Division 2013-2015 County Healthy Families Oregon -Medicaid
Administrative Activities Intergovernmental Agreement (this "Agreement") is entered into by and
between the State of Oregon, (the "State") acting by and through its Early Learning Division
("AGENCY") and Deschutes County, a political subdivision of the State of Oregon ("COUNTY").
RECITALS
WHEREAS, under Title XIX of the Social Security Act (the "Act"), the federal government
and states share the cost of funding the Medicaid program, which provides medical assistance to
certain low-income individuals. Federal Financial Participation ("FFP") is the federal government's
share for states' Medicaid program expenditures. The State is required to share in the cost of
medical assistance expenditures, and the Act permits both state and local governments to
participate in the financing of the non-Federal portion of medical assistance expenditures ("State
Share"). States may claim FFP for providing administrative activities that are found to be
necessary by the Secretary of the U.S. Department of Health and Human Services (DHHS).
Centers for Medicare and Medicaid Services ("CMS") for proper and efficient administration of the
Title XIX Medicaid Oregon State Plan (the "State Medicaid Plan").
WHEREAS, the State Medicaid program is administered by the Oregon Health Authority
("OHA"), pursuant to DRS 409.010(3). OHA has an interagency agreement with AGENCY that
authorizes AGENCY to administer Medicaid administrative activities for purposes of the Healthy
Families Oregon programs authorized under DRS 417.795 (formerly known as the Healthy Start
Family Support Services Program). AGENCY desires to administer those Medicaid administrative
services. in part, through its Agreement with the COUNTY.
WHEREAS, DRS 417.795. authorizes AGENCY to establish Healthy Families Oregon
programs, as funding becomes available.
WHEREAS, COUNTY desires to receive funding from AGENCY to implement Health
Families Oregon programs to improve the wellness of children and families located within
COUNTY'S jurisdiction.
WHEREAS, consistent with the goals of the Healthy Families Oregon programs. AGENCY
and COUNTY, intend to improve health services access and availability for children and families
eligible for medical assistance under Medicaid who reside in the geographic areas served by the
COUNTY. Under the Agreement, COUNTY, through contracts with local providers ("Providers"),
who must be enrolled with the Oregon Health Authority, Department of Medical Assistance
Program ("DMAP") to provide Medicaid services, will perform Title XIX administrative activities.
COUNTY will utilize Providers to perform outreach, health care coordination, and other medical
assistance related to administrative activities that support the administration of the State Medicaid
Plan.
Agreement #DES1315 Deschutes County Page 1 of 30
OC-201 -293
WHEREAS, 42 CFR 433.51 permits the use of public funds to be appropriated directly to
the COUNTY to be considered as the State Share in obtaining FFP;
WHEREAS, AGENCY and COUNTY desire to enter into this Agreement to ensure optimal
utilization of available federal funding for Healthy Oregon Families administrative activities in order
to better serve the eligible Medicaid population of Oregon; and
WHEREAS, COUNTY acknowledges that, in accordance with 2013 Oregon legislation, the
implementation of Health Families Oregon programs may change and that, accordingly, AGENCY
may terminate this Agreement, as provided herein, to provide for continuing implementation of the
Healthy Families Oregon programs, as contemplated by 2013 legislation.
NOW THEREFORE, in consideration of the mutual premises set forth above and other
good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the
parties hereto agree as follows:
1. AGREEMENT. This Agreement is effective on July 1, 2013, or on the date it has been fully
executed by every party and, when required, approved by the Oregon Department of Justice.
Unless extended or terminated in accordance with its terms, this Agreement terminates on
June 30, 2015.
Upon execution by each of the parties hereto and approval as required by applicable law, the
Agreement shall become effective as of July 1, 2013.
2. STATEMENT OF WORK. COUNTY shall, through subcontracts with its Providers, provide
Title XIX administrative activities as further described in Attachment A, section (A 1 )
Medicaid/OHP Outreach Activities and Facilitating Medicaid/OHP Eligibility, section (B 1)
Referral, Coordination, Monitoring, and Training of Medicaid/OHP Covered Services (C1)
Medicaid/OHP Transportation and Translation, (D1) Program Planning, Policy Development,
and Interagency Coordination Related to Medicaid/OHP Services; which are incorporated
herein by this reference (the 'Work"). Medicaid does not pay for administrative expenditures
related to, or in support of, services that are not included in the State Medicaid Plan, the
Oregon Health Plan, or services which are not reimbursed under Medicaid those activities are
further described in Attachment A, section (A2) Outreach and Application Assistance for Non
Medicaid/OHP Programs, (B2) Case Planning, Monitoring, Coordination, Referral and
Training of Non Medicaid/OHP Covered Services, (C2) Non Medicaid/OHP Transportation
and Translation means, and (02) Coordination Related to Non-Medicaid/OHP Services.
A. COUNTY RESPONSIBILITIES.
1. COUNTY represents that it is a local governmental entity authorized by local authority
to enter into the Agreement.
2. COUNTY shall enter into written subcontracts that require its Providers to submit
necessary information for developing a Medicaid claim for Medicaid allowable
activities to AGENCY on a quarterly basis, including: a list of each individual identified
as performing activities under this Agreement and the salary and other personnel
Agreement #DES1315 Deschutes County Page 2 of 30
expenses for each identified individual; and the actual time study record of all
activities.
3. COUNTY shall enter into written subcontracts that require its Providers to participate
in time studies required under this Agreement and to utilize the specific activity codes
("Activity Codes") and time study methodology approved by AGENCY, OHA, and the
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid
Services ("CMS") to document time spent on each administrative activity listed in
Attachment A and to claim all allowable costs under this Agreement. COUNTY shall
require its Providers to participate in the time study during the four days per quarter
determined by AGENCY. The Activity Codes that COUNTY shall require its Providers
to use are attached to the Agreement as Attachment A. AGENCY will provide to
COUNTY the form of the time study Providers must utilize.
4. COUNTY shall enter into written subcontracts that require its Providers to participate,
not less than annually, in State-offered Medicaid training on the implementation of the
time study and Activity Codes to ensure its Providers make claims only for allowable
Medicaid administrative activities.
5. COUNTY shall enter into written subcontracts that require of its Providers that all
reimbursement claims for administrative activities are claimed in accordance with Title
2 CFR PART 225 (OMB Circular A-87). The administrative activities eligible for
reimbursement must be directly related to the administration of the State Medicaid
Plan.
6. COUNTY shall enter into written subcontracts that require its Providers to maintain,
and make available to COUNTY and AGENCY upon request, the following information
on:
a. Employees who perform services under this Agreement: the employee's name,
title, job description, education level, salary, and other personnel expenses for
each individual; and
b. Cost information: records to indicate the nature and extent of services provided,
and other resources that have been applied to offset costs; and Ic. Time study records
d. Any other information applicable to the Medicaid administrative services provided I
under this Agreement. f
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7. COUNTY shall enter into written subcontracts that require its Providers to provide all
records that support the quarterly claim, upon request of AGENCY, OHA, the
Oregon Department of Justice, the Oregon Secretary of State, or federal officials.
8. COUNTY'S written subcontracts with Providers shall comply with all requirements of !42 CFR 434.6 as applicable. t
Agreement #DES1315 Deschutes County Page 3 of 30
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9. COUNTY shall enter into written subcontracts that require of its Providers that
Medicaid eligible children and families receiving assistance administered under this
Agreement be free to accept or reject Medicaid services and to receive such service
from an enrolled Provider of their choice unless otherwise restricted to a provider of
the Oregon Health Plan by OHA.
10. COUNTY must advise Provider that Provider may include in its claim to COUNTY
the actual costs billed to Provider by COUNTY for the performance of Medicaid
Administrative Activities provided by COUNTY to Provider in its submission to the
COUNTY for the purpose of calculating the Provider's Medicaid Administrative
Claim.
11. COUNTY shall comply with and require by contract that any Provider comply with all
requirements set forth in this Agreement, including but not limited to Attachment S,
"Additional Requirements", attached to and made a part of this Agreement by this
reference.
B. AGENCY RESPONSIBILITIES.
1. OHA shall determine the dates during each quarter on which the time study shall be
conducted, and AGENCY shall communicate those dates to the COUNTY and
Providers conducting the time study.
2. Upon receipt of time study records from Providers, AGENCY will compile the time
study results on a quarterly basis, calculate the administrative Medicaid claim, and
submit the administrative Medicaid claim for payment to OHA.
3. AGENCY shall provide technical assistance in the identification of allowable
Medicaid administrative activities under the Agreement.
4. AGENCY shall assist COUNTY and Providers in responding to any federal Medicaid
compliance issues related to the Agreement.
3. CONSIDERATION
A. Summary of Medicaid Payment Methodology
Under Title XIX of the Act, the federal government and states share the cost of providing
allowable Medicaid administrative activities. COUNTY will provide under this Agreement
50% of the total allowable costs attributable to Medicaid Administrative activities.
AGENCY will pay COUNTY the total allowable costs of providing Medicaid administrative
activities, in arrears, on a quarterly basis. COUNTY shall then reimburse AGENCY 50% of
the total allowable costs of providing Medicaid administrative activities, which represents
the State match portion of the Medicaid expenditures. The State match funds COUNTY
transfers to AGENCY shall be public funds that are not federal funds, or shall be federal
funds authorized by federal law to be used to match other federal funds. Oregon Health
Authority will claim the Federal Financial Participation (FFP) amount from U.S. Department
of Health and Human Services. Centers for Medicare and Medicaid Services (CMS).
Agreement #DES1315 Deschutes County Page 4 of 30
In addition, COUNTY on a quarterly basis will pay to AGENCY an Intergovernmental
charge of 1% (one percent) of the total allowable cost of providing Medicaid administrative
activities under this Agreement.
Allowable administrative Medicaid costs are separate from any other direct Medicaid or
other services that may be provided by COUNTY pursuant to separate Medicaid funding
agreements or authorizations. Duplicate payments are not allowable when determining
administrative costs under Medicaid. Payments for allowable activities must not duplicate
payments that have been or should have been included and paid as part of a rate for
services, part of a capitation rate, or through some other local, State or federal program.
Medicaid administrative costs may not be claimed for activities that are integral parts or
extensions of medical services. Furthermore, in no case shall COUNTY be reimbursed
more than the actual cost of the activities claimed by COUNTY under this Agreement.
AGENCY'S payment obligation is conditioned on: (1) AGENCY receiving payment from
OHA in an amount sufficient to pay COUNTY; (2) AGENCY receiving the necessary time
study results from Providers to calculate the quarterly claim for Medicaid administrative
activities; and (3) AGENCY reasonably determining to accept the quarterly claim for
Medicaid administrative activities, in whole or in part. COUNTY'S obligation to perform
under this Agreement is conditioned on: (1) AGENCY'S timely payment in arrears for past
performance due under this Agreement, and (2) AGENCY receiving payment from OHA in
an amount sufficient to pay COUNTY for the provision of prospective performance due
under this Agreement.
B. Payment for all Work performed under this Agreement shall be subject to the provisions of
ORS 293.462. The maximum, not to exceed amount for the total cost of providing
Medicaid administrative activities under this Agreement is $175,000. COUNTY shall
reimburse AGENCY 50% of this amount for the State match portion.
C. AGENCY will not pay for any Work performed before the beginning date or after the
expiration date of this Agreement including amendments thereto.
D. COUNTY shall submit claims for Medicaid allowable activities only. Medicaid does not
pay for administrative expenditures related to, or in support of, services that are not
included in the State Medicaid Plan, the Oregon Health Plan, or services which are not
reimbursed under Medicaid. In addition, Medicaid does not pay for health care services
that are rendered free of charge to the general population. Thus, any administrative
activity which supports the referral, coordination, planning of screening or services that are
provided free to the general population would not be considered as Medicaid
administration.
E. Total Allowable Administrative Costs for which COUNTY may request reimbursement from
AGENCY under this Agreement include the following costs.
1. AGENCY incurs administrative costs in its administration of the Agreement, including
but not limited to processing the Provider time studies and calculating the allowable
Agreement #DES1315 Deschutes County Page 5 of 30
Medicaid administrative claiming on behalf of COUNTY, and payment of an
intergovernmental charge to OHA. AGENCY invoices COUNTY on a quarterly basis
for the administrative expenses incurred from the above responsibilities under this
Agreement, not to exceed actual costs.
2. COUNTY incurs indirect Medicaid costs in its administration of the Agreement,
including payment of AGENCY administrative costs invoiced to COUNTY as described
in paragraph 1 of this subsection and other actual Medicaid indirect costs associated
with administering the tasks authorized under this Agreement with its Providers such
as implementation of the time study requirements. COUNTY'S actual Medicaid
indirect costs must be documented and justifiable. COUNTY will include in its claim
for Total Allowable Administrative Costs to AGENCY the amount of the COUNTY'S
actual Medicaid indirect costs.
3. Consistent with Subsection II.A of this Agreement, COUNTY will obtain Provider time
study information for the purpose of obtaining reimbursement for Provider Medicaid
administrative claiming. COUNTY'S total Allowable Administrative Costs shall include
the Provider Medicaid administrative claiming information.
4. Total Allowable Administrative Costs that may be claimed by COUNTY under this
Agreement are the amounts described in paragraphs 2 and 3 of this subsection.
F. COUNTY shall invoice AGENCY quarterly, in arrears for the Total Allowable Administrative
Costs identified in Subsection E of this section.
1. AGENCY will reimburse COUNTY in arrears on a quarterly basis for the total
allowable costs of providing Medicaid administrative services accepted by AGENCY.
2. COUNTY will reimburse AGENCY quarterly upon invoice from the State for the State
match portion which is equal to 50% of the amount billed by COUNTY and accepted
by AGENCY for the total allowable Medicaid administrative costs.
G. COUNTY shall send itemized invoice to the following AGENCY supervising representative:
Attn: Serena Harris
Early Learning Division
Contracts and Procurement Office
775 Court Street NE
Salem, OR 97301
H. COUNTY represents by its Signature to this Agreement that for the purposes of 42 CFR
433.51, the funds it transfers to AGENCY pursuant to this Agreement are public funds that
are not federal funds, or are federal funds authorized by federal law through a waiver in
order for federal funds to be used as match other federal funds.
4. RECOVERY OF FUNDS
To the extent permitted by law, including without limitation, applicable constitutional, statutory
Agreement #DES1315 Deschutes County Page6of30
and regulatory provisions and controlling governmental determinations and orders, COUNTY
shall be financially responsible for the final amount of any claim for Work provided under this
Agreement that CMS, OHA, or AGENCY finds unallowable under the Medicaid program. In the
event CMS, OHA, or AGENCY finds any costs claimed by COUNTY unallowable, AGENCY
shall provide COUNTY written notice identifying the amount that must be refunded to CMS,
OHA, or AGENCY. Within thirty (30) calendar days of AGENCY'S notice, COUNTY shall either
(1) make payment to AGENCY for the full amount of the unallowable cost identified by
AGENCY in its notice; or (2) notify AGENCY in writing that COUNTY wishes to repay the
unallowable amount from future payments or other means. AGENCY may then offset the
unallowable amount from future payments owed to COUNTY under this Agreement, or any
payment to COUNTY from AGENCY under any other contract or agreement between COUNTY
and AGENCY, present or future. Nothing in this section shall be construed as a waiver by
either party of any process or remedy that might otherwise be available. The rights and
remedies of AGENCY set forth in this section shall not be exclusive and are in addition to any
other rights and remedies provided to AGENCY by law or under this Agreement.
If payment to COUNTY by AGENCY under this Agreement are made in error or are found to
be excessive under the terms of this Agreement, AGENCY, after giving written notification to
COUNTY, shall enter into nonbinding discussions with COUNTY within 15 days of the written
notification. If, after discussions, the parties agree that payments were made in error or found
to be excessive, AGENCY may withhold payments due COUNTY under this Agreement in such
amounts, and over such periods of time, as are deemed necessary by the parties to recover the
amount of the overpayment.
Nothing in this Agreement shall require COUNTY or AGENCY to act in violation of law,
including without limitation, applicable constitutional, statutory and regulatory provisions and
controlling governmental determinations and orders.
5. GENERAL PROVISIONS
A. Compliance with Law. COUNTY shall comply and shall require its Providers to comply,
with all federal, state and local laws, regulations, executive orders and ordinances
applicable to the Work under this Agreement. Without limiting the generality of the
foregoing, COUNTY expressly agrees to comply with: (i) Title VI of the Civil Right Act of
1964; Oi) Section V of the Rehabilitation Act of 1973; (iii) the Americans with Disabilities
Act of 1990 and ORS 659A.142; (iv) the Health Insurance Portability and Accountability
Act of 1996; (v) the Federal Funding Accountability and Transparency Act (FFATA) of
2006 (P.L.1 09-282), provisions of which include but may not be limited to a requirement
for County and/or Providers to have a Data Universal Numbering System (DUNS)
number and to maintain a current registration in the Central Contractor Registration
(CCR) database; (vi) all regulations and administrative rules established pursuant to the
foregoing laws; and (vii) all other applicable requirements of federal and state civil rights
and rehabilitation statutes, rules and regulations. In the perfonnance of Work under this
Agreement, COUNTY shall use recyclable and recycled products to the maximum extent
which is economically feasible. No federal funds may be used to provide Services in
violation of 42 USC 14402.
B. Subcontracts. COUNTY shall enter into subcontracts for the purposes of perfonning
Agreement #DES 1315 Deschutes County Page 7 of 30
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the Work under the Agreement. COUNTY shall not permit any person or entity to be a
Provider unless the person or entity holds all licenses, certificates, authorizations and
other approvals required by applicable law to deliver the Work. Subcontracts must be in
writing and contain each of the provisions necessary to permit COUNTY to comply with
its obligations under the Agreement with respect to the Work performed by the Provider,
and any other provisions AGENCY deems to be reasonably appropriate. COUNTY shall
maintain an originally executed copy of each subcontract at its office and shall furnish a
copy of any subcontract to AGENCY upon written request.
6. Termination.
A. The Agreement may be terminated at any time by mutual written consent of both parties,
or by either party upon thirty (30) days' notice, in writing, and delivered by certified mail or
in person. COUNTY acknowledges that AGENCY may terminate this Agreement in
accordance with this Section 6, if AGENCY determines that such termination is necessary
or desirable to continue implementation of Healthy Families Oregon programs in
accordance with Oregon law that becomes effective January 1,2014.
B. In addition, either Party may terminate the Agreement, in whole or in part, immediately
upon notice to the other, or if AGENCY terminates, at such later date as AGENCY may
choose to establish in such notice, under any of the following conditions:
1. Federal or state regulations or guidelines are modified, changed, or interpreted in such
a way that the Work under the Agreement is prohibited or AGENCY is prevented from
paying for such Work from the planned funding source;
c. AGENCY fails to receive funding, appropriations, limitations, or other expenditure authority
at levels sufficient to pay for the Work; or
D. The other party, including its employees, agents or assigns, commits any material breach
or default of any covenant, warranty, or obligation under this Agreement, fails to perform
the Work under this Agreement within the time specified herein or any extension thereof,
or so fails to pursue the Work as to endanger the other's performance under this
Agreement in accordance with its terms, and fails to correct such breach, default, or
failures within ten (10) calendar days after delivery of notice by the other Party, or if
AGENCY terminates, such longer period as AGENCY may choose to specify in such
notice.
E. Upon receiving a notice of termination from AGENCY, COUNTY shall immediately cease
all activities under the Agreement, unless expressly directed otherwise by AGENCY in the
notice of termination. Upon termination, COUNTY shall deliver to AGENCY all
Agreement documents, information, works-in-progress and other property that are or
would be deliverables had the Agreement been completed.
F. Termination of this Agreement pursuant to this Subsection G shall be without prejudice to
any obligations or liabilities of either party already accrued prior to such termination.
Specifically, but without limiting the generality of the preceding sentence, termination of
this Agreement shall neither affect AGENCY'S right to recover funds from COUNTY
Agreement #DES 1315 Deschutes County Page 8of30
pursuant to Section IV nor COUNTY'S right to payment under Subsection 3.A for Work
appropriately performed prior to termination.
G. In the event insufficient funds are appropriated for performance of the Work under this
Agreement and the COUNTY has no other lawfully available funds to pay for such Work,
then the COUNTY may terminate this Agreement at the end of its current fiscal year, with
no further liability or penalty to AGENCY.
COUNTY must deliver written notice to AGENCY of termination pursuant to this paragraph 5 not
later than {a} thirty {30} days from the determination by the COUNTY of the event of non
appropriation or (b) thirty (30) days from the end of the legislative session, whichever first occurs.
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7. Confidentiality of Client Information
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tA. The Work provided under the Agreement does not include the use of, access to, exchange
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of or disclosure of personally identifiable health information. Therefore, the parties
reasonably believe that the HIPAA Privacy Rules in 45 CPR Parts 160 and 164 do not
apply. The Agreement does not require or provide for the use of "standard transactions"
as that term is used in the HIPAA Transaction Rules, 45 CPR Part 162. If the Work is
revised, or if the federal HIPAA requirements are changed or interpreted in a way that
would require the Work to comply with any HIPAA requirement, the parties may amend
the Agreement to address such change or interpretation.
B. The use or disclosure of information conceming the administration of the Medicaid
program shall be limited to persons directly connected with the administration of this
Agreement unless otherwise authorized or required by law. AGENCY and COUNTY shall
apply confidentiality policies to all requests from outside sources.
8. Record Maintenance; Access. COUNTY shall maintain all fiscal records relating to the
Agreement in accordance with generally accepted accounting principles. In addition,
COUNTY shall maintain any other records pertinent to the Agreement in such a manner as to
clearly document COUNTY'S performance. COUNTY acknowledges and agrees that
AGENCY, OHA, the Oregon Department of Justice, the Oregon Secretary of State's
Office, and the federal government and their duly authorized representatives shall have
access to such fiscal records and other books, documents, papers, plans, and writings of
COUNTY that are pertinent to the Agreement to perform examinations and audits and to
make excerpts and transcripts. COUNTY shall retain and keep accessible all such fiscal
records, books, documents, papers, plans, and writings for a minimum of seven (7) years, or
such longer period as may be required by applicable law, following final payment and
termination of the Agreement, or until the conclusion of any audit, controversy or litigation
arising out of or related to the Agreement, whichever date is later. COUNTY shall require its
Providers to comply with the requirements in this section.
9. Notice. Except as otherwise expressly provided in the Agreement, any communications
between the parties hereto or notices to be given hereunder shall be in writing by personal
delivery, facsimile, or mailing the same, postage prepaid to COUNTY or AGENCY at the
address or number set forth below, or to such other addresses or numbers as either party
may indicate pursuant to this section. Any communication or notice so addressed and
Agreement #DES 1315 Deschutes County Page 9 of 30
mailed shall be effective on the fifth calendar day after the date of mailing. Any
communication or notice delivered by facsimile will be effective on the day the transmitting
machine generates a receipt of the successful transmission, if transmission was during
normal business hours of the recipient, or on the next business day, if transmission was
outside normal business hours of the recipient. To be effective against AGENCY, any notice
transmitted by facsimile must be confirmed by telephone notice to AGENCY'S Office of
Contracts and Procurement at (503) 373-1283.
To be effective against COUNTY, any notice transmitted by facsimile must be confirmed by
telephone notice to COUNTY'S Early Learning Division Office. Any communication or notice
given by personal delivery shall be effective when actually delivered.
Notices to AGENCY: Early Learning Division
Contracts and Procurement Office
775 Court Street NE
Salem, OR 97301
Notices to COUNTY: Deschutes County CCF
1130 NW Harriman, Suite A
Bend, OR 97701
10. Severability. The parties agree that if any term or provision of the Agreement is declared by
a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the
remaining terms and provisions shall not be affected, and the rights and obligations of the
parties shall be construed and enforced as if the Agreement did not contain the particular
term or provision held to be invalid.
11. Counterparts. The Agreement may be executed in several counterparts, all of which when
taken together shall constitute one agreement binding on all parties, notwithstanding that all
parties are not signatories to the same counterpart. Each copy of the Agreement so
executed shall constitute an original.
12. Governing Law; Venue; Consent to Jurisdiction. The Agreement shall be governed by and
construed in accordance with the laws of the State of Oregon without regard to principles of
conflicts of law. Any claim, action, suit or proceeding (collectively, "Claim") between
AGENCY (and/or any other agency of the State of Oregon) and COUNTY that arises from or
relates to the Agreement shall be brought and conducted solely and exclusively within a
circuit court in the State of Oregon of proper jurisdiction. In no event shall this section be
construed as a waiver by the State of Oregon of any form of defense or immunity, whether
sovereign immunity, governmental immunity, immunity based on the eleventh amendment to
the Constitution of the United States or otherwise, from any Claim or from the jurisdiction of
any court. COUNTY, BY EXECUTION OF THE AGREEMENT, HEREBY CONSENTS TO
THE IN PERSONAM JURISDICTION OF SAID COURTS.
13. Assignment of Contract, Successors in Interest.
A. COUNTY shall not assign or transfer its interest in the Agreement without prior written
approval of AGENCY. Any such aSSignment or transfer, if approved, is subject to such
Agreement #DES 1315 Deschutes County Page 10 of 30
conditions and provisions as the AGENCY may deem necessary. No approval by the
AGENCY of any assignment or transfer of interest shall be deemed to create any obligation
of the AGENCY in addition to those set forth in the Agreement.
B. The provisions of this Agreement shall be binding upon and shall inure to the benefit of the
parties hereto, and their respective successors and permitted assigns.
14. No Third Party Beneficiaries. AGENCY and COUNTY are the only parties to the Agreement
and are the only parties entitled to enforce its terms. The parties agree that COUNTY'S
performance under this Agreement is solely for the benefit of AGENCY to assist and enable
AGENCY to accomplish its statutory mission. Nothing in the Agreement gives, is intended to
give, or shall be construed to give or provide any benefit or right, whether directly, indirectly or
otherwise, to third persons any greater than the rights and benefits enjoyed by the general
public unless such third persons are individually identified by name herein and expressly
described as intended beneficiaries of the terms of the Agreement.
15. Integration and Waiver. The Agreement, including all of its Attachments, constitutes the
entire Agreement between the parties on the subject matter hereof. There are no
understandings, Agreements, or representations, oral or written, not specified herein
regarding the Agreement. The failure of either party to enforce any provision of the
Agreement shall not constitute a waiver by that party of that or any other provision. The
remedies provided herein are cumulative and not exclusive of any remedies provided by law.
16. Amendment. No waiver, consent, modification or change of terms of the Agreement shall
bind either party unless in writing and signed by both parties and when required the
Department of Administrative Services and Department of Justice. Such waiver, consent,
modification or change, if made, shall be effective only in the specific instance and for the
specific purpose given. COUNTY, by signature of its authorized representative, hereby
acknowledges that it has read this Agreement, understands it, and agrees to be bound by its
terms and conditions.
17. Headings. The headings and captions to sections of the Agreement have been inserted for
identification and reference purposes only and shall not be used to construe the meaning or to
interpret the Agreement.
18. Construction. This Agreement is the product of negotiations between representatives of
AGENCY and representatives of COUNTY. The provisions of this Agreement are to be
interpreted and their legal effects determined as a whole. An arbitrator or court interpreting
this Agreement shall give a reasonable, lawful and effective meaning to the Agreement to the
extent possible, consistent with the public interest.
19. Limitation of Liabilities. EXCEPT FOR LIABILITY OF DAMAGES ARISING OUT OF OR
RELATED TO SECTIONS VI AND V OF THIS AGREEMENT, NEITHER PARTY SHALL BE
LIABLE TO THE OTHER FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES
ARISING OUT OF OR RELATED TO THE AGREEMENT. NEITHER PARTY SHALL BE
LIABLE FOR ANY DAMAGES OF ANY SORT ARISING SOLELY FROM THE
TERMINATION OF THIS AGREEMENT OR ANY PART HEREOF IN ACCORDANCE WITH
ITS TERMS.
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20. Force Majeure. Neither AGENCY nor COUNTY shall be held responsible for delay or default
caused by fire, civil unrest, labor unrest, natural causes and war which is beyond
respectively, the AGENCY'S or COUNTY'S reasonable control. Each party shall, however,
make all reasonable efforts to remove or eliminate such cause of delay or default and shall,
upon the cessation of the cause, diligently pursue performance of its obligations under the
Agreement.
21. Time is of the Essence. The parties agree time is of the essence under this Agreement.
22. FEDERAL PROVISIONS
A. In addition to the requirements of Subsection V.A, COUNTY shall comply and, as
indicated, require all Providers to comply with the following federal requirements. For
purposes of the Agreement, all references to federal and state laws are references to
federal and state laws as they may be amended from time to time.
A1. Equal Employment Opportunity. If the Agreement, including amendments, is for more
than $10,000, then COUNTY shall comply with Executive Order 11246, entitled "Equal
Employment Opportunity," as amended by Executive Order 11375, and as
supplemented in Department of Labor regulations (41 CFR Part 60).
A2. Clean Air, Clean Water, EPA Regulations. If the Agreement, including amendments,
exceeds $100,000 then COUNTY shall comply with all applicable standards, orders, or
requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 1857(h)), the
Federal Water Pollution Control Act as amended (commonly known as the Clean Water
Act) (33 U.S.C. 1251 to 1387), specifically including, but not limited to Section 508 (33
U.S.C. 1368). Executive Order 11738, and Environmental Protection Agency regulations
(40 CFR Part 15), which prohibit the use under non-exempt Federal contracts, grants
or loans of facilities included on the EPA List of Violating Facilities. Violations shall be
reported to AGENCY, the U.S. Department of Health and Human Services and the
appropriate Regional Office of the Environmental Protection Agency. COUNTY shall
comply with, and include in its contracts with all Providers receiving more than $100,000
in Federal Funds language requiring the Provider to comply with, the federal laws
identified in this section.
A3. Energy Efficiency. COUNTY shall comply with applicable mandatory standards and
conservation plan issued in compliance with the Energy Policy and Conservation Act
(Pub. L. 94-163).
A4. Truth in Lobbying. COUNTY certifies, to the best of COUNTY'S knowledge and belief
that:
a. No federal appropriated funds have been paid or will be paid, by or on behalf of
COUNTY, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the
Agreement#DES1315 Deschutes County Page 12 of 30
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any federal contract, grant, loan or cooperative
agreement.
b. If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with this federal contract, grant, loan or
cooperative agreement, COUNTY shall complete and submit Standard Form LLL,
"Disclosure Fom1 to Report Lobbying" in accordance with its instructions.
c. COUNTY shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients
and subcontractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when the Agreement was made or entered into. Submission of this certification is a
prerequisite for making or entering into the Agreement imposed by section 1352, Title
31, U.S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such
failure.
AS. Resource Conservation and Recovery. COUNTY shall comply and require all
providers to comply with all mandatory standards and policies that relate to resource
conservation and recovery pursuant to the Resource Conservation and Recovery Act
(codified at 42 USC 6901 et. seq.). Section 6002 of that Act (codified at 42 USC 6962)
requires that preference be given in procurement programs to the purchase of specific
products containing recycled materials identified in guidelines developed by the
Environmental Protection Agency. Current guidelines are set forth in 40 CFR Parts 247
253.
A6. Audits. COUNTY shall comply and, if applicable, require Providers to comply, with the
applicable audit requirements and responsibilities set forth in the Office of Management
and Budget Circular A-133 entitled "Audits of States, Local Governments and Non-Profit
Organizations. "
A7. Debarment and Suspension. COUNTY shall not permit any person or entity to be a
Provider if the person or entity is listed on the non-procurement portion of the General
Service Administration's "List of Parties Excluded from Federal Procurement or
Nonprocurement Programs" in accordance with Executive Orders No. 12,549 and No.
12,689, "Debarment and Suspension" (See 45 CFR part 76). This list contains the
names of parties debarred, suspended, or otherwise excluded by agencies, and
contractors declared ineligible under statutory authority other than Executive Order No.
12549. Providers with awards that exceed the simplified acquisition threshold shall
provide the required certification regarding their exclusion status and that of their
principals prior to award.
Agreement #DES1315 Deschutes County Page 13 of 30
A8. Medicaid Compliance. To the extent COUNTY provides any Work whose costs are paid
in whole or in part by Medicaid, COUNTY shall comply with and require its Providers to
comply with the federal and state Medicaid statutes and regulations applicable to the
Work, including but not limited to:
a. Keeping such records as may be necessary to disclose the extent of services
furnished to clients and, upon request, furnish such records or other information to
OHA, the Oregon Department of Justice and the Secretary of the U.S. Department
of Health and Human Services;
b. Complying with all applicable disclosure requirements set forth in 42 CFR 1002.3(a)
and 42 CFR Part 455, Subpart B;
c. Complying with any applicable advance directive requirements specified in 42 USC
Section 1396{a)(57) and 42 CFR section 431.107(b)(4);
d. Complying with the applicable certification requirements of 42 CFR sections 455.18
and 455.19, including that information submitted with any claim for the provision of
Medicaid Services is true, accurate and complete; and
e. Requiring that entities receiving $5 million or more annually under this Agreement
and any other Medicaid contract shall, as a condition of receiving such payments,
adopt written fraud, waste and abuse policies and procedures and inform
employees, contractors and agents about the policies and procedures in compliance
with Section 6032 of the Deficit Reduction Act of 2005,42 USC §1396a(a){68).
COUNTY shall include in all agreements with Providers receiving Medicaid language requiring the
Provider to comply with the record keeping and reporting requirements set forth in this section and
with the federal laws identified in this section.
A9. Americans with Disabilities Act. COUNTY shall comply with and require all Providers
by contract to comply with Title II of the Americans with Disabilities Act of 1990 (codified
at 42 USC 12131 et. seq.) in the construction, remodeling, maintenance and operation of
any structures and facilities, and in the conduct of all programs, services and training
associated with the delivery of Work.
A10. Pro-Children Act. COUNTY shall comply with and require all Providers by contract to
comply with the Pro-Children Act of 1995 (codified at 20 USC section 6081 et. seq.).
A11. HIPAA Compliance. COUNTY shall comply with and require all Providers to comply
with Title II of the Americans with Disabilities Act of 1990 (codified at 42 USC 12131 et.
seq.) in the construction, remodeling, maintenance and operation of any structures and
facilities, and in the conduct of all programs, services and training associated with the
delivery of services.
Additional Certification: By execution of the Agreement, I, an authorized representative of
COUNTY, certify that COUNTY has provided training and education to its employees and agents
employed to comply with the required terms and conditions of this Agreement, and so require of
Agreement #DES1315 Deschutes County Page 14 of 30
them that all data, claims, submissions or other submissions that provide a basis for claiming or
receiving reimbursement under the Agreement will be true, accurate, and complete; that payment
of claims to COUNTY will be from federal and State funds, and therefore, any falsification or
concealment of a material fact by COUNTY when submitting claims or other submissions to obtain
payments may be prosecuted under federal and State laws.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly executed as
of the dates set forth below their respective signatures.
OREGON DEPARTMENT OF EDUCATION
EARLY LEARNING DIVISION
By:___________________________________
Name:__________________
Title:,_________________
Date:,_________________
DEPARTMENT OF JUSTICE
Approved for Legal Sufficiency (ORS 291.047)
THE CHAIR, BOARD OF COUNTY COMMISSIONER
By:_______________________________
Name:_ Ahm Unger, Chair
Title:_ Desehures Coumy Board ofC("nmissioners
Date:__________________
COUNTY COMMISSIONERS DELEGATE
By:__________________
Name:__________________
Title:_________________
Date:__________________
Agreement #DES 1315 Deschutes County Page 15 of 30
ATTACHMENT A
TIME STUDY ACTIVITY CODES
A1. Medicaid/OHP Outreach Activities and Facilitating Medicaid IOHP Eligibility
This code should be used when performing activities that inform eligible or potentially eligible
individuals about Medicaid/OHP/Oregon Healthy Kids. This code should also be used when
describing the range of services covered under Medicaid/OHP/Oregon Healthy Kids, how to
access and obtain them, and the benefits of Medicaid/OHP preventative services. Use this code
when assisting children and their families in applying for and becoming eligible for Medicaid/OHP.
Activities for obtaining and sharing information for Medicaid/OHP outreach and facilitating
Medicaid/OHP eligibility can be written or verbal and may occur during meetings, home visits, or
over the phone. This includes related paperwork,clerical activities, and staff travel required to
perform these activities. Please note it is not necessary that the child/family actually receive
Medicaid/OHP in order for this code to be used.
Examples:
• Informing Medicaid eligible and potential Medicaid eligible children and families about the
benefits and availability of services provided by Medicaid (including preventative treatment
and screening) including services provided through Enter Periodic Screening Diagnosis
and Treatment (EPSDT) program.
• Developing and/or compiling materials to inform individuals about the Medicaid program
(including EPSDT) and how and where to obtain those benefits. Note: this activity should
not be used when Medicaid-related materials are already available to the children and
families served in your target population (such as through the Medicaid agency). As
appropriate, obtain prior approval from Medicaid when creating/developing outreach
materials.
• Distributing literature about the benefits, eligibility requirements, and availability of the
Medicaid program, including EPSDT.
• Assisting the Medicaid agency to fulfill the outreach objectives of the Medicaid program by
informing individuals, children and their families about health resources available through
the Medicaid program.
• Providing information about Medicaid EPSDT screening (e.g., dental, vision) available that
will help identify medical conditions that can be corrected or improved by services offered
through the Medicaid program.
• Contacting pregnant and parenting women and teens about the availability of Medicaid
covered prenatal and well-baby care programs, immunizations, birth control options and
services.
• Providing information regarding Medicaid managed care programs and health plans such
as Oregon Healthy Kids to individuals and families, including how to access the system.
Agreement #DES1315 Deschutes County Page 16 of 30
• Encouraging families to access medical/dental/mental health services provided by the
Medicaid program.
• Verifying an individual's current Medicaid eligibility status for purposes of the Medicaid
eligibility process. (This may be accomplished by performing an eligibility check on-line, by
reviewing the medical card, or contacting a local DHS/OHA facility to verify status of
eligibility.)
• Reminding or assisting families to reapply for OHP to keep it current.
• Explaining Medicaid eligibility rules and the Medicaid eligibility process to prospective
applicants.
• Assisting individuals or families complete a Medicaid eligibility application
• Gathering information related to the application and eligibility determination process for an
individual, including resource information and third party liability (TPL) information, as a
prelude to submitting a formal Medicaid application.
• Providing necessary forms and/or packaging forms in preparation for Medicaid eligibility
determination.
• Referring an individual or family to a local assistance office to make application for
Medicaid benefits.
• Assisting an individual or family in collecting/gathering required information and documents
for the Medicaid application.
• Identifying enrolled providers to provide Medicaid covered services, such as:
immunizations, well child exams, dental services, mental health services.
• Participating as a Medicaid eligibility outreach outstation. NOTE: excludes determining
eligibility.
• Preparing, presenting and disseminating child health related materials identifying Medicaid
covered services and how to access such services including preventative health care and
substance abuse prevention programs, related staff travel and paperwork.
• Informing parents/families on how to appropriately access/use Medicaid-covered medical
care/services.
A2. Outreach and Application Assistance for Non-Medicaid/OHP Programs:
Activities that assist the child/family in gaining access to non-Medicaid/OHP services and
effectively utilizing social services and community wellness programs. (Included are housing,
commodities, food banks, Women's Infant and Children Program ("WIC"), foster care, financial
assistance, exercise and weight loss programs, energy assistance, child care, after school
Agreement#DES1315 Deschutes County Page 17 of 30
programs, friendly visitor and vocational services.) Providers that are not enrolled with Medicaid or
part of Medicaid Managed care network of providers and activities that assist the child/family in
applying for these services, including form preparation, related staff travel, clerical, and
paperwork.
Examples:
• Informing families about general health education programs or campaigns and how to
access them, conducting, scheduling or promoting these programs.
• Scheduling and promoting activities which educate individuals about the benefits of healthy
lifestyles, home safety and accident prevention.
• Non-Medicaid/OHP outreach directed toward encouraging persons to access social,
educational, legal, or other services not covered by Medicaid/OHP.
• Explaining eligibility rules and the eligibility process to prospective applicants for NON-OHP
programs, providing the necessary forms and packaging all forms in preparation for such
NON-OHP services.
• Informing individuals and families about NON-OHP programs, such as Housing, food
banks, Foster Care, Financial Assistance for needy families TANF, Food Stamps, Women's
Infant and Children (WIC) program, Childcare, Legal Aid and other NON-OHP social or
educational programs, and referring them to the appropriate agency to make application for
such services.
• Providing outreach, developing and verifying initial and continuing eligibility for the Free and
Reduced Lunch Program.
81. Referral, Coordination, Monitoring, and Training of Medicaid/OHP Covered Services
Staff should use this code when making referrals for, coordinating, and/or monitoring the delivery
of, (Medicaid-covered) services. This code may also be used when coordinating or participating in
training events and seminars for outreach staff regarding the benefits of the Medicaid/OHP
program, how to assist families to access Medicaid-covered services, and how to more effectively
refer participants for services. Activities that are an integral part of or an extension of a direct
medical service are not claimable as an administrative activity and must be reported as E. Note:
Targeted case management is also not claimable as an administrative activity and must be
reported as E. Claimable activities reported include related staff travel, clerical, and paperwork.
Note: If medically licensed staff provide these activities they are considered integral to Medical
services they provide whether they are actively billing Medicaid for direct medical services or not
must be reported under E for Direct Healthcare Services.
• Monitoring, coordination, and training of Medicaid/OHP services: for vulnerable
children and families, including agency staffing to coordinate Medicaid/OHP services
for child health and development, (Note: this does not include Individualized Family
Services Goal Plan meetings), arranging for Medicaid-covered services, coordinating
child specific Medicaid-covered services in coordination with services identified (Le.
Agreement #DES 1315 Deschutes County Page 18 of 30
psychological counseling, health, substance abuse counseling and consultation),
related staff travel and paperwork.
• Referral and Coordination: Gathering information in advance of a referral for a
Medicaid-covered service utilizing questionnaires (i.e. New Baby Questionnaire or
Family Update). Making referrals for and coordinating Medicaid covered screenings,
examinations, assessments and evaluations for health, vision, dental, developmental,
mental health, substance abuse, and other Medicaid-covered medical services.
Contacts with parents regarding their child's Medicaid covered healthcare needs.
Gathering background information and supportive data such as social history and
medical history. Helping families meet goals related to Medicaid covered services and
coordinating medical care with partnering agencies also serving the family such as
Early Intervention and/or Community Health Nurses, and related staff travel and
paperwork.
• Immunization: Scheduling immunizations, coordination of immunizations for children,
related staff travel and paperwork.
• Maternal Care Services: Referring for Medicaid-covered prenatal, postpartum and
newborn care, pre-pregnancy risk prevention, family planning and related staff travel
and paperwork.
• Developmental Delay: Gathering information in advance of a referral for a Medicaid
covered service utilizing Ages and Stages Questionnaire (ASQ) and ASQ Social
Emotional Questionnaire for early identification of age appropriate child development
and/or delays to assure health and developmental problems are found, diagnosed and
treated. Coordinating or referring for early Medicaid-covered medical consultation and
evaluations, related staff travel and paperwork. Participating in or coordinating training
which improves the delivery of Medicaid/OHP services, enhances early identification,
intervention, screening and referral of children with special health needs.
82. Case Planning, Monitoring, Coordination, Referral and Training of Non
Medicaid/OHP Covered Services
• Assessing and monitoring of the home learning environment using standardized
forms, creating and disseminating information on positive and interactive learning
environments, providing or arranging for reading material for the child, providing or
arranging for age appropriate toys.
• Classroom instruction or presentations, preparation, related paperwork and travel,
attendance at conferences, providing educational or career guidance or consultation.
Includes related staff travel, clerical, and paperwork.
• Case management of social services and community well ness programs (including
housing, commodities, food banks, WIC, foster care, financial assistance, exercise
and weight loss programs, energy assistance, child care, after school programs,
friendly visitor and vocational services) arranging transportation for these services.
Making referrals for and coordinating the delivery of these social services and
Agreement #DES1315 Deschutes County Page 19 of 30
community well ness programs. Arranging transportation for these services and
coordinating or participating in training events and seminars for these services.
Includes related staff travel, clerical, and paperwork.
• Making direct referrals to social services such as housing, energy assistance,
educational and/or special education, childcare, education and Early Intervention,
vocational and transportation to these services, etc., monitoring and follow-up.
Includes related staff travel, clerical and paperwork.
• Participating in or coordinating training which improves the delivery of non
Medicaid/OHP services.
Examples:
• Helping families meet non Medicaid covered related goals
• General education and referrals about topics like nutrition, normal breastfeeding, exercise,
wellness, attachment, infant development
• Sharing toys, making toys
• Literacy
• Parent child interactions
C1. Medicaid/OHP Transportation and Translation:
Assisting an individual to obtain transportation to services covered by OHP, arranging for or
providing translation services to facilitate access to OHP services. This does not include the
provision of the actual transportation services, but rather the administrative activities involved in
arranging or scheduling transportation to a Medicaid covered service. Translation services must
be provided by an employee whose role is performing translation functions to facilitate access to
Medicaid-covered services. Include related paperwork, clerical activities or staff travel required to
perform these activities.
Examples:
• Arranging for or providing translation services (oral and signing) that assist the
individual to access and understand necessary care or treatment covered by Medicaid.
• Developing translation materials that assist individuals to access and understand
necessary care or treatment covered by Medicaid.
• Scheduling or arranging transportation to Medicaid/OHP covered services
• Related staff travel and paperwork
C2. Non-Medicaid/OHP Transportation and Translation means:
Assisting an individual to obtain transportation to services not covered by Medicaid/OHP, or
arranging for or providing translation services related to social, vocational, or educational
programs. Include related paperwork, clerical activities or staff travel time required to perform
these activities.
Special Note: Use this code when accompanying an individual to non-Medicaid/OHP services.
Agreement#DES1315 Deschutes County Page 20 of 30
I
D1. Program Planning, Policy Development, and Interagency Coordination Related to !
lMedicaid/OHP Services
Performing activities associated with the development of strategies to improve the coordination
and delivery of medical/dental/mental health services, and when performing collaborative activities rwith other agencies and/or providers. Planning and developing procedures to track requests for I fservices; the actual tracking of requests for Medicaid services would be coded under 81 Referral,
Coordination and Monitoring of Medical Services. Working internally and with other agencies to
improve services, expand health and medical services and their utilization to specific target
populations, gathering information about their functions, to improve early identification of health
and developmental problems, related staff travel, clerical, and paperwork.
Examples:
• Identifying gaps or duplication of medical/dental/mental services and developing strategies
to improve the delivery and coordination of these services.
• Developing strategies to assess or increase the capacity of medical/dental/mental health
programs.
• Monitoring medical/dental/mental health delivery systems.
• Developing procedures for tracking families' requests for assistance with
medical/dental/mental services and providers, including Medicaid. (This does not include
the actual tracking of requests for Medicaid services.)
• Evaluating the need for medical/dental/mental services in relation to specific populations or
geographic areas.
• Analyzing Medicaid data related to a specific program, population, or geographic area.
• Working with other agencies and/or providers that provide medical/dental/mental services
to improve the coordination and delivery of services, to expand access to specific
populations of Medicaid eligibles, and to increase provider participation and improve
provider relations.
• Working with other agencies and/or providers to improve collaboration around the early
identification of medical/dental/mental problems.
• Developing strategies to assess or increase the cost effectiveness of medical/dental/mental
health programs.
• Defining the relationship of each agency's Medicaid services to one another.
• Working with Medicaid resources, such as the Medicaid agency and Medicaid managed
care plans, to make good faith efforts to locate and develop EPSDT health services referral
relationships.
• Developing advisory or work groups of health professionals to provide consultation and
advice regarding the delivery of health care services.
• Working with the Medicaid agency to identify, recruit and promote the enrollment of
potential Medicaid providers.
• Developing medical referral sources such as directories of Medicaid providers and
managed care plans who will provide services to targeted population groups, e.g., EPSDT
children.
• Coordinating with interagency committees to identify, promote and develop EPSDT
services
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• System coordination, community meetings to improve services, expand access to OHP,
improve system of care.
• Developing a family planning, education, counseling and service program compatible with
community norms, locating or developing family planning information and materials and
methods of distribution, developing a family planning service referral network
• Notifying medical providers of Healthy Start/Healthy Families Oregon services and
coordination opportunities.
• Recruitment of enrolled providers to provide Medicaid covered services, such as:
immunizations, well child exams, dental services, and mental health services.
• System coordination to improve delivery of immunizations.
• Related supervision, travel, case conferences, team meetings and paperwork.
D2. Coordination Related to Non-Medicaid/OHP Services
Working internally and with other agencies to improve social services, identify gaps in services,
expand and improve capacity to engage in non-Medicaid/OHP activities, expand access and
linkage to non-Medicaid/OHP services, their utilization by specific target populations; related staff
travel, clerical, and paperwork.
E. Direct Health Care Services
Providing medical care, treatment, and/or counseling services to an individual. This code also
includes administrative activities that are an integral part of or extension of a medical service (e.g.,
patient follow-up, patient assessment, patient counseling, patient education, parent consultations,
billing activities). This code also includes all related paperwork, clerical activities, or staff travel
required to perform these activities.
• Providing health/mental health services.
• Medical/health assessment and evaluation.
• Conducting medical/health assessments/evaluations and diagnostic testing and preparing
related reports.
• Providing personal aide services.
• Providing speech, occupational, physical and other therapies.
• Administering first aid, or prescribed injection or medication.
• Providing direct clinical/treatment services.
• Performing developmental assessments.
• Providing counseling services to treat health, mental health, or substance abuse conditions.
• Developing a treatment plan (medical plan of care) for a student if provided as a medical
service.
• Performing routine or mandated child health screens including but not limited to vision,
hearing, dental, scoliosis, and EPSDT screens.
• Providing immunizations.
F. General Administration/Other Services
General administrative functions, such as payroll, maintaining inventories, developing budgets,
executive direction, lunches, paid leave, educational or professional development conferences,
Agreement #DES 1315 Deschutes County Page 22 of 30
staff meetings, and personnel issues.
Examples:
• Paid lunches, breaks, or other time not at work
• Paid time off (vacation, sick)
• Most trainings, conferences and meetings (not related to Medicaid covered services)
• Personnel issues
• Emails and phone messages, general office work, filing
• Establishing goals and objectives of health-related programs as part of an annual or multi
year plan.
• Reviewing agency procedures and rules.
• Attending or facilitating staff or board meetings.
• Performing administrative or clerical activities related to general building or agency
functions or operations.
• Providing general supervision of staff, including assistants or volunteers, and evaluation of
employee performance.
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Agreement #DES 1315 Deschutes County Page 23 of 30
ATTACHMENT B
ADDITIONAL REQUIREMENTS
AGENCY hereby grants COUNTY the authority to subcontract the Work required under this
Agreement but COUNTY may not assign or transfer any of its interests in this Agreement without
the prior written consent of the AGENCY. AGENCY'S consent to subcontracts shall not relieve
COUNTY of any of its duties or obligations under this Agreement. In addition to any other
provisions AGENCY may require, COUNTY shall include in any permitted subcontract under this
Agreement a requirement that subcontractor be bound by the following provisions as if the
subcontractor were COUNTY:
1. STATEMENT OF WORK
A. COUNTY RESPONSIBILITIES.
COUNTY SHALL:
A1. Utilize the specific activity codes ("Activity Codes") for time study ("Time Study"), as set
forth in Attachment A, and approved by Oregon Health Authority (OHA) and the U.S.
Department of Health and Human Services, Centers for Medicare and Medicaid Services
("CMS") to document all time spent on the Work and to claim all costs under this
Agreement for allowable Medicaid administrative activities.
A2. Ensure training is available and provided to its employees and subcontractors on the
implementation of the Time Study and Activity Codes to ensure COUNTY'S subcontractors
make claims only for allowable Medicaid administrative activities.
A3. Ensure that all reimbursement claims for the Work are in accordance with 2 CFR PART
225 (OMS Circular A-87) and the State Medicaid Plan, both of which are incorporated
herein by this reference. The Work for which COUNTY claims reimbursement must be
directly related to the administration of the State Medicaid Plan for Federal Financial
Participation (FFP) to be available.
A4. Maintain the following information on employees and subcontractors who perform Work
under this Agreement: the employee's or subcontractors employee's name, title, job
description, salary, and other personnel expenses for each individual; the percent of time
each employee spends on the coded activities identified in the Time Study; costs
attributable to each person's position providing Work; the salary of each person providing
Work under subcontracts.
AS. Claim indirect costs in accordance with 2 CFR PART 225 (OMS Circular A-87).
A6. Monitor compliance with the requirements of this Agreement and maintain all records that
support the quarterly payment claim for the Work performed, including but not limited to,
position details, cost information, Time Study results, records to indicate that services
were requested and the extent of services provided, other resources that have been
applied to offset costs, and any other information applicable to the Work provided under
Agreement #DES1315 Deschutes County Page 24 of 30
I
I
I
A7. Upon request from AGENCY, aHA, the Oregon Department of Justice, the Secretary of
State's Office, or the federal government, make available all records that support the l t
this Agreement.
quarterly payment claim for Work performed.
A8. Assure that Medicaid eligible children and families receiving assistance under this
Agreement are free to accept or reject Medicaid services and/or to receive such services
from an enrolled provider of their choice unless otherwise restricted to a provider of the
Oregon Health Plan by aHA.
A9. Use the Medicaid-eligible percentage for the COUNTY in its cost calculations unless
another statistically based calculation has been approved by AGENCY and aHA.
B. EARLY LEARNING DIVISION RESPONSIBILITIES.
ELD SHALL:
B1. Ensure its sub agreements for the purpose of carrying out the Work under this Agreement
are in compliance with requirements described in Section H below.
B2. Utilize the specific Time Study Activity Codes as set forth in Attachment A Time Study
Activity Codes.
B3. Ensure that all reimbursement claims for the costs related to provision of the Work are in
accordance with Title 2 CFR Part 225 (OMS CircLllar A-87) and the State Medicaid Plan,
which are incorporated herein by this reference.
B4. Claim indirect costs in accordance with Title 2 CFR Part 225 (OMS Circular A-87).
B5. Provide aHA with a signed copy of the subcontract boilerplate executed for the purpose
of carrying out the Work under this Agreement.
B6. Monitor subcontracts to ensure that the Medicaid administrative activities and costs being
claimed by subcontractors are allowable and related to the purpose of this Agreement.
B7. Monitor compliance with the requirements of this Agreement and maintain all records that
support the quarterly payment claim for the Work performed including, but not limited to,
position details, cost information, Time Study results, records to indicate that services
were requested and the extent of services provided, other resources that have been
applied to offset costs, and any other information applicable to the Work provided under
this Agreement.
B8. Transfer the 50% state match portion of total amount claimed for each completed survey
period for allowable Medicaid administrative claiming activities submitted to the aHA.
Transfers must be made quarterly in arrears, to aHA.
Agreement #DES 1315 Deschutes County Page 25 of 30
2. CONSIDERATION.
COUNTY shall submit claims for Medicaid allowable activities only. Medicaid does not pay for
administrative expenditures related to, or in support of, services that are not included in the
State Medicaid Plan, OHP, or services which are not reimbursed under Medicaid. In addition,
Medicaid does not pay for health care services that are rendered free of charge to the general
population. Thus, any administrative activity which supports the referral, coordination, planning
of screening or services that are provided free to the general population would not be
considered as Medicaid administration.
3. GENERAL PROVISIONS
A. Amendment
The terms of this Agreement shall not be waived, altered, modified, supplemented or
amended, in any manner whatsoever, except by written agreement signed by the Parties.
This Agreement shall not be amended after the expiration date. No amendment to this
Agreement shall be effective until it has been signed by all Parties and all
necessary governmental approvals have been obtained.
B. Compliance with Applicable Law
COUNTY shall comply with all federal, state and local laws, regulations, executive orders
and ordinances applicable to the Work under the Agreement. Without limiting the
generality of the foregoing, COUNTY expressly agrees to comply with the following laws,
regulations and executive orders, as they may be amended from time to time during the
term of the Agreement, to the extent they are applicable to the Agreement: (i) Titles VI
and VII of the Civil Rights Act of 1964, as amended; (ii) Sections 503 and 504 of the
Rehabilitation Act of 1973, as amended; (iii) the Americans with Disabilities Act of 1990,
as amended; (iv) Executive Order 11246, as amended; (v) The Age Discrimination in
Employment Act of 1967, as amended, and the Age Discrimination Act of 1975, as
amended; (vi)The Vietnam Era Veterans' Readjustment Assistance Act of 1974, as
amended; (vii) The Family Educational Rights and Privacy Act, as amended; (viii) ORS
Chapter 659, as amended; (ix) all regulations and administrative rules established
pursuant to the foregoing laws; and (x) all other applicable requirements of federal and
state civil rights and rehabilitation statutes, rules and regulations. These laws, regulations
and executive orders are incorporated by reference herein to the extent that they are
applicable to the Agreement and required by law to be so incorporated. AGENCY'S
performance under this Agreement is conditioned upon COUNTY'S compliance with the
provisions of ORS 279.312, 279.314, 279.316, and 279.320, which are incorporated by
reference herein. In the performance of Work under this Agreement, COUNTY shall use
recycled and recyclable products to the maximum extent which is economically feasible.
4. Compliance with Federal Law
A. Equal Employment Opportunity
If this Agreement, including amendments, is for more than $10,000, then COUNTY shall
Agreement #DES 1315 Deschutes County Page 26 of 30
comply with Executive Order 11246, entitled "Equal Employment Opportunity," as
amended by Executive Order 11375, and as supplemented in Department of Labor
regulations (41 CFR Part 60).
B. Clean Air, Clean Water, EPA Regulations
If this Agreement, including amendments, exceeds $100,000 then COUNTY shall comply
with all applicable standards, orders, or requirements issued under Section 306 of the
Clean Air Act (42 U.S.C. 1857(h», the Federal Water Pollution Control Act as amended
(commonly known as the Clean Water Act) (33 U.S.C. 1251t01387), specifically including,
but not limited to Section 508 (33 U.S.C. 1368). Executive Order 11738, and
Environmental Protection Agency regulations (40 CFR Par 15), which prohibit the use
under non-exempt Federal contracts, grants or loans of facilities included on the EPA List
of Violating Facilities. Violations shall be reported to AGENCY, OHA, the U.S. Department !
of Health and Human Services, and the appropriate Regional Office of the Environmental I
Protection Agency, COUNTY shall include and cause all subcontractors to include in all
contracts with subcontractors receiving more than $100,000 in Federal Funds, language
requiring the subcontractor to comply with the federal laws identified in this section.
C. Energy Efficiency r
!
i
COUNTY shall comply with applicable mandatory standards and policies relating to energy
efficiency that are contained in the Oregon energy conservation plan issued in compliance
with the Energy Policy and Conservation Act (Pub. L. 94-163). ~
D. Truth in Lobbying I
COUNTY certifies, to the best of the COUNTY'S knowledge and belief that: f
t a. No federal appropriated funds have been paid or will be paid, by or on behalf of
COUNTY, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any federal contract, grant, loan or cooperative
agreement.
b. If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this federal contract, grant,
loan or cooperative agreement, COUNTY shall complete and submit Standard Form
LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions.
c. COUNTY shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all
Agreement #DES 1315 Deschutes County Page 27 of 30
subreceipients and subcontractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this Agreement was made or entered into. Submission of this certification is a
prerequisite for making or entering into this Agreement imposed by section 1352,
Title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.
E. Resource Conservation and Recovery
COUNTY shall comply and cause all subcontractors to comply with all mandatory
standards and policies that relate to resource conservation and recovery pursuant to the
Resource Conservation and Recovery Act (codified at 42 USC 6901 et. seq.). Section
6002 of that Act (codified at 42 USC 6962) requires that preference be given in
procurement programs to the purchase of specific products containing recycled materials
identified in guidelines developed by the Environmental Protection Agency. Current
guidelines are set forth in 40 CPR Parts 247-253.
F. Audits
COUNTY shall comply and, if applicable, cause a subcontractor to comply, with the
applicable audit requirements and responsibilities set forth in the Office of Management
and Budget Circular A-133 entitled "Audits of States, Local Governments and Non-Profit
Organizations. "
G. Debarment and SuspenSion
COUNTY shall not permit any person or entity to be a subcontractor if the person or entity
is listed on the non-procurement portion of the General Service Administration's "List of
Parties Excluded from Federal Procurement or Nonprocurement Programs" in
accordance with Executive Orders No. 12,549 and No. 12,689, "Debarment and
Suspension". (See 45 CFR part 76). This list contains the names of parties debarred,
suspended, or otherwise excluded by agencies, and contractors declared ineligible under
statutory authority other than Executive Order No. 12549. Subcontractors with awards
that exceed the simplified acquisition threshold shall provide the required certification
regarding their exclusion status and that of their principals prior to award.
H. Medicaid Compliance
To the extent COUNTY provides any service whose costs are paid in whole or in part by
Medicaid, COUNTY shall comply with and require its subcontractors to comply with the
federal and state Medicaid statutes and regulations applicable to the service, including
but not limited to:
a. Complying with all applicable disclosure requirements set forth in 42 CFR Part 455,
Subpart B;
Agreement #DES1315 Deschutes County Page 28 of 30
b. Complying with any applicable advance directive requirements specified in 42 CFR
section 431.107(b)(4);
c. Complying with the certification requirements of 42 CFR sections 455.18 and 455.19;
and.
d. Requiring that entities receiving $5 million or more annually under this Agreement and
any other Medicaid contract shall, as a condition of receiving such payments, adopt
written fraud, waste and abuse policies and procedures and inform employees,
contractors and agents about the policies and procedures in compliance with Section
6032 of the Deficit Reduction Act of 2005,42 USC §1396a(a)(68).
COUNTY shall include and require all subcontractors to include in all contracts with
subcontractors receiving Medicaid, language requiring the subcontractor to comply
with the requirements set forth in this section and with the federal laws identified in this
section.
I. Americans with Disabilities Act
COUNTY shall comply and require all subcontractors to comply with Title II of the
Americans with Disabilities Act of 1990 (codified at 42 USC 12131et. seq.) in the
construction, remodeling, maintenance and operation of any structures and facilities, and
in the conduct of all programs, services and training associated with the delivery of
services.
J. Pro-Children Act
COUNTY shall comply and require all subcontractors to comply with the Pro-Children Act
of 1995 (codified at 20 USC section 6081 et. seq.).
5. No Third Party Beneficiaries
The parties to this agreement are the only parties entitled to enforce its terms. Nothing in the
Agreement gives, is intended to give, or shall be construed to give or provide any benefit or
right, whether directly, indirectly or otherwise, to third persons unless such third persons are
individually identified by name herein and expressly described as intended beneficiaries of the
terms of this Agreement.
6. Confidentiality of Client Information
A. COUNTY shall treat all information as to personal facts and circumstances obtained by
COUNTY on Medicaid eligible individuals as privileged communication, shall hold such
information confidential, and shall not disclose such information without the written
consent of the individual, his or her attorney, the responsible parent of a minor child, or the
child's guardian, except as required by law. Nothing prohibits the disclosure of information
in summaries, statistical information, or other form which does not identify particular
individuals.
Agreement #DES 1315 Deschutes County Page 29 of 30
B. The use or disclosure of information concerning Medicaid eligible or potentially eligible
individuals shall be limited to persons directly connected with the administration of this
Agreement. Confidentiality policies shall be applied to all requests from outside sources.
AGENCY, COUNTY, OHA and subcontractors will share information as necessary to
effectively serve Medicaid eligible, or potentially eligible individuals.
C. To the extent that any individually identifiable health information about students is used to
perform the Work under this Agreement, the confidentiality of that information is governed
by the Family Educational Rights and Privacy Act. Accordingly, such student information is
not included within the requirements of the Privacy Rules, 45 CPR Part 164,adopted by the
U.S. Department of Health and Human Services to implement the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA"). In addition, this Agreement does not
require or provide for the use of "standard transactions" as that term is used in the HIPAA
transaction rules, 45 CPR Part 162. If the Work is revised, or if the federal HIPAA
requirements are changed, in a material way that would require compliance with HIPAA,
the Parties may amend the Agreement to address such material changes.
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Agreement #DES1315 Deschutes County Page 30 of 30
