The URL can be used to link to this page

Home My WebLink AboutDoc 268 - IGA - State Funding for Behav HealthDeschutes 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 July 3, 20t3 DATE: June 25,2013 FROM: Nancy Mooney, Contract Specialist, Deschutes County Health Services, 322-7516 TITLE OF AGENDA ITEM: Consideration of Board Signature of Document #2013-268, Intergovernmental Financial Agreement Award #141408 between Deschutes County Health Services, Behavioral Health Division and the Oregon Health Authority for the financing of Community Addictions and Mental Health Services for year 2013-2015. PUBLIC HEARING ON THIS DATE? No. BACKGROUND AND POLICY IMPLICATIONS: The Oregon Health Authority (OHA) was created by the 2009 Oregon legislature to bring most health-related programs in the state into a single agency to maximize its purchasing power; the attached Intergovernmental Agreement (#141408) outlines the services and financing for fiscal year 2013-2015. OHA is at the forefront of lowering and containing costs, improving quality and increasing access to health care in order to improve the lifelong health of Oregonians. In the public sector, OHA will consolidate most of the state's health care programs, including Addictions &Mental Health Services (AMH), Public Health, the Oregon Health Plan (OHP), HealthyKids Connect, employee benefits and public-private partnerships. This will give the state greater purchasing and market power to begin tackling issues with costs, quality, lack of preventive care and health care access. In both the public and the private sector, OHA will be working to fundamentally improve how health care is delivered and paid for, but because poor health is only partially due to lack of medical care, OHA will also be working to reduce health disparities and to broaden the state's public health focus. Ultimately, OHA is charged with delivering a plan to the Legislature to ensure that all Oregonians have access to affordable health care. The 2013-2015 biennium Intergovernmental Agreement for the Financing of Community Addictions and Mental Health Services sets the dollar amounts and guidelines for Deschutes County Health Services to provide or coordinate provision of behavioral health as well as alcohol, other drug and problem gambling prevention and treatment services for the next two (2) years. FISCAL IMPLICATIONS: Funding reimbursement for FY 13-15 is estimated to be $3,359,931. RECOMMENDATION & ACTION REQUESTED: Approval and signature of Document #2013-268, Intergovernmental Financial Agreement Award #141408 between Deschutes County Health Services, Behavioral Health and the Oregon Health Authority is requested. ATTENDANCE: Scott Johnson, Director and/or DeAnn Carr DISTRIBUTION OF DOCUMENTS: E-Mail (tami.j.goertzen@state.or.us) Tami Goertzen, signed Page 2 of the agreement, a completed page 19. "Notices" of Exhibit G, and the completed, signed Document Return Statement. Original documents to Nancy Mooney at Health Services. DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This fonn 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 Fonn is also required. If this fonn 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 fonn with your documents, please submit this fonn electronically to the Board Secretary.) Please complete all sections above the Official Review line. Date: I June 13,2013 Department: I Health Services, Behavioral Health Contractor/Supplier/Consultant Name: I Oregon Health Authority Contractor Contact: I April Barrett I Contractor Phone #: I 503-945-5821 Type of Document: Intergovernmental Agreement Goods and/or Services: The Oregon Health Authority (OHA) was created by the 2009 Oregon legislature to bring most health-related programs in the state into a single agency to maximize its purchasing power; the attached Intergovernmental Agreement (#141408) outlines the services and financing for the Health Services Department, Behavioral Health division, for the 2013-2015 fiscal year. Background & History: OHA is at the forefront of lowering and containing costs, improving quality and increasing access to health care in order to improve the lifelong health of Oregonians. In the public sector, OHA will consolidate most of the state's health care programs, including Public Health, the Oregon Health Plan (OHP), HealthyKids Connect, employee benefits and public-private partnerships. This will give the state greater purchasing and market power to begin tackling issues with costs, quality, lack of preventive care and health care access. In both the public and the private sector, OHA will be working to fundamentally improve how health care is delivered and paid for, but because poor health is only partially due to lack of medical care, OHA will also be working to reduce health disparities and to broaden the state's public health focus. Ultimately, OHA is charged with delivering a plan to the Legislature to ensure that all Oregonians have access to affordable health care. The 2013-2015 biennium Intergovernmental Agreement for the financing of community addictions and mental health services sets forth the dollar amounts and guidelines for Deschutes County Health Services to provide or coordinate provision of behavioral health and developmental disability treatment services to individuals, as well as alcohol, other drug and problem gambling prevention and treatment services for the coming two (2) years. Agreement Starting Date: I July 01, 2013 I Ending Date: I June 30, 2015 Total Payment: I Maximum compensation is estimated at $3,359,931. 6113/2013 Check all that apply: o RFP, Solicitation or Bid Process o Informal quotes «$150K) ~ Exempt from RFP, Solicitation or Bid Process (specify -see DCC §2.37) Funding Source: (Included in current budget? ~ Yes D No If No, has budget amendment been submitted? DYes D No Is this a Grant Agreement providing revenue to the County? D Yes ~ No Special conditions attached to this grant: Deadlines for reporting to the grantor: 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: DYes D No Contact information for the person responsible for grant compliance: Name: Phone#:D Departmental Contact and Title: I Nancy Mooney, Contract Specialist I Phone #: I 541-322-7516 I Deputy Director Approval: 1025l3Department Director Approval: --.::........'f-I'It'--'-"'------ Date Distribution of Document: E-Mail tami.·.oertzenstate.or.us) Tami Goertzen, signed Page 2 of the agreement, a completed page 19. "Notices" of Exhibit G, and the completed, signed Document Return Statement. Original documents to Nancy Mooney at Health Services. Official Review: County Signature Required (check one): ~ BOCC 0 Department Director (if <$25K) o Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ____-' Legal Review ~,(lAj) Date t -2(;.. -( :5 Document Number: =20=-1.:...::3~-2=6:::..:8=---______ 6/13/2013 Nancy Mooney From: Barrett Flesh Sent: Tuesday, June 11, 2013 5:26 PM To: Lori Hill; Nancy Mooney; DeAnn Carr Subject: RE: Can we move forward with signing the new OHA agreement? (attached) OeAnn, I have reviewed and can approve the service element portions that pertain to Child and Family programs-these include MHS 22;MHS 26; MHS 27 and relevant portions of MHS 37 (Flexible Funding). Program areas include; Child & Adolescent Mental Health Services; Non-Residential Youth and Young Adults Mental Health Services In Transition (Designated)~ and Residential Youth and Young Adults Mental Health Services In Transition (MHS 26 & 27 only as they may apply). It would have been nice if they had included an index. It is massive. For reference, exhibit 0-1 starts on page 252. Barrett -----Original Message---- From: Lori Hill Sent: Tuesday, June 11, 2013 5: 15 PM To: Nancy Mooney; DeAnn Carr; Barrett Flesh Subject: RE: Can we move forward with signing the new OHA agreement? (attached) OeAnn I have reviewed and can approve the service element portions that pertain to the adult program these include MHS 20; MHS 28; MHS 28A; MHS 31; MHS 34; MHS 35; MHS 36MHS 39; and relevant portions of MHS 37 Flexible funding which include acute care. Crisis/pre-commitment, PSRB, General out-pat, A&D, SE/ACT,Jaii Diversion and Co-Mngt Heads up that it looks like there are additional department-wide reporting requirements under Financial Section of MHS 37 that will need review. Financial numbers probably need Sherri's review? This is a massive document -and it may make sense for a review in manager's meeting at some point of key elements to make sure all are clear on any new department wide requirements. Just a thought as there is seems to be alot of new general info. Lori -----Original Message---- From: Nancy Mooney Sent: Tuesday, June 11,20134:33 PM 1 Nancy Mooney From: Lori Hill Sent: Tuesday, June 111 2013 5:15 PM To: Nancy Mooney; DeAnn Carr; Barrett Flesh Subject: RE: Can we move forward with signing the new OHA agreement? (attached) DeAnn I have reviewed and can approve the service element portions that pertain to the adult program these include MHS 20; MHS 28; MHS 28A; MHS 31; MHS 34; MHS 35; MHS 36MHS 39; and relevant portions of MHS 37 Flexible funding which include acute care. Crisis/pre-commitment, PSRB, General out-pat, A&D, SE/ACT,Jail Diversion and Co-Mngt Heads up that it looks like there are additional department-wide reporting requirements under Financial Section of MHS 37 that will need review. Financial numbers probably need Sherri's review? This is a massive document -and it may make sense for a review in manager's meeting at some point of key elements to make sure all are clear on any new department wide requirements. Just a thought as there is seems to be alot of new general info. Lori -----Original Message---- From: Nancy Mooney Sent: Tuesday, June 11, 20134:33 PM To: DeAnn Carr; Lori Hill; Barrett Flesh Subject: Can we move forward with signing the new OHA agreement? (attached) Importance: High Hello, I just wanted to check-in about signing the new OHA agreement which outlines the service elements and funding for 2013-2015. Please approve the portion of the contract that is applicable to your program. I can't move forward until I hear from you. Thank you! Nancy Mooney Contract Specialist 541-322-7516 phone 541-322-7565 fax Deschutes County Health Services 2577 NE Courtney Drive 1 I ADMINISTRATIVE SERVICES DIVISION)tQtt~orlm'"t ] [ealth of Human Services Office of Contracts and Procurement Authority John A. Kitzhaber, MD, Governor 250 Winter St NE, Room 306 Salem, OR 97301 Voice: (503) 945-5818 FAX: (503) 378-4324 DOCUMENT RETURN STATEMENT Re: Amendment #00 to Agreement #141408 hereinafter referred to as "Document." Please complete the following statement and return it along with the completed signature page and the Contractor Data and Certification page and/or Contractor Tax Identification Information form (if applicable). Important: If you have any questions or find errors in the above referenced Document, please contact the contract specialist, April D. Barrett at (503) 945-5821. (Name) (Title) received a copy of the above referenced Document, between the State of Oregon, acting by and through its Oregon Health Authority, and Deschutes County, bye-mail from April D. Barrett on May 20, 2013. On _________, I signed the electronically transmitted Document without (Date) change. I am returning the completed signature page and Contractor Data and Certification page and/or Contractor Tax Identification Information form (if applicable) with this Document Return Statement. (Authorizing Signature) (Date) In compliance with the Americans with Disabilities Act, this document is available in alternate formats such as Braille, large print, audio recordings, Web-based communications and other electronic formats. To request an alternate format, please send an e-mail to dhs oha.publicationreguest@state.or.us or call 503-378-3486 (voice) or 503-378 3523 (TTY) to arrange for the alternative format. AGREEMENT # 141408 2013-20151NTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES This 2013-2015 Intergovernmental Agreement for the Financing of Community Addictions and Mental Health Services (the "Agreement") is between the State of Oregon acting by and through its Oregon Health Authority ("OHA") and Deschutes County, a political subdivision of the State of Oregon ("County"). RECITALS WHEREAS, ORS 430.61 0(4) and 430.640( 1) authorize OHA to assist Oregon counties and groups of Oregon counties in the establishment and financing of community addictions and mental health programs operated or contracted for by one or more counties; WHEREAS, County has established and proposes, during the term of this Agreement, to operate or contract for the operation of community addictions and mental health programs in accordance with the policies, procedures and administrative rules ofOHA; WHEREAS, County has requested financial assistance from OHA to operate or contract for the operation of its community addictions and mental health programs; WHEREAS, in connection with County's request for financial assistance and in connection with similar requests from other counties, OHA and representatives of various counties requesting financial assistance, including the Association of Oregon Counties, have attempted to conduct agreement negotiations in accordance with the Principles and Assumptions set forth in a Memorandum of Understanding that was signed by both parties; WHEREAS, OHA is willing, upon the terms of and conditions of this Agreement, to provide financial assistance to County to operate or contract for the operation of its community addictions and mental health programs; WHEREAS, various statutes authorize OHA and County to collaborate and cooperate in providing for basic community addictions and mental health programs and incentives for community-based care in a manner that ensures appropriate and adequate statewide service delivery capacity, subject to availability offunds; and -;;:VIJIdJ LEGAL COUNSEL 141408 Deschutes lof330 DC -20 13 - 2 r B WHEREAS, within existing resources awarded under this Agreement, each CMHPILMHA shall develop a plan to improve the integration of mental health, chemical dependency and physical/dental health care services with each Coordinated Care Organization (CCO) serving individuals in the CMHPILMHAs county or counties. The plan shall be submitted as part ofthe Biennial Implementation Plan, required by ORS 430.630(9)(b), except for Central Oregon counties subject to the Regional Health Improvement Plan (RHIP) as identified in Oregon Laws 2011, SB204, Sections 13 -20. and be limited to providing a brief description of the approach, the basic goals and expected outcomes, and be attached hereto in Exhibit C. NOW, THEREFORE, in consideration ofthe foregoing premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as follows: AGREEMENT 1. Effective Date and Duration. This Agreement shall become effective on July 1,2013. Unless terminated earlier in accordance with its terms, this Agreement shall expire on June 30, 2015. 2. Agreement Documents, Order of Precedence. This Agreement consists ofthe following documents: This Agreement without Exhibits Exhibit A Definitions Exhibit B-1 Service Descriptions Exhibit B-2 Specialized Service Requirements Exhibit C Biennial Implementation Plan or Regional Health Improvement Plan Exhibit 0-1 Financial Assistance Award Exhibit 0-2 OWITS Financial Assistance Award Exhibit E Special Terms and Conditions Exhibit F General Terms and Conditions Exhibit G Standard Terms and Conditions Exhibit H Required Federal Terms and Conditions Exhibit I Required Provider Contract Provisions Exhibit J Provider Insurance Requirements Exhibit K Startup Procedures Exhibit L Catalogue of Federal Domestic Assistance (CFDA) Number Listing In the event of a conflict between two or more of the documents comprising this Agreement, the language in the document with the highest precedence shall control. The precedence of each of the documents comprising this Agreement is as follows, listed from highest precedence to lowest precedence: (a) this Agreement without Exhibits, (b) Exhibit H, (c) Exhibit A, (d) Exhibit 0, (e) Exhibit E, (0 Exhibit B-1, (g) Exhibit B-2, (h) Exhibit C, (i) Exhibit G, ((j) Exhibit F,(k) Exhibit I, (I) Exhibit J, (m) Exhibit K. (n) Exhibit K, (0) Exhibit L. 141408 Deschutes 20[330 EACH PARTY, BY EXECUTION OF THIS AGREEMENT, HEREBY ACKNOWLEDGES THAT IT HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. Deschutes County By: Alan Unger, Chair Deschutes County Board of Commissioners Authorized Signature Title Date State of Oregon acting by and through its Oregon Health Authority By: Authorized Signature Title Date 141408 Deschutes 30f330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBIT A DEFINITIONS As used in this Agreement, the following words and phrases shall have the indicated meanings. Certain additional words and phrases are defined in the Service Descriptions, Specialized Service Requirements and special conditions in the Financial Assistance Award. When a word or phrase is defined in a particular Service Description, Specialized Service Requirement or special condition in the Financial Assistance Award, the word or phrase shall not necessarily have the ascribed meaning in any part of the Agreement other than the particular Service Description, Specialized Service Requirement or special condition in which it is defined. 1. "Addiction Services" means prevention, treatment, maintenance and recovery services for individuals diagnosed with substance use and problem gambling disorders or are at risk of developing those disorders. 2. "Aging and People with Disabilities" or "APD" means a division within the Department of Human Services that is responsible for management, financing and regulation services for aging adults and people with disabilities. 3. "Addictions and Mental Health" or "AMH" means a division within the Oregon Health Authority that is responsible for substance abuse and problem gambling prevention and treatment services, children and adult mental health services, maintaining custody of persons committed to the state by courts for care and treatment of mental illness, and managing the state hospital system. 4. "Agreement Settlement" means OHA's reconciliation, after termination or expiration of this Agreement, of amounts OHA actually disbursed to County under this Agreement from the Financial Assistance Award with amounts that OHA is obligated to pay to County under this Agreement from the Financial Assistance Award, as determined in accordance with the financial assistance calculation methodologies set forth in the Service Descriptions. OHA reconciles disbursements and payments on an individual Service basis as set forth in the Service Descriptions, and in accordance with Exhibit F, Section 1, Disbursement and Recovery of financial assistance. 5. "Allowable Costs" means the costs described in OMB Circular A-87 except to the extent such costs are limited or excluded by other provisions of this Agreement, whether in the applicable Service Descriptions, Specialized Service Requirements, special conditions identified in the Financial Assistance Award (FAA), or otherwise. 6. "Amending Line" has the meaning set forth in Exhibit 0-1. 7. "Authorizing Resolution" has the meaning set forth in section 4 of Exhibit F. 8. "Biennial Implementation Plan" or "BIP" means a mechanism for the Community Mental Health Programs to articulate the service needs of their communities and plans to meet those needs as required by ORS 430.632. 9. "Claim" has the meaning set forth in section] of Exhibit G. 141408 Deschutes 40[330 10. "Client" means, with respect to a particular Service, any individual who is receiving that Service, in whole or in part, with funds provided under this Agreement. 11. "Client Process Monitoring System" or ....CPMS" means OHA's information system that tracks and documents Service delivery or any successor system designated by OHA. 12. "Community Mental Health Program" or "CMHP" means a centrally organized and coordinated program of services for persons with mental and emotional disorders and addiction dependencies operated by, or contractually affiliated with a LMHA and operated in a specific geographic area of the State of Oregon. 13. "Community Outcome Management and Performance Accountability Support System" or "COMPASS" means the AMH project to implement a new contracts system, roll out an optional free Electronic health records system (OWITS), and enhance the collection of data through another new system (MOTS). 14. "Coordinated Care Organizations" or "CCO" means an entity that has been certified by the Oregon Health Authority to provide coordinated and integrated health services. 15. "Corresponding Line" has the meaning set forth in Exhibit 0-1. 16. "County" has the meaning set forth in the first paragraph of this Agreement. 17. "County Financial Assistance Administrator" means a County appointed officer to administer this Agreement and amend the Financial Assistance Award on behalf of County, by execution and delivery of amendments to this Agreement in the name of County in hard copy, or electronically. 18. "DHS" means the Department of Human Services of the State of Oregon. 19. "Drug Court" or "Drug Treatment Court" means any court given the responsibility pursuant to ORS 3.450 to handle cases involving substance-abusing offenders through comprehensive supervision, drug testing, treatment services and immediate sanctions and incentives. 20. "Federal Funds" means all funds paid to County under this Agreement that OHA receives from an agency, instrumentality or program of the federal government of the United States. 21. "Financial Assistance Award" or "FAA" means the description of financial assistance set forth in Exhibit 0 attached hereto and incorporated herein by this reference; as such Financial Assistance Award may be amended from time to time. Disbursement of funds identified in the FAA is made by OHA using procedures described in the Exhibit B-1 Service Description for each respective Service. 22. "Grant Appeals Board" has the meaning set forth in section I of Exhibit F. 23. "Local Mental Health Authority" or "LMHA" means the county court or board of commissioners of one or more counties who choose to operate a CMHP. 24. "Medicaid" means Federal Funds received by OHA under Title XIX of the Social Security Act and Children's Health Insurance Program Funds administered jointly with Title XIX funds as part of state medical assistance programs by OHA. 25. "Mental Health Services" means treatment services for individuals diagnosed with serious mental health illness, or other mental or emotional disturbance posing a danger to the health and safety of themselves or others. 141408 Deschutes 50f330 26. "Misexpenditure" means money, other than an Overexpenditure, disbursed to County by OHA under this Agreement and expended by County that: (a) Is identified by the federal government as expended contrary to applicable statutes, rules, OMB Circulars or any other authority that governs the permissible expenditure of such money, for which the federal government has requested reimbursement by the State of Oregon and whether in the form of a federal determination of improper use of federal funds, a federal notice of disallowance, or otherwise; or (b) Is identified by the State of Oregon or OHA as expended in a manner other than that permitted by this Agreement, including without limitation, any money expended by County, contrary to applicable statutes, rules, OMB Circulars or any other authority that governs the permissible expenditure of such money; or (c) Is identified by the State of Oregon or OHA as expended on the delivery ofa Service that did not meet the standards and requirements ofthis Agreement with respect to that Service. 27. "Measures and Outcomes Tracking System" or "MOTS" means the AMH data system that stores data submitted by AMH contractors and subcontractors. 28. "Overexpenditure" means money disbursed by OHA under this Agreement and expended by County that is identified by the State of Oregon or OHA, through Agreement Settlement or any other disbursement/payment reconciliation permitted or required by this Agreement, as in excess of the amount County is entitled to as determined in accordance with the financial assistance calculation methodologies set forth in the applicable Service Descriptions or Exhibit E. 29. "Oregon Web Infrastructure for Treatment Services" or "OWITS" means 1) an optional free electronic health records system available to Counties and their Providers to submit the MOTS data and 2) a system to manage the AMH services and County Financial Assistance Agreements. 30. "Program Area" means anyone of the following: Mental Health Services or Addiction Services. 31. "Provider" has the meaning set forth in section 5 of Exhibit F. As used in a Service Description and elsewhere in this Agreement where the context requires, Provider also includes County if County provides the Service directly. 32. "Provider Contract" has the meaning set forth in section 6 of Exhibit F. 33. "Regional Health Improvement Plan" or "RHIP" means a mechanism for Central Oregon counties subject to the Regional Health Improvement Plan (RHIP) as identified in Oregon Laws 2011, SB204, Sections 13 -20. 34. "Service(s)" means anyone of the following services or group of related services as described in Exhibit B-1, whose costs are covered in whole or in part with financial assistance pursuant to Exhibit D of this Agreement. Only Services whose costs are covered in whole or in part with financial assistance pursuant to Exhibit D, as amended from time to time, are subject to this Agreement. 141408 Deschutes 60f330 I • 35. "Service Description" means the description of a Service set forth in Exhibit B-1. 36. "Specialized Service Requirement" means anyone ofthe following specialized service requirements as described in Exhibit B-2 whose costs are covered in whole or in part with Financial Assistance pursuant to Exhibit D ofthis Agreement. Only Services whose costs are covered in whole or in part with financial assistance pursuant to Exhibit D, as amended from time to time, are subject to this Agreement. Service Name Service Code Local Administration -Mental Health Services MHSOI Local Administration -Addictions Services A&D03 A&D Special Projects A&D60 Adult Alcohol and Drug Residential Treatment A&D61 Housing Services for Dependent Children Whose Parents are in Alcohol and Drug Residential Treatment A&D62 Alcohol and Drug Residential Capacity Services A&D67 Problem Gambling Residential Services A&D82 Non-Residential Mental Health Services For Adults General MHS20 Child and Adolescent Mental Health Services MHS22 Non-Residential Youth and Young Adults Mental Health Services In Transition (Designated) MHS26 Residential Mental Health Treatment Services for Youth and Young Adults In Transition MHS27 Residential Treatment Services MHS28 Enhanced CarelEnhanced Care Outreach Services MHS31 Adult Foster Care Services MHS34 Older/Disabled Adult Mental Health Services MHS35 Pre-Admission Screening and Resident Review Services MHS36 MHS Special Proiects MHS37 Projects For Assistance In Transition From Homelessness (PATH) Services MHS39 S(!ecialized Service Reguirement Name S(!ecialized Service Reguirement Code Intensive Treatment and Recovery Services A&D61A Secure Residential Treatment Facility MHS28A Relative Foster Care MHS34A Gero-Specialist MHS 35A APD Residential MHS 35B 37. "Underexpenditure" means money disbursed by OHA under this Agreement that remains unexpended at Agreement termination or expiration, other than money County is permitted to retain and expend in the future under section 4.b of Exhibit F. 141408 Deschutes 7of330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBIT B-1 SERVICE DESCRIPTIONS Not all Services described in Exhibit B-1 may be covered in whole or in part with financial assistance pursuant to Exhibit 0 of this Agreement. Only Services whose costs are covered in whole or in part with financial assistance pursuant to Exhibit 0, as amended from time to time, are subject to this Agreement. 141408 Deschutes 80f330 Service Name: Local Administration -Mental Health Services Service ID Code: MHSOI 1. Service Description Mental Health Local Administration (MHS 01) is the central management ofa Mental Health Services system on behalf of an LMHA for which financial assistance is included in Exhibit D-l, "Financial Assistance A ward" ofthis Agreement. As related to the Residential system, MHS 01 includes planning and resource development, coordination of a Mental Health Services system with state hospital services, negotiation and monitoring of contracts and subcontracts, and documentation of service delivery in compliance with state and federal requirements. 2. Performance Requirements In providing MHS 01 Mental Health Services, County must comply with OAR 309-014 0000 through 309-014-0040, as such rules may be revised from time to time. 3. Special Reporting Requirements No special reporting requirements. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: The financial assistance awarded for MHS 01 is general financial assistance to County for local administration of Mental Health Services. Accordingly, OHA will not track delivery ofMHS 01 Services or service capacity on a per unit basis so long as County utilizes the funds awarded for MHS 01 on administration of a Mental Health Services system on behalfofan LMHA. Total OHA financial assistance for MHS 01 Services under a particular line of the Financial Assistance Award, Exhibit D-l shall not exceed the total funds awarded for MHS 01 as specified on that line. b. Disbursement of Funds: Unless a different disbursement method is specified in Exhibit D-l, "Financial Assistance Award", OHA will disburse the financial assistance awarded for MHS 01 Services identified in a particular line of the Financial Assistance A ward to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in funds awarded for MHS 01 Services on that line ofthe Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will be used to confirm County's administration of a Mental Health Services system on behalf ofa LMHA and reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of financial assistance awarded for MHS 01 Services under a particular line ofthe Financial Assistance Award and amounts due for such services based on the delivery of Mental Health Services and the financial assistance awarded for those services under a particular line of the Financial Assistance Award. 141408 Deschutes 90f330 Service Name: Local Administration Addictions Services Service ID Code: A&D03 1. Service Description Local Administration (A&D 03) is the central management of an Addictions Services system on behalf of a LMHA for which financial assistance is included in Exhibit D-l , "Financial Assistance Award", ofthis Agreement. A&D 03 includes planning and resource development, coordination of service delivery for alcohol abuse, drug abuse and problem gambling, negotiation and monitoring of contracts and subcontracts, and documentation of service delivery in compliance with state and federal requirements. 2. Performance Requirements In providing A&D 03 Services for Addiction Services, County must comply with OAR 309-014-0000 through 309-014-0040, as such ru les may be revised from time to time. 3. Special Reporting Requirements No special reporting requirements. 4. Financial Assistance Calculation and Disbursement Procedures a. Calculation of Financial Assistance: The financial assistance awarded for A&D 03 is intended to be general financial assistance to County for local administration for Addiction Services. Accordingly, OHA will not track delivery of A&D 03 Services or service capacity on a per unit basis so long as County utilizes the funds awarded for A&D 03 on administration of an Addictions Services system on behalf of a LMHA. Total OHA financial assistance for A&D 03 Services under a particular line of Exhibit D-I, "Financial Assistance Award" shall not exceed the total funds awarded for A&D 03 as specified on that line. b. Disbursement of Funds. Unless a different disbursement method is specified in Exhibit D-I, "Financial Assistance Award", OHA will disburse the financial assistance awarded for A&D 03 Services identified in a particular line of the Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in funds awarded for A&D 03 Services on that line of the Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will be used to confirm County's administration of an Addictions Services system on behalf of a LMHA and reconcile any discrepancies that may have occurred during the term ofthis Agreement between actual OHA disbursements of financial assistance awarded for A&D 03 Services under a particular line ofthe Financial Assistance Award and amounts due for such services based on the delivery ofAddictions Services and the financial assistance awarded for those services under a particular line ofExhibit D-I, "Financial Assistance Award". 141408 Deschutes 10 of330 Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR ADULTS (GENERAL) Service ID Code: MHS20 1. Service Description Non-Residential Mental Health Services For Adults (General) (MHS 20) are mental health services delivered to persons diagnosed with serious mental health illness, or other mental or emotional disturbance posing a danger to the health and safety ofthemselves or others. Non-Residential Mental Health Services for Adults (General) shall include one or more of the following: a. Supported Housing service payment; b. Rental Assistance; c. Non-Medically approved services required by PSRB (Part C); and d. Other services as needed for individuals at the sole discretion of AMH. 2. Performance Requirements Providers ofMHS 20 shall provide coordination of care services for county of responsibility residents in residential treatment programs, which include extended care managed services, regardless of the location. The coordination of care shall include participation in the residential provider's treatment planning process and in planning for the individual's transition to outpatient services. Providers ofMHS 20 Services funded through this Agreement must: a. Comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time; b. Maintain a Certificate of Approval, for the delivery of clinical services, in accordance with OAR 309-012-0130 through OAR 309-012-0220, as such rules may be revised from time to time; and c. Investigate and report allegations of abuse regarding served individuals and provide protective services to those individuals to prevent further abuse. The investigation, reporting and protective services must be completed in compliance with ORS 430.735 through 430.765 and OAR 407-045-0000 through 407-045 0980, as such statutes and rules may be revised from time to time. 141408 Deschutes 11 0[330 3. S)!ecial Re)!orting Requirements Providers ofMHS 20 Services funded through this Agreement must: a. Submit information and data on abuse reports, investigations and protective services involving individuals to whom the Provider provides MHS 20 Services, as such information and data is reasonably requested by the Oregon Health Authority (OHA) in order to fully understand allegations and reports of abuse, the resulting investigations and protective services and any corrective actions. b. All individuals receiving MHS 20 Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: (I) the Client Processing Monitoring System (CPMS as specified in OHA' s CPMS manual located at: http://www.oregon.gov/OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time. (2) the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/electronic-data capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation, Disbursement & Settlement Procedures OHA provides financial assistance for MHS 20 Services in three different ways, through Part A, Part B ("Limitation"), and Part C Awards. The Award is set in Exhibit D-l, "Financial Assistance Award", on MHS 20 lines in column one (1) that contain an "A" for Part A or "B" for Part B or "C" for Part C Award. The Part B award is not calculated, disbursed or settled under this Agreement, but is included for budgetary purposes. The provider ofthe service needs to be enrolled as a Medicaid Provider and follow the procedures for billing the OHA for Medicaid mental health services outlined in the Chemical Dependency Medicaid Provider Manual. OHA calculates the rates and the claims are processed through the OHA's Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis. Rates are available on the OHA website located at http://www.oregon.gov/ohalamh/pages/tools-providers.aspx#m . OHA will provide notice to Contractor in a timely manner if there is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at .http://www.oregon.gov/ohalamh/publications/other/provider2009manual.pdf 141408 Deschutes 1201'330 The Part A Award financial assistance will be calculated, disbursed and settled as follows: a. Calculation of Financial Assistance: The Part A Award for MHS 20 Services is intended to be general financial assistance to County for MHS 20 Services. Accordingly, OHA will not track delivery ofMHS 20 Services or service capacity on a per unit basis so long as County offers and delivers MHS 20 Services as part ofitsCMHP. (1) Total OHA financial assistance for MHS 20 Services under a particular line of Exhibit 0-1, "Financial Assistance Award", shall not exceed the total funds awarded for MHS 20 Services as specified on that line. (2) OHA is not obligated to provide financial assistance for any MHS 20 Services delivered to individuals that are not properly reported in accordance with section 3., "Special Reporting Requirements" above or as required by this Service Description or an applicable Specialized Service Requirement by the date sixty (60) days after the earlier of termination of this Agreement, termination ofOHA's obligation to provide financial assistance for MHS 20 Services, or termination of County's obligation to include the Program Area, in which MHS 20 Services fall, in its CMHP. b. Disbursement of financial assistance: Unless a different disbursement method is specified in that line of Exhibit 0-1, "Financial Assistance Award", OHA will disburse the Part A Award for MHS 20 Services identified in a particular line of the Financial Assistance A ward to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award, subject to the following: (1) OHA may, upon written request of County, adjust monthly allotments. (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 20 Services on that line ofthe Financial Assistance Award. c. The Part C Award financial assistance will be disbursed as follows: (I) Unless a different disbursement method is specified in that line of Exhibit 0-1, "Financial Assistance Award", OHA will disburse the Part C Award for MHS 20 Services identified in a particular line ofthe Financial Assistance Award to County per receipt and approval of written invoice, with attached copy ofthe bill or receipt for the item or service and a copy ofthe POC and CCO refusal of payment, in the monthly allotments during the period specified in that line of the Financial Assistance Award. Part C Awards for PSRB non-medically approved services is for the time period as shown only and does not carry forward into following years funding. d. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery ofMHS 20 Services by County as part of its CMHP, based on data properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. The settlement process will not apply to funds awarded for Rent Subsidy payments. 141408 Deschutes 13 of330 Service Name: CHILD AND ADOLESCENT MENTAL HEALTHTREATMENT FOSTER CARE SERVICES Service 10 Code: MHS22 1. Service Description Funds awarded for MHS 22 Services that are identified in Exhibit 0-1, "Financial Assistance Award", as subject to Treatment Foster Care Services are reserved in Oregon Health Authority's (OHA) budget for delivery ofindividual skills training services to Medicaid-eligible children residing in specialty foster homes approved by DHS' Children, Adults and Family Division (CAF). MHS 22 Services may be delivered, as appropriate, in clinic, home, school or other settings familiar and comfortable for the individual receiving such services. 2. Performance Requirements Providers ofMHS 22 Services funded through this Agreement must comply with applicable law including, but not limited to OAR 309-032-1540 (6), (7), (8), & (9) and OAR 309-016-0605 through 309-016-0650, as such rules may be revised from time to time, and maintain a Certificate of Approval in accordance with OAR 309-012-0130 through 309-012-0220, as such rules may be revised from time to time. Providers of MHS 22 Services funded through this Agreement must be certified to provide Intensive Community-Based Treatment and Support Services (lCTS), or must refer children who meet criteria for ISA services to a provider certified as an ICTS provider under OAR 309-032-1540 (5). 3. Special Reporting Requirements All individuals receiving services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www .oregon.gov/OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www .oregon.gov /OHAIamh/pages/compass/electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 141408 Deschutes 140f330 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Funds awarded for MHS 22 Services that are identified in Exhibit D-I, "Financial Assistance Award", (the "MHS 22 Limitation") are not calculated, disbursed or settled under this Agreement. The Limitation is set forth in the Financial Assistance A ward on MHS 22 lines that contain a "B" in column one. The Limitation is included in this Agreement for budgetary purposes. The provider of the Part B service needs to be enrolled as a Medicaid Provider and follow the procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA calculates the rates and the claims are processed through OHA' Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis. Rates are available on the OHA website located at .http://www.oregon.gov/ohalamh/pages/tools-providers.aspx#m OHA will provide notice to Contractor in timely manner ifthere is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0000 through 309-016-0450 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/ohalamh/publications/other/provider2009manual.pdf. b. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery ofMHS 22 Services by County as part of its CMHP, based on data properly reported in accordance with section 3., "Special Reporting Requirements" above. 141408 Deschutes 150[330 Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR YOUTH & YOUNG ADULTS IN TRANSITION (DESIGNATED) Service 10 Code: MHS 26 1. Service Description Non-Residential Mental Health Services for Youth & Young Adults In Transition (Designated) (MHS 26) are mental health services delivered to individuals through 25 years of age who are under the jurisdiction ofthe Juvenile Panel ofthe Psychiatric Security Review Board (JPSRB) or in the Young Adults in Transition (Y AT) program, specified in Exhibit D-I, "Financial Assistance Award", and have a mental or emotional disorder posing a danger to the health and safety of themselves or others. The purpose of MHS 26 Services is to provide mental health services in community settings that reduce or ameliorate the disabling effects of mental or emotional disorders. Non-Residential Mental Health Services for Youth & Young Adults in Transition (Designated) include: a. Care coordination and residential case management services; b. Vocational and social services; c. Rehabilitation; d. Support to obtain and maintain housing; e. Abuse investigation and reporting; f. Medication and medication monitoring; g. Skills training; h. Mentoring; I. Peer support services; j. Emotional support; k. Occupational therapy; l. Recreation; m. Supported employment; n. Supported education; o. Secure transportation; p. Individual, family and group counseling and therapy; q. Rent Subsidy; r. Non-Medically approved services required by JPSRB (Part C); and s. Other services as needed for individuals at the sole discretion of AMH. 141408 Deschutes 1601'330 2. Performance Requirements Services to individuals through 25 years of age under the jurisdiction of the JPSRB, or in the Young Adults in Transition (Y A T) program, will be delivered with the least possible disruption to positive relationships, and will incorporate the following: a. The rapport between professional and individual will be given as much of an emphasis in service planning as other case management approaches; b. Services will be coordinated with applicable adjunct programs serving both children and adults, so as to facilitate smoother transitions and improved integration of services and supports across both adolescent and adult systems; c. Services will be engaging and relevant to youth and young adults; d. Services will accommodate the critical role of peers and friends; e. The Individual Service and Support Plan will include a safety component to insure that identity development challenges and boundary issues are not cause for discontinuing service; f. The Individual Service and Support Plan will include a specific section addressing serv ices and supports unique to the developmental progress of Youth and Young Adults in Transition including school completion, employment, independent living skills, budgeting, finding a home, making friends, parenting and family planning, and delinquency prevention; g. The Young Adult Service Delivery Team or its designee shall provide direction to provider regarding services to be delivered to the youth or young adult; and h. Secured Transportation services under MHS 26 will be approved by OHA on a case by case basis. 3. Special Reporting Requirements a. County shall provide Oregon Health Authority (OHA) with a summary report of MHS 26 Services delivered with funds provided under this Agreement within 45 days after the end of each State fiscal year or within 40 days of termination, whichever occurs first. Submit reports to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator 500 Summer Street N.E. E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by OHA. b. All individuals receiving services with funds provided under this Agreement must be enrolled and that client's record maintained in either: 141408 Deschutes 170[330 (1) the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time; or (2) the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/electronic-data capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified ofthe change. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures OHA provides financial assistance for MHS 26 Services in three different ways, through Part A, Part B ("Limitation"), and Part C Awards. The Award is set forth in Exhibit D-l, "Financial Assistance Award", on MHS 26 lines in column one (1) that contain an "A" for Part A or "B" for Part B or "C" for Part C Award. The Part B award is not calculated, disbursed or settled under this Agreement, but is included for budgetary purposes. The provider ofthe service needs to be enrolled as a Medicaid Provider and follow the procedures for billing the OHA for Medicaid mental health services outlined in the Medicaid Provider Manual. OHA calculates the rates and the claims are processed through OHA' Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for service basis. Rates are available on the OHA website located at http://egov .oregon.gov10 HA/mentalhealth/publ ications/codebooks/mhO 1 09rates.pdf. OHA will provide notice to Contractor in timely manner ifthere is a change in rates. All Medicaid reimbursable service billings shall be in accordance with OHA' Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0000 through 309-016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/OHAImentalhealth/publications/codebooks/manual.pdf. The Part A Award financial assistance will be calculated, disbursed and settled as follows: a. Calculation of Financial Assistance: The Part A Award for MHS 26 Services is intended to be general financial assistance to County or Contractor for MHS 26 Services. Accordingly, OHA will not track delivery ofMHS 26 Services under a particular line of Exhibit D-l, "Financial Assistance Award", on a per unit basis so long as County or Contractor offers and delivers MHS 26 Services to the individual designated on that line of the Financial Assistance Award. TotalOHA financial assistance for MHS 26 Services under a particular line ofthe Financial Assistance Award shall not exceed the total funds awarded for MHS 26 Services as specified on that line, subject to the following: 141408 Deschutes 180f330 (1) OHA is not obligated to provide financial assistance for any MHS 26 Services delivered to individuals who are not properly reported in accordance with section 3., "Special Reporting Requirements" above or as required by this Service Description or an applicable Specialized Service Requirement by the date sixty (60) days after the earlier of termination of this Agreement, termination ofOHA' obligation to provide financial assistance for MHS 26 Services, or termination of County's obligation to include the Program Area, in which MHS 26 Services fall, in its CMHP. (2) OHA will reduce the financial assistance for MHS 26 Services delivered under a particular line of Exhibit 0-1, "Financial Assistance Award", containing an "A" in the first column by the amount received by a Provider of MHS 26 Services, as payment of a portion of the cost of the services from an individual receiving such services. b. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line of Exhibit 0-1, "Financial Assistance Award", OHA will disburse the Part A A ward for MHS 26 Services identified in a particular line of the Financial Assistance Award to County or Contractor in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: (1) OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the monthly allotments based on under used allotments or non-delivery of services identified in accordance with section 3., "Special Reporting Requirements" above or as required by this Service Description or an applicable Specialized Service Requirement; (2) OHA may, upon written request of county, adjust monthly allotments; and (3) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 26 Services on that line of the Financial Assistance Award. c. The Part C Award financial assistance will be disbursed as follows: A. Unless a different disbursement method is specified in that line of Exhibit 0-1, "Financial Assistance Award", OHA will disburse the Part C Award for MHS 26 Services identified in a particular line of the Financial Assistance Award to County per receipt and approval of written invoice, with attached copy of the bill or receipt for the item or service and a copy of the POC and CCO refusal of payment, in the monthly allotments during the period specified in that line of the Financial Assistance Award. Part C Awards for JPSRB non-medically approved services is for the time period as shown only and does not carry forward into following years funding. d. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery ofMHS 26 services by County as part of its CMHP based on the delivery ofMH 26 services as properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. The settlement process will not apply to funds awarded for an approved Rent Subsidy payment. 141408 Deschutes 190f330 Service Name: RESIDENTIAL MENTAL HEALTH TREATMENT SERVICES FOR YOUTH & YOUNG ADULTS IN TRANSITION Service ID Code: MHS27 1. Service Description Residential Mental Health Treatment Services for Youth & Young Adults in Transition (MHS 27) are mental health services delivered to individuals through 25 years of age for individuals under the jurisdiction of the Juvenile Panel of the Psychiatric Security Review Board (JPSRB) or in the Youth and Young Adults in Transition program. Residential Mental Health Treatment Services for Youth and Young Adults in Transition (MHS 27) are: a. Services delivered on a 24-hour basis to individuals with mental or emotional disorders who have been hospitalized or are at immediate risk of hospitalization, who need continuing services to avoid hospitalization or who are a danger to themselves or others or who otherwise require long-term care to remain in the community; and b. Only those individuals who the OHA's Young Adult Service Delivery Team determines are unable to live independently without supervised intervention, training, or support. The specific MHS 27 Services delivered to an individual are determined based upon an individualized assessment of care and treatment needs and are intended to promote the well being, health, resiliency and recovery of the individual through the availability of a wide-range of residential service options. MHS 27 Services delivered in appropriately licensed and certified programs or facilities include, but are not limited to, the following: a. Crisis stabilization services, such as accessing psychiatric, medical, or qualified professional intervention to protect the health and safety of the individual and others; b. Timely, appropriate access to crisis intervention to prevent or reduce acute, emotional distress, which might necessitate psychiatric hospitalization; c. Money and household management; d. Supervision of daily living activities such as skill development focused on nutrition, personal hygiene, clothing care and grooming, and communication skills for social, health care, and community resources interactions; e. Provision of care including assumption of a responsibility for the safety and well-being of the individual; f. Administration, supervision and monitoring of prescribed and non-prescribed medication, and client education on medication awareness; 141408 Deschutes 200[330 g. Provision or arrangement of routine and emergency transportation; h. Developing skills to self manage emotions; i. Management of a diet, prescribed by a physician, requiring extra effort or expense in preparation of food; J. Management of physical or health problems including, but not limited to, diabetes and eating disorders; k. Skill training; I. Mentoring, peer delivered services and peer support services; m. Positive use of leisure time and recreational activities; n. Supported Education; o. Supported Employment; p. Occupational Therapy; and q. Recreation. 2. Performance Requirements The Young Adult Service Delivery Team or its designee shall provide direction to the provider regarding the prioritization of individuals for admission. Services to Youth and Young Adults in Transition will be delivered with the least possible disruption to positive relationships, and will incorporate the following: a. The rapport between professional and individual will be given as much of an emphasis in service planning as other case management approaches; b. Services will be coordinated with applicable adjunct programs serving both children and adults so as to facilitate smoother transitions and improved integration of services and supports across both adolescent and adult systems; c. Services will be engaging and relevant to Youth & Young Adults in Transition; d. Services will accommodate the critical role of peers and friends; e. The Individual Service and Support Plan will include a safety component to insure that identity development challenges and boundary issues are not cause for discontinuing service; and f. The Individual Service and Support Plan will include a specific section addressing services and supports unique to the developmental progress of Youth & Young Adults in Transition including school completion, employment, independent living skills, budgeting, finding a home, making friends, parenting and family planning, and delinquency prevention. Services to JPSRB Youth and Young Adults in Transition shall be delivered in support of the conditional release plan as set forward by the JPSRB Board. 141408 Deschutes 210[330 3. Snecial Renorting Requirements County or Contractor must complete and deliver to Oregon Health Authority (OHA) the "Personal Care Data Form For Residential Facilities" for any individual receiving MHS 27 Services funded through this Agreement when the individual is transferred to another residence or facility operated by the Provider, the individual is transferred to another Provider ofMHS 27 Services, MHS 27 Services to the individual end or the payment rate for the individual changes. An individual's payment rate may only be changed after consultation with and approval by OHA and only if the MHS 27 Services for that individual are funded from the Residential Limitation (as defined below). If County has authorized or anticipates authorizing delivery ofMHS 27 Services to an individual with funds from the Residential Limitation (as defined below) and wishes to reserve MHS 27 service capacity for that individual for a short period of time when the individual is not actually receiving the services, the provider must submit a written Reserved Service Capacity Payment (RSCP) Request and Contract Amendment Request to OHA under OAR 309-011-0 105 through 309-011-0115. If OHA approves the RSCP and Contract Amendment Request, OHA and County shall execute an amendment to the Financial Assistance Award to reduce Funding, Part A, and Residential Limitation, Part B, and add funds necessary to make the approved payments to reserve the service capacity to the Part A Award. OHA shall have no obligation to make the payments unless and until the Financial Assistance Award has been so amended. If County has authorized or anticipates authorizing delivery of MHS 27 Services to an individual and wishes to reserve MHS 27 service capacity for that individual for a short period oftime when the individual is not actually receiving the services, County must submit a written Reserved Service Capacity Payment (RSCP) Request and Contract Amendment Request to OHA under OAR 309-011-0105 through 309-011-0115. IfOHA approves the RSCP and Contract Amendment Request, OHA and County shall execute an amendment to the Financial Assistance Award to reduce Residential Limitation, Part B, and add funds necessary to make the approved payments to reserve the service capacity to the Part A Award. OHA shall have no obligation to make the payments unless and until the Financial Assistance Award has been so amended. All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHAlamh/training/cpms/index.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www .oregon.gov /OHA/amh/pages/compass/electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 141408 Deschutes 220f330 4. Financial Assistance Calculation, Disbursement and Settlement Procedures OHA provides financial assistance for MHS 27 Services in two different ways. Certain funds (the "Part A Award") are calculated, disbursed and settled as set forth in section 4.a.below. The Part A Award is set forth in Exhibit D-I, "Financial Assistance Award", on MHS 27 lines that contain an "A" in column one. Other funds (the "Residential Limitation") are not calculated, disbursed or settled under this Agreement. These funds are set forth in Exhibit D-I, "Financial Assistance Award", on MHS 27 lines that contain a "B" in column one and are paid as described in section 4.b. below. a. The Part A Award will be calculated, disbursed and settled as follows: (1) Calculation of Financial Assistance. OHA will provide financial assistance for MHS 27 Services identified in a particular line of the Financial Assistance A ward, Exhibit D-I with an "A" in column one from funds identified on that line in an amount equal to the rate set forth in the special condition identified in that line ofthe Financial Assistance Award, multiplied by the number of units ofMHS 27 Services delivered under that line of the Financial Assistance Award during the period specified in that line, subject to the following: (a) Total OHA payment for MHS 27 Services delivered under a particular line in Exhibit D-l, "Financial Assistance Award", containing an "A" in column one shall not exceed the total funds awarded for MHS 27 Services as specified in that line ofthe Financial Assistance Award; (b) OHA is not obligated to provide financial assistance for any MHS 27 Services that are not properly reported in accordance with section 3., :Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement by the date sixty (60) days after the earlier oftermination ofthis Agreement, termination ofOHA's obligation to provide financial assistance for MHS 27 Services, or termination of County's or Contractor's obligation to include the Program Area, in which MHS 27 Services fall, in its Community Mental Health Program (CMHP); and (c) OHA will reduce the financial assistance for MHS 27 Services delivered under a particular I ine of Exhibit D-I, "Financial Assistance Award", containing an "A" in column one by the amount received by a Provider of MHS 27 Services, as payment of a portion ofthe cost of the services, from an individual receiving such services with funds awarded in that line ofthe Financial Assistance Award. (2) Disbursement of Financial Assistance. OHA will disburse funds awarded for MHS 27 Services identified in a particular line of Exhibit D-I, "Financial Assistance Award", with an "A" in column one, to County or Contractor in substantially equal monthly allotments during the period 141408 Deschutes 230f330 specified in that line ofthe Financial Assistance Award, subject to the following: (a) OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the month Iy allotments based on under used allotments identified in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement; (b) OHA may, upon written request of County, adjust monthly allotments; and (c) Upon amendment to the financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 27 Services on that line of the Financial Assistance Award. (3) Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of funds awarded for MHS 27 Services under a particular line of Exhibit D-l, "Financial Assistance Award", containing an "A" in column one and amounts due for such services provided by County based on the rate set forth in the special condition identified in that line ofthe Financial Assistance Award. For purposes of this section, amounts due to County is determined by actual amount of services delivered under that line of the Financial Assistance Award during the period specified in that line of the Financial Assistance Award, as properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. The settlement process will not apply to funds awarded for an approved Reserved Service Capacity Payment. b. Part B Limitation: The provider of the service needs to be enrolled as a Medicaid Provider and follow the procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA calculates the rates and the claims are processed through OHA's Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis. OHA sets procedures and rates for the Limitation. Rates are available on the OHA website located at http://www.oregon.gov/ohalamh/pages/tools-providers.aspx#m OHA wi II provide notice to County in timely manner if there is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for 141408 Desch utes 240f330 Rehabilitative Mental Health Services Rule as I isted in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/ohalamh/publications/other/provider2009manual.pdf c. Residential Limitation. The Residential Limitation Part B, is disbursed by OHA directly to service providers based on monthly rates authorized by County or Contractor after consultation with OHA, subject to the following: (I) All payment rates authorized by County under this section 4.b. for delivery ofMHS 27 Services must meet the following requirements: (a) The rates must be reasonable under the facts and circumstances in existence at the time each rate is set, including but not limited to the state of the market for MHS 27 Services in the geogmphic area in which the services will be delivered and the needs of the particular individual receiving services; (b) County may (i) set different rates for delivery of MHS 27 Services to different individuals and (ii) revise existing rates to reflect cost of living adjustments or other scheduled increases in payment for MHS 27 Services to the extent approved or authorized by the Oregon Legislative Assembly or the Legislative Emergency Board; (c) County must document its methodology for determining a particular rate and furnish such documentation to OHA. County or Contractor shall retain such documentation in accordance with section 10 of Exhibit E of this Agreement. (2) County shall not authorize, in aggregate under this section 4.b., financial assistance for MHS 27 Services in excess ofthe Residential Limitation. Total aggregate financial assistance means the total of all financial assistance authorized before reducing payments to account for client resources received by the provider from a client, or another on behalf of the client, in support of client care and services provided; (3) The monthly mte will be promted for any month in which the individual is not served for a portion ofthe month; (4) Financial assistance will be reduced (offset) by the amount of client resources received by the provider from the client or the client's health insurance in support of client care and services provided; and (5) The Residential Limitation is included in this Agreement for budgetary purposes. IfOHA anticipates that payments for MHS 27 Services authorized by County under this section 4.b. will exceed the amount ofthe Residential Limitation, OHA may unilaterally reduce the award of funds, as set forth in Exhibit D-I, "Financial Assistance A ward", for any other MHS Service or Services to the extent of the general fund portion of the anticipated Residential Limitation shortfall. OHA and County or Contractor shall execute an appropriate amendment to the Financial Assistance Award to reflect the reduction of the Part A Award and the increase in the Residential Limitation. 141408 Deschutes 250f330 Service Name: RESIDENTIAL TREATMENT-SERVICES Service 10 Code: MHS28 1. Service Description Residential Treatment Services (MHS 28) are: a. Services delivered on a 24-hour basis to individuals 18 years of age or older with mental or emotional disorders who have been hospitalized or are at immediate risk of hospitalization, who need continuing services to avoid hospitalization or who are a danger to themselves or others or who otherwise require continuing care to remain in the community; and b. Services delivered to individuals who the County, in conjunction with the Oregon Health Authority (OHA) determines are unable to live independently without supervised intervention, training or support. The specific MHS 28 Services delivered to an individual are determined based upon an individual ized assessment of treatment needs and development of plan of care that are intended to promote the well being, health and recovery of the individual through the availability of a wide-range of residential service options. MHS 28 Services delivered in Residential Treatment Facilities (as defined in OAR 309 035-0100 through 309-035-0190) (RTF) or Residential Treatment Homes (as defined in OAR 309-035-0250 through 309-035-0460) (RTH), or another licensed setting approved by OHA include, but are not limited to, the following: a. Crisis stabilization services, such as accessing psychiatric, medical, or qualified professional intervention to protect the health and safety of the individual and others; b. Timely, appropriate access to crisis intervention to prevent or reduce acute, emotional distress, which might necessitate psychiatric hospitalization; c. Management of personal money and expenses; d. Supervision of daily living activities and life skills such as training with nutritional wellness, personal hygiene, clothing care and grooming, communication with social skills, health care, household management and using community resources; e. Provision of care including assumption of a responsibility for the safety and well-being of the individual; 14 J408 Deschutes 260f330 f. Administration and supervision of prescribed and non-prescribed medication; g. Provision or arrangement of routine and emergency transportation; h. Management of aggressive or self-destructive behavior; I. Management of a diet, prescribed by a physician, requiring extra effort or expense in preparation of food; and j. Management of physical or health problems, including, but not limited to, seizures or incontinency. Financial assistance is dependent upon an individual meeting defined criteria, established by the Oregon Health Authority (OHA) and posted on the OHA, Addictions and Mental Health (AMH) website. OHA and its designees have the authority to review Clinical records and have direct contact with individuals. The County and any Providers must notify individuals in writing within five state business days of a determination on admission, as defined by OHA policy, posted on the OHA AMH website located at: http://www.oregon.gov/oha/amhlPages/tools-providers.aspx. 2. Performance Requirements A provider ofMHS 28 services shall give first priority in admission to referrals from individuals transitioning from the State Hospitals, and referrals of individuals on the State Hospital wait list. A Provider ofMHS 28 Services funded through this Agreement must deliver the Services in a facility licensed as a Residential Treatment Facility or Secured Residential Treatment Facility under OAR 309-035-0100 through 309-035-0190 or as a Residential Treatment Home under OAR 309-035-0250 through 309-035-0460, as such rules may be revised from time to time. 3. Special Reporting Requirements County must complete and deliver to OHA the form as prescribed by OHA for any individual receiving MHS 28 Services funded through this Agreement when the individual is transferred to another residence or facility operated by the Provider, the individual is transferred to another Provider ofMHS 28 Services, MHS 28 Services to the individual end or the payment rate for the individual changes. An individual's payment rate may only be changed after consultation with and approval by OHA and only if the MHS 28 Services for that individual are funded from the Residential Limitation (as defined below). IfCounty has authorized or anticipates authorizing delivery ofMHS 28 Services to an individual and wishes to reserve MHS 28 service capacity for that individual for a short period of time when the individual is not actually receiving the services, County must submit a written Reserved Service Capacity Payment (RSCP) Request and Contract Amendment Request to OHA under OAR 309-011-0105 through 309-011-0115. IfOHA approves the RSCP and Contract Amendment Request, OHA and County shall execute 141408 Deschutes 270f330 an amendment to the Financial Assistance Award to reduce Residential Limitation, Part 8, and add funds necessary to make the approved payments to reserve the service capacity to the Part A Award. OHA shall have no obligation to make the payments unless and until the Financial Assistance Award has been so amended. All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHAlamh/pages/compass/electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures OHA provides financial assistance for MHS 28 Services in two different ways. Certain funds (the "Part A Award") are calculated, disbursed and settled as set forth in Section 4.a. below. The Part A Award is set forth in Exhibit 0-1, "Financial Assistance Award", on MHS 28 lines that contain an "A" in column one. Other funds (the "Residential Limitation") are not calculated, disbursed or settled under this Agreement. These funds are set forth in Exhibit 0-1, "Financial Assistance Award", on MHS 28 lines that contain a "8" in column one and are paid as described in Section 4.b. below. Part 8 Limitation: The provider ofthe service needs to be enrolled as a Medicaid Provider and follow the procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA calculates the rates and the claims are processed through OHA' Medicaid Management Information System (MMIS). OHA calculates the Part 8 limitation and OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis. OHA sets procedures and rates for the Limitation. Rates are available on the OHA website located at http://www .oregon.gov 10haJamh/pages/too Is-providers.aspx#m. OHA will provide notice to County in timely manner ifthere is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/ohaJamh/publications/other/provider2009manual.pdf. a. The Part A Award will be calculated, disbursed and settled as follows: 141408 Deschutes 280f330 (I) Calculation of Financial Assistance. OHA will provide financial assistance for MHS 28 Services identified in a particular line of Exhibit 0 I, "Financial Assistance Award" with an "A" in column one from funds identified on that line in an amount equal to the rate set forth in the special condition identified in that line ofthe Financial Assistance Award, mUltiplied by the number of units ofMHS 28 Services delivered under that line of the Financial Assistance Award during the period specified in that line, subject to the following: (a) Total OHA payment for MHS 28 Services delivered under a particular line in the Financial Assistance Award containing an "A" in column one shall not exceed the total funds awarded for MHS 28 Services as specified in that line ofthe Financial Assistance A ward; (b) OHA is not obligated to provide financial assistance for any MHS 28 Services that are not properly reported in accordance with section 2., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement by the date 60 days after the earlier oftennination or expiration ofthis Agreement, tennination ofOHA's obligation to provide financial assistance for MHS 28 Services, or tennination of County's obligation to include the Program Area, in which MHS 28 Services fall, in its Community Mental Health Program (CMHP); and (c) OHA will reduce the financial assistance for MHS 28 Services delivered under a particular line of the Financial Assistance Award containing an "A" in column one by the amount received by a Provider ofMHS 28 services, as payment ofa portion of the cost of the services from an individual receiving such services. (2) Disbursement of Financial Assistance. Unless a different disbursement method is specified in that line of Exhibit D-l "Financial Assistance Award", OHA will disburse funds awarded for MHS 28 Services identified in a particular line of the Financial Assistance Award with an "A" in column one, to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award, subject to the following: (a) OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the monthly allotments based on under used allotments identified in accordance with section 3.,"Special Reporting Requirements" above or applicable Special Tenns and Conditions. (b) OHA may, upon written request of County, adjust monthly allotments. 141408 Deschutes 290f330 (c) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 28 Services on that line ofthe Financial Assistance Award. (3) Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term ofthis Agreement between actual OHA disbursements of funds awarded for MHS 28 Services under a particular line of Exhibit D-1, ""Financial Assistance Award", containing an "A" in column one and amounts due for such services provided by County based on the rate set forth in the special condition identified in that line ofthe Financial Assistance Award. For purposes ofthis section, amounts due to County is determined by the actual amount of services delivered under that line of the Financial Assistance Award during the period specified in that line ofthe Financial Assistance Award, as properly reported in accordance with section 3. "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. The settlement process will not apply to funds awarded for an approved Reserved Service Capacity Payment. b. Residential Limitation. The Residential Limitation, Part 8 is disbursed by OHA directly to service providers based on monthly rates authorized by County after consultation with OHA, subject to the following: (1) All payment rates authorized by County under this Section IV (8) for delivery ofMHS 28 Services must meet the following requirements: (a) The rates must be reasonable under the facts and circumstances in existence at the time each rate is set, including but not limited to the state of the market for MHS 28 Services in the geographic area in which the services will be delivered and the needs of the particular individual receiving services. (2) County shall not authorize, in aggregate under this Section IV (8), financial assistance for MHS 28 Services in excess of the Residential Limitation. Total aggregate financial assistance means the total of all financial assistance authorized before reducing payments to account for client resources received by the provider from a client, or another on behalf of the client, in support of client care and services provided; (3) The monthly rate will be prorated for any month in which the individual is not served for a portion of the month; (4) Financial assistance will be reduced (offset) by the amount of client resources received by the provider from the client or client's health insurance in support of client care and services provided; 141408 Deschutes 300[330 (5) The Residential Limitation is included in this Agreement for budgetary purposes. IfOHA anticipates that payments for MHS 28 Services authorized by County under this Section IV (B) will exceed the amount of the Residential Limitation, OHA may unilaterally reduce the award of funds, as set forth in the Financial Assistance award, for any other MHS Service or Services to the extent of the general fund portion of the anticipated Residential Limitation shortfalL OHA and County shall execute an appropriate amendment to the Financial Assistance Award to reflect the reduction ofthe Part A Award and the increase in the Residential Limitation; and (6) OHA is not obligated to provide financial assistance for any MHS 28 Services that are not properly reported in accordance with section 3., "Specialized Reporting Requirements" above or as required in an applicable Specialized Service Requirement by the date 60 days after the earlier of termination or expiration ofthis Agreement, termination of OHA' obligation to provide financial assistance for MHS 28 Services or termination of County's obligation to include the Program Area, in which MHS 28 Services fall, in its CMHP. 141408 Deschutes 310f330 Service Name: ENHANCED CARE AND ENHANCED CARE OUTREACH SERVICES Service ID Code: MHS31 1. Service Description Enhanced Care Services and Enhanced Care Outreach Services (MHS 31) enable an individual to leave, or avoid placement in, the geriatric treatment units at the Oregon State Hospital (OS H). MHS 31 Services are outpatient community mental health and psychiatric rehabilitation services delivered to individuals that are Aging and People with Disabilities (APD) service need eligible and who have been deemed eligible by the Enhanced Care Services (ESC) Coordinator. Eligibility criteria includes, but is not limited to, the following: a. Severe and persistent mental illness or behavioral disorders; b. Reside in a nursing facility, residential care facility, assisted living facility or foster home operated by a Provider licensed by the Department of Human Services (DHS) Aging and People with Disabilities Division (APD); and c. Exhibit symptoms and related behaviors requiring a high level of service including, but not limited to: (1) History of self-endangering behaviors with a likel ihood of continued self endangering behaviors without 24-hour supervision; (2) Aggressive behavior that could not be managed in a lesser level of care; (3) Intrusive or sexually inappropriate behavior; (4) Inability to set and maintain appropriate personal boundaries requiring a high level of management and supervision; (5) Intractable psychiatric symptoms requiring intensive management, problematic medication needs and ongoing potential adjustments of multiple medications requiring 24-hour supervision; (6) Documented history offailed community placements; and (7) Length of stay at a psychiatric hospital and been denied placement in a lesser level of care. Requirements for MHS 31 also include: (1) Evaluation: All individuals shall be evaluated by the provider and local APD licensed facility staff prior to placement; and (2) Transition/Discharge: CMHP or its designee shall notity Enhanced Care Services (ECS) Coordinator prior to transition from ECS. The CMHP or 141408 Deschutes 320[330 its designee shall notify the ECS Coordinator within three working days of any change in an individual's medical or psychiatric condition which jeopardizes the placement. 2. Performance Requirements Providers ofMHS 3 I Services funded through this Agreement must comply with OAR 309-032-1540 (3), as such rules may be revised from time to time. Providers ofMHS 31 Services funded through this Agreement must maintain a Certificate of Approval in accordance with OAR 309-012-0130 through 309-012-0220, as such rules may be revised from time to time. MHS 31 Services funded through this Agreement may only be delivered to individuals who satisfy the requirements for receipt of nursing facility or community based care under Medicaid as specified in OAR 411-015-0000 through 411-015-0100, as such rules may be revised from time to time, and who receive such services in a nursing facility, residential care facility, assisted living facility or foster home operated by a Provider that has entered into an agreement with the APD Division to provide services to designated individuals and that is licensed by DHS', APD Division. If County wishes to use MHS 31 funds made available under this Agreement for delivery ofMHS 31 Services to otherwise eligible individuals not residing in an APD facility, County must receive a variance from the Oregon Health Authority (OHA) in accordance with OAR 309-032-1565, as such rules may be revised from time to time. 3. Special Reporting Requirements Providers ofMHS 3 I Services funded through this Agreement must complete and submit the following forms to OHA in accordance with the instructions in the forms: a. Monthly Enhanced Care Services Census Report; b. Enhanced Care Services Referral Outcome Form; c. ECS Data Base Part I; d. ECS Data Base Part II; and e. Enhanced Care Staffing Requirement Report Form. All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www .oregon .gov /OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: 141408 Deschutes 330[330 http://www .oregon.gov /OHA/amh/pages/compass/electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures OHA provides financial assistance for MHS 31 Services in two different ways, through Part A and part B ("Limitation") Awards. The Award is set in Exhibit D-l., "Financial Assistance Award", on MHS 31 lines in column one that contain an "A" for Part A or "B" for Part B A ward. The provider of the service needs to be enrolled as a Medicaid Provider and follow the procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA calculates the rates and the Part B Limitation and the claims are processed through OHA's Medicaid Management Information System (MMIS). OHA's Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis. Rates are available on the OHA website located at http://www.oregon.gov/ohalamh/pages/tools-providers.aspx#m . OHA will provide notice to County in timely manner ifthere is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/ohalamh/publications/other/provider2009manual.pdf. The Part A Award financial assistance will be calculated, disbursed and settled as follows: a. Calculation of Financial Assistance: The Part A Award for MHS 31 Services is intended to be general financial assistance to County for MHS 31 Services. Accordingly, OHA will not track delivery of MHS 31 Services on a per unit basis so long as County offers and delivers MHS 31 Services as part of its CMHP. Total OHA financial assistance for MHS 31 Services under a particular line of Exhibit D-1, "Financial Assistance A ward", shall not exceed the total funds awarded for MHS 31 Services as specified on that line. b. Disbursement of financial assistance: OHA will disburse the Part A Award for MHS 31 Services identified in a particular line of Exhibit D-l., "Financial Assistance Award", to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award, subject to the following: (1) OHA may, upon written request of County, adjust monthly allotments. 141408 Deschutes 340f330 (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes for MHS 31 Services on that line ofthe Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery ofMHS 31 Services by County as part of its CMHP, based on data properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. 141408 Deschutes 350f330 Service Name: ADULT FOSTER CARE SERVICES Service ID Code: MHS34 1. Service Description Adult Foster Care Services (MHS 34) are services delivered to individuals with chronic or severe mental illness who have been hospitalized or are at immediate risk of hospitalization, are in need of continuing services to avoid hospitalization, or who pose a danger to the health and safety ofthemselves or others, and who are unable to live by themselves without supervision. MHS 34 Services are delivered in a family home or facility with five or fewer individuals receiving MHS 34 Services. MHS 34 Services are delivered, in part, either by relatives, as defined in OAR 309-040-0305(57), referred to herein as Relative Foster Care, or by non relatives, referred to herein as Non-Relative Foster Care. The purpose ofMHS 34 Services is to maintain the individual at his or her maximum level of functioning or to improve the individual's skills to the extent that he or she may live more independently. MHS 34 Services include, but are not limited to, the following: a. Crisis stabilization services, such as accessing psychiatric, medical, or qualified professional intervention to protect the health and safety of the individual and others; b. Timely, appropriate access to crisis intervention to prevent or reduce acute, emotional distress, which might necessitate psychiatric hospitalization; c. Management of personal money and expenses; d. Supervision of daily living activities and life skills such as training with nutritional wellness, personal hygiene, clothing care and grooming, communication, social skills, health care, household management and using community resources; e. Provision of care including assuming the responsibility for the safety and well-being of the individual; f. Administration and supervision of prescribed and non-prescribed medication; g. Provision or arrangement of routine and emergency transportation; h. Management of aggressive or self-destructive behavior; I. Management of a diet, prescribed by a physician, requiring extra effort or expense in preparation of food; and J. Management of physical or health problems, including seizures or incontinence. 141408 Deschutes 360f330 2. Performance Standards Providers of Non-Relative Foster Care MHS 34 Services funded by the Oregon Health Authority (OHA) must comply with OAR 309-040-0300 through 309-040-0455, as such rules may be revised from time to time. Prior to commencement of both Relative and Non-Relative Foster Care MHS 34 Services funded by OHA for an individual, County or its designee must develop and submit to OHA for review and approval a personal care plan for the individual. After commencement ofMHS 34 Services, the County must insure that the Provider ofMHS 34 Services delivers the Services to the individual in accordance with the personal care plan. County must complete a new personal care plan annually for each individual receiving MHS 34 services funded by OHA and review the plan at least every 180 days or as needed and revise the plan as necessary. County must assist OHA in licensing and certifYing homes providing Non-Relative Foster Care MHS 34 Services funded by OHA by performing the following tasks within timelines required in the above-referenced administrative rules: a. For new licenses and certifications, inspection of the homes, and completion and submission to OHA ofthe following forms, as prescribed by OHA: (a) Foster Home License or Certification Application; (b) Foster Home Inspection Form; (c) Criminal History Check; and (c) any other information necessary for licensing or certifYing the residences; b. For renewal of existing licenses and certifications, inspection of the homes, and completion and submission to OHA of the Foster Home License/Certification Evaluation Forms; and c. Assistance to currently-licensed and potential new foster homes providing MHS 34 Services to meet statutory requirements for training and testing by: (1) Maintaining and distributing copies ofOHA' "Basic Training Course and Self-Study Manual" and associated video tapes; (2) Making test site(s) available, administering tests provided by OHA, and mailing completed tests promptly to OHA for scoring. OHA will make the final determination on issuance and renewal of licenses and certifications, based on information submitted by the County and as required above. 3. Special Reporting Requirements All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: 141408 Deschutes 370[330 a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/eJectronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. Enrollments for Relative and Non-Relative Foster Care must include the applicable code for 'Living Arrangement' of the Client. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures OHA provides financial assistance for MHS 34 Services in two different ways. Certain funds (the "Part A Award") are calculated, disbursed and settled as set forth in Section 4.a. below. The Part A Award is set forth in Exhibit 0-1., "Financial Assistance Award", on MHS 34 lines that contain an "A" in column one. Other funds (the "Residential Limitation") are not calculated, disbursed or settled under this Agreement. These funds are set forth in the Financial Assistance Award on MHS 34 lines that contain a "B" in column one and are paid as described in Section 4.b. below. a. The Part A Award will be calculated, disbursed and settled as follows: (1) Calculation of Financial Assistance. OHA will provide financial assistance for MHS 34 Services identified in a particular line of Exhibit o J, "Financial Assistance A ward", with an "A" in column one from funds identified on that line in an amount equal to the rate set forth in the special condition identified in that line of the Financial Assistance Award, multiplied by the number of units ofMHS 34 Services delivered under that line ofthe Financial Assistance Award during the period specified in that line, subject to the following: (a) Total OHA payment for MHS 34 Services delivered under a particular line in the Financial Assistance Award containing an "A" in column one shall not exceed the total funds awarded for MHS 34 Services as specified in that line of the Financial Assistance Award; (b) OHA is not obligated to provide financial assistance for any MHS 34 Services that are not properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement by the date sixty (60) days after the earlier of termination of this Agreement, termination of OHA's obligation to provide financial assistance for MHS 34 Services, or termination of County's obligation to include 141408 Deschutes 380[330 the Program Area, in which MHS 34 Services fali, in its Community Mental Health Program (CMHP); and (c) OHA will reduce the financial assistance for MHS 34 Services delivered under a particular line ofthe Financial Assistance Award containing an "A" in column one by the amount received, by a Provider of MHS 34 Services as payment of a portion ofthe cost ofthe services from an individual receiving such services with funds awarded in that line of the Financial Assistance Award. (2) Disbursement of Financial Assistance. OHA will disburse the Part A funds awarded for MHS 34 Services identified in a particular line of the Financial Assistance Award, Exhibit D-l with an "A" in column one, to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance A ward, subject to the following: (a) OHA may after notice to County, reduce the monthly allotments based on under delivery of services identified in accordance with section 3., "Special Reporting Requirements" above; (b) OHA may, upon written request of County adjust monthly allotments; and (c) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary to reflect changes in the funds awarded for MHS 34 Services on that line of the Financial Assistance Award. (3) Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of funds awarded for MHS 34 Services under a particular line of Exhibit D-], "the "Financial Assistance Award", containing an "A" in column one and amounts due for such services provided by County based on the rate set forth in the special condition identified in that line of the Financial Assistance Award. For purposes of this section, amounts due to County is determined by the actual amount of services delivered under that line of the Financial Assistance Award during the period specified in that line of the Financial Assistance Award, as properly reported in accordance with section 3., "Special Reporting Requirements" or as required in an applicable Specialized Service Requirement. b. Part B Limitation. The provider of the service needs to be enrolled as a Medicaid Provider and follow the procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA calculates the rates and the claims are processed through OHA's Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and OHA's Division of Medical Assistance Programs (DMAP) disburses the payment directly to service 141408 Desch utes 390f330 providers on a fee-for-service basis. Rates are available on the OHA website at http://www.oregon.gov/ohalamh/pages/tools-providers.aspx#m . OHA will provide notice to County in a timely manner ifthere is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/ohalamh/publications/other/provider2009manual.pdf. c. County shall not authorize, in aggregate, financial assistance for MHS 34 Services funded by OHA during the period specified in the Financial Assistance Award, in excess ofthe Adult Foster Care Limitation. Total aggregate financial assistances means the total of all financial assistance authorized before reducing payments to account for client resources received by the Provider from a client, or another on behalf of the client, in support of client care and services provided. d. The monthly rate will be prorated for any month in which the individual is not served for a portion of the month. e. Financial Assistance will be reduced (offset) by the amount of client resources received by the Provider from the client in support of client care and services provided. f. The Adult Foster Care Limitation is included in this Agreement for budgetary purposes. IfOHA anticipates that financial assistance for MHS 34 Services authorized by County will exceed the amount of the Adult Foster Care Limitation, OHA may unilaterally reduce the award of funds, as set forth in the Financial Assistance Award, for any other MHS Service or Services to the extent necessary to offset OHA's general fund cost of the payments authorized by County in excess ofthe Adult Foster Care Limitation. OHA and County shall execute an appropriate amendment to the Financial Assistance Award to reflect the reduction in the funds awarded for the other MHS Service or Services and the increase in the Adult Foster Care Limitation. g. OHA is not obligated to pay for any MHS 34 Services that are not properly reported through in accordance with section 3 .. "Special Reporting Requirements" above or as required in an applicable Special Service Requirements by the date 60 days after expiration or termination ofthis Agreement, whichever date is earlier. 141408 Deschutes 400f330 Service Name: OLDERIDISABLED ADULT MENTAL HEALTH SERVICES Service ID Code: MHS35 1. Service Description OlderlDisabled Adult Mental Health Services (MHS 35) are: a. If Specialized Service Requirement 35A applies, specialized geriatric mental health services delivered to older/disabled adults with mental health illness, as such services are further described in the 35A Specialized Service Requirement; or b. If Specialized Service Requirement 358 applies, residential services delivered to older/disabled individuals with severe and persistent mental health illness, as such services are further described in the 358 Specialized Service Requirement. 2. Performance Reguirements Funds awarded for MHS 35 Services on lines in Exhibit 0-1, ""Financial Assistance Award", specifYing that Specialized Service Requirement 35A applies may only be expended on MHS 35 Services described in paragraph a. below and funds awarded for MHS 35 Services on lines in Exhibit 0-1, "Financial Assistance Award", specifYing that Specialized Service Requirement 358 applies may only be expended on MHS 35 Services described in paragraph b. below: a. If Specialized Service Requirement 35A applies, the funds awarded for MHS 35 Services may only be expended on community based care services for older/disabled adults with mental health illness who are determined eligible for residential services from DHS' Aging and People with Disabilities (APD) Division. Such services include, but are not limited to, medication management, quarterly interagency staffing and follow-up services after treatment in local or state inpatient psychiatric hospitals, or indirect services, including but not limited to, screening, referral, and consultation and training to agencies and caregivers who provide services that may affect older/disabled adults with mental health illness; or b. If Specialized Service Requirement 358 applies, the funds awarded for MHS 35 Services may only be expended on residential services for older/disabled adults with severe and persistent mental health illness who are determined not eligible for, yet require, residential services from DHS' APD Division and who meet service need eligibility for Medicaid financed residential services under OAR 411-015-0000 through 411-015-0100 and are residing in a facility whose operator is licensed by the APD Division and has contracted with the APD Division to deliver residential services to specified individuals. If indirect services, as described in Section 2.a. above, are delivered with MHS 35 funds provided under this Agreement, those services must be available to relevant agencies and 141408 Deschutes 41of330 caregivers in the geographic area served by the CMHP operated by or contracted for by County and must be coordinated with protective services provided by DHS' APD Division and County's mental health crisis/commitment service. All MHS 35 Services delivered with funds provided under this Agreement that are subject to Specialized Service Requirement 35A must be delivered by a Qualified Mental Health Professional (as defined in OAR 309-016-0605(37» (QMHP) and in compliance with OAR 309-032-1500 through 309-032-1565, Standards for Adult Mental Health Services, as such rules may be revised from time to time. The QMHP delivering such services must have a background with the older/disabled adult population or be participating in relevant training programs to acquire such knowledge. 3. Special Reporting Requirements County shall provide summary reports on its delivery ofMHS 35 Services that are supported with funds provided under this Agreement that are subject to Specialized Service Requirement 35A. The reports must be submitted within 45 days of the end of each State fiscal year (ending June 30) and after the termination of this Agreement. Submit reports to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator 500 Summer Street N .E. E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by the Oregon Health Authority (OHA). All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www .oregon.gov/OHA/amh/training/cpms/index.shtm \, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: The funds awarded for MHS 35 Services are intended to be general financial assistance to County for MHS 35 Services. 141408 Deschutes 420[330 Accordingly, OHA will not track delivery ofMHS 35 Services or service capacity on a per unit basis so long as County offers and delivers MHS 35 Services as part of its CMHP. Total OHA financial assistance for MHS 35 Services under a particular line of Exhibit D-l, "Financial Assistance Award", shall not exceed the total funds awarded for MHS 35 Services as specified on that line. b. Disbursement of financial assistance: OHA will disburse the Part A funds awarded for MHS 35 Services identified in a particular line of Exhibit D-l, "Financial Assistance Award", to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award subject to the following: (1) OHA may, upon written request of County, adjust monthly allotments; and (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 35 Services on that line of the Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery ofMHS 35 Services by County as part of its CMHP, based on data properly reported in accordance with section 3. "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. 141408 Deschutes 430[330 Service Name: PRE-ADMISSION SCREENING AND RESIDENT REVIEW SERVICES Service ID Code: MHS36 1. Service Description Pre-admission Screening and Resident Review Services (MHS 36) are evaluation services delivered to individuals: a. Referred for placement in Medicaid-certified long-term care nursing facilities if they are exhibiting symptoms of a serious mental health illness, or b. Residing in Medicaid-certified long-term care nursing facilities experiencing a significant change in mental health status. Pre-admission Screening and Resident Review Services must determine if: a. Individuals have a serious mental health illness, as defined in OAR 309-032 0311; and b. Ifthose determined to have a serious mental health illness are appropriately placed in a nursing facility or need inpatient psychiatric hospitalization. 2. Performance Requirements Providers ofMHS 36 Services funded through Medicaid must comply with the Nursing Home Reform Act, under the Omnibus Budget Reconciliation Act OBRA 1987, as amended by OBRA 1990, including, but not limited to, 42 U.S.C. 1396r(e) 7, and OAR 309-048-0050 through 309-048-0130, as such laws and rules may be revised from time to time. Providers must maintain a Certificate of Approval in accordance with OAR 309 012-0130 through OAR 309-012-0220, as such rules may be revised from time to time. County must insure that all individuals referred for MHS 36 Services by licensed nursing facilities in County (or in the region served by the CMHP operated by or contractually affiliated with County, whichever area is larger) receive MHS 36 review and evaluation services. All MHS 36 Services funded through Medicaid must be delivered by a Qualified Mental Health Professional (as defined in OAR 309-016-0605) or a Licensed Medical Practitioner (as defined in OAR 309-032-1505). 3. Special Reporting Requirements Providers ofMHS 36 Services funded through Medicaid must complete and deliver to the Oregon Health Authority's (OHA) Addictions and Mental Health Division (AMH), within 21 days after a review, form AMH 0438 and form AMH 0440, with respect to that review. 141408 Deschutes 440[330 All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www .oregon.gov /OHA/am h/traininglcpms/index.shtmf, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www .oregon.gov /0HNamh/pages/compass/electron ic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation and Disbursement Procedures OHA provides financial assistance for MHS 36 Services in Part 8 ("Limitation") Awards. The Award is set in Exhibit D-l, "Financial Assistance Award", on MHS 36 lines in column one that contain "8" for Part 8 A ward. The provider of the service needs to be enrolled as a Medicaid Provider and follow the procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manuaL OHA calculates the rates and the Part 8 limitation and the claims are processed through OHA' Medicaid Management Information System (MMIS). OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis. Rates are available on the OHA website located at http://egov .oregon.gov /OHA/mentalhealth/publ ications/codebooks/mhO 1 09rates.pdf. OHA will provide notice to County in timely manner ifthere is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA' Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0755 and OHA' AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www .0regon.gov/OHA/mentalhealth/publications/codebookslmanual.pdf, and as it may be revised from time to time. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0755. 141408 Deschutes 450[330 Service Name: MHS SPECIAL PROJECTS Service lD Code: MHS37 1. Service Description MHS Special Projects (MHS 37) are mental health services within the scope ofORS 430.630 delivered on a demonstration or emergency basis for a specified period of time. Each project is described in a separate exhibit to this MHS 37 Service Description. When the Financial Assistance Award in Exhibit D-I contains a line awarding funds for MHS 37 Services, that line will contain a special condition specifYing the exhibit to this MHS 37 Service Description that describes the project for which the funds are awarded. The specific MHS 37 Services to be provided under this Agreement are described in exhibits, if any, to this MHS 37 Service Description, which exhibits are incorporated herein by this reference. 2. Performance Requirements Providers ofMHS 37 Services funded through this Agreement with Medicaid dollars must comply with OAR 309-016-0600 through 309-016-0755. See exhibits, if any, to this MHS 37 Service Description. 3. Special Reporting Requirements See exhibits, if any, to this MHS 37 Service Description. 4. Payment Procedures See exhibits, ifany, to this MHS 37 Service Description. Even if the Financial Assistance Award in Exhibit D-1 awards funds for MHS 37 Services, the Oregon Health Authority (OHA) shall have no obligation to provide financial assistance for any MHS 37 Services under this Agreement (even if funds therefore are disbursed to County) unless a special project description is attached to this Service Description as an exhibit. 141408 Deschutes 46 of 330 Exhibit MIlS 37-Start-Up 1. Service Description The funds awarded for this special project must be used for start-up activities described in a Special Condition. For purposes of this special project description, start-up activities are activities necessary to begin, expand, or improve Mental Health Services. These expenses are distinct from routine operating expenses incurred in the course of providing ongoing services. Notwithstanding the description of the start-up activities in a Special Condition, funds awarded for this special project may not be used for real property improvements of $5,000 and above. When Oregon Health Authority (OHA) funds in the amount of $5,000 and above are to be used for purchase or renovation of real property, County must contact the Community Housing, Employment & Supports Unit of the Addictions and Mental Health Division and follow procedures as prescribed by that Unit. Start-Up funds are typically disbursed prior to initiation of services. Funds awarded are used to cover approved allowable Start-Up expenditures as described in Exhibit K that will be needed to provide the services planned and delivered at the specified site(s). 2. Performance Requirements The funds awarded for this special project may be expended only in accordance with Exhibit K Start-Up Procedures, which is incorporated herein by this reference. 3. Special Reporting Requirements a. County must prepare and submit reports to the Oregon Health Authority (OHA) on the expenditure ofthe funds awarded for this special project and any special conditions which are specified in the Financial Assistance Award. The reports must be prepared in accordance with forms prescribed by OHA and procedures described in Exhibit K Start-Up Procedures. b. When OHA Start-Up funds in the amount of $1 ,000 and above are to be used for purchase of a vehicle, as security for the County's performance of its obligations under this Agreement, the County grants to OHA a security interest in, all of the County's right, title, and interest in and to the goods, i.e. the vehicle. The County agrees that from time to time, at its expense, the County will promptly execute and deliver all further instruments and documents, and take all further action, that may be necessary or desirable, or that OHA may reasonably request, in order to perfect and protect the security interest granted under this Agreement or to enable OHA to exercise and enforce its rights and remedies under this Agreement with respect to the vehicle. County must forward a copy of the title registration application showing OHA' Addictions and Mental Health Division (AMH) as the Security Interest Holder to OHA within five (5) days of the acquisition from the seller. File Security Interest Holder information with DMV as follows: Oregon Health Authority Addictions and Mental Health Division 141408 Deschutes 470[330 Attention: Contracts Administrator 500 Summer Street NE, E86 Salem, Oregon 97301 Vehicles costing $1,000 or more must be used to provide the service for which OHA approved the Start-Up funds awarded. Dedicated use must continue for the useful life of the vehicle or five (5) years, whichever is less. The following steps describe the process for removal ofliens: (I) To release a vehicle title on which OHA is listed security interest holder County or any subcontractor(s) must make a request in writing to OHA. The request must specifY why the vehicle is being disposed of and the intended use of any funds realized from the transaction. (2) If approved, the original title is signed offby OHA and forwarded to the County. c. The following circumstances require special written authorization from OHA prior to acquisition when using Start-Up funds awarded. These circumstances should be communicated to OHA within fourteen (14) days ofthe anticipated acquisition date. ( I ) When Leasing: (a) Acquisition of real property, vehicles, or capital items pursuant to a Lease; (b) Acquisition of real property, vehicles, or capital items where another party, in addition to OHA, will also become a secured party (lienholder) at the time of acquisition; (c) Renovations or alterations of real property where County is not the owner of the property and OHA has no security interest in the property. (2) Other: (a) A change in the intended use of Start-Up funds awarded or a change in the amount or date ofanticipated acquisition indicated on County's request for payment of Start-Up funds, for those acquisitions requiring OHA's interest to be secured. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: OHA will provide financial assistance, from funds awarded for this special project in a particular line of Exhibit D-l, "Financial Assistance Award", in an amount equal to the actual allowable expenditures (as described in Exhibit K Start-Up) incurred by a Provider in implementing the special project described herein, subject to the requirements of Exhibit K Start-Up and subject to the following additional restrictions: (I) Total OHA financial assistance for implementation of the special project described herein under a particular line of Exhibit D-l, "Financial 141408 Deschutes 480[330 Assistance Award", shall not exceed the total funds awarded for the special project described herein as specified in that line of the Financial Assistance Award; and (2) OHA is not obligated to reimburse any special project expenditures that are not properly reported to OHA using forms prescribed by OHA and procedures contained in Exhibit K within sixty (60) days after the earlier of: (a) Termination of this Agreement, (b) Termination ofOHA's obligation to provide financial assistance for MHS 37 Services; or (c) Termination of County's obligation to include the Program Area, in which MHS 37 Services fall, in its Community Mental Health Program (CMHP). (3) Funds will be awarded for actual allowable expenses up to the limit approved in the Start-Up & Expenditure Inventory Form. (4) After execution ofthe Agreement or any amendment(s) for Start-Up payments, County may request an advance of funds it anticipates using in the subsequent one hundred twenty (120) days. b. Disbursement of Financial Assistance: OHA will disburse the funds awarded for this special project in a particular line of Exhibit 0-1, "tFinancial Assistance Award", after OHA's receipt, review and approval of County's properly completed "Start-Up Request & Expenditure Form", as described in and in accordance with Exhibit K Start-Up. County shall keep a copy of all requests for payment using the Start-Up Request & Expenditure Form. County shall keep a copy of all Expenditure Reports for Start-Up services using the Start-Up Request & Expenditure Form. County is responsible for requiring its subcontractors to comply with expenditure reporting requirements and furnishing evidence of filing OHA's security interest on applicable items. OHA may inspect these reports, which must include the following by service element: (1) The amount advanced; (2) The amount expended on each allowable category, and the amount expended on each item listed for items needing special written approval authorization; and (3) Copies of all subcontractor contracts awarding Start-Up payments. Such contracts must require subcontractors to execute dedicated use contracts and other security documentation as required in this Exhibit. Each County shall maintain supporting documentation for all expenditures (i.e., receipts). 141408 Deschutes 490[330 c. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of funds awarded for this special project under a particular line of Exhibit 0-1, "Financial Assistance Award", and amounts due for implementation of the special project based on actual allowable expenditures incurred in implementing the special project under that line of the Financial Assistance Award during the period specified on that line, as such expenses are properly reported using forms prescribed by OHA and procedures outlined in Exhibit K Start-Up Procedures. County shall submit all Start-Up Request & Expenditure Reports at the level of detail prescribed by OHA. Any reports not submitted by thirty (30) calendar days after the expiration date ofthe contract shall not be accepted or owed by OHA. In the event County fails to submit an expenditure report when due for itself or its subcontractor(s), fails to submit security interests, vehicle titles, or other instrument as required by OHA to secure the State's interest, or reports unauthorized expenditures, or reports under expenditures without accompanying repayment, OHA may act, at its option, to recover Start-Up payments as follows: (I) Bill the County for subject payment; (2) Following thirty (30) days' non-response to the billing, initiate a payment reduction schedule against any current payments or advances being made to County; or (3) Take other action needed to obtain payment. 141408 Deschutes 500f330 EXHIBIT lVIHS 37-Peer Delivered Services (PDS) to MRS 37 Service Description MHS Special Projects 1. Service Description This special project is known as the Peer Delivered Services (PDS) project. "Peer Delivered Services" means an array of agency or community-based services and supports provided by peers and peer support specialists to individuals or family members with similar lived experience, that are designed to support the needs of individuals and families as applicable. This support may be financially compensated or voluntary. The PDS project will assist the establishment or expansion of PDS in a specified geographic area for the period of the Agreement. 2. Performance Requirements County shall use the funds awarded under this Agreement for this special project to implement PDS in a manner that benefits individuals with a severe and persistent mental illness. 3. Special Reporting Requirements Within 30 days after the end of each subject quarter, the County shall submit to the Oregon Health Authority's (OHA) Addictions and Mental Health Division (AMH), a quarterly report that includes: a. Amount of funds spent as of the end of the reporting period; b. Description of PDS implementation progress, technical assistance needs, and any relevant implementation challenges; c. Number of persons with severe and persistent mental illness who were trained or received PDS services during the quarter; and d. Outcome measures to include: (I) Shortened hospital stays; (2) Improved ability to cope with mental illness (3) Reduced crisis events (4) Improved quality of life (5) Increased level of empowerment Reports shall be submitted to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator 500 Summer Street N.E. E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by OHA. 141408 Deschutes 51of330 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: Funds awarded for this special project are intended to be general financial assistance to County for this special project. Accordingly, OHA will not track delivery ofspeciaJ project services or service capacity on a per unit basis except as necessary to verify that the performance requirements set forth above have been met. Total OHA financial assistance for this special project shall not exceed the total funds awarded for this special project as specified in Exhibit D-l, "Financial Assistance Award". b. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line of Exhibit D-1. "Financial Assistance Award", OHA will disburse the funds awarded for this special project on a particular line ofthe Financial Assistance Award to County in substantially equal monthly allotments during the period specified in the Financial Assistance Award, subject to the following: (1) OHA may, upon written request of County adjust monthly allotments; and (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments to reflect changes in the funds awarded for this special project on that line of the Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will be used to confirm implementation of the special project described herein based on data properly reported through reports required or permitted by this special project description. J 4 J 408 Deschutes 52 of330 Exhibit MHS 37 -Flexible Funding MHS Special Projects 1. Service Description Flexible funding is the promotion, prevention, early identification and intervention of conditions that lead to mental health, substance use and addiction disorders. This focus will lead to improved outcomes and enhanced healthcare experiences for individuals as well as reduce overall expenditures. County will have the flexibility to allocate the funds to meet community needs and statutory requirements. Based upon the source of the funds shown in OWITS, County shall prioritize persons to be served as outlined in ORS 430.644, federal Mental Health and Substance Abuse Prevention and Treatment grants, and OAR 309-032-1525. County is responsible to establish and maintain a structure for meaningful system design and oversight that includes involvement by individuals and families across all ages that have or are receiving addictions or mental health services. System design and oversight structure must include: a. Planning b. Implementation c. Monitoring d. Evaluation of services and supports e. Involvement in activities that focus on: (1) Resource allocation (2) Outcomes (3) Quality improvement (4) Advisory councils 2. Performance Requirements County shall provide the following Services, subject to availability of funding. Services may be reduced commensurate with reductions in funding by OHA: a. Behavioral Health Promotion and Prevention. (1) Behavioral Health Promotion and Prevention is distinct from treatment. (2) Behavioral Health Promotion and Prevention is focused on changing common influences on the development of individuals across their lifespan, reducing risk factors and increasing protective factors. (3) Behavioral Health Promotion and Prevention is designed to target universal populations and indicated popUlations based on risk. 141408 Deschutes 530[330 (4) Behavioral Health Promotion and Prevention must incorporate the Strategic Planning Framework (SPF). The SPF provides an effective, comprehensive prevention process and a common set of goals to be adopted and integrated at all levels. This process is built upon state and local data assessment, building capacity, development of a comprehensive strategic plan, implementation of evidence-based strategies, and evaluation of work. (5) The SPF takes a public health approach to prevent community problems. The focus is on change for entire popUlations, collections of individuals who have one or more personal or environmental characteristics in common. Population-based public health considers an entire range of factors that determine health. (6) The SPF strives to infuse data in decisions made across all steps. Deliberate processes to collect, analyze, interpret and apply lessons from data will drive state prevention efforts. b. Outreach (Case Finding), Early Identification and Screening, Assessment and Diagnosis. (I) Outreach: Partner with healthcare providers and other social service partners who provide screening for the presence of behavioral health conditions to facilitate access to appropriate services. (2) Early Identification and Screening: Conduct periodic and systematic methods that identify individuals with behavioral health conditions and potential physical health consequences of behavioral health conditions which consider epidemiological and community factors, as identified in the Biennial Implementation Plan (BIP), or Regional Health Improvement Plan (RHIP) as applicable, pursuant to Exhibit C; (3) Assessment and Diagnosis: Perform multidimensional biopsychosocial assessment as appropriate based on OAR 309-032-1525 to guide person centered services and supports planning for behavioral health and co existing physical health conditions. (a) Use the following standardized protocols and tools to identifY the level of service need and intensity of care and coordination, addressing salient characteristics such as age, culture and language. i. American Society of Addiction Medicine (AS AM) for individuals receiving alcohol and drug services ii. Level of Care Utilization System (LOCUS) for adults transitioning between the state hospitals, licensed mental health residential services and intensive community services. "Intensive community services" are defined as assertive community treatment, intensive case management and supported/supportive housing. iii. Level of Service Intensity Determination for children including use of Child and Adolescent Service Intensity Instrument (CASH) and Early Childhood Service Intensity Instrument 141408 Deschutes 54of330 (ECSII) for children receiving services with an Intensive Community-Based Treatment and Support Services or Intensive Treatment Services as described in OAR 309-032 1540 (5 and6). (b) Identify individuals who need intensive care coordination. c. Initiation and Engagement. Promote initiation and engagement of individuals receiving services and supports which may include but are not limited to: (I) Brief motivational counsel ing; (2) Supportive services to facilitate participation in ongoing treatment; and (3) Withdrawal management for Substance Use and Addiction Disorders, supportive pharmacotherapy to manage symptoms and adverse consequences of withdrawal, following assessment. d. Therapeutic Interventions. (1) General Community Based Services which may include: (a) Condition management and a whole person approach to single or multiple chronic conditions based on goals and needs identified by the individual; (b) General outpatient services; (c) Medication Management for: i. Mental Health disorders ii. Substance Use disorders (A) Includes pharmacotherapy for adults diagnosed with opioid dependence, alcohol dependence or nicotine dependence and without medical contraindications. Publicly funded programs will not discriminate in providing access to services for individuals using medications to treat and manage addictions. (B) Pharmacotherapy, if prescribed, should be provided in addition to and directly linked with psychosocial treatment and support. (d) Detoxification for alcohol and drug dependent individuals under OAR 415-012-0000 through 415-012-0090 and 415-050-0000 through 415-050-0095 and the equivalent type of service for pathological gamblers. Supportive pharmacotherapy may be provided to manage the symptoms and adverse consequences of withdrawal, based on a systematic assessment of symptoms and risk of serious adverse consequences related to the withdrawal process. 141408 Deschutes 550f330 (e) Meaningful individual and family involvement; and (t) Services provided by peers. The County is encouraged to make available services and supports delivered by peers. Ifthe County lacks these services and supports, the County is encouraged to develop a plan to expand the array of services and supports provided by peers in a manner that is consistent with their Biennial Implementation Plan (BIP), or Regional Health Improvement Plan (RHIP) as applicable, and in consultation with AMH. (2) Provide Crisis Services including but not limited to 24 hours a day, seven days a week screening to determine the need for immediate services for any individual requesting assistance or for whom assistance is requested. (3) Provide Pre-Commitment Services: (a) Pre-commitment investigation (b) Treatment planning and referral (c) Adherence to the individual's rights through all legal proceedings. (4) Provide Acute Care Services in accordance with ORS 430.630 and ORS 426.241. Except as provided by ORS 426.241(1), which states that "[t]he county is responsible for the cost when state funds available therefore are exhausted," County need only provide services up to the funding amount outlined in the document found at http://www.oregon.gov/OHA/amh/Pages/reporting-regs.aspx Acute Care Services shall be provided to: (a) An individual in need of emergency hold services under ORS 426.232 and ORS 426.233. (b) An individual committed to Oregon Health Authority under ORS 426.130. (c) An individual voluntarily seeking crisis services provided that service capacity is available and the individual satisfies one or more of the following criteria: I. The individual is at high risk for an emergency hold or civil commitment without voluntary inpatient psychiatric services; or ii. The individual has a history of psychiatric hospitalization and is beginning to decompensate and for whom a short period of inpatient psychiatric treatment may provide stabilization; or iii. The individual is an appropriate candidate for inpatient psychiatric treatment but other inpatient psychiatric treatment resources are unavailable. (5) Provide monitoring and supervision services to all individuals under the Jurisdiction of the Psychiatric Security Review Board (PSRB) or the 141408 Deschutes 560f330 Juvenile Psychiatric Security Review Board (JPSRB) that have been referred to County: (a) Assessment and evaluation for the Court and the PSRB or JPSRB of an individual for Conditional Release from a state hospital or facility designated by OHA or placement on a waiting list for conditional release from a state hospital or facility designated by OHA to determine if the individual can be treated in the community; this includes identification of the specific requirements for the community placement of an individual. (b) Supervision and Urinalysis Drug Screen consistent with the Conditional Release Order. (c) Coordination with a state hospital or facility designated by OHA on transition activities related to conditional release of an individual. (d) Administrative activities related to the supervision services described above, including but not limited to: i. Modification of Conditional Release Orders. ii. Revocations of conditional release. iii. Admission or re-admission to a state hospital. IV. Respond to Law Enforcement Data System (LEDS) notifications as a result of contact by the individual with law enforcement agencies. (6) Provide alcohol and drug treatment services in accordance with ORS 813.270. County shall be responsible for meeting service targets communicated by the Oregon Health Authority and are subject to regular review and reconciliation. Treatment program and Driving under the Influence of Intoxicants (DUn) information program services shall be provided to: (a) Individuals who enter diversion agreements under ORS 813.200 and who are found to be indigent. (b) Individuals required to comply with the obligations imposed under ORS 813.020 or ORS 471.432 and who are found to be indigent. OHA may redistribute the funding allocations quarterly, based on utilization data. (7) Provide Secured Transport. (8) Supported Employment (SE), Assertive Community Treatment (ACT) and Early Assessment and Support Alliance (EASA). When providing these services, the County shall provide SE, ACT and EASA services in a manner that is consistent with fidelity standards established by AMH. 141408 Deschutes 570f330 (a) Assess individuals to determine whether SE, ACT and EASA services and supports are appropriate. (b) Provide those services with the individual's engagement and choice. (c) The assessment and SE, ACT or EASA services and supports must be provided by Providers that meet fidelity standards found at http://www.oregon.gov/OHA/amh/Pages/reporting-regs.aspx. (d) If the County lacks qualified Providers to deliver SE, ACT or EASA services and supports, the County is encouraged to develop a plan to develop qualified Provider network or to access SE, ACT or EASA for individuals in a manner that is consistent with their BIP, or RHIP as applicable, and in consultation with AMH. e. Continuity of Care and Recovery Management. (1) Continuity of Care (a) Coordinate and facilitate access to appropriate housing services and community supports in the individual's community of choice. (b) Facilitate access to appropriate levels of care and coordinate management of services and supports based on an individual's needs in the community of choice. (c) Facilitate access to services and supports provided in the community and individual's home designed to assist children and adults with mental health disorders whose abil ity to function in the community is limited and for whom there is significant risk of higher level of care needed. (d) Coordinate with other agencies to provide intensive care coordination sufficient to help individuals prevent placement in a more restrictive level of care and to be successfully served in their community of choice. (2) Recovery Management a. Continuous case management. b. Monitoring of conditions and ongoing recovery and stabilization. c. Individual and family engagement. d. Transition planning that addresses the individual's needs and goals. 3. Special Reporting Requirements a. Biennial Implementation Plan (BIP) as identified in ORS 430.630 (9) (c) except for Central Oregon counties subject to the Regional Health Improvement Plan (RHIP) as identified in Senate Bill 204 (2011), Sections 6. The components of the RHIP are identified in OAR 309-014-0320. 141408 Deschutes 58of330 (I) Components of the HlP or RHIP can be found at http://www.orgeon.gov/OHA/amhlPages/reporting-reqs.aspx. (2) Submit HlP, or RHIP as applicable, in compliance with AMH BIP Policy and Procedures as specified in OHA's HlP Guidelines located at: http://www.oregon.gov/OHA/amh/Pages/reporting-regs.aspx. For counties subject to the RHIP, submit RHIP in compliance with OAR 309-014 0340. (a) 2015-2017 BIP or RHIP due to OHA no later than March 1,2015. County must participate in the collaboration process for revisions that result in an approved BIP or RHIP. b. PSRB/JPSRB Supervision Services (I) County must submit a copy of the Conditional Release Order to AMH for all individuals conditionally released into the community each month no later than 15 calendar days following the month the conditional release occurred. (2) PSRB/JPSRB monthly progress report: County must submit a copy of each individual's monthly progress report to the PSRB/JPSRB directly, with a copy to OHA no later than 15 calendar days following the month supervision services were delivered. c. Jail Diversion (l) For services funded with this financial assistance fully or partially: (a) Report the number of individuals receiving services intended to divert from jail. (b) Report the number of individuals receiving services intended to divert from Oregon State Hospital aid and assist services. (2) The reporting schedule is as follows: Data from July] -December 31,2013 due February 14,2014 Data from January I-June 30, 2014 due August 15,2014 Data from July I-December 31, 2014 due February 14, 20 IS Data from January I-June 30, 2015 due August 15,2015 (3) Data will be submitted on a form provided by AMH. (4) Co-management County shall facilitate transition of individuals at a state hospital campus within 30 calendar days following the Ready To Transition (RTI) date as determined by the Oregon State Hospital (OS H). OHA may reduce the monthly allocation, associated with this Special Project, when the County is identified by OHA as the County of 141408 Deschutes 590f330 Responsibility of a patient at a state hospital campus and the patient exceeds the RIT date by more than 30 days. The reduction of the monthly allocation will be based on the following table: Percentage of State Hospital Cost of Care 0 30 Days Beyond RIT 0% 31-60 25% 61 -90 50% 91 -120 r 75% 121 and over 100% The percentage of the cost of care will be reduced by an additional 50% if the County's patient Average Daily Population (ADP) or identified OHA approved multi-county region's ADP is at or below the ADP Targets established by OHA as indicated at http://www.oregon.gov/OHA/amhlPageslreporting-reqs.aspx State hospital cost of care will be identified in the current Institutional Cost of Care Rates Report published by the Oregon State Hospital Financial Services Division at http://www.oregon.gov/OHAlamh/osh/cost of-care.shtml An appeal of the reduction in funds related to co-management may be sent in writing to OHA when the procedural problems not related to the County's actions interfered with the County's ability to facilitate transition from the state hospital. All appeals must be submitted in writing. Submit appeal as indicated at http://www.oregon.gov/OHA/amh/osh/cost of-care.shtm I 4. Data Reporting a. The following reporting is required as applicable: (1) All individuals receiving Services with funds provided under this Special Project must be enrolled and that client's record maintained in either: (a) the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amh/Pages/reporting-reqs.aspx; or (b) the Measures and Outcomes Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/Pages/reporting-reqs.aspx. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 141408 Deschutes 600f330 (2) If the Services are provided in a designated psychiatric acute care setting, the Services must be reported in Oregon Patient and Resident Care System (OPIRCS) by the hospital providing the service, as specified in the OPIRCS Manual located at http://www.oregon.gov/OHA/amhlPages/reporting-regs.aspx, (3) Submission of applicable prevention data via the Minimum Data Set for Prevention (MDS). All substance abuse prevention services delivered by County or its Providers must be entered into MOS. Mental Health, Education and Outreach service activity may also be captured using the MDS or by submitting bi-annual expenditure and service reports to OHA subject to this Special Project as indicated at http://www.oregon.gov/OHA/amhlPages/reporting-regs.aspx. (4) Submission of applicable gambling services data as defined in the Gambling Process Management System (GPMS) Manual located at http://www .oregon.gov IOHA/amhlPages/reporting-regs.aspx. (5) County must participate in User Acceptance Testing and implementation activities for a new reporting system as designated by OHA. Once Testing has been completed, County must ensure data is submitted for all individuals receiving services with funds provided under this Special Project by way of one of the following options: (a) comply with data submission using the Oregon Web Infrastructure for Treatment Services (OWITS) system as specified in the OHA OWITS Memorandum of Understanding located at: http://www.oregon.gov/OHA/amhlPages/reporting-reqs.aspx, or (b) comply with the data submission specifications for submitting data using File Transfer from an existing Electronic Health Record (other than OWITS) as specified in the AMH File Transfer Specifications located at http://www.oregon.gov/OHA/amh/Pages/reporting-reqs.aspx, or(c)comply with data submission specifications by entering data in the Minimum Data Entry (MOE) application as specified in the AMH MOE user manual located at: http://www.oregon.gov IOHA/amh/Pages/reporting-req s.aspx. (6) Submission of reports for child and adolescent mental health services provided with funds under this Special Project as applicable: (a) comply with Level of Service Intensity Determination Data located at: http://www.oregon.gov/OHA/amh/Pages/reporting-reqs.aspx, or (b) comply with Integrated Service Array (ISA) Progress Review Report located at: http://www.oregon.gov/OHA/amh/Pages/reporting-reqs.aspx. 141408 Deschutes 610f330 (7) Non-encounter Reporting Categories: County shall submit the following non-encounter data as indicated at http://www.oregon.gov/OHA/amhlPages/reporting-reqs.aspx: (a) Population or service specific funding carve outs (b) Medical and physical health (c) Behavioral health (d) Transportation and travel (e) Service management and planning (f) Community services and supports (g) Community housing planning and assistance (h) Peer Services b. The reporting schedule is as follows: (I) Claims paid data from July I-December 31,2013 due February 14,2014 (2) Claims paid data from January I-June 30, 2014 due August 15,2014 (3) Claims paid data from July I-December 31,2014 due February 14,2015 (4) Claims paid data from January I-June 30, 2015 due August 15,2015 5. Financial Reporting a. County shall submit all Financial Reports as indicated at http://www.oregon.gov/OHA/amh/Pages/reporting-regs.aspx b. County shall submit a narrative that addresses the following: (1) Util ization of existing services and programs; (2) Innovative strategies, programs or services which have been implemented; (3) Strategies, programs or services that are being planned; (4) Barriers experienced when planning, implementing or providing services or programs; and (5) Analyzing the service data they have reported. c. The reporting schedule is as follows: (I) Data from July I-December 31,2013 due February 14,2014 (2) Data from January I-June 30, 20]4 due August 15,2014 (3) Data from July I-December 31, 2014 due February 14,2015 (4) Data from January I-June 30, 2015 due August 15, 2015 141408 Deschutes 620f330 6. Financial Assistance Calculation, Disbursement & Reconciliation Procedures a. Calculation of Financial Assistance. OHA will provide financial assistance identified in Exhibit D-2, "OWlTS Financial Assistance Award", from funds identified on that line in an amount equal to the amount set forth in that line ofthe OWITS Financial Assistance Award, subject to the following: Total OHA financial assistance for this Special Project under a particular line of Exhibit D-2, "OWlTS Financial Assistance Award", shall not exceed the total funds awarded for this Special Project as specified on that line. b. Disbursement of Financial Assistance. OHA will disburse the funds awarded for this Special Project on a particular line of Exhibit D-2, "OWITS Financial Assistance Award", to County in substantially equal monthly allotments during the period specified in the OWITS Financial Assistance Award, subject to the following: (1) Upon amendment to the OWITS Financial Assistance Award, OHA shall adjust monthly allotments to reflect changes in the funds awarded for this Special Project on that line of the OWITS Financial Assistance Award. c. Calculation ofIncentive Payment: OHA will provide incentive payments (as indicated at http://www.oregon.gov/OHA/amhlPages/reporting-reqs.aspx) identified in Exhibit 0-2, "OWlTS Financial Assistance Award, with a special condition attached. d. Disbursement of Incentive Payment: OHA will disburse the funds awarded for this Special Project incentive payment on a particular line of Exhibit 0-2, "OWlTS Financial Assistance Award", to County in a one-time payment during the period specified in the OWITS Financial Assistance Award. e. Agreement Reconciliation: Agreement Reconciliation will be used to: (1) Verify services were provided to priority populations and County complied with specific funding stream requirements, using data properly reported as required in this Special Project. (2) Verify County service delivery is consistent with the OHA approved BIP or RHIP as identified in Exhibit C. 141408 Deschutes 6301'330 Service Name: PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS (PATH) SERVICES Service ID Code: MHS 39 1. Service Description The PATH program is designed to support the delivery of eligible services to persons who are: a. Homeless or at imminent risk of homelessness; b. Have serious mental health illnesses; and c. May have co-occurring substance use disorders. Eligible services are as follows: a. Outreach services; b. Screening and diagnostic treatment services; c. Habilitation and rehabilitation services; d. Community mental health services; e. Alcohol and drug treatment services; f. Stafftraining, including the training of individuals who work in shelters, mental health clinics, substance abuse programs, and other sites where individuals who are homeless require services; g. Case management services; h. Supportive and supervisory services in residential settings; i. Referrals for primary health services, job training, educational services, and relevant housing services; and J. Housing services as specified in Section 522 (b) (10) of the Public Health Service Act (PHSA), 42 USC 290cc-22(b)(lO) , including: (1) Minor renovation, expansion, and repair of housing. (2) Planning of housing. (3) Technical assistance in applying for housing assistance. (4) Improving the coordination of housing services. (5) Security deposits. (6) Costs associated with matching eligible individuals who are homeless with appropriate housing situations. (7) One-time rental payments to prevent eviction. OHA places particular emphasis on outreach, screening and diagnostic services. OHA also emphasizes that case management, community mental health services, and alcohol and drug treatment services funded by PATH are meant to be transitions services. 141408 Deschutes 64 of330 2. Performance Requirements Providers ofMHS 39 Services funded through this Agreement must comply with OAR 309-032-0175 through 309-032-0210, as such rules may be revised from time to time, and must maintain a Certificate ofApproval in accordance with OAR 309-012-0130 through 309-012-0220, as such rules may be revised from time to time. Services provided must be eligible services as stated in the Public Health Services Act, Section 522 (b). Providers ofMHS 39 Services funded through this Agreement shall: a. Assist the Oregon Health Authority (OHA), upon request, in the development of an annual application requesting continued funding for MHS 39 Services, including the development of a Budget and an Intended Use Plan for Projects for Assistance in Transition from Homelessness (PATH) funds consistent with federal requirements in Section 526, Part C, Public Health Service Act; and b. Provider minimum requirements: (1) At least 85% of individuals serviced must be PATH-eligible and not currently enrolled in community mental health services. (2) Of the total individuals who are PATH-enrolled, 75% must be transitioned into permanent housing. (3) Ofthe total individuals who are PATH-enrolled, 100% must be engaged in community mental health services. (4) Active participation in the local Continuum of Care. (5) Attendance at semi-annual PATH provider meetings. (6) Attendance at PATH Technical Assistance trainings as requested by OHA. (7) Development of an annual PATH Intended Use Plan including a line item budget and budget narrative. (8) Participation in annual PATH program site reviews conducted by OHA. (9) Participation in Federal site reviews as needed or requested by OHA. 3. Special Reporting Requirements Providers of MHS 39 Services funded through this Agreement must submit: a. Annual on-line report on the activities conducted and services provided during the year with the funds awarded under this Agreement for MHS 39 services. The report must comply with federal requirements for PATH program, as authorized through the Public Health Service Act, Part C, Section 521, as amended, 42 U.S.C. 290cc-21 et seq.; Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101-645. Providers must supply actual utilization numbers for the Federal Voluntary Outcomes Measures within the annual on-line report. 141408 Deschutes 650f330 b. Quarterly written report documenting PATH eligible expenditures and actual utilization and demographic data due no later than forty-five (45) days following the end of the reporting period. Reports shall be submitted to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator 500 Summer Street N.E. E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by OHA. All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amh/training/cpms/index.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass!electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: The funds awarded for MHS 39 Services are intended to be general financial assistance for MHS 39 Services. Accordingly, OHA will not track delivery ofMHS 39 Services on a per unit basis except as necessary to verity that the performance requirements set forth in the special condition identified in a particular line of Exhibit 0-1, "Financial Assistance Award", from funds identified on that line in an amount equal to the rate set forth in the special condition identified in that line of the Financial Assistance Award. Total OHA financial assistance for MHS 39 Services under a particular line of the Financial Assistance Award shall not exceed the total funds awarded for MHS 39 Services as specified on that line. b. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line of Exhibit 0-1, "Financial Assistance Award", OHA will disburse the financial assistance awarded for MHS 39 Services identified in a particular line ofthe Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: 141408 Deschutes 660f330 (1) OHA may, upon written consent of County, adjust monthly allotments; and (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 39 Services on that line of the Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of funds awarded for PATH services, as described herein, under a particular line of Exhibit D-l, "Financial Assistance Award", and satisfaction of the minimum performance requirements, based on data properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement and/or through reports required or permitted by this MHS 39 Service Description. 141408 Desch utes 670f330 Service Name: A&D SPECIAL PROJECTS Service ID Code: A&D 60 1. Service Description A&D Special Projects (A&D 60) are alcohol and drug abuse services within the scope of ORS 430.630. Each project is described in a separate exhibit to this A&D 60 Service Description. When Exhibit D-1, "Financial Assistance A ward" contains a I ine awarding funds for A&D 60 Services, that line will contain a special condition specifying the exhibit to this A&D 60 Service Description that describes the project for which the funds are awarded. The specific A&D 60 Services for which financial assistance is provided under this Agreement are described in exhibits, if any, to this A&D 60 Service Description, which exhibits are incorporated herein by this reference. 2. Performance Standards See exhibits, if any, to this A&D 60 Service Description. 3. Special Reporting Requirements See exhibits, if any, to this A&D 60 Service Description. 4. Payment Procedures See exhibits, if any, to this A&D 60 Service Description. Even if the Financial Assistance Award awards funds for A&D 60 Services, OHA shall have no obligation to disburse any funds or provide financial assistance under this Agreement for any A&D 60 Services (even if funds therefore are disbursed to County) unless a corresponding special project description is attached to this Service Description as an exhibit. 141408 Deschutes 680[330 Exhibit A&D 60-Startup 1. Service Description The funds awarded for this special project must be used for start-up activities described in a special condition. For purposes ofthis special project description, start-up activities are activities necessary to prepare for new or revised implementation of alcohol and drug abuse services. 2. Performance Requirements The funds awarded for this special project may be expended only in accordance with Exhibit K, Startup Procedures, which is incorporated herein by this reference. 3. Special Reporting Requirements County shall prepare and submit expenditure reports to OHA on the expenditure of the funds awarded for this special project. Reports shall be sent to: Oregon Health Authority Addictions and Mental Health Division Attention: Contracts Administrator 500 Summer Street N.E. E86 Salem, OR 97301-11]8 Reports must be prepared using forms and procedures prescribed by OHA. 4. Financial Assistance Calculation and Disbursement Procedures a. Financial Assistance Calculation: OHA will provide financial assistance for this special project, from funds identified in a particular line of Exhibit 0-1, "Financial Assistance A ward", in an amount equal to the actual allowable expenditures (as described in Exhibit K, Startup Procedures) incurred in implementing the special project during the period specified in that line, subject to the requirements of Exhibit K, Startup Procedures and subject to the following additional restrictions: (I) Total financial assistance for implementation of the special project described herein under a particular line of Exhibit 0-1, "Financial Assistance Award", shall not exceed the total funds awarded for the special project described herein in that line of the Financial Assistance Award; and (2) OHA is not obligated to provide financial assistance for any special project expenditures that are not properly reported to OHA using forms and procedures described in Exhibit K, Startup Procedures by the date 60 days after the earlier of termination of this Agreement, termination of OHA's obligation to provide financial assistance for A&D 60 services, or 141408 Deschutes 690f330 tennination of County's obligation to include the Program Area, in which A&D 60 Services fall, in its CMHP. b. Disbursement: OHA will disburse the funds awarded for this special project in a particular line of Exhibit 0-1, "Financial Assistance Award", after OHA's receipt of County's properly completed "Request for Payment of Start-Up Funds", as described in and in accordance with Exhibit K, Startup Procedures. c. Agreement Settlement: Agreement Settlement will reconcile any discrepancies that may have occurred during the tenn of this Agreement between actual OHA disbursements of funds awarded for these special projects under a particular line of Exhibit 0-1, "Financial Assistance Award", and amounts due for implementation of the special projects based on actual allowable expenditures incurred in implementing the special project under that line ofthe Financial Assistance A ward, as such expenses are properly reported using fonns and procedures described in Exhibit K, Startup Procedures. 141408 Deschutes 700[330 Exhibit A&D 60 Oregon Children's Plan -Parent Child Interaction Therapy 1. Service Description This special project is intended to meet the goals of the Oregon Childhood System (ORS 417.727) and to serve children ages 2 through 8 and their parents when the children have traits ofthe disruptive behavior disorders of Conduct Disorder, Oppositional Defiant Disorder and Attention Deficit Hyperactivity Disorder, who are not Medicaid eligible and who have no other resources to pay for services. All services delivered as part of this special project must be provided in a culturally competent manner, including sensitivity to family, language, race and ethnicity. This special project will: a. Implement the evidence-based practice Parent Child Interaction Therapy (PCIT) with fidelity review by OHA or an OHA approved entity, and provision of services to families; b. Demonstrate outreach to and access by identified ethnic, linguistic or cultural minorities; c. Establish and maintain a formal relationship with, and support and link family members through referral to a family organization, that meets the purpose of assuring that family and youth voices are part ofall decision making and planning for the development of mental health supports and services, quality assurance, and use of resources. The formal relationship includes the following: (1) The relationship is defined in a written agreement; (2) Family representation is included on governing and advisory bodies in numbers that result in meaningful participation; and (3) The family organization is developed by family members; the organization is 51 % family members or advocates; and the organization is more than an advisory group of family members. It has links with and standing in the community, operates in accordance with system of care principals, and the support of the County Mental Health Program and the Coordinated Care Organization. d. Certify two or more mental health clinicians in PCIT, and at least one ofthese clinicians is from the identified ethnic, cultural or linguistic population or with experience with the population; e. Develop two or more trainers for PCIT, including at least one trainer from the ethnic, cultural or linguistic population or with experience with the population; and t: Develop a local and statewide training program in PClT. 141408 Deschutes 710[330 2. Performance Standards Providers of these special project services must coordinate, collaborate and otherwise participate actively in regularly scheduled meetings with: a. The local early childhood team per Oregon Administrative Rule on Early Childhood Planning 423-045-0020 through 423-045-0025; b. Service providers and local referral sources for families with the empirically demonstrated risk factors that include: (I) A combination of demographic, child, family, and environmental risks such as single parent; receiving public assistance; lack of employment, current education or job training; being a teen parent; or lack of school diploma or general equivalency diploma (GED); (2) Children with the known circumstances to place them at risk, including placement in foster care; having an incarcerated parent; or homelessness; (3) Children whose parents have factors known to place children at risk, including parental mental health issues, depression, substance abuse, and domestic violence; and (4) Other referral sources for families who are not eligible for services through the Oregon Health Plan. c. The local partners for the OHA-funded program Intensive Treatment and Recovery Services for Addicted Families, a cross-system collaborative approach including DHS Children Adults and Families, addiction service providers, recovery support services and early childhood system partners funded through the 2013 Legislatively Adopted Budget; and d. The local family-run organization. Providers of these services must develop the infrastructure for implementing the evidence based practice PClT, including system, agency and direct service supports, provide initial staff training, support and supervision to at least 2 mental health clinicians. At least one clinician and one trainer must have experience working with the identified population, linguistic capability or links to the ethnic population. Providers will train an annual cohort (5 or more) of clinicians. Providers of these services must collaborate to develop and implement plans with members from an identified cultural, ethnic or linguistic minority community and a family-run organization to link and retain family members from the identified cultural, ethnic or linguistic popUlation and other appropriate groups with PCIT services. Providers ofthese services must provide planning, outreach and implementation of culturally, linguistically and ethnically appropriate PClT services. They must implement any necessary incentives to engage and maintain families in treatment. They must develop information about and referral processes for family members to the local family run organization for peer support, family groups or other support processes. They must provide participating families the means to complete the Youth Services Survey for Families found at http://www.mhsip.org/ . 141408 Deschutes 72 01'330 Providers ofthese services must establish and maintain information pertinent to fidelity reviews including: a. Content and hours of clinician training, support and supervision; b. Evidence of data-driven treatment decisions and the development of performance expectations through the use of the Eyberg Child Behavior Inventory, the Dyadic Parent-Child Interaction Coding System and the Parenting Stress Index-Short Form; c. Use of manuals and workbooks for implementing the practice; d. Developing, tracking and utilizing client level data in clinical decisions; and e. Developing and maintaining appropriate clinic space, equipment and toys for the children. Providers of these services must participate in one or more fidelity reviews by OHA or an OHA-approved external entity and implement required changes. Providers ofthese services must develop and deliver local and statewide training to clinicians in PCIT, including training of a cohort of clinicians to deliver PCIT services following the most current PCIT Training Guidelines in their training of PCIT therapists. The training guidelines are disseminated by the PCIT Training Committee and posted on the PCIT website at http://pcit.phhp.ufl.edu. Trainers must stay up-to-date in PCIT innovations by attending conferences, reading the research, etc, and be available to provide guidance and supervision throughout the consultation period. Providers ofthese services must disseminate lessons learned, collaborate to develop an Oregon annual forum or regional PCIT conference or provide presentations at other Oregon conferences, and support the implementation of state and local systems of care and other behavioral health cross systems projects. 3. Special Reporting Requirements Each provider of these project services must submit quarterly written reports to OHA in a format prescribed by OHA within 30 days following the end of each calendar quarter including: a. Data on the reporting form developed by AMH in conjunction with county PCIT providers, including child and session level data; b. One or more case examples describing child behaviors, family challenges and changes accomplished through implementation of PC IT, and noteworthy skill development by clinicians; c. Narrative describing project accomplishments and challenges; d. Electronic copies of notes from meetings with the local Early Childhood Team, cultural/ethnic or linguistic community members, service providers with the Intensive Treatment and Recovery Services, the family run organization and other referral sources; e. Annual report including: 141408 Desch utes 730f330 (2) Names of therapists in training and trained, including the following information: (a) Identified ethnic, cultural or linguistic population or with experience with the popUlation and other specialties; (b) Location of therapists; and (c) Training dates. (3) Names oftherapists trained, including identified ethnic, cultural or linguistic population or with experience with the population and other specialties. (4) Description of lessons learned and dissemination activities. f. Quarterly and year-to-date budget expenditures. Providers must prepare and submit a written annual summary of project accomplishments and challenges and a narrative interpretation of project data. Reports must be prepared using forms and procedures prescribed by OHA, and sent to: Oregon Health Authority Addictions and Mental Health Division Attention: PCIT Coordinator 500 Summer Street N .E. E86 Salem, OR 97301-1118 All individuals receiving services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. A dedicated provider number in the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amh/training/cpms/index.shtml.asit may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/electronic-data-capture.aspx., as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Payment Procedures Basis of Payment. The funds awarded for this special project are intended to be general financial assistance to County for the project. Accordingly, except as necessary to verifY that the performance standards set forth above have been met, OHA will not track delivery of special project services or service capacity on a per unit basis as long as County implements the special project described herein. Total OHA payment for the 141408 Deschutes 740f330 special project described herein shall not exceed the total funds awarded for this special project in Exhibit D-l, "Financial Assistance Award". Disbursement of Funds. OHA will disburse the funds awarded, for the special project services described herein, in a particular line of Exhibit D-l, "Financial Assistance A ward", to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award and subject to the following: a. OHA may reduce the monthly allotments based on under delivery of services identified through the quarterly reports described above; b. OHA may adjust monthly allotments to meet cash flow requirements for continued delivery of the special project services described herein; and c. OHA may adjust monthly allotments to reflect changes in the funds awarded for the special project services described herein, on that line of the financial Assistance Award as a result of amendments to the Financial Assistance Award. 5. Agreement Settlement Agreement Settlement will be used to confirm implementation of the special project described herein and satisfaction of the minimum performance requirements, based on data properly reported in accordance with section 3., "Special Reporting Requirements" above. 141408 Deschutes 750f330 EXHIBIT A&D 60-Strategic Prevention Framework (SPF) 1. Service Description The Strategic Prevention Framework State Incentive Grant (SPF SIG) program will provide an effective, comprehensive prevention framework with a common set of goals to be adopted and integrated at the local level to: • Prevent the onset and reduce the progression of substance abuse, including childhood and underage drinking; • Reduce substance abuse-related problems; and • Build prevention capacity and infrastructure at the local level. SPF SIG-funded programs shall utilize the Department of Health and Human Service's Substance Abuse Mental Health Service Administration's (SAMHSA's) SPF SIG (available at http://prevention.samhsa.gov/evidencebasedlevidencebased.pdf) as the model on which to develop long-range strategic plans and annual action plans. The SPF SIG is a five-step evidence-based process for community planning and decision-making. The five-step model includes, but is not limited to: a. Assessment: Mobilize key stakeholders to collect the needed data to understand substance abuse consequences, consumption patterns, and contributing factors to those patterns of the specific drug use issues identified. b. Capacity: Mobilize/build capacity with a local coalition to change the conditions and address the specific drug use issues identified. c. Planning: Produce strategic goals, objectives, and performance targets as well as preliminary action plans including a logic modeL d. Implementation: Implement the plan with multiple policies, practices, strategies, or interventions based on characteristics, culture, and context ofthe target population. e. Evaluation: Measure impact of SPF and monitor, sustain, improve, or replace implemented practices, policies or programs based on evaluation findings. SPF SIG services will be implemented through one or more ofthe SAMHSA Center for Substance Abuse Prevention's (CSAP) six strategies. The six strategies with examples of services are: a. Information Dissemination-media campaigns, speaking engagements; b. Prevention Education -school curricula and parenting education and skill building; c. Alcohol, Tobacco & Other Drug (ATOD) free alternatives, youth leadership and community service projects; d. Problem Identification and Referral-student assistance programs 141408 Deschutes 760[330 e. Community Based Processes-interagency collaboration, coalition building, and networking; f. Environmental/Social Policy-school policies and community laws concerning alcohol, tobacco and other drugs. 2. Performance Requirements County, in providing A&D 60 Services, must comply with OAR 415-056-0000 through 415-056-0025, and must have a current Letter of Approval issued by OHA. County must implement its SPF SIG Services funded through this Agreement in accordance with the SPF SIG framework, described in section I, culminating with a Strategic Plan, (Plan), which is subject to OHA approval, within the first six months of funded services. OHA Financial Assistance to the County in the subsequent biennium, for SPF SIG Services, will in part depend upon the County achievement of the outcomes set forth in the Plan. In the event of a conflict or inconsistency between the provisions of the Plan and the provisions of this Service Description, the provisions of this Service Description shall control. County's performance shall include the following: Assessment: • Additional needs assessment data collection: measuring the intervening variables for problem behavior through completion of a logic model. Data is expected to be as localized as possible. Complete other assessment tools as directed to include Tri-Ethnic Community Readiness Assessment and cross-site evaluation instruments (e.g. GLI, CLI and PLI). Capacity: One FTE for Project Director. Coalition: County must either have in place or form a coalition with required sectors, as defined by the SPF Advisory Council. The coalition must demonstrate the following: mission statement, bylaws (including cultural competency statement/policy), officers, records of meeting notes/minutes, meeting schedule, coalitionlboard development/training plan, etc. Planning: A comprehensive Plan will be completed for priorities identified by OHA. The Plan will address all five steps of the SPF SIG process with inclusion of sustainability and cultural competency. Logic models addressing root causes or intervening variables from sub-recipient location will be included to ensure that counties will be able to guarantee the right fit of the practices, policies or programs selected for implementation to make countywide changes in the priority area. Detailed timelines, goals and objectives, and challenges/barriers will also be addressed in the Plan. 141408 Deschutes 77 of330 Implementation: The Plan will be reviewed by OHA's Evidence-Based Practices Committee to ensure that the appropriate strategies, policies, and practices are implemented to address the priority area. All chosen strategies, policies, and practices must meet the 75% threshold of being evidence based. The Plan must also be approved by the SPF Advisory Council. Training will be provided by OHA to ensure that the County has the capacity to deliver and replicate the programs, policies, and practices in order to reach the desired change. Evaluation: County will complete evaluation tools and any other evaluation requirements as instructed by OHA's evaluation team. Data entry and reports will be monitored and tracked. County will make best efforts to have a written commitment from all ofthe County's schools to implement the Student Well ness Survey. County must participate in site visits, any state trainings or required meetings. County shall comply with OHA's written materials provided at OHA's training sessions. 3. Special Reporting Requirements Ongoing monitoring and evaluation are essential to determine if the outcomes desired are achieved and to assess program effectiveness and service delivery quality. All tools and evaluation measures will be provided by OHA's prevention unit. County must provide federally required performance data including the Community Level Instrument (CLI) and the Program Level Instrument (PLI) upon request by OHA, with quarterly reports being completed for and returned to OHA. County will complete the needs assessment workbook, evaluation workbook and any other tool deemed reasonably necessary by OHA. County must provide a one-year budget narrative (budget detail and justification) for each year of funding to OHA's prevention unit. 4. Financial Assistance Calculation and Disbursement Procedures a. Calculation of Financial Assistance. The funds awarded for SPF are intended to be general financial assistance to County for this SPF project. Accordingly,OHA will not track delivery ofSPF services on a per unit basis so long as County delivers SPF Services as part of its CMHP. Total OHA financial assistance for SPF Services under a particular line of Exhibit D-J, "Financial Assistance A ward", shall not exceed the total funds awarded for SPF Services as specified on that line. 141408 Deschutes 780f330 I l b. Disbursement: OHA will disburse the funds awarded for SPF Services identified in a particular line of Exhibit 0-1, "Financial Assistance Award", to County as set t forth in the Special Condition on that line: t (1) OHA may, upon written request of County, adjust allotments. (2) Upon amendment to the Financial Assistance Award, OHA shall adjust ! allotments as necessary, to reflect changes in the funds awarded for SPF , Services on that line of the Financial Assistance Award. l t(3) OHA may, after notice to County, suspend allotments pending receipt of & complete and accurate CLI and PLI data and required reports described in t Section III above. •t Ic. Agreement Settlement. Agreement Settlement will be used to verify the inclusion I [ ofSPF Services as part of County's CMHP, based on data properly reported to OHA through reports required or permitted by this Service Description or an applicable Specialized Service Requirement. 141408 Deschutes 790[330 Exhibit A&D 60-Housing Assistance 1. Service Description Housing Assistance Services are services to assist individuals, who are in recovery from substance abuse, in locating and paying for housing designated as "alcohol and drug free" as defined in ORS 90.243 or approved by the County Alcohol and Drug Abuse Program Manager. Individuals who receive assistance may be living with other family members (e.g. where a parent is re-assuming custody of one or more children). Housing Assistance Services include: a. Rental assistance in the form of cash payments made on behalf of individuals recovering from substance abuse to cover all or a portion of the monthly rent and utilities and may include payment of associated move-in costs, such as cleaning and security deposits; and b. Housing coordination services to assist individuals recovering from substance abuse in locating suitable housing, equipping the housing unit, referrals to other resources, and housing repairs. No more than 10% of the total funds awarded under this Exhibit may be used for housing repairs. 2. Performance Standards All individuals receiving Housing Assistance Services (A&D 6O-Housing Services) funded through this Agreement must reside in County, be in recovery from substance abuse and be enrolled in a verifiable program of substance abuse recovery. Utilization requirements for A&D-60 Housing Assistance will be identified in a special condition subject to funds awarded in a particular line in the Financial Assistance Award. 3. Special Reporting Requirements For each calendar quarter (or portion thereof) during the period for which financial assistance is awarded under this Agreement for Housing Assistance Services, County shall submit written quarterly progress reports on the delivery of Housing Assistance Services not later than 30 days after the end of the quarter, which shall be sent to: Oregon Health Authority Addictions and Mental Health Division Attention: Housing Specialist 500 Summer Street NE E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by OHA. 141408 Deschutes 8001'330 4. Financial Assistance Calculation and Disbursement Procedures a. Calculation of Financial Assistance. OHA will provide financial assistance to County for Housing Assistance Services identified in a particular line of Exhibit D-l, "Financial Assistance Award", in an amount equal to the amount of cash assistance actually paid by County on behalf of the individuals for rent assistance, as described above, plus the costs incurred by County in providing housing coordination services, under that line of the Financial Assistance Award during the period specified in that line, subject to the following: (I) Total OHA financial assistance for all Housing Assistance Services delivered under a particular line of the Financial Assistance Award shall not exceed the total funds awarded for Housing Assistance Services as specified in that line of the Financial Assistance Award; (2) OHA is not obligated to provide financial assistance for any Housing Assistance Services that are not properly reported to OHA in the quarterly reports described above; and (3) OHA will not provide financial assistance, under this Agreement, for more than 24 months of Housing Assistance Services for any particular individual unless approved in advance and in writing by OHA. b. Disbursement of Financial Assistance. Unless a different disbursement method is specified in that line of Exhibit D-I, "Financial Assistance Award", OHA will disburse the funds awarded for Housing Assistance Services in a particular line of the Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: (1) OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the monthly allotments based on under used allotments identified through the required quarterly reports. (2) OHA may, upon written request of County, adjust monthly allotments. (3) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary to reflect changes in the funds awarded for A&D 60-Housing Assistance Services on that line ofthe Financial Assistance A ward. c. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term ofthis Agreement between actual OHA disbursements of funds awarded for Housing Assistance Services under a particular line of Exhibit D-l, "Financial Assistance Award", and amounts due for such services based on the cash assistance paid on behalf of the individuals for rent assistance and costs incurred by County for housing coordination services under that line of the Financial Assistance Award, as properly reported in the quarterly reports described above. 141408 Deschutes 810f330 Service Name: ADULT ALCOHOL AND DRUG RESIDENTIAL TREATMENT SERVICES Service ID Code: A&D 61 1. Service Description Adult Alcohol and Drug Residential Treatment Services (A&D 61) are services delivered to individuals 18 years of age or older who are unable to live independently in the community, cannot maintain even a short period of abstinence and are in need of 24-hour supervision, treatment and care. The purpose of A&D 61 Services is to support, stabilize and rehabilitate individuals and to permit them to return to independent community living. A&D 61 Services provide a structured environment for an individual on a 24-hour basis consistent with Level III of the chemical dependency placement, continued stay and discharge criteria set forth in OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time, as appropriate to the individual's needs and include structured counseling, educational services, recreation services, self help group participation services, and planning for self-directed recovery management to support the gains made during treatment. In addition, providers must have written admission policies and procedures in place for individuals who appropriately use prescribed medications to treat addiction. Written policies and procedures must include referrals to alternate treatment resources for those not admitted to the program. A&D 61 Services address the needs of diverse population groups within the community, with special emphasis on ethnic minorities. 2. Performance Requirements Providers of A&D 61 Services funded through this Agreement must comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time. Providers of A&D 61 Services funded through this Agreement must also have a current license issued by the OHA in accordance with OAR 415-012-0000 through 415-012 0090. a. Subject to the preference for pregnant women and intravenous drug users described in Exhibit H, Required Federal Terms and Conditions, County and Providers of A&D 61 Services funded through this Agreement must give priority access to such Services first to individuals referred from the Department of Human Services and then to individuals referred by Drug Treatment Courts from within the region as such region is designated by OHA after consultation with County, then from Coordinated Care Organizations, and then from relevant Providers. A&D 61 Services funded through this Agreement may be delivered to individuals referred from any county within the State of Oregon and contiguous areas and no priority or preference shall be given to individuals referred from any particular county, provider or relevant Coordinated Care Organization. Providers of A&D 61 Services funded through this Agreement must only provide such Non Medicaid funded Services to individuals who are not eligible for Medicaid. 141408 Deschutes 82of330 Service Name: HOUSING SERVICES FOR DEPENDENT CHILDREN WHOSE PARENTS ARE IN ALCOHOL AND DRUG RESIDENTIAL TREATMENT Service ID Code: A&D 62 1. Service Description Housing Services for Dependent Children Whose Parents are in Alcohol and Drug Residential Treatment (A&D 62) are housing services (room and board) delivered to individuals who are dependent children age 18 and younger so the child(ren) may reside with their custodial parent in the same adult alcohol and drug residential treatment facility. 2. Performance Requirements Providers of A&D 62 services funded through this Agreement must comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time. Providers of A&D 62 services funded through this Agreement must also have a current license issued by the OHA in accordance with OAR 415-012-0000 through 415-012 0090, as such rules may be revised from time to time, and participate in outcome studies conducted by the OHA. 3. Special Reporting Requirements All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHA/amhltraining/cpms/index.shtml, as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/electronic-data-capture.aspx., as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified ofthe change. 4. Financial Assistance Calculation and Disbursement Procedures a. Calculation of Financial Assistance. The funds awarded for A&D 62 services are intended to be general financial assistance to the County for A&D 62 services with funds provided under this Agreement. Accordingly, the OHA will not track delivery ofA&D 62 services on a per unit basis, so long as the County offers and delivers A&D 62 services as part of its CMHP. Total OHA payment for all A&D 62 services delivered under a particular I ine of Exhibit D-l, "Financial Assistance 141408 Deschutes 850[330 Award" shall not exceed the total funds awarded for A&D 62 services as specified in that line of the Financial Assistance Award. b. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line ofthe Financial Assistance Award, OHA will disburse the financial assistance awarded for A&D 62 Services in a particular line of Exhibit 0-1, "Financial Assistance Award", to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: (1) OHA may, upon written request of County, adjust monthly allotments; and (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for A&D 62 Services on that line of the Financial Assistance Award. c. Agreement Settlement. Agreement Settlement will be used to confirm the offer and delivery of A&D 62 services by County as part of its CMHP based on the delivery of A&D 62 services as properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. 141408 Deschutes 86of330 b. Providers of A&D 61 Services funded through this Agreement must participate in client outcome studies conducted by OHA. 3. Special Reporting Requirements All individuals receiving services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www .oregon.gov/OHA/amh/training/cpms/index.shtml, as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amhlpages/compass/electronic-data-capture.aspx., as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation and Disbursement Procedures a. Calculation of Financial Assistance for Non-Medicaid Funded Services: OHA will provide financial assistance for A&D61 Services identified in a particular line of Exhibit D-l, "Financial Assistance Award", from funds identified on that line in an amount equal to the rate set forth in the special condition identified in that line ofthe Financial Assistance Award, multiplied by the number of units of A&D 61 Services delivered under that line ofthe Financial Assistance Award during the period specified in that line, subject to the following: (1) Total OHA financial assistance for A&D61 Services delivered under a particular line in the Financial Assistance Award shall not exceed the total funds awarded for A&D6] Services as specified in that line in the Financial Assistance Award; and (2) OHA is not obligated to provide financial assistance for any A&D61 Services for individuals who are not properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement by the date 60 days after the earlier oftermination of this Agreement, termination ofOHA's obligation to provide financial assistance for A&D 6] Services, or termination of County's obligation to include the Program Area, in which A&D 6] Services fall under this Agreement. b. Disbursement of Financial Assistance for Non-Medicaid funded Services. Unless a different disbursement method is specified in that line of Exhibit D-l, "Financial Assistance Award", OHA will disburse the financial assistance awarded for A&D 61 Services in a particular line of the Financial Assistance 141408 Desch utes 830f330 A ward to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: (I) OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the monthly allotments based on under-used allotments identified through data reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement or Special Terms and Conditions; (2) OHA may, upon written request of County, adjust monthly allotments; and (3) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for A&D 61 Services on that line ofthe Financial Assistance Award. c. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of funds awarded for A&D 61 Services under a particular line of Exhibit D-I, "Financial Assistance Award", and amounts due for such services provided based on the rate set forth in the special condition identified in that line of the Financial Assistance Award. For purposes of this section, "amounts due" is determined by the actual amount of services delivered under that line of the Financial Assistance Award during the period specified in that line of the Financial Assistance Award, as properly reported in accordance with section 3., "Special Reporting Requirements" above or as required in an applicable Specialized Service Requirement. 141408 Deschutes 84of330 Service Name: ALCOHOL AND DRUG RESIDENTIAL CAPACITY SERVICES Service 10 Code: A&D 67 1. Service Description Alcohol and Drug Residential Capacity Services (A&D 67) are 24-hour residential services delivered to individuals who are enrolled in alcohol and drug adult or youth residential treatment services, or both. A&D 67 Services provide a structured environment for an individual on a 24-hour basis consistent with Level III ofthe chemical dependency, continued stay and discharge criteria set forth in OAR 309-032 1500 through 309-032-1565, as such rules may be revised from time to time, are appropriate to the individual's needs and include housing and food services. 2. Performance Requirements Providers of A&D 67 Services funded through this Agreement must comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time. Providers of A&D 67 Services funded through this Agreement must also have a current license issued by OHA in accordance with OAR 415-012-0000 through 415-012-0090 and must participate in client outcome studies conducted by OHA. 3. Special Reporting Requirements No special reporting requirements. 4. Financial Assistance Calculation and Disbursement Procedures a. Calculation of Financial Assistance. The funds awarded for A&D 67 services are intended to be general financial assistance to the County for A&D 67 services for individuals receiving alcohol and drug adult or youth residential treatment services or both. Accordingly, OHA will not track delivery of A&D 67 services on a per unit basis, so long as the County offers and delivers A&D services under this Agreement. Total OHA payment for all A&D 67 services delivered under a particular line of Exhibit 0-1, "Financial Assistance Award", shall not exceed the total funds awarded for A&D 67 services as specified in that line of the Financial Assistance A ward. b. Disbursement of Financial Assistance. Unless a different disbursement method is specified in that line of the Financial Assistance Award, OHA will disburse the financial assistance awarded for A&D 67 Services in a particular line of Exhibit D-I, "Financial Assistance Award", to County as set forth in the Special Condition on that line, subject to the following: (1) OHA may, upon written request of County, adjust allotments; and 141408 Deschutes 870[330 (2) Upon amendment to the Financial Assistance Award, OHA shall adjust allotments as necessary, to reflect changes in the funds awarded for A&D 67 Services on that line ofthe Financial Assistance Award. c. Agreement Settlement. Agreement Settlement will be used to confirm the offer and delivery of A&D 67 services by County under this Agreement based on the delivery of alcohol and drug adult or youth residential treatment services, or both. 141408 Deschutes 880f330 Service Name: PROBLEM GAMBLING TREATMENT SERVICES (RESIDENTIAL) Service ID Code: A&D82 1. Service Description Problem Gambling Treatment Services (A&D 82) are residential problem gambling treatment services that provide problem gambling assessment, treatment, rehabilitation and twenty-four hour observation monitoring for pathological and problem gamblers consistent with appropriate level of care. For purposes of this Agreement, an individual with a gambling related problem is an individual with (a) a primary diagnosis of Pathological Gambling (DSM-IV code 312.31), (b) a primary diagnosis of sub-clinical Pathological Gambling (meets two to four DSM-IV diagnostic criteria for Pathological Gambling), or (c) a primary diagnosis of Relational Problem Related to Pathological Gambling (a variant ofDSM-IV code V61.9). Problem Gambling Treatment Services are to be made available to any Oregon resident meeting criteria as described above. Service to out of state residents is permissible if the presenting gambling problem is reported as primarily related to an Oregon lottery product. 2. Performance Standards Providers of A&D 82 Services must maintain a License as a Mental Health Service Agency or a Letter of Approval as an Alcohol and Drug Treatment Agency for all levels of outpatient treatment in accordance with OAR 309-032-1500 through 309-032-1565 Building Requirements, OAR 415-012-0000 through 415-012-0090 Standards for ApprovallLicensure of Alcohol and Other Drug Programs and OAR 309-012-0130 through 309-012-0220 Certificates of Approval for Mental Health Services; as such rules may be revised from time to time. Providers of A&D 82 Services paid through this Agreement must comply with OAR 415 012-0050 through 415-012-0090 Onsite Reviews. Providers of A&D 82 Services must meet the performance standards below. These performance standards are imposed and assessed on an individual Provider basis. lfOHA determines that a Provider of A&D 82 Services fails to comply with any ofthe specified performance standards, the specific areas out of Agreement compliance would then be reviewed at the next scheduled site review or a discretionary site review could be scheduled specifically to review these areas. Access: The amount oftime between a problem gambling affected individual's request for A&D 82 Services and the first offered service appointment must be five business days or less for at least 90% of all individuals receiving A&D 81 Services. Retention: The percent of problem gambling affected individuals receiving A&D 82 141408 Deschutes 89 of 330 Services who actively engage in the A&D 82 Services for at least 10 clinical contact sessions must not be less than 40%. Successful Completion: The percent of all individuals receiving A&D 82 Services who successfully complete treatment must not be less than 35%. A successful problem gambling treatment completion is defined as the individual's: (a) achievement of at least 75% of short-term treatment goals, (b) completion of a continued wellness plan (i.e., relapse prevention plan), and (c) lack of engagement in problem gambling behaviors for at least 30 days prior to successful completion of A&D 82 Services. Client Satisfaction: The percent of problem gambling affected individuals receiving A&D 82 Services who complete a problem gambling client satisfaction survey and would positively recommend the Provider to others must not be less than 85%. Client satisfaction surveys must be collected from not less than 50% oftotal enrollments. Long-term Outcome: At the six month follow up for individuals completing treatment, a minimum of 50% must report abstinence or reduced gambling. 3. Special Reporting Requirements Providers of A&D 82 Services must submit the following information to OHA (or to OHA's designee), regarding individuals receiving A&D 82 Services. All providers must comply with the current GPMS User Manual located at http://www .oregon.gov /OHA/addiction/gam bl ing/20 I O/gpms-data-collection. pdf. a. GPMS (Gambling Process Monitoring System) Intake Data: The GPMS record abstracting form and the client self-report survey must be collected and submitted within 14 days of the first face-to-face treatment contact with an individuaL b. Client Consent Form: A completed client informed consent form to participate in evaluation follow-up efforts must be collected and submitted prior to service conclusion. Client refusal to participate in the follow-up survey must be documented in the cl ient file. c. Encounter Data: Encounter data for billing must be collected and submitted as described in Exhibit A&D 82-1 attached hereto and incorporated herein by this reference. Prior to submitting an encounter claim each claimed encounter must be documented in the clinical record. Encounter claim documentation placed in the clinical record must include the date of the encounter service, the type of service delivered, the length of service, a clinical note describing data from the session, the clinician's signature and date the note was completed. d. GPMS Discharge Data: GPMS discharge data must be collected and submitted within 90 days after the last date of service to an individual. 4. Financial Assistance Calculation and Disbursement Procedures a. Financial Assistance Calculation. OHA will provide financial assistance for A&D 82 Services identified in Exhibit 82-2, Procedure Code and Rate on a per diem basis. 141408 Desch utes 900[330 ( I) Providers of A&D 82 Services may not charge individuals whose A&D 82 Services are paid under this Agreement any co-payor other fees for such Services; (2) OHA is not obligated to provide financial assistance for any A&D 82 Services that are not properly reported as described or referenced in this Service Description by the date 60 days after the termination of this Agreement, termination ofOHA 's obligation under this Agreement to provide financial assistance to County for A&D 82 Services, or termination of County's obligation under this Agreement, to include the Program Area, in which A&D 82 Services fall; (3) If during the term ofthis Agreement, County delivers less than the anticipated level of service upon which allotments were calculated, in a particular line of Exhibit D-l, "Financial Assistance Award", OHA may unilaterally reduce the amount of the remaining financial assistance for services in that line. (4) County is expected to reconcile encounter data reports and correct any errors within 30 days of receipt of encounter data report received from OHA's management information system provider. Discrepancies must include apparent cause and remedy. Adjustments will be carried forward to the next month within the effective period ofthis Agreement. b. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line of Exhibit D-l "Financial Assistance Award", OHA will disburse the funds awarded for A&D 82 Services in a particular line of the Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line, subject to the following: (1) OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the monthly allotments based on actual delivery of services identified through GPMS or through other reports required or permitted by this Service Description or an applicable Specialized Service Requirement; (2) OHA may, upon written request of County, adjust monthly allotments; (3) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary to reflect changes in the total allotments for A&D 82 Services on that line ofthe Financial Assistance Award; and (4) County may, with OHA approval, apply A&D 82 allotments for services not provided in the first fiscal year toward A&D 82 Services in the second fiscal year. 141408 Deschutes 91 of330 c. Agreement Settlement: Agreement settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements for A&D 82 services under a particular line of Exhibit D-l, "Financial Assistance A ward", and amounts due for such services provided by County based on the rates set forth in Exhibit A&D 82-2. For purposes of this section, "amounts due" to County is determined by the actual amount of services delivered under that line of the Financial Assistance Award during the period specified on that line of the Financial Assistance Award, as properly reported as described or referenced in this Service Description or an applicable Specialized Service Requirement. d. Provider Audits. Providers and sub-contracted Providers receiving A&D 82 payments from OHA are subject to audit for all payments applicable to A&D 82 services rendered. The audit ensures that proper payments were made for covered services, to recover overpayments, and to discover possible instances of fraud and abuse. This audit will verity that encounter data submissions are documented in the client file as described in section 3.c. above. OHA may apply the Division of Medical Assistance Program (DMAP) Provider Audit rules and the Fraud and Abuse rules to providers and provider sub-contractors of A&D 82 Services in accordance with OAR 410-120-1505 through 410-120-1510 Provider Audits, as such rules may be revised from time to time. 141408 Desch utes 92 of330 Exhibit A&D 82-1 Encounter Data Reporting Requirements In order to efficiently implement the disbursement of financial assistance, it is necessary for all Providers of A&D 82 Services to submit individual-level service delivery activity (encounter data) within 30 days following the end of each month to OHA or its designee. Data shall be electronically submitted utilizing the HIPAA approved "837" format. Files to be transferred over non-secure web/internet facilities must be encrypted utilizing an encryption format approved by OHA. The subject line for each electronic transmission of data must include the program name, the month covered by the submission (e.g. August 2013) and the words "Gambling Encounter Data." Agencies with secure web services may post the data to their server as long as access and timely notification is provided to OHA, Problem Gambling Services. 141408 Deschutes 9301'330 EXHIBIT A&D 82-2 Oregon Problem Gambling Services Procedure Code and Rate Code Description Rate Service Criteria H2013 Psychiatric health facility service, per diem $160.00 Services provided in a licensed mental health residential facility and intensively staffed 24 hours under a physician approved treatment plan for which treatment includes an appropriate mix and intensity of assessment, medication management, individual and group therapies and skills development to reduce or eliminate the acute symptoms of the disorder and restore the client's ability to function in a home or the community to the best possible level. *** Providers must bill at rates, based upon the cost of services determined through a cost allocation, not in excess of their usual and customary charge to the general public ** (OAR 309 016-0105 and OAR 309-016-0420) 141408 Deschutes 940f330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBIT B-2 SPECIALIZED SERVICE REQUIREMENTS Not all Services described in Exhibit B-2 may be covered in whole or in part with financial assistance pursuant to Exhibit D of this Agreement. Only Services whose costs are covered in whole or in part with financial assistance pursuant to Exhibit D, as amended from time to time, are subject to this Agreement. 141408 Deschutes 950f330 Service Name: RESIDENTIAL TREATMENT SERVICES Service ID Code: MHS 28 Specialized Service: SECURE RESIDENTIAL TREATMENT FACILITY Exhibit B-2 Code: 28A 1. Service Description and Performance Requirements (exceeding Exhibit B-1, MHS 28) Funds awarded for MHS 28 Services that are identified in Exhibit 0-1., "Financial Assistance Award", as subject to this Specialized Service Requirement may only be expended on MHS 28 Services that are delivered in Secure Residential Treatment Facilities (as defined in OAR 309-035-0100 through 309-035-0190, as such rules may be revised from time to time) to individuals discharged from state psychiatric hospitals or local acute psychiatric programs who have a history of behaviors that are harmful to themselves or others. MHS 28 Services delivered with funds provided under this Agreement and subject to this Specialized Service Requirement include the following, in addition to the services otherwise described in the MHS 28 Service Description: a. Rehabilitative services such as mental health assessment, diagnosis, and treatment plan development; b. Monitoring and management of psychotropic medications; c. Development of behavioral programs; d. Establishment of a therapeutic milieu; e. Group and individual skills training; f. Consultation to other Agencies/Providers serving individuals receiving MHS 28 Services. Providers fMHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must comply with OAR 309-035 0100 through 309-035-0190, as such rules may be revised from time to time. Providers ofMHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must deliver the Services in a facility that is residential in nature and as homelike as possible but whose buildings and grounds are locked to prevent free egress by individuals receiving services at the facility, in compliance with Building Code and Uniform Fire Code provisions. Providers ofMHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must deliver the services in a facility staffed with a combination of on-site Qualified Mental Health Professionals (as defined in OAR 309-035-0100 through 309-035-0190), Qualified Mental Health Associates (as defined in OAR 309-032-0180(8)) and other staff sufficient to meet the security, behavioral, recreational, and mental health needs of residents, as identified in their service plans, on a 24-hour basis. County must perform a standardized level of care assessment prior to admission. MHS 28 Services delivered under this Agreement that are subject to this Specialized Service Requirement may only be delivered to individuals who meet the standardized criteria 141408 Deschutes 96of330 developed by OHA for this level of care. The standardized criteria will be posted on the OHA AMH web page. Priority will be for individuals ready to discharge from the State Hospitals. OHA will have the right to review admissions and continued stay determinations. 2. Reporting Requirements (exceeding Exhibit B-1, MHS 28) Providers ofMHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must provide data related to the assessment of outcomes of such services, as such data may be reasonably requested by OHA' AMH. 3. Financial Assistance Calculation, Disbursement and Settlement Procedures (exceeding Exhibit B-1, MHS 28) None 141408 Deschutes 970[330 Service Name: ADULT FOSTER CARE SERVICES Service ID Code: MHS 34 Specialized Service: RELATIVE FOSTER CARE Exhibit B-2 Code: 34A 1. Service Description (exceeding Exhibit B-], MHS 34) Relative Foster Care is personal care as detailed in a personal care plan provided to an adult client, age 18 or older, by a relative caregiver in a private residence setting that promotes the client's safety and independence. 2. Performance Requirements (exceeding Exhibit B-1, MHS 34) For new Relative Foster Care providers, County must complete an inspection ofthe provider's home and submit to the Oregon Health Authority (OHA) the following documents, as prescribed by OHA: a. County's letter of support; b. Approved Criminal Record Check (CRC) for the foster care provider and all persons 16 years of age and older living in the home (not including the client); and. c. The personal care plan and other information as requested by OHA for OHA approval of the Relative Foster Care provider. For renewal of existing Relative Foster Care providers, County must complete an inspection of the home and submit to OHA a completed Relative Foster Care Renewal Form. Relative Foster Care providers must renew their applications every two years. 3. Reporting Requirements (exceeding Exhibit B-1, MHS 34) None 4. Financial Assistance Calculation and Disbursement Procedures (exceeding Exhibit B-1, MHS 34) None 141408 Deschutes 980[330 Service Name: OLDER\DISABLED MENTAL HEALTH SERVICES Service Element ID Code: MHS 35 Specialized Service: GERO-SPECIALIST Exhibit B-2 Code: 35A 1. Service Description Older/Disabled Adult Mental Health Services (MHS 35) Specialized Service Requirement (MHS 35A) are specialized geriatric mental health services delivered directly or indirectly to older/disabled adults with mental health illness. 2. Performance Requirements The funds awarded for MHS 35A Services may only be expended on community based care services for older/disabled adults with mental health illness who are determined eligible for residential services from DHS' Aging and People with Disabilities (APD) Division. Such services include, but are not limited to, medication management, quarterly interagency staffing and follow-up services after treatment in local or state inpatient psychiatric hospitals, or indirect services, including but not limited to, screening, referral, and consultation and training to agencies and caregivers who provide services that may affect older/disabled adults with mental health illness. If indirect services, as described above, are delivered with MHS 35A funds provided under this Agreement, those services must be available to relevant agencies and caregivers in the geographic area served by the CMHP operated by or contracted for by County and must be coordinated with protective services provided by DHS' APD Division and County's mental health crisis/commitment service. All MHS 35A Services delivered with funds provided under this Agreement must be delivered by a Qualified Mental Health Professional (as defined in OAR 309-016-0605) (QMHP) and in compliance with OAR 309-032-] 500 through 309-032-] 565, Standards for Adult Mental Health Services, as such rules may be revised from time to time. QMHP' delivering such services must have a background with the older/disabled adult population or be participating in relevant training programs to acquire such knowledge. Providers ofMHS 35 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must insure that staff providing such services: a. Regularly access a psychiatrist or nurse practitioner for case and medication review for individuals receiving MHS 35 Services; b. Regularly participate in interdisciplinary team meetings with DHS' Aging and People with Disabilities (APD) staff or contractors serving individuals receiving MHS 35 Services; 14 1408 Deschutes 990[330 c. Provide discharge assistance (from in-patient psychiatric hospitals) and provide, or arrange for, short term follow-up services for individuals receiving MHS 35 Services; and d. Be available to County's crisis team and DHS' APD protective services for consultation on geriatric cases. 3. Special Reporting Requirements County shall provide summary reports on its delivery of MHS 35A Services that are supported with funds provided under this Agreement. The reports must be submitted within 45 days of the end of each State fiscal year (ending June 30) and after the termination of this Agreement. Submit reports to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator500 Summer Street N.E. E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by the Oregon Health Authority (OHA). 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: The funds awarded for MHS 35A Services are intended to be general financial assistance to County for MHS 35A Services. Accordingly, OHA will not track delivery ofMHS 35A Services or service capacity on a per unit basis so long as County offers and delivers MHS 35A Services as part of its CMHP. Total OHA financial assistance for MHS 35A Services under a particular line of Exhibit 0-1. "Financial Assistance Award", shall not exceed the total funds awarded for MHS 35A Services as specified on that line. b. Disbursement of financial assistance: OHA will disburse the funds awarded for MHS 35A Services identified in a particular line of Exhibit 0-1, "Financial Assistance Award", to County in substantially equal monthly allotments during the period specified in that line ofthe Financial Assistance Award, subject to the following: (1) OHA may, upon written request of County, adjust monthly allotments; and (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 35A Services on that line of the Financial Assistance Award. c. Agreement Settlement: Agreement Settlement will be used to confirm the delivery of MHS 35 Services by County as part of its CMHP, based on data properly reported in reports required or permitted by this Specialized Service Requirement. 141408 Deschutes 1000[330 Service Name: OLDERJDISABLED ADULT MENTAL HEALTH SERVICES Service ID Code: MHS 35 Specialized Service: APD RESIDENTIAL Exhibit B-2 Code: 35B 1. Service Description Older/Disabled Adult Mental Health Services (MRS 35) Specialized Service Requirement (MHS 35B) are residential services delivered directly or indirectly to individuals with severe and persistent mental health illness. 2. Performance Requirements Providers of MHS 35 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must, with respect to each individual receiving MHS 35 Services, enter into and maintain a written agreement with DHS' Aging and People with Disabilities Division (APD) and the Provider of residential services to that individual that addresses: approval of APD or its designee for the placement, the services to be provided by each entity, and an annual review of the appropriateness ofthe placement. The funds awarded for MHS 35B Services may only be expended on residential services for older/disabled adults with severe and persistent mental health illness who are determined not eligible for, yet require, residential services from DHS' APD Division and who meet service need eligibility for Medicaid financed residential services under OAR 411-015-0000 through 411-015-0100 and are residing in a facility whose operator is licensed by the APD Division and has contracted with the APD Division to deliver residential services to specified individuals. 3. Special Reportin2 Requirements Providers ofMHS 35 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must notifY the Oregon Health Authority's (OHA), Addictions and Mental Health Division (AMH), when the Provider discontinues such services to an individual whose services are delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement. Providers of MHS 35 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must be able to provide a copy of all written agreements described above to OHA upon request. 141408 Deschutes 1010f330 Submit reports to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator 500 Summer Street N.E. E86 Salem, OR 97301-1118 Reports must be prepared using forms and procedures prescribed by the Oregon Health Authority (OHA). All individuals receiving Services with funds provided under this Agreement must be enrolled and that client's record maintained in either: a. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www .0regon.gov/OHA/amhitraining/cpmsiindex.shtml, and as it may be revised from time to time; or b. the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/OHA/amh/pages/compass/electronic-data-capture.aspx, and as it may be revised from time to time. Over the next two years, AMH will be closing the CPMS system and replacing it with the MOTS system. Providers will be notified of the change. 4. Financial Assistance Calculation, Disbursement and Settlement Procedures a. Calculation of Financial Assistance: The funds awarded for MHS 35B Services are intended to be general financial assistance to County for MHS 35B Services. Accordingly, OHA will not track delivery ofMHS 35B Services or service capacity on a per unit basis so long as County offers and delivers MHS 35B Services as part of its CMHP. Total OHA financial assistance for MHS 35B Services under a particular line of Exhibit D-I, "Financial Assistance Award", shall not exceed the total funds awarded for MHS 35B Services as specified on that line. b. Disbursement of financial assistance: OHA will disburse the funds awarded for MHS 35A Services identified in a particular line of Exhibit D-l, ""Financial Assistance Award", to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: (1) OHA may, upon written request of County, adjust monthly allotments; and (2) Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 35A Services on that line of the Financial Assistance Award. 141408 Deschutes 1020[330 c. Agreement Settlement: Agreement Settlement will be used to confirm the delivery ofMHS 35B Services to the individuals specified in Exhibit 0-1, "Financial Assistance Award", by County as part of its CMHP, based on data properly reported in accordance with section 3., "Special Reporting Requirements" above or as permitted by this Specialized Service Requirement. 141408 Deschutes 1030f330 Service Name(s): Adult Alcohol and Drug Residential Treatment Services Service ID Code: A&D61 Specialized Service: Intensive Treatment and Recoverv Services Exhibit B-2 Code: 61A 1. Service Description (exceeding Exhibit B-1, A&D 61) Funds awarded for A&D 61 Services that are identified in the Financial Assistance Award as subject to this Specialized Service Requirement may only be expended on A&D 61 Services that are delivered in Residential Alcohol and Other Drug Treatment Programs (as defined in OAR 309-032-1505(109). Families referred by the Department of Human Services-Children, Adults and Families Division (CAF) not covered by the Oregon Health Plan shall receive first priority followed by any person needing residential treatment while parenting children under the age of 18. In addition, providers must have written admission policies and procedures in place for individuals who appropriately use prescribed medications to treat addiction. Written policies and procedures must include referrals to alternate treatment resources for those not admitted to the program. A&D 61 A Services delivered with funds provided under this Agreement, in addition to the services otherwise described in the A&D 61 Service Description; include a recovery oriented system of care for addicted parents involved in or at risk of involvement with child welfare and self-sufficiency programs (CAF) that includes the following: a. Effective transitions for clients moving from one level of care to another level of care; b. Collaborative case planning and management with CAF as evidenced by staffing notes, progress notes, or other documentation; and c. Coordination and referral services for client's family members including early childhood services for infants and toddlers and recovery support services for spouses and older children. 2. Performance Standards a. All individuals receiving addiction services with funds provided under this Agreement and subject to this A&D 61A Specialized Service Requirement must be clients involved in, or individuals at risk of involvement with, child welfare or CAF self-sufficiency programs b. County is responsible for the following outcome for those clients referred to in Section I of this Specialized Service Requirement: • Continuum of Care-Clients who are stabilized and who no longer meet American Society of Addiction Medicine Level III criteria must receive at least one face-to-face service in an outpatient setting within 7 days of transitioning from residential treatment. 141408 Deschutes 1040f330 3. Special Reporting Requirements (exceeding Exhibit B-1, A&D 61) a. One copy oflntensive Treatment and Recovery Services (ITRS) referral form is filed in client records. b. Clients shall be reported according to A&D 61, section 3., "Special Reporting Requirements". Use of a dedicated provider number for ITRS is required for data reported through CPMS. 4. Financial Assistance Calculation and Disbursement Procedures (exceeding Exhibit B 1, A&D 61) None. 141408 Deschutes 1050f330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITC REGIONAL HEALTH IMPROVEMENT PLAN 141408 Deschutes 1060f330 2012-2015 CENTRAL OREGON HEALTH IMPROVEMENT PLAN alth 1 141408 Deschutes 107 of 330 TABLE OF CONTENTS Executive Summary Introduction Mission, Guiding Principles and the Triple AIM Assessment Process and Priorities Socio-Ecological Planning Model Improve Health Equity and Increase Access Improve Health • Early Childhood Wellness (prenatal through age 6) • Safety, Crime and Violence Prevention • Preventive Care and Services • Chronic Disease Prevention • Alcohol, Tobacco, and Other Drugs • Behavioral Health and Suicide Prevention • Oral Health • Healthy Environments Improve Health Care and Service Delivery Reduce Cost and Increase Effectiveness Increase Health Integration and System Collaboration Pursue Excellence Promote Regional Efforts Strengthen Health and Service Organizations 2 Page 4 Page 6 Page 7 Page 8 Page 12 Page 14 Page 19 Page 19 Page 22 Page 25 Page 27 Page 30 Page 32 Page 33 Page 34 Page 36 Page 39 Page 41 Page 44 Page 46 Page 48 141408 Deschutes 1080[330 Promote Sound Health Policy Page 52 55 55 56 57 58 59 60 60 69 73 76 84 86 86 101 120 138 Appendices Page Socio-Ecological Model Page Health Data Summary Page Page Organization Chart Page Annual Regional Strategic Planning Cycle Page Definitions Page Family Planning Page Crook Page Deschutes Page Jefferson Page Minimum Standards Page Personnel Qualifications Page Tobacco Prevention and Education Program Page Deschutes Page Jefferson Page Crook Page Mental Health Maintenance of Effort Page Current Use of 2145 funds for Alcohol Treatment Services 3 141408 Deschutes 1090f330 EXECUTIVE SUMMARY The Central Oregon Health Council and the Central Oregon Health Board see the Triple Aim as the key part of the new vision for a healthy Central Oregon, with the long term goal of making it the healthiest region in the nation. It involves better health care for people, greater satisfaction with care and the reduced cost of care. In order to accomplish this vision, collective effort in the region must occur. The Central Oregon Regional Health Improvement Plan (RHIP) is an effort to collectively look for common directions and common measures that can guide the system and improve the health of the region. The plan addresses the broad issue of health and the specifics of health care. Health is the state of complete physical, mental and social well-being; reduction in mortality, morbidity, and disability due to detectable disease or disorder; an increase in the perceived level of health and the capacity to adapt to, respond to or control life's challenges and changes. Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in public health. Strategic Framework The outline or framework for the regional plan was based on the nine strategies established and agreed upon by the three counties and the Central Oregon Health Board for the county-specific strategic plans (which tie into the RHIP). The RHIP strategies emphasize efforts to approach changes in the health care system in a coordinated and collective manner. The approach also recognizes that all health care and social service interests must work collaboratively in order to accomplish the goals of health care reform. The nine strategies are: 1. Improve health equity and access to care and services 2. Improve Health 3. Improve health care and service delivery 4. Reduce cost and increase effectiveness 5. Strengthen health integration and system collaboration 6. Pursue excellence in health care and service delivery 7. Promote regional efforts 4 141408 Deschutes 1100f330 8. Strengthen health service organizations 9. Promote sound health policy . Within each of the nine strategies are goals and identified actions that will be taken toward achieving those goals. The plan is a broad picture of the direction health care changes will take in Central Oregon. Ten Focus Areas Preparation for the first two strategies in the framework (improve equity and access, better health and well-being) required a thorough review of existing health data. Qualitative and quantitative data was reviewed to determine which issues or areas of concern required attention and which were common to all three counties. The top ten issues were prioritized and recommended as the primary focus areas for the first two sections of the 2012-2015 Regional Health Improvement Plan. The ten prioritized focus areas of need were: disparity/inequity, isolation and access to resources, food insecurity, early childhood wellness, safety, crime and violence, chronic disease and preventive care, alcohol, drug and tobacco use, behavioral health and suicide, oral health, and healthy environments. Socio-Ecological Model In preparing for the work plan development, the Steering Committee decided to use a socio-ecological planning model, which is a comprehensive approach that includes strategies impacting five levels necessary for broad-based change: individual, interpersonal, organizational, community and public policy. This model utilizes a collective impact approach and provides a more comprehensive perspective, even though not every level may be necessary for each of the ten focus areas in the final work plan. Work Plans Once the plan is approved, annual work plans will be developed to identify the lead entity responsible for the implementation, the goal and targeted outcomes, the specific strategies and actions to be taken to achieve the identified goals and outcomes, and the source and/or tools that will used to measure and evaluate progress and effectiveness. The work plans will also be used to help monitor and assess where changes are needed when the targeted results or outcomes are not being achieved. 5 141408 Deschutes 111 of330 INTRODUCTION Senate Bill 204, now Administrative Rule 309-014-0330 through 309-014-0340, established a Regional Health Improvement Plan (RHIP) for Central Oregon creating a four year comprehensive, coordinated plan for the tri-county area that would incorporate and replace all health and human service plans prescribed by the Oregon Health Authority, including but not limited to plans required by the State 430.640, 431.385 and 624.510 and plans required by the State Commission on Children and Families under ORS 417.705-417.801. The Central Oregon Health Board, in a delegated capacity, will function as the regional public health and behavioral health board for Crook, Jefferson and Deschutes Counties. This will facilitate the public health and behavioral health services being efficiently and effectively coordinate with the new Comprehensive Care Organization which will be connected to the Central Oregon Health Council. The Central Oregon Health Council through the Central Oregon Health Board has been directed to conduct a regional health assessment and to adopt a RHIP to serve as the strategic population health and health care system plan for the region. The plan must define the scope of the activities, services and responsibilities that the Council proposes to assume upon implementation of the plan. The activities and services under this plan may include, but are not limited to: A. Analysis of public and private resources B. Health Policy C. System Design D. Outcome and quality improvement E. Integration of service delivery F. Workforce Development 6 141408 Deschutes 1120[330 MISSION The mission is to transform the health of our region's residents, making Central Oregon the healthiest region in the nation. The Central Oregon Health Council creates community alignment in pursuit of better health, better care and lower cost. GUIDING PRINCIPLES 1. Creation of efficient organizations 2. Assurance of financial sustainability 3. Reinvestment of shared savings 4. High levels of transparency and accountability 5. Flexibility and responsiveness 6. Use of outcomes-based decision making principles 7. Orientation toward whole person health In order to create a healthy Central Triple Aim: Oregon, we must involve a broad group of stakeholders: A POPULATION HEALTH PERFORMANCE SYSTEM • Chambers of Commerce and The Triple Aim is a key part of the vision for a business community healthy Central Oregon, with the long term goal • School Districts of making it the healthiest region in the nation. The Aims are: • City and County Government • Community Colleges and • Improve health of the population Universities • Enhance the patient experience of care • Insurance companies (including quality, access and reliability); and • Reduce or at least control the per capita cost • Consumers or customers of care • Hospitals and medical providers • Health and Human Service Organizations To start this process, we completed a regional assessment to identify the critical areas of need to move toward achieving a healthy community. 7 141408 Desch utes I I3 of330 I ASSESSMENT PROCESS (Full Health AsseSsment is on COHC Website) Compiling and using 150 pages of quantitative and qualitative data from a variety of Central Oregon Health and Community sources, the Regional Health Improvement Plan (RHIP) Data and Assessment Work Group met to review the data and to determine the critical issues impacting the tri-county area. The work group initially identified nine priority areas in which to focus and recommended those to the RHIP Steering Committee. The Committee accepted the nine and added a tenth area, healthy environment, to the list. These ten priority focus areas will be the focus of the first 2012 2015 RHIP, and are listed in the blue box below. The following sections also provide a brief tri-county data summary and overview for each of the ten focus areas. There will be ongoing monitoring and assessment of the RHIP and related work plans to ensure progress is being made, to determine the effectiveness of the strategies used and to make adjustments as needed. Health statistics will also be monitored through the Healthy Community Institute web site that will be fully operational by the summer of 2012. The RHIP Steering Committee, with representation from the tri-county area, will meet on an annual basis to review and evaluate any changes in health statistics, to check on the status of the plan, and to make adjustments and updates when necessary. -rhe RHIP plan is posted on the Central Oregon Health Council (COHC) web site www.cohealthcouncil.org. 1. Health Disparity and Inequities Comparative mortality rates in areas of southern Deschutes County and northern Jefferson County are significantly higher than the state average and are considered a disparity (or difference) in health. Mortality in this case is related to geographic area, but the disparity is also inequitable as it is avoidable and unjust. It is no surprise that our rural areas have high rates of poverty, less access to services, and greater distances to travel for needed care, or that many individuals 8 141408 Deschutes 1140f330 struggle to meet basic needs. These systematic barriers needlessly impact individuals' health. This is one example of disparity and inequity in our region. Many other disparities exist, warranting investigation to determine if these differences are equitable and just or not. Improving public health will require work toward health equity-aiming for communities where all individuals have the opportunity to attain their full health potential, and where no one is disadvantaged from achieving this potential due to sOcially determined circumstance. Crook and Jefferson counties are consistently among the top 5 Oregon counties with highest food insecurity. Deschutes County has the largest total number of food insecure individuals in Central Oregon. In Crook County, the average cost per meal is nearly $1 higher than the rest of Oregon. It is estimated that more than 37% of children in Jefferson and Crook Counties may be food insecure. In Deschutes County, of all the food insecure adults and children, 45% are not eligible for SNAP or other federal food programs-a sizeable number of children and adults who may not be able to access much needed assistance. 2. Acce8$Jo RespurceS:iand Quality Services The ability to access resources, services or assistance is impacted by numerous factors, including transportation, travel distance and time, finances, social and cultural barriers, clinic flow, and the systems of care in place. An elderly person living alone and unable to drive may have financial means, but limited access to care. Similarly, a working single mother with no car may have access to public transportation, but can't afford the cost of unpaid leave from work to access resources. More than 41% of Central Oregonians live in unincorporated areas and towns with less than 2,500 people. 3. Early Childhood Wenness A child's growth begins in pregnancy and continues into adulthood. Many factors impact childhood well ness: social, environmental, phYSical, and cognitive. Children in environments unable to meet these needs are at increased risk for poorer health, safety, development, and the ability to learn. These unmet needs during childhood pose threats to health long into adult and later life. Early childhood wellness is a short-term 9 141408 Deschutes 1150f330 investment for today and a long-term investment for the business, health, education and social sectors for decades to come, and can result in millions in long term savings to the social services and health system. 4. SafetY, Crime, and Violence Central Oregon counties have higher rates of confirmed child abuse and neglect than the rest of Oregon. This may be due to differences in reporting and resources in the system of care or it may be an actual higher rate of abuse/neglect. In 2009, Deschutes and Crook Counties were ranked in the top ten Oregon Counties with highest crude rate of total violent crimes reported. In the same year, Jefferson County was in the bottom ten Oregon counties for number of police per 1,000. last year, more than 1,450 individuals in Central Oregon called an emergency crisis line about domestic violence alone. 5. Preventive Care and Services "To prevent" literally means "to keep something from happening". The term "prevention" is reserved for those interventions that occur before the initial onset of disorder. The improvements in health status are the result of a health system that influences health status through a variety of intervention strategies and services. Health and illness are dynamic states that are influenced by a wide variety of biologic, environmental, behavioral, social and health service factors acting through an ecological model. Preventive services and health promotion involve activities that alter the interaction of the various health influencing factors in ways that contribute to either averting or altering the likelihood of occurrence of disease or injury. In Central Oregon, prevention activities can playa role in creating a healthier region. Preventive services include immunization rates, teen pregnancy prevention, and screening mammograms along with other interventions. 6. Chronic Disease Prevention In the last 65 years, adult chronic disease has grown to be the main health problem for industrialized nations. Cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease account for at least 50% of the global mortality burden. In Central Oregon, chronic diseases, including heart disease and cancer, are the leading causes of 10 141 408 Deschutes 1160f330 death for each county. Crook County's age-adjusted prevalence of adults with high blood pressure is 46.2%, significantly higher than 25.8% of adults for all of Oregon. Exposures, modifiable behaviors, and risk factors all playa role in the development of chronic disease in later life. When exacerbated by a mental health condition, the cost of chronic disease management grows exponentially, often two to five times more than someone without a mental health condition. Death, disability and injury due to drug use take a significant toll on the lives of Oregonians each year. In fact, Oregon's death rate from alcohol-induced disease alone is 80% higher than the US rate. A closer look at chronic disease death in Oregon discovers that 50% can be attributed to tobacco use, alcohol abuse and obesity directly. Central Oregon continues to see increasing rates from Alcohol, Tobacco and Other Drug use/abuse, and in some cases statistics show as Significantly higher than State rates (death from alcohol-induced disease, adult 3~-day alcohol use, and 8th grade 3~-day alcohol use). Of particular concern are high risk drinking (underage, heavy and binge consumption), marijuana use, prescription drug abuse and tobacco use. The region agrees that in order to improve long term health, prevention efforts should focus on making population-based community change. In order for healthy-decision making to occur, prevention efforts should target alcohol, tobacco and other drug prevention specifically, as well as the issues associated with such use, including but not limited to: suicide, bullying, teen pregnancy, violence, problem gambling, mental health, physical health and nutrition. Communities throughout the region will develop plans with specific prevention strategies and projects that address the unique concerns and needs of each community. 8. Behavioral Health and Suicide Prevention Oregon suicide rates have been higher than national rates for two decades. It is estimated more than 9,000 adults in the tri-county region have serious mental illness. Roughly 1/3 of Central Oregon 11th graders reported having a depressive episode in the last year. High depression scores are associated with poor academic achievement, anxiety, and poor peer and teacher relationships. 11 141408 Deschutes 1170f330 The extent of the need for behavioral health services and the capacity to provide services should be included and studied as part of the Access focus area work. Early risk factors and prevention data also needs to be investigated as related to behavioral health. Though frequently identified by providers and community members as a problem in Central Oregon, there is little recent data to estimate total burden of poor oral health in the region. Poor oral health can cause pain, discomfort, and disfigurement; it can affect an individual's quality of life, ability to eat and to speak, and can interfere with opportunities to learn, work, participate, engage and contribute. What's more, oral health is related to chronic disease in later life, and results in increased avoidable emergency department usage, further increasing regional healthcare costs. 1Q. Healthy Environments There is much to learn about the specific environmental health characteristics of Central Oregon's communities. The ecological surroundings of individuals, families, communities and regions impact the options available to individuals to reach their full potential for health. Environments-on any scale-Simultaneously impact and are impacted by those within them. Built and natural environment directly impact human health, and humans directly impact the built and natural environment. Current and relevant data on all scales of environment is lacking in the Central Oregon region. locations of stores to purchase affordable fresh fruits and vegetables impact healthy choices. Promoting and encouraging the safe and affordable alternative commute options impacts the behaviors of individuals to choose alternatives to driving, thus impacting the environment. Safe and easily accessible places to play outdoors impacts the ability of children to play outside. This model looks at planning in a connected approach. It recognizes there are small units for planning and large units for planning. It is understood that small moves contribute to 12 141408 Deschutes 118of330 large moves and large moves, and the large in turn contribute to the small. There is ecological synergy in how we address health issues promoting more holistic, coordinated and population based planning structure. This model includes the following five areas: • Individual-Enhancing skills, knowledge, attitudes and motivation • Interpersanal-Increasing support from friends, family and peers • Organizational-Changing policies and practices of an organization • Community -Collaborating and creating partnership to effect change in the community and increase the efficiency and effectiveness of care • Public Policy -Developing, influencing and enforcing local, state and national laws which promote health and create safe and healthy environments 13 141408 Deschutes 1190f330 Improve Equity and Increase Access (Attachment 3 for definitions) Improve Health Equity and Population Health Indicators and Metrics for Health Inequities (SES) Social Determinants - a primary approach to achieving health equity (CDC) Social Status (education, ethnicity, race) • Kindergarten readiness assessment • Academic progress over time • Absenteeism -specifically fewer than 18 days in 6th grade 3rd • grade reading and math scores 8th• grade algebra (and/or other standardized test scores?) • Credits earned in 9th grade • High School graduation or completion rates (including GEDs) • College credits earned in high school • Work skills, attitudes and/or behavior • Life skills and problem solving skills Economic Status and Environment • Number of children in free and reduced lunch program • Median household income, per capita income, SES, SAIPE • Poverty rates (TANF, Food Stamps, Child Care Subsidies) • Food insecurity, free and reduced lunch rates, other (NI) • One day homeless count, school age homelessness • Housing conditions Work Status (occupations and, jobs per capita) • Employment opportunities for living wage jobs mata Snapshot " 'c • The number of school districts meeting or exceeding the state benchmarks in reading and math varies by county. All school districts met or exceeded the 3rd grade reading benchmark. Only Bend-La Pine and Sisters school districts met or 14 141408 Deschutes 1200f330 r ! f exceeded 3rd grade math benchmark. Bend-La Pine, Sisters, and Culver met or exceeded the 8th grade math benchmark. Jefferson County SD was well below the Oregon target of 70% for both 3'd and 8th grade math (2010-2011) • Graduation rates (4 year cohort) for Central Oregon school districts were as follows: Crook County 67%, Jefferson County 57%, Bend -La Pine 68%, Redmond 49%, and Sisters 80% *Redmond School district 4 year graduation rate may be low due to participation in the Advanced Diploma • The percentage of children living at or below the federal poverty level for Crook, Deschutes, and Jefferson Counties are 29%, 22% and 34%, respectively • The percentage of children qualifying for free and reduced lunch for Crook, Deschutes, and Jefferson Counties are 61%, 52% and 80%, respectively • Jefferson County has the highest percentage of children on free or reduced lunches in the state, while having the lowest percent (72%) of 3'd graders meeting the state benchmark (in 2009-2010) • 2,271 people were reported homeless during the tri-county One Day Homeless count on January 27,2011 (down from 2,401 in 2010) • Nearly half of those experiencing homelessness during the 2011 count were under age 18 (significantly higher than 2010) • The number of homeless pregnant and parenting teens under 18 decreased significantly from 19 to 7 between 2010 and 2011 • 20% of those experiencing homeless ness report as disabled, a majority of whom stated that they suffer from a psychiatric disability • In nearly all categories, Hispanic and Native America populations were over represented Goal 1: Improve Education Success for all Central Oregon Students (with emphasis on those experiencing disparities) Organizational Strategies • Provide training to develop a community and education workforce, working together, that is not only more aware of the social determinants of health and what they can do to address inequities Community Strategies • Convene and/or support local partnerships among tri-county region public health agencies, community-based organizations, ESDs, and local school districts to support health improvement strategies for students 15 141408 Deschutes 1210[330 I Public Policy Strategies • Support educational success as a primary means of reducing child poverty and improving children's health (e.g. through School Based Health Centers, OHP application assistance for qualified uninsured children and Community Schools) Goal 2: Address Basic Needs, Living conditions and Environments Organizational Strategies • Develop a simple tool that quickly gathers basic needs and living conditions • Use community health workers or other supports to help patients connect with organizations to meet basic living needs Community Strategies • Continue to let the community know about food insecurity needs through media • Support food banks and other food distribution centers to assist people meeting some of their food needs • Promote healthy environments for local income housing • Find ways to support people in housing to reduce homelessness Public Policy Strategies • Public and non-public organizational policies must take into consideration the basic needs and healthy environment for the residents Goal 3: Increase Number of Living Wage Jobs in the Region Organizational Strategies • Organizations should evaluate their salary and benefits to see if it meets the living wage standard Community Strategies • Encourage the economic development of living wage jobs • Economic development organizations and groups must addressing living wages in their establishment and recruitment of new businesses Public Policy Strategies • Promote livable wage jobs as a part of economic development plans 16 14 1408 Desch utes 122of330 • Counties, cities and chamber of commerce's must continue to collaborate and where appropriate consolidate their efforts in pursuing business that provide living wage jobs Increase Access Indicators and Metrics Health services, medical care • Number and percentage of population with medical insurance • Number and percentage of population with a primary care provider • Under and uninsured • Capacity and availability of care, services and resources • Hours of operation, wait time, wait lists • Challenges for specific populations: adults/seniors, multicultural • Well trained work force (including cultural awareness training • Outpatient utilization • Emergency room utilization Physical environment • Geographic isolation • Transportation challenges Data Snapshot • In Crook and Jefferson Counties, an estimated 12.3 to 19.1% of all residents are uninsured. In Deschutes County an estimated 12.2 to 18.6% of all residents are uninsured • Those individuals (ages 19-64) who make two times the Federal Poverty Limit or less have the highest rates of uninsured • The percent of uninsured children (18 years and younger) in Crook and Jefferson Counties is estimated to be 9.7%, while percent in Deschutes County is 4.1% Goal 1: Increase Access to Quality Health Care (with emphasis on those experiencing disparities) Individual Strategies • Address geographical barriers (transportation, bringing services to isolated individuals) 17 141408 Deschutes 1230[330 • Promote individual utilization of self-management approaches to health care conditions Organizational Strategies • Make services available outside of normal work hours, including weekends • Implement Patient Centered Medical Homes in Primary Care settings and increase use of Health Engagement Team to support primary care • Evaluate the need for and access to primary care providers • Increase use of telehealth to make use of specialty care more efficient and effective and increase access to such care in rural areas • Use community outreach workers, peer support mentors or community health workers to identify and intervene on barriers to accessing medical and behavioral health Services • Assure quality, timely access to reproductive health services as a part of implementing healthcare reform Community Strategies • Safety Net services engaged in collaborating with health care services. • Identification of and intervention with barriers to accessing medical and behavioral health services • Increase community wide development of population self-management programs like the living Well Program • Seek funding for uninsured that would help fund a primary care provider position, like at Volunteers in Medicine (VIM) • For uninsured, recommend providers, hospital and others explore joint fund financial contribution to strengthen ShareCare Program • Develop a system to assure Oregon Health Plan (OHP) members have access to needed behavioral health services • For OHP, embed access improvements and incentives with individual Central Oregon Independent Practice Association (C01PA) provider agreements and improvements with other providers such as St. Charles, Bend Memorial Clinic and others • Promote access and support School Based Health Centers Public Policy Strategies • Support maintenance of current funding for access to health care coverage through Oregon Health Plan and School Based Health Centers 18 141408 Deschutes 124of330 Improve Health Early Childhood Wellness (prenatal through age 6) Indicators and Metrics (within five domains) Maternal and Child Health: Prenatal care, smoking during pregnancy, post-partum depression, birth weight, breastfeeding rates, immunization rates, child abuse Language and Literacv: Age appropriate vocabulary, key literacy measures Social/Emotional Development: Quality early childhood care and education settings including child care and preschool, healthy attachment, behavioral indicators for school readiness, cultural identity Parent and Family Support: Family and parent involvement, realistic parental expectations and interactions, family stability, role and engagement of father figure Cognitive Development: Problem solving abilities, age appropriate cognitive ability, adaptability oata SnaP$hot • Over the past ten years, the rates of low and very low birth weights in the tri counties have usually exceeded the state rate. From 2000-2009, these rates were as follows: Crook County 51.05, Deschutes 57.93, Jefferson County 66.24, per 1,000 live births • The percent of live births with adequate prenatal care is better than the state rate in Crook and Deschutes Counties. In Jefferson County, the percent of live births with inadequate, late, or no prenatal care is well above the state rate, indicating a problem area • The percentage of births to unwed mothers in 2009 in Oregon, Crook, Deschutes, and Jefferson Counties were 35%, 34%, 30%, 49%, respectively • Percent of WIC moms who started out breastfeeding was as follows: Crook County 83%, Jefferson County 90%, and Deschutes County 94% (2010) • The percent of live births with maternal alcohol, tobacco, or illicit drug use varies by county. In Crook County, maternal tobacco use is problematic, while Jefferson County struggles with maternal alcohol use. Deschutes County 19 141408 Deschutes 1250[330 numbers are similar or better than the state rates with regard to all three behaviors • The 2010 rate of teen pregnancy (per 1,000 females ages 10-17) is higher than the state rate (7.3) in Jefferson County (13.4), but lower than the state rate in Deschutes County (6.1). Due to privacy regarding small numbers, Crook County rates are not reported, however health professionals in that area have identified this as a concern • The prevalence of childhood serious mental illness « age 18) is 13% in Warm Springs, 12% in Jefferson County, 11% in Crook County, and 10% in Deschutes County (2008) • The two year old immunization rates were as follows: Crook County 76%, Deschutes County 69%, and Jefferson County 77%. The state rate is 73%. There is a public health concern in Deschutes County due to the growing number of parents who are opting out of some or all immunizations for their children • The state is in the process of developing assessment tools that will measure language/literacy development, cognitive development, and social emotional health, and family support • The state is in the process of developing a tiered quality rating and improvement system that will help assess quality in early care and education settings Goal 1: Develop and Coordinate Early Childhood System Data Collection and Services Organizational Strategies • Develop universal screening and data collection systems for prenatal through six year olds that integrate with regional system(s) including recommendations for a unified and coordinated system for HProviding developmental assessments andtracking, compiling, analyzing, and intervention services for young children summarizing data experiencing significant adversity before • All children 0-5 years of age will be they exhibit problems in their behavior or screened in all five domains at pre-development will increase their chance for determined intervals (tools and intervals more positive life outcomes." defined by the state) through well baby National Scientific Council on thechecks DeveloDlna Child Community Strategies • Support early childhood programs which implement and evaluate early childhood well ness media campaigns 20 141408 Deschutes 126of330 • Coordinate support for families across Early Learning and Health Care Systems through Family Resource managers and Community Health Workers • Need a demographic picture, using data, of enrollment in early childhood programs (ECP) • Need data to address location and accessibility to ECP • Make sure, based on the data, that the ECP are culturally competent • Conduct assessment to determine whether evidence based curriculum being used and whether ECPs are effective in preparing children for school .Jdlp~onand Quality in EarIyQhildhQodea~.amthils . .... .. Interpersonal Strategies • Educate parents about the importance of quality in ECE settings and what standards to look for so they will expect and demand quality "High quality care is ass~i(lted witJjOrganizational Strategies children's positive develOpment oj• Implement best practices in ECE language and cognitive junction, s~1settings skillS-QIld emotionol well~ing.N • Pursue continuing education or accreditation for ECE providers The E<onomlt /mptlct ofOregon's ChIld Core Industry, 2010 Community Strategies • Increase involvement from the business community in supporting early childhood programs as an economic development strategy • When available, utilize Kindergarten Readiness data to identify origin of children who arrive "not ready"; offer and/or require remediation (and technical support) for providers with children from their facility that are arriving unprepared or not meeting standards • When available, utilize the Tiered Quality and Improvement Rating System to monitor and assess quality in ECE settings • Continue to incorporate integration of WIC services as a part of the health and education transformation framework and planning Public Policy Strategies • Promote policies to increase quality standards for providers. Support and monitor development and implementation of improved quality child care standards 21 141408 Deschutes 1270f330 • Provide comparative data on facilities • Fund child care assistance programs adequately such as Employment Related Day Care (ERDC) Safety, Crime and Violence Prevention Indicators and Metrics Child (0-18) • Child abuse rates • Elder abuse rates • Assault and violent crime rates • Runaway and homeless youth • Bullying incidents • Pro-social skills and behaviors • Life skills and problem-solving skills • Juvenile crime rates and indicators (recidivism rates, referrals and/or suspensions for delinquent behavior) • % of youth not entering or moving further into the juvenile justice system at 6 month and 1 year assessments • % of youth with reduced risk factors as measured by the JCP Risk assessment at 6 mo. and 1 year assessments • Foster care rates Adult • Domestic/interpersonal violence • Assault • The total crimes rate (per 10,000 population) was lower in each county than the state rate of 338, although by county ranking Deschutes ranked 3rd with 337, Jefferson ranked 12th with 268, and Crook ranked 31st with 68 (2010) • The violent crimes rate (per 10,000 population) was lower for each county than the state rate during 2008-2009. Deschutes County exceeded the state rate in 2010. County ranking indicate Deschutes ranked 4th with 31, Jefferson ranked 21st24th with 7, and Crook ranked with 10 (2010). The state rate was approximately 23. 22 141408 Deschutes 1280f330 • The juvenile arrest rate was higher in all three counties as compared to the state rate between the years 1990-2008. In 2008 and 2009, however, the county rates were the same or better than the state rate. County ranking indicate Deschutes ranked 9th with 203, Jefferson ranked 16th with 155, and Crook ranked 14th with 172. The state rate was 200 (2009) • 2010 reversed a five year downward trend in child abuse and neglect victim rates in Deschutes County. Crook and Jefferson Counties have also experienced increased rates in the past two years. The rate per 1,000 children was 9.5 in Crook County, 8.1 in Deschutes County, and 13.3 in Jefferson County. The state rate was 12.7 (2010). • The foster care rate per 1,000 children was 5.0 in Crook County, 3.6 in Deschutes County, and 7.5 in Jefferson County. Deschutes and Jefferson Counties experienced an increase in point in time rates from 2009-2010 while at the same time experiencing an increase child victim rates • Nearly half of the people identified at last year's Regional One Night Count were under the age of 18. Out of those 1,032 youth, 189 were unaccompanied youth or not living in the physical or financial care of their parent or guardian. In this region there are 49 beds that are youth specific. That is 140-bed discrepancy from the count • Current 30 day waiting list for only homeless shelter serving youth in the region. A $50,000 federal grant for staffing and basic needs supplies for the Street Outreach Program was not renewed resulting in further decline in capacity to serve runaway and homeless youth at time when need has increased Regional Homeless Student Count by School District 2010-2011 Bend La Pine 726 4.6% i Crook County 40 1.4% Culver 47 7.4% Jefferson 94 3.4% Redmond 235 3.4% Sisters 35 2.7% • Average age of runaway and unaccompanied youth served at Cascade Youth and Family Center is age 15, 53% are female, 46% male and 1% transgendered • Top Problems (self reported by youth): parent! youth conflict, neglect, substance abuse by the adult caregiver and/or poor school attendance and behind in credits to graduate 23 141408 Deschutes 1290[330 Goal 1: Decrease Child Abuse and Neglect Community Strategies • In Spring/Summer of 2012, convene Central Oregon child abuse prevention teams and regional partners to review current data trends, issues and barriers related to child abuse in the tri-county area. Develop local and regional plan and strategies to reduce child abuse and neglect in Central Oregon • Continue to identify resource development opportunities to fund and address identified needs and service providers working to decrease child abuse • Community and providers in the region engage in child abuse prevention training, such as Darkness to Light Training Public Policv Strategies • Enforce policies, such as mandatory reporting and safety protocols, in order to decrease child abuse • Enforce staff background checks for "recorded" facilities • Change zoning and / or licensing regulations to meet the needs of providers • Work with policy makers in the tri-county area to advance the awareness of the lifetime social and economic impact of child maltreatment, to ensure support for programs proven to reduce child maltreatment (i.e. Nurse Family Partnership, Healthy Families) Goal 2: Reduce Incidence of Domestic andlnterp~rsona"Niolence (including elder abuse) ... Community Strategies • In Spring/Summer of 2012, convene the tri-county domestic and interpersonal violence prevention partners and service providers to review current data trends, issues and barriers related to interpersonal violence in the tri-county area. Develop local and regional plan and strategies to reduce interpersonal violence in Central Oregon • Continue to identify resource development opportunities to fund and address identified needs and service providers working to decrease interpersonal violence and elder abuse Goal 3: Improve Safety for Runaway and Homeless Youth Individual Strategies • Provide emergency and transitional shelter • Promote and make available evidence-based Life Skills training 24 141408 Deschutes 130of330 • Provide needed educational and social services (e.g. drug and alcohol assessment and treatment, tutoring, medical and dental care) Community Strategies • Create a drop-in center for homeless, independent youth or youth who are on the verge of becoming homeless • Continue to promote, support and expand Community School initiatives as a poverty prevention strategy that provides supervision during non-school hours and as a strategy proven to improve academic achievement Goal 4: ~velop Regional St"'tegi~to Reduce JuvenileeiimeJ' Individual Strategies • Provide individual group opportunities in skill development for youth 11-17, to include Girls Circle, Boys Council, etc. • Provide individualized case management to youth 11-17 with three or more risk factors to decrease further involvement in juvenile justice system Community Strategies • Provide community service/involvement opportunities for youth 11-17 involved in Juvenile Crime Prevention Programming Public Policy Strategies • Development of regional Youth Council structure to provide accountability and advocacy for JCP and Youth Investment funding for region Improve Preventive Care and Services Prevention services are both individual based and population based and must recognize the cultural uniqueness of an individual and community, must be based on data and must engage youth, parents, adults, other community members, providers and other community partners. Indicators and l1etri~~ " • 2 year old immunization rates • Influenza Immunization Rates • Pneumonia Immunization Rates • Teen pregnancy rate 25 141408 Deschutes 1310[330 • Chlamydia rates • HIV rates • Percentage of reproductive age women using effective contraceptive method Data Snapshot • The two year old immunization rates were as follows: Crook County 76%, Deschutes County 69%, and Jefferson County 77%. The state rate is 73%. (2010). There is a public health concern in Deschutes County due to the growing number of parents who are opting out of some or all immunizations for their children. Deschutes County's kindergarten religious exemption orate of 9% for the 2010-2011 school year is substantially higher than the state average of 5.6% • The 2010 rate of teen pregnancy (per 1,000 females ages 10-17) is higher than the state rate (7.3) in Jefferson County (13.4), but lower than the state rate in Deschutes County (6.1). Due to privacy regarding small numbers, Crook County rates are not reported, however health professionals in that area have identified this as a concern • The aggregated incidence rate (per 10,000 population) for chlamydiosis, 2005 2010, is 21.67 for Crook County, 25.7 for Deschutes County, and 42.81 for Jefferson County • The aggregated incidence rate (per 10,000 population) for gonorrhea, 2005 2010, is .97 for Crook County, .54 for Deschutes County, and 2.66 for Jefferson County • The number of cases (per 100,000 population) of persons living with HIV or AIDS in 2010 were as follows: Crook County 0-26.4; Deschutes County 26.5-53.9; Jefferson County 26.5-53.9 Goal 1: Improve Immunization rates in Central Oregon Individual Strategies • Provide education to new parents about the benefits of immunizations (in the hospital through Healthy Start or NFP, at the pediatrician's office, at wlq • Provide education and training to clinic staff on quality improvement activities to increase clinic immunization rates Organizational Strategies • Require immunizations for enrollment in childcare and preschool settings • Mitigate refusal rates for immunizations for education setting (K-12) • Ensure easy and affordable access to immunizations through school based health centers and private clinics 26 141408 Deschutes 1320f330 • Promote adult vaccination for flu, pneumonia, and shingles • Provide education about the benefits of immunizations (in the hospital through Healthy Start or NFP, at the pediatrician's office, at wlq and through primary care provider • Leverage electronic medical record (EMR) reporting capabilities to allow for better tracking and outreach within the primary care setting and could EMR be integrated with ALERT system Community Strategies • Inform the public, through traditional media, social media, school newsletters, and tabling at children focused events about importance of immunizations • Maintain a strong immunization coalition that includes representatives from private and public clinics • Clear provider consensus on communication with patient on recommended immunizations Public Policy Strategies • Enforce policies to ensure immunizations • Partner with Oregon Health Authority to strengthen immunization laws Goal 2: QJmmllfli,cableQlseaSe(CO)Preventlon -Seven days per week response for CDinvestigation~comrnonityeducatlon and Intervention • Maintain practice and standard of a seven day a week response capability for communicable disease investigation, responding and implementing control measures for reportable diseases • Maintain Tuberculosis case management to provide care and service management and to assure communication with the patient's primary care physician • Make available, through multiple media sources, information to the public about communicable diseases and their prevention • Increase testing of Chlamydia • Increase HIV testing -standard screening Goal 3: Strengthen Family Planning Services and Reduce Teen Pregnancy Organizational Strategies • Use the public health referral cheat sheet for family planning • Develop guidelines for prescribers in public health services 27 141408 Deschutes 1330f330 • Maintain the family planning services, primarily through public health, for sexually active teens • Maximize resources for family planning medications to increase access • Increase outreach for women in need for reproductive health services Public Policy Strategies • Evaluate our drug prior authorization policy Chronic Disease Prevention Indicators and MetricS~ , • Obesity rates • Physical activity rates • Controlling high blood pressure • Cholesterol percentages • Asthma rates • Death rates • living Well participants • Breast and cervical cancer screening • Breast cancer rates • Diabetes rates • AlC checked annually • Pulmonologists, or Allergists-Controller/Rescue Ration>=.45% among asthmatic patients • Number of patients participating in colorectal and mammogram cancer screenings • Primary Care sensitive hospital admission for chronic conditions (diabetes, asthma, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease) In the last 65 years, adult chronic disease has grown into the main health problem for industrialized nations. Cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease account for at least 50 % of the global mortality burden. In Central Oregon, chronic diseases are the leading causes of death for each county. Crook County's age-aqjusted prevalence of adults with high blood pressure is 46.2%, 28 141408 Deschutes 1340[330 significantly higher than 25.8% of adults for all of Oregon. Exposures, modifiable behaviors, and risk factors all playa role in the development of chronic disease in later life. GoaJ01;lmprove community h_tth and wellness Individual • Access information resource Centers Wellness media campaigns through print, radio, or television Community Strategies • Public education on mental health, suicide prevention & intervention, and physical health (i.e. workshops, seminars, classes) • Promote and raise awareness for healthy decision-making (i.e. activities supporting bullying prevention, suicide prevention, problem gambling prevention, obesity prevention, gender specific activities, cultural diversity activities, and health & wellness activities) Organizational Policy Strategies • Consider organizational policy strategies that promote health and weI/ness of employees Public Policy Strategies • Assess, promote and improve access to healthy lifestyle choices (Le. biking to school/work, healthy food options at school/work/community) • Consider other public policies that will contribute to improving mental health and physical health • Promote safe fund in the public arena to maintain wellness Goal 2: Ca.rdiovascular Disease Prevention Individual Strategies • Promote exercise and healthy diet • Monitor to see that lab screening is done • Annual physical exams with Primary care Provider for risk management as well as early identification and treatment of hypertension and hyperlipidemia Organizational Strategies • Complex Care and Advanced medical management 29 141408 Deschutes 1350f330 • Care coordination • Promote individual prevention or self-management of cardiovascular disease through patient education, like the "living Well Program", and through engaging patients as active participants in the development of their treatment plan • Assure that appropriate lab screening is completed and reviewed with the patient Community Strategies • Community education and prevention that focus on healthy diets at all ages and the value of exercise • Accessible, affordable smoking cessation programs • Community education, with cultural considerations, focusing on nutrition and healthy food choices Public Policy Strategies • Promote policies that make walking easier and safer • Explore the possibilities of other environmental factors that may contribute to cardiovascular disease GOal 3: eance~Prevention Individual Strategies • Promote reminders and ease of access to follow up care • Promote the use of sun screen and other protectors from over sun exposure • Annual physical exam with Primary Care Provider Organizational Strategies • Care coordination and use of community health workers • Develop and promote good electronic health information exchange that promotes collaboration and coordination of care • Leverage electronic medical record systems within the primary care setting for tracking and reminder/outreach to patients for timely screening and exams Community Strategies • Promote community prevention and early intervention through community education • Promote mammograms and Pap smears as good preventive screening • Develop a Task Force to consider focused project(s) to improve colon cancer screening 30 141408 Deschutes 1360f330 • Provide known care gaps to PCPs regarding breast cancer Public Policy Strategies • Examine policies that may contribute to environmental factors that contribute to cancer • Coordinate and enhance Media Blast 90a14: Compl~.Care: Community Strategies • Develop a comprehensive complex care strategy (CCCS) • Develop a detailed business and operations plan, as a part of the CCCS, for a freestanding complex care center • Develop short term opportunities into successes of a comprehensive complex care strategy for Central Oregon • Self-Management skills is a part of complex care strategy, Living Well is an example a evidence based program ALCOHOL, TOBACCO AND OTHER DRUGS rndlcators and Metrics • Youth 30-day marijuana, tobacco, alcohol and prescription drug use • Adult current tobacco use (including prenatal tobacco use) • Prenatal tobacco use • Tobacco use in Coordinated Care Organization members • Tobacco use in general population • Use of SBIRT • Death from alcohol induced disease Data Snap$hot • Central Oregon has the highest rate of current alcohol consumption, teen consumption and overall alcohol dependence, as compared to the State 31 141408 Deschutes 1370f330 • Rate of death from alcohol induced disease is of particular concern. Jefferson County is statistically significantly higher than the State rate and has been for several years. • Central Oregon youth have a high rate of "new" users of marijuana smoking • Amongst youth, prescription drug use trend has had a notable increase • The chart displays 30-day use rates by drug category for 8th and 11th graders in each respective County. As noted in yellow some rates are statistically significantly higher than the State of Oregon. Goal 1: Reduce Alcohol/Tobacco / Other I)rug Use Individual • Access to information resource centers • Media Campaigns through print, radio, or television Community Strategies • Central Oregon will actively engage and support coalitions through facilitation and technical assistance to implement the Strategic Prevention Framework model and evidenced based strategies as well as support resource development (i.e. enforcement of underage drinking laws such as minor compliance checks) • Public education and training on substance use/abuse (j.e. workshops, seminars, classes) • ATOD-Free activities support (i.e. ATOD-free activities, events, Fair, Red Ribbon, after school activities) • Youth education & involvement (i.e. drug prevention curriculum in schools, youth leadership, youth coalition efforts) Public Policy Strategies • Policy leaders will coordinate implementation and enforcement of consequences as outlined in alcohol, tobacco, and other drug (ATOD) protocol • Develop a regional approach to comprehensive prescription drug drop off sites in every county 32 14 I 408 Deschutes 1380f330 • Resource and referral development (i.e. Tip Box, Tip Line, Text Line, CRT) • Work with regional partners to establish 100% tobacco free policies at all educational centers and government properties (state and local) • Resource and referral development (Le. Tip Box, Tip Line, Text Line, etc.) • Increase policy efforts to reduce exposure to secondhand smoke where community members live by working with all multi-unit housing properties in the tri-county region to voluntarily go smoke free, with a priority on the local housing authority • Consider other public policies that will reduce ATOD use and related issues BEHAVIORAL HEALTH AND SUICIDE PREVENTION Indicators and Metrics • All-age suicide death rate • Suicide ideation measures (Oregon Student Wellness Survey) Data Snapshot • Oregon suicide rates have been higher than national rates for two decades in tri county region • Total number of suicides from 1993-2010 have been 69 for Crook, 398 for Deschutes, and 66 for Jefferson counties respectively Goal 1: utilize EVidence Based Strategies to·Reduce SuicffjeRisk Factors Individual Strategies • Increase the public's awareness of how to help someone at-risk for suicide by providing suicide prevention presentations Community Strategies • Develop a regional approach to suicide education using evidenced based strategies in order to prevent and reduce suicide attempts and completions Oral Health • Number of children K-S with untreated tooth decay 33 141408 Deschutes 1390f330 • Number of emergency department visits showing dental codes • Number people treated in hospital operating room for dental diagnosis • Students graduating from high school with no tooth decay Data Snapshot "C' • 201029% of K-5 children in Crook County has untreated decay • less than 50% of Oregonians have at least one dental visit a year let alone a preventive visit • Fee for service dentistry leads to focusing on "sick care" service delivery model • Upwards of 40% of Oregonians either do not have the ability or the resources to access traditional restorative/replacement dental care • Access to dental care is challenging due to the limited number of providers who participate in the Medicaid Program Goal 1: Il'Dprove the Dental Health of Children, Youth, and Adults Individual Strategies • care ofteeth through brushing, eating right and regular preventive check ups • Teeth varnish on 12 month old • 1st grade and 6th grade students get sealants Organizational Strategies • Create dental homes in every community • Conduct primary care provider (PCP) education so that fluoride varnish could be done in the PCP office • Improve education and coordination between dentists and medical care providers regarding importance of dental care during Community Strategies • Promote values of children getting good care of teeth through preventive strategies including fluoride varnish and distribution ofTooth Tool Kits to K-8. • Provide community education on the need for pregnant women to care for their teeth which in turn helps their unborn child Public Policy Strategies • Promote healthy access to school snacks 34 141408 Deschutes 1400[330 Healthy Environments Indicators or metrics • Number of food borne disease outbreaks • Air Quality Index Exceeding 100 • Number of water borne disease outbreaks • Number of times land use plans and housing developments address health issues in their plans Data Snapshot • One in six Americans get a food borne sickness • 3000 Americans die each year from food borne infections • Food borne infections caused by bacteria, viruses and parasites not toxic substances • Built environments can include in the design physical activity components that because of the activity will prevent diseases and prolong life • Physical inactivity and poor diet cause estimated 400,000 deaths annually from chronic diseases in the United States in 2000 Goal 1: Improve the Quality of Air, W@ter, and Food Individual Strategies • Promote carbon monoxide dictators in all homes to protect and improve health • Encourage radon testing in all homes where geology indicates there is a threat Community Strategies • Protect the quality and quantity of drinking and sub-surface water • Reduce exposure to food to air, water and hand borne-contaminants • Built environments, land use planning and housing plans must include the health impact of the plan and include it in the decision making processes for permits • Maintain public health food inspection programs to aid in safe food for public consumption assuring adequate and trained sanitarians for licensure, inspection and enforcement • Maintain current practice of investigating complaints and cases of foodborne illness • Support use and sale of locally grown fruit and vegetables as a means of promoting freshness and quality 35 141408 Deschutes 141of330 Improve Health Care and Service Delivery Inditators or Metrics • Number and growth of patient centered homes • Number of Integrated quality councils promoting collaborative quality improvement • Use of telehealth in chronic care cases • Rural areas with telehealth care being provided • Quality and efficiency in service delivery • Consumers being actively involved in their care • Customer feedback on satisfaction with service Data Snapshot • Telehealth can improve the care for persons with chronic health conditions living in isolated areas • Patient centered homes provide coordinated care for the whole person • Consumer input and involvement in their care will improve care and their attitude about their care • Joint stakeholder quality groups or councils can be effective in identifying systematic issues that impact deliver of quality care and quality educational services Goal 1: Promote and Develop Systems for Consumers or Customers to Express Their View on Their Care Experiences Individual Strategies • Collect quarterly feedback on consumer/customer perception of care from across the system with leadership provided by the Coordinated Care Organization (CCO) • Encourage consumer/customers to submit grievances about the care they have received to the CCO • Develop electronic reminders to consumers/customers of needed action and appointments to improve engagement in care 36 141408 Deschutes 14201'330 Gqa,l 2: ~ pportand Encourage Family, Friend!; am:t P~rs to Partl9ipcite ag:,Su· care BeIt1gGiventoa C9nsurrler/~C)mer::' Interpersonal Strategies • Encourage and simplify confidentiality releases that support and encourage family, friends and peers to be present with medical providers and others in the treatment of an individual • Provide immunization clinics that are convenient for families Organizational Strategies • Promote care that is patient and family-centered, meaning that patients and families are active participants in their care • Use quality councils to continuously improve care Goal, 3:Promo~,Best Practices and $afePf(Jct-' Heatui'q:.re in COmmunity, Public ani Private Organizational Strategies • Assure there are quality standards that are available and used to evaluate the delivery of safe practices • Assure that organizations have internal policies and practices that review best and safe practices • Utilize system wide quality care councils to review practices throughout the system • Sustain and continue to report on essential public safety programs and services throughout the region including 24/7 crisis services, Crisis Intervention Training, work with treatment and drug courts, support, where feasible, addiction treatment in jails and correction programs, and civil commitment processes • Build community resilience through emergency preparedness planning and practice in the region • Promote the use of Patient Centered Home • Recognized the value of telehealth in improving care and service delivery for persons with chronic care conditions • Promote coordination of care throughout the system to assure comprehensive care within the medical care community and between medical care, behavioral health and other safety net providers 37 141408 Deschutes 1430f330 G~I~:Promote and ljevefop Quality Review Groups that Utilize COnslJm~@/CUstomers in the Evaluation of/care Community Strategies • Coordinated Care Organization will appoint a consumer/customer advisory committee to help assess and improve care • Behavioral Health Organization will work with a citizen advisory group including consumers/customers to help assess and improve the delivery of mental health, developmental disability and substance abuse services • The needs of long term care consumers will be integrated in the comprehensive system of care for Central Oregon • Create an Integrated Regional Quality Care Council through the Central Oregon Health Board (COHB) to enhance regional quality improvements • Work to implement electronic health records across the region in all health care providers and other social service or safety net providers as appropriate • Create an Early Learning Council on a regional basis through the COHB to better integrate early education and improved health of children Goal 5: H~lth Oouncil and Health Bperd will Mon.itor Compliance and~ Manage RiSk inCQllab9ration with the Coordinated care Organi~tion· Public Policy Strategies • Council and Board will utilizes professional and clinical advisory committees to assist them in compliance and managing risk 38 141408 Deschutes 1440f330 Reduce Cost and Increase Effectiveness Indicators and Metrics • Decrease in per patient care costs • Patients return to hospital with 30 days • Inappropriate use of emergency room • The development of a new payment model • Number of preventable hospital stays • Percentage reduction in inappropriate use of emergency room by persons with a chronic health problem and mental illness • Reduction in Oregon Health Plan (OHP) per patient cost of care Data Snapshot • Individuals with a chronic health problem and mental illness use the emergency room inappropriately • The OHP per patient cost in Central Oregon is the highest in the State • Fee for service payment system is a disincentive to providing whole person health care leading to fragmented care • Early intervention in cases of early psychosis reduces the long term disability Goal 1: Engage Consurllers fri,Mannerth~l,-nproves Their satisfaction with care and in TurnEncouragesTh~m to Follow the care Plan Individual Strategies • Educational efforts through the primary care provider and other educational media will provide guidance to consumer/customer in helping reduce cost and make their primary care more effective Organizational Strategies • Organizations will engage their customers in ways that help them reduce their health care costs and promote effective use of the care being provided • Connect with consumer/customer in a manner that engages the individual in care to reduce inappropriate use of the emergency room Community Strategies • When screening tools are developed by the state, work with tri-county providers to develop a system to coordinate and ensure universal screenings of all pregnant women and children 0-5 39 141408 Desch utes 1450f330 • Use coordinated care strategies to engage individuals in the emergency room that have a wide range of needs that are not being met and contribute to their inappropriate use of ER • Develop and strengthen Assertive Community Treatment teams to address the support and structure needs of chronic behavioral health clients in collaboration and coordination with community health workers • Reduce symptoms of psychosis, mental health crises and hospitalizations by maintaining and expanding the Early Assessment and Support Alliance throughout the region Goal 2: Develqp New Funding and~yment StruCtures that Support and Address the WHole Person Thus Increasing Satisf?ictlon,Reducing Cost, and ImprovingQ8re .. ..... , Community Strategies • Establish a reimbursement model, new payment structure in a manner that supports the Health Engagement Team deployment and allows its partners to realize administrative simplifications Public Policy Strategies • Promote the key components of the Triple Aim which are reduce per-capita health costs, improved consumer/customer satisfaction and improved care 40 141408 Deschutes 1460f330 Increase Health Integration and System Collaboration Indicators and Metrics • Oregon Health Plan members are able to access a wide range of services • Use of social media to communicate health information • Use of technology to communicate with consumers about care issues or reminder appointments • Advanced Illness Management Task Force activity • Youth at Risk Task Force developed and meeting • Communication system between care providers regarding consumer care and treatment is in place and efficient • Percentage of primary care providers who report no difficulty in obtaining specialty care, including behavioral health, for members Data Snapshot • Care is fragmented and not coordinated • Consumers not having a primary care provider • Social Media is becoming a ready source of information for consumers • Coordination of care hindered by challenges of technology not protecting privacy • Services to youth at risk and runaway youth need improved coordination and better collaboration • long term care is growing but is not coordinated as effectively with the health delivery system and as a part of the Advanced Illness Management process Goal 1: Develop Task Groups that Look at C9rnbinJng ActJvfties,~rvices and Care by Promoting Coordinated Care and ResoLJrce Development Interpersonal Strategies • Utilize the social media to improve health integration of treatment and service plans with the consumer/client Organizational Strategies • Develop ways of communicating electronically with clients and community providers to improve integration and collaboration in consumer and client care 41 141408 Deschutes 147of330 Community Strategies • Identify, develop and pursue public and private resources to address needs of runaway and homeless youth • Reconvene prevention task force to coordinate efforts between social service organizations and public and private providers • Develop and implement a task group to develop a coordinated, early identification and intervention system for students identified as at-risk and include addressing runaway and homeless youth • Convene the Child Abuse System Task Force and regional partners to develop strategies to reduce child abuse and neglect in Central Oregon • Regional participation in the Advanced Illness Management Workgroup in Bend to develop practice and program recommendations around primary, specialty, palliative, hospice and in-home care • Continue and further collaborative efforts to provide needed food to residents in the region GpaI2:~f3velop Improved Integration and Collaboration Between Behavioral Heafth and Primary care Organizational Strategies • Timely access to behavioral health and substance abuse treatment/services regardless of payer type or insured status • Open communication between BH providers and Primary Care Providers to ensure a collaborative approach to patient treatment, appropriate medication management, and continuity of care • Promote cost-effective treatment through use of generic medications when clinically appropriate • Collaborate with community partners to develop a maternal mental health system which provides prevention, screening and treatment for women at risk Goal 3: Develop Supports that Aid Schools in Addressing, with the Support of the Community and Parents, the Physical, Social and Environmental Barriers that Create Heatth Disparities Public Policy Strategies • Support passage of legislation that funds districts and schools to assess and address phYSical, social and environmental health barriers that impede learning (must include funding) 42 141408 Deschutes 1480f330 Goal 4: Engage ttle Community in Ungerstanding, Acknowledging, and ec,llaboratlngfn'PromQtlng H~1th ,eq'uity Public Policy Strategies • Better use of a variety of public and social media to not only broadcast health information, but to engage the community in understanding and addressing health issues in a means of community collaboration to improve health equity and improve health outcomes 43 141408 Deschutes 1490f330 Pursue Excellence Indicators and Metrics • Health Assessment process is in place and updated annually • Health data is available • Web based data system for public to use • Timely Clinical and other social data is readily available to providers • Local data is used to guide local quality of care • Accreditation standards of providers met • Community standards for managing disease states is established Data Snapshot • Accreditation is a marketing sign of quality • Accreditation could be tied to funding • Safety and quality of care are major issues of focus both in hospitals and in community care settings • Data driven decisions regarding care • Development of Comprehensive Care Organizations • Development of Accountable Care Organizations Goal 1: Develop Systems that Support, Promote and Monitor the Quality of Heatthcare and Service Delivery Organizational Strategies • Some funders want some form of accreditation to assure that services are delivered in accordance with standards of care and best practices • The Joint Commission is a standard for hospital accreditation. Public Health accreditation is moving forward as the measurement of health department's performance against a nationally recognized set of practice standards, evidence based sta nda rds • National Accreditation: Receive accreditation from Public Health Accreditation Board for all three Central Oregon public health agencies • Collaboratively, align behavioral health measureable outcomes and clinical and system improvements • Assure providers have timely accurate data that can draw assessments and lead to conclusions that will improve care and service delivery 44 141408 Deschutes 1500[330 • Standards of practice should be a result of evidenced-based medicine or other evidence based practices of care Community Strategies • Promote through the COHB an on-going Health Assessment Capacity to guide program decisions and resources allocation • Create a regional hub for the collection, analysis, interpretation and dissemination of primary and secondary health related data to guide programmatic decisions, resource distribution and gauge outcomes • Launch a web-based regional and community health data site with shared investment and public health leadership. Develop as an initiative of the Central Oregon Health Board • Maintain excellence in epidemiological education, surveillance and coordinated intervention Public Policy Strategies • Central Oregon Health Council will promote, along with the Central Oregon Health Board the importance of excellence through accreditation and the use of evidence based medicine and evidence based services • Promote health in all important policies in the region • Promote the development of community standards for managing disease states 45 141408 Deschutes 151of330 Promote Regional Efforts Inaicators ana MetricS ' ~ • Number of regional programs • Health Information Exchange operational • Specific MOU between three counties for emergency preparedness • Behavioral Health Organization for Central Oregon in place and operating • Regional reduction in inappropriate use of emergency rooms by individuals with a mental illness • Improved prenatal and early childhood outcomes in the region, including low birth weight and adequate prenatal care • Regional HUB Administrative structure for Early Childhood System in place and operating • Regional MOU/Formal Agreements in place with public and private partners for Early Childhood System Administration and Implementation Data Snapshot 0 , • Regional programs, where appropriate, create efficiencies and permit sharing of best practices and technology • Improving collaboration in areas where there is joint planning, joint funding and interagency agreements which value and promote regionalization • Regional training saves time and creates system consistency • Some behavioral health services have been regionalized and work efficiently and effectively Goal 1: Create Incentives ana Systems to expana Care ana Services Organizational Strategies • Regionally, collaborate with local agencies to reduce the burden of chronic disease by way of policy, systems and environmental change • Use data to develop and implement health related policies to address priority population health needs and disparities using the HIE and the Health Assessment Capacity Hub • Inform decision makers and stakeholders about potential health impacts of proposed plans, projects or policies wherein health is not a consideration • Promote no and low cost community resources that support health related policies 46 141408 Deschutes 152of330 • Collaborate with land use and transportation agencies on projects that impact population health (Le.; Health Impact Assessments, membership on Regional Transportation Planning steering committee and active transportation initiatives) • Maintaining a local presence, promote and incentivize regional services that are cost-effective and add to service delivery (including early childhood learning) • Collaborate regionally with local services, education and health partners to develop a system of early childhood care and education that together addresses health and education outcomes Community Strategies • Develop a new Behavioral Health Organization Partnership to coordinate and improve the system and benefits of Behavioral Health (BH) in the region • Work to provide BH Services to indigent residents in the region • Develop annual work plans tied to the Regional Health Improvement Plan (RHIP) to improve health care, increase effectiveness of services and increase the efficient delivery of services • Support and expand the emergency room diversion programs to reduce the inappropriate use of emergency rooms in the region • Develop a regional complex system of care, in conjunction with other stakeholders that will improve quality of care for patients and reduce the costs of delivering chronic health care • Coordinate and develop a regional system of home visiting programs that will improve prenatal and early childhood outcomes in the region • Develop local and regional maternal mental health programs to support the health and wellness of the mother and new born child • Develop regional early childhood system of supports that ensures "no wrong door" for family access to appropriate services • Develop and implement regional strategies for quality care of children with public and private child care providers Public Policy Strategies • Ensure public private partnerships will promote regional efforts of quality care and service delivery • Pursue poliCies (or variances to current policy) to allow sharing of information, better coordination of services and supports, and more effective, cost-efficient service delivery between education and health service delivery systems 47 141408 Deschutes 1530f330 Strengthen Health Service Organizations Indicators and Metrics • Clinical information system is timely and efficient • Number of collaboratives around special health issues • Number of existing workers whose skills have been upgraded • Data collection systems are compatible • Workforce development programs in place • Number of training programs that are coordinating training with Central Oregon health community Qata Snapshot P • Addressing social determinants is a critical need in the tri-county area hit hard by the current economic conditions in the region. Addressing social determinants is challenging but necessary to improve personal and population health • Improving clinical practice comes when data is collected and timely disseminated to providers • Comprehensive and coordinated care only comes when information is shared quickly among providers • The new healthcare environment will require current workforce member's skills to be upgraded and training to be developed to meet the new job and skill requirements Goal 1: Develop and Coordinate Data Collection Systems and Services Community Strategies • Refine mission and guiding principles for a Community Health Information Exchange (HIE) • Develop an organization, new or existing, to provide governance and operation of a Community HIE • Develop a selection process for a Community HIE • Define and develop the financial model necessary to support a Community HIE • Develop a system for collecting and tracking of screening and assessment data from all participating providers including schools that could be entered into a Community HIE • Use the data collection to continuously improve the Regional Health Improvement Plan and its corresponding annual work plan 48 141408 Deschutes 1540f330 Goal 2: Provide Training to ~\(elopi~nd f?:rQroote f?:rQgtessi\tt ~q'laborative Regional Service Delivery via Inforrnationfechnology'·' ',;;,' Community Strategies • Develop a data collection system for the region through the Healthy Communities Imitative • Pilot and special projects should be collecting and analyzing data on health disparities with focus on diabetes • Implement coordinate regional media campaigns on areas of prevention with focus on suicide and alcohol abuse prevention • Develop means of promoting coordination and collaboration using video conferencing • Create relevant metrics for social determinants of health that would be monitored by subject matter experts; ensure inclusion of social determinants of health in data collection systems; and share, link, integrate data to the greatest extent possible to facilitate analysis • Develop internal screening and data collection systems that integrate with regional system(s) to compile, track, analyze, and summarize data • Deploy Clara a Vista logic software program, which is an integrated, client centered uniform information management system, throughout the region as appropriate and needed Goal 3: Develop Strategies to Increate and Enhan~the Health care Workforce in Central Oregon ..... ',i" . Organizational Strategies • Develop and deploy a comprehensive workforce training and retraining strategy with focus on multidisciplinary teams • Collaborate with academic partners to provide the needed training and certification for existing workers and recruit from the same programs the additional workers required to support the workforce needs and promotes cultural competency • Develop an internal Health Engagement Teams (HEl) training program • Contract with a group to train a local practice coaches who will work directly with targeted primary care clinics to optimize the care team and its role in care delivery and assist clinics in patient engagement strategies that will be developed into self-management support that will complement the HEl strategies 49 141408 Deschutes 1550f330 • Provide training to develop a workforce that is not only more aware of the social determinants of health but what they can do to more effectively address inequities that involves understanding cultures • Expand the use of community health workers including peer support, peer mentors, and family resource managers • Promote the development and sharing of specialists throughout the region Goal 4: Create and Build a Regional Robust Infrastructure thatSupports. and Strengthens the Partnering Organizations . . . Community Strategies • Coordinate funding to create regional infrastructure for partnering organizations • Collaborate with local hospitals, through the Central Oregon Health Council, in the development of a regional assessment and regional health improvement plan • Promote and support health collaboratives on areas of need, for example oral health or diabetes Goal 5: Develop Strategies that Integrate Care and Solutions for Families, Youth and Children Interpersonal Strategies • Support educational success as a primary means of reducing child poverty and improving children's health • Promote community dialogue, engagement and accountability in efforts to reduce child poverty and improve children's health Community Strategies • Develop and use school based health centers to coordinate, collaborate and integrate urgent care for school age children with primary care providers • Maintain intensive, collaborative and coordinated community based mental intervention services for youth and adolescents with the goal of keeping them home and in their community Goal 6: Align Workforce Development, Housing, Human Service and Education Investments Through Policy Development that Promotes Collaborative Planning, Implementation and Data Sharing Community Strategies • Implement policies adopted in Central Oregon lO-year Homelessness Plan 50 141408 Deschutes 156of330 Public Policy Strategies • Regional county policies will align the efforts of local county departments • Continue aligning community efforts between the public and private sector 51 141408 Deschutes 1570[330 Promote Sound Health Policy Indicators and Metrics • Number of bike commuters and miles of walking paths • Communities built with walking, biking, parks and closeness to fresh vegetables • Workforce with cultural competency skills • Cultural competency care policies in place • Protocols and Policies in place to coordinate work of Family Resource Managers, Community Health Workers and family advocate functions in existing early childhood education and health care programs • Percent of early childhood education and health care programs that are utilizing best or effective practices • Policies for and development of parent advisory role and function for early childhood education and health programs Data Snapshot • More consideration being given to integrating health into comprehensive planning • Transportation planners are considering biking and walking in their transportation plans • Early education focus and its impact on poverty and health • Demographic changes requiring cultural competency to deliver quality care Goal 1: Engage Community Leaders and Community in Early Childhood Policy Development and Importance for Long Term Health and Productivity Interpersonal Strategies • Promote and support parent and service providers' understanding of the value and impact quality early childhood services have on long term health and academic achievement goals • Promote use of best practices in early childhood health and education services, program implementation and workforce development Organizational Strategies • Promote and implement policy that supports universal screening tools and standardized process across all early childhood health and education services and allows for effective, efficient and consistent referral to services 52 141408 Deschutes 1580f330 • Develop, promote and implement policy that supports "no wrong door" for child and family access to early childhood health and educational services • Develop and implement regional protocol and procedures to ensure coordination of services provided by Family Resource Managers (Early Childhood Education System), Community Health Workers (Health Care System) and existing family advocate in early care and education programs Community Strategies • Develop and implement policy to support, encourage and allow for parent involvement and input to the development of and maintenance of early childhood health and education services Public Policy Strategies • Pursue policies (or variations in current policy) to allow sharing of information and better coordination of supports and services between education and health care systems to improve effectiveness and efficiencies Gqal 2: P~bllc POlicies Will R~lteaJld pr()mQ~,eult~~~J A~reness and CQmpetencfes as itRela,* to WQrkf()',.andService;bel~,ry Interpersonal Strategies • Promote community and service providers' understanding of cultural differences, priorities, traditions and practices that may impact an individual's ability to access health care, succeed in school and/or in the work place Organizational Strategies • Organizations will have policies that recognized the need for their workforce to have the cultural competency to service their consumer/client population Community Strategies • Communities, through consumer and citizens advisory groups, will insist on the system will develop poliCies for and assure that organizations and providers will provide culturally competent care Goal 3: Create a Safe and Healthy Environment for Children in their Family and in the CQmmunity Community Strategies • Land use planning and urban planning will integrate built environment policies which encourage walking, and biking 53 141408 Deschutes 1590[330 • land use planning and urban planning will consider safe play areas for children in the development Public Policy Strategies • Enforce policies, such as mandatory reporting and safety protocols, in order to decrease child abuse • Support passage of legislation that funds districts and schools to assess and address physical, social and environmental health barriers that impede learning (must include funding). • Principles of such legislations should include specific student health measures and routine reporting on these measures (e.g. annual community report card) • Creating mechanism for training and technical assistance to support school districts in developing and implementing plans • Ensuring all actions are based on student health data and are connected to measurable outcomes • Utilize best available evidence including emerging practices 54 141408 Deschutes 1600f330 APPENDICES Attachment 1 Socio-Ecological Model 55 141408 Deschutes 161of330 Attachment 2 -Health Data Summary Page The data/assessment workgroup met January 3, 2012. Available data to date were reviewed and discussed incorporating experiential and professional knowledge. From that meeting, nine priority areas for the Central Oregon Region were identified. Within priorities, sub-categories of interest were called out and listed where appropriate. This document has been prepared to assist the work of RHIP workgroups. For additional web-based resources and data. visit: I ndicators Northwest http://www.indicatorsnorthwest.org/ OR Rural communities Explorer: http://oe.oregonexploorer.info/rural/CommunitesReporter/ County Health Rankings http://www,countyhealthrankings.org Atlas of Rural & Small Town America http://www.ers.usda.ovg!data[ruralatlas/atlas.htm#map US Census: http://2010.census.govI2010census[data[ 56 141408 Deschutes 1620[330 Attachment 3 -Organizational Chart 57 141408 Deschutes 1630f330 Central Oregon Health Board County Commissioners Winter -+Create Annual Work Plan Make Adjustments to Strategic Plan ,.....---------1 /7 Spring L.! Attachment 4 -Annual Regional Strategic Planning Cycle .----V Fall -+Evaluate Strategic Plan Progress -+Review Health Report Data Summer -+Review legislative Session Outcomes -+Begin implementing Work Plan 2011 2012 .. c" .~: O:I g> .~ a: " ~ 0: .~.~:: ~~~ Ula.a. -+ Budgets Aligned with Plan Priorities -+Adoption of Plans and Priorities 2013 2014 2015 2016 cc ~ ~& a: c E ~ u c ~ J~ii~ ~ ;; '01.2c" ~.~!!!'C..~: ~ ~ c ~ ~.g t;i5. O:I ~Ea:8 Ul« ~~ Continuous Regional Health Report Updating-+ Strategic Plan Updating as needed-+ 58 .. 141408 Deschutes 164 of330 Attachment 5 -Definitions Health Equity When all people have the opportunity to attain their full health potential and no one is disadvantaged from achieving their potential because of their social position or other socially determined circumstance (Journal of Health, Population and Nutrition, 2003. 21[3]: p. 181). Addressing social determinants of health is a primary approach to achieving health equity. The Centers for Disease Control and Prevention (CDC) recommends that health organizations and education programs look beyond behavioral factors and address underlying factors related to social determinants of health. Social Determinants 0/Health Social determinants are the economic and social conditions that influence the health of people and communities. These conditions are shaped by the amount of money, power and resources that people have, all of which are influenced by policy choices. Scientists generally recognize five determinants of health of a population: 1. Genes and biology (e.g. gender, age) 2. Health behaviors (e.g. alcohol use, unprotected sex, tobacco use) 3. Social environment and social characteristics (e.g. income, discrimination, education) 4. Physical environment (e.g. where a person lives, crowding conditions) 5. Health services/medical care (e.g. access to quality health care, having or not having insurance) Socioeconomic Status (SES) A composite measure that typically includes economic, social, and work status: 1. Economic status is measured by income 2. Social status is measured by education 3. Work status is measured by occupation 59 141408 Desehutes 1650f330 Attachment 6 -Family Planning Crook County FAMILY PLANNING PROGRAM ANNUAL PLAN FOR FY 2013 July 1, 2012 to June 30, 2013 As a condition of Title X, funding agencies are required to have a plan for their Family Planning Program, which includes objectives that meet SMART requirements (Specific, Measurable, Achievable, Realistic, and Time Bound). In order to address state goals in the Title Xgrant application, we are asking each agency to choose two of the following four goals and identify how they will be addressed in the coming fiscal year: Goal 1: Move forward with adapting family planning and reproductive health services to the requirements of state and national heath care reform, including the use of electronic health records, partnering with Coordinated Care Organizations (CCOs), investigating participation in health insurance exchanges, etc. Goal 2: Assure ongoing access to a broad range of effective family planning methods and related preventive health services, including access to EC for current and future use. Goal 3: Promote awareness and access to long acting reversible contraceptives (lARCs). Goal 4: Address the reproductive health disparities of individuals, families, and communities through outreach to Oregon's high priority and underserved populations (including Hispanics, limited English proficient (lEP), Native Americans, African Americans, Asian Americans, rural communities, men, uninsured and persons with disabilities) and by partnering with other community-based health and social service providers. The format to use for submitting the annual plan is provided below. Please include the following four components in addressing these goals: 1. Problem Statement -For each of two chosen goals, briefly describe the current situation in your county to be addressed by that particular goal. The data provided may be helpful with this. 2. Objective(s) -Write one or more objectives for each goal. The objective(s) should be realistic for the resources you have available and measurable in some way. An objective checklist has been provided for your reference. 3. Planned Activities -Briefly describe one or more activities you plan to conduct in order to achieve your objective(s). 4. Evaluation Briefly describe how you will evaluate the success of your activities and objectives, including data collection and sources. Specific agency data is also provided to help with local agency planning. If you have any questions, please contact Carol Elliot (971673-0362) or Connie Clark (541386-3199 x200). 60 141408 Deschutes 1660f330 FAMILY PLANNING PROGRAM ANNUAL PLAN FOR COUNTY PUBLIC HEALTH DEPARTMENT FY2013 July 1, 2012 to June 30, 2013 Agency: Crook County Health Department Contact: Nelda Grymes, RN Goal #1-Move forward with adapting family planning and reproductive health services to the requirements of state and national health care reform, including the use of electronic health records, partnering with Coordinated Care Organizations (CCO's), investigating participation in health insurance exchanges, etc. Department implemented electronic health records June 22, 2011. The department continues to work with EPIC/OCHIN to improve processes with the EH R system. In addition, the county is involved with health care partners in the region forming the Central Oregon Health Council made up of private/public partners and the Central Oregon Health Board, made of the Crook, Jefferson, Crook County Health Department staff will create a family planning fact sheet explaining the family planning program in the tri-county area for private practitioners understanding of the program by February 1, 2012. -Completion of fact sheet -Share with Jefferson and Deschutes County to create buy-in. -Provide to Pacific Source Health Plans and Central Oregon Independent Physicians association for distribution. -Increase in # of clients in family planning program. I 61 141408 Deschutes 1670f330 I and Deschutes County. In this process, the department is working with Pacific Source Crook County Health -Attend quarterly meetings and -Attendance at Health Plans to Department Director will provide input to medical staff meetings, meeting implement preventive attend quarterly meetings about the family planning minutes. strategies in their plans with the medical director of program. for physicians. This Pacific Source to continue includes family education of the medical planning. staff in the region about the Family Planning program. Goal # 4 -Address the reproductive health disparities of individuals, families, and communities through outreach to Oregon's high priority and underserved populations (including Hispanics, limited English proficient (lEP), Native Americans, African Americans, Asian Americans, rural communities, men, uninsured and persons with disabilities) and by partneringwith other community-based health and social service providers. ~bJem.Statement ,?!!?~" ',~~' ~~~ Crook County Health To increase the number of 1. Place ads in local media An increase in Department is seeing a women in need served, percentage of low number of women in including Hispanic radio including teens and program and high school women in need, need, 22.7% currently Hispanic populations. newspaper. compared to 20.5% statewide. Even though the number is higher 2. Utilize our Americorp than the state average volunteer to provide we would like to serve a reproductive health education higher number of that in the High school to increase population. awareness of our program. Objectives checklist: Does the objective relate to the goal and needs assessment findings? o Is the objective clear in terms of what, how, when and where the situation will be changed? o Are the targets measurable? o Is the objective feasible within the stated time frame and appropriately limited in scope? 62 141408 Deschutes 1680f330 Progress on Goals I Activities for FY 2012 (Currently in Progress) The annual plan that was submitted for your agency last year is included in this mailing. Please review it and report on progress meeting your objectives so far this Fiscal Year. Time Period: July 1, 2011-June 30, 2012 GOAL 1: Assure continued high quality clinical family planning and related preventive health services to improve overall individual and community health. Progress on Problem Statement Objectives Planned Activities Evaluation activities -The wait time increased There is an -Complete monthly -Monthly time studies. objective was need for family time studies -Continue progress monthly to monitor through RPI process. met through planning services in clinic flow and -Monitor information time study Crook County and as Improved client decrease the wait from the client show rate and monitoring Noted above we time by 10% by satisfaction survey. client process have improved no through clinic -The no-show show rates and want June 2012. -Set time standards for reports. rate decreased -Improved clinical services. from 20% to-Research new clientcontinue to see efficiency and improvement. scheduling system. 17%. decreased no-Implement new show rate based -Wepractice management on time study. implementedand EHR system in May EHR in June 2011. 2011. 63 141408 Deschutes 1690f330 I Time Period: July 1, 2011-June 30, 2012 GOAL 1: Assure continued high quality clinical family planning and related preventive health services to improve overall individual and community health. Need to gather client Client satisfaction -Update and print client -Customer We created a ~urvey satisfaction surveys. feedback client information to -Reception staff will hand -Staff feedback satisfaction document client will be provided to out to clients quarterly for a one week period. survey and clients quarterly continue to use satisfaction and way to hroLigh in the programs. improve the clinical the 2011-2012 fiscal Staff is services. year. provided the information for feedback. The Women in Need % -The WIN in Crook -Increase outreach for i -Increased WIN served in the county is percentage of slightly less than the County percentage family planning services women served in We had a slight state average and rwill in the community the county. decrease in needs improvement. increase from 24.2% this area from 0 through outreach cards. 24.2%to 23.1%. We will 30% by July 2012. -Increase the women continue to referred to work on this FP through other health area. department programs. -The # of male clients : -Continue outreach forIncrease the # of male -Increased % of clients attending the males through the male males attending We continue toattending the clinic reproductive health the reproductive client for services. see increased program grant. health clinics. rwill #'5 of males in increase by 3% in the the clinic. 7.5% currently.2011-2012 fiscal year. 64 141408 Deschutes 1700[330 Time Period: July 1, 2011-June 30, 2012 GOAL 1: Assure continued high quality clinical family planning and related preventive health services to improve overall individual and community health. There is not a -The department will -Apply for an Americorp -10 consistent educational volunteer to assist with presentations component to the provide 10 outreach and education in completed in the schools provided by presentations the schools for the community and -The the health department. We will continue to utilize AmeriCorps for to schools hroughout the Reproductive Health Program. -Train additional staff to provide community the schools. -Increase in #'s of clients to the department. AmeriCorp Members continue to this purpose. 2011-2012 fiscal year in Crook County by une 2012. outreach including volunteers. complete this work for the health department. 65 141408 Deschutes 171of330 Time Period: July 1, 2011-June 30, 2012 GOAL 1: Assure continued high quality clinical family planning and related preventive health services to improve overall individual and tommunity health. There is not a -Create bylaws -Advisory -We have ~~.r~~'~tonsistent family h Department planning advisory utilize the current process in place. This and C4 boards to -Recruit for positions -Ongoing Meetings process for family planning materials. assigned this process to the CCF Board of has been resolved. sist with this which there process. are community members. The Public Health Director is part of this board and will guide the process. We will also use the expertise of the My Future My Choice students to assess brochure. This process has been positive and works when the program needs assistance. Time Period: July 1, 2011-June 30, 2012 GOAL 2: Assure ongoing access to a broad range of effettive family planning methods and related preventative health services. Problem Statement I Objectives I Planned Activities I Evaluation I Progress on Activities 66 141408 Deschutes 172 of330 TIme Period: July 1, 2011-June 30,2012 GOAL 2: Assure ongoing access to a broad range of effective family planning methods and related preventative health services. Unable to offer Increase the # -New nurse Implanon of clients using practitioner is ·Increased # of Clients in Crook Implanon in offering to clients with County. Crook County. clients. Implanon The new nurse -Family Planning ·Supplies in stock We are now offering practitioner is very Coordinator will and NP begin use Implanon. experienced and order necessary of Implanon in offering to clients items for the clinical in regularly. insertion/remova I of Implanon. services. The % of visits where clients received equally or more effective method is at 86.8% compared to 91% statewide. This is an area for improvement. Each client will be evaluated for an appropriate birth control method at each visit by July 2012. ·Family Planning Coordinator will meet with FP staff and update as needed to improve this measure. ·New nurse practitioner will implement best practice approaches ·Measure for % of visits where clients received equally or more effective method will improve by 2012. Our % increased from 86.8% to 87.1%. The addition of a new nurse practitioner has addressed this area of concem. 67 141408 Deschutes 1730[330 Time Period: July 1, 20ll-June 30, 2012 GOAL 2: Assure ongoing access to a broad range of effective family planning methods and related preventative health services. Proportion of visits The %of women -Research the data -Proportion of at receiving EC for entry for FP to see visits at which which female client future use will if the lack of female client will received EC for future use (2008) was documented as a total of 3.7% compared to increase from 13.5% to the statewide average of 23.8%. information is a data entry issue. -Family Planning Coordinator will work with staff to received EC for future use will increase by 2012. Our current numbers decreased from 22.5 to 18.9% for teens and increased for adults from 2.6 to 6.5%. We 18.7% make sure EC is will continue to work in Statewide and dispensed this area. could use appropriately. improvement. It improved in 2009 to 13.5% and still needs additional improvement. 68 141408 Deschutes 1740f330 FAMILY PLANNING PROGRAM ANNUAL PLAN FOR COUNTY PUBLIC HEALTH DEPARTMENT FY 2012 July 1,2011 to June 30,2012 Remains same for 2012-2013 Agency: Deschutes County Health Services Contact: Kathleen Christensen Goal #1 Assure continued high quality clinical family planning and related preventive health services to improve overall individual and community health. Problem Statement Objective(s) Planned Activities Evaluation With budget shortfalls The Clinic Supervisor, Clinic • Continued monitoring of • Monthly no-show and potential public Coordinator and Office no-show rates and data health funding Supervisor are all evaluation of trends decreases this next fiscal year we want to participating in the Clinic EffiCiency Project through throughout the next year. • Implement text messaging for clients who prefer • Text messaging implemented. assure the same level of the Center for Health communication through Client satisfaction clinical services or Training, which is funded by text by 6/11. increased. increase clinical services a grant from the Center for • Identify needed triage and • Resource by improving clinic Disease Control. practice protocols and completed. Staff effiCiency. Through participation in this project we have set new goals and objectives for our program and plan to make positive efficiency and quality changes within the next year. procedures and create staff resource by 7/1l. • Reorganize clinic structure and schedules so that providers are always working at their highest level by 7/11. • Conduct a Clinic Flow Analysis and Cycle Time Analysis two time within the next year. • Research and prepare charting area and exam rooms for EMR system. • Involve clinic staff in the preparation process and provide available training reports increased efficiency. • Reorganization complete. • Analysis complete. • Preparation complete. 69 141408 Deschutes 1750f330 for an smoother transition to EMR with the least amount of decreased • Ahlers data. productivity possible. In Deschutes County we are unaware of the true need for Family Planning Services due to the lack of data and information. We are currently serving about 31.5% of the Women in Need within our county. To conduct a Family Planning (reproductive health) needs assessment in Deschutes County to assess and assure services for adolescents, women, men and families. • Conduct needs assessment with all Title X Family Planning components included during spring and summer 2011. • New program goals and objectives set based on the findings from the needs assessment by 12/2011. • Needs assessment completed by 9/2011. Goal #2 Assure ongoing access to a broad range of effective family planning methods and related preventive health services. Problem Statement Objective(s} Planned Actll(lties > Evaluation With current budgets and resources it is challenging Maintain all birth control methods we are currently • Update pricing monthly for billing and clinical staff. • Fee schedule updated. to maintain a broad range of birth control methods. offering, including Title X IUDs and Implanons. • Monthly monitoring of the medication budget. • Tight inventory control. • Thorough counseling with clients on side effects and use of methods making sure to find the right method for • Medications budget on target. • No wasted medications • Decreased number of clients changing the client. methods. 70 141408 Deschutes 1760[330 Progress on Goals I Activities for FY 10 (Currently in Progress) • Through the Clinic Efficiency Project we have established monthly monitoring of the no-show rates. By rearranging The clinic supervisor and office schedules (based on days with the best show rates) and supervisor are currently implementing consistent reminder calls 2 days ahead of time we participating in the Clinic Efficiency have been able to reduce our no-show rates significantly. • With staff participation we increased provider productivity byLearning Group through the decreasing meeting times from weekly to monthly. The monthlyCenter for Health Training and the meeting that we have is more organized, efficient and valuable. Center for Disease Control. We We also rearranged clinician schedules to increase available clinic will continue to participate in the time. Learning Group throughout the • We conducted a "Clinic Flow Analysis" and set some goals based year completing projects that on the outcome. include; production estimates, • The clinic and office supervisor attended the two day meeting in monitoring, goal setting and Seattle for the Clinic Efficiency Learning Group. training. • The rate ofteens we are serving has stayed the same, however preliminary data shows our teen pregnancy rate at 5.4 per 1,000 To increase the numberofteens in females aged 10-17. need of birth control services who • Our Health Educator and AmeriCorps presented classes on birth are seen at our clinics within the control, communication, healthy relationships and STis to 4803 students during school year 09/10. Every student was given coming year. information about all services they could access, if needed. • All teachers and counselors have received information resource information for our services. • A teen walk-in / same-day schedule has been implemented in Redmond. Assure ongoing access to a broad range of effective family planning methods and related preventive health services. 71 141408 Deschutes 177 of330 ~~I~~j~iye~ (:< :'~~'~,~~~0l~\~iiZ~:(;, / ,~ During the next fiscal year we will continue to provide a broad range of birth control methods, while monitoring costs and being thoughtful of how medications are being dispensed. GOaElj' ". ",';>:§G?ffj,'".« .""~..,,,.,, ',' '.,',;;' c, • We were able to stay within budget on medications this past year, which was partially due to adopting a practice of more thorough counseling with clients on all possible side effects especially with the longer acting, more expensive methods. • We were able to reduce our medical and lab supply costs by having all programs purchase their own supplies. We are also keeping a much tighter inventory. All women with abnormal pap results will receive appropriate and timely follow-up recommendations and will be referred to colposcopy clinic as needed within the next fiscal year. • We completed our evaluation of the current pap tracking system and implemented some more efficient processes. • Dr. Norburg increased the number of colposcopy appts. we could make available to clients and we have greatly reduced our waiting list. • Through a partnership we established with Mosaic Medical Clinic (our local FQHC), we were able to refer all clients with a HGSIL pap to their clinic for colposcopy and related flu care like LEEP procedures. Within the past year all of our clients except one, who we lost contact with, received all needed follow-up services at a reduced or affordable rate. 1. Assure access to birth control services for Women in Need, reducing unplanned pregnancies. During FY 2010, an estimated 658 unintended pregnancies were averted. 5,000 client visits will be made for family planning services in FY 2012. 2. Increase collaboration and client referral between the Family Planning and Maternal Child Health programs (MCH). 100% of all low-income, first time moms who are seen in a Family Planning Clinic will be referred to Maternal Child Health. 95% of MCH clients needing family planning services will be referred to the Family Planning Program. 95% of the clients referred to the Family Planning Program will have follow-up contact. 3. The Reproductive Health Program will conduct a county-wide needs assessment for family planning and other related reproductive health services. New program goals and objectives will be set based on the findings from the needs assessment by December 2011. 72 141408 Deschutes 178of330 FAMILY PLANNING PROGRAM ANNUAL PLAN FOR COUNTY PUBLIC HEALTH DEPARTMENT FY 2013 July 1, 2012 to June 30, 2013 Agency: Jefferson Countv Public Health Contact: Joy Harvey Assure ongoing access to a broad range of effective FP methods and related preventative health services, including access to EC for current and future use. Jefferson County h as one of the highest number of teen pregnancies; our percentage of teen client visits is low (18.1%). Goal/;_4_ 1. Increase # of teen clients by 2-3% from current 18.1%. 2. Increase proportion of visits where female clients receive EC for future use 2-3% from current % of 21.7. 1. Full time clinic RN available to provide FP services including EC. 2. Provide education at local schools re: services available at JCHD. 3. Continue with current range of FP methods offered at the health dept. 4. Implement social marketing to enhance teen awareness 1. Percentage of FP clients represented by teens on 2012 annual report. 2. Measurement of proportion of visits where female clients received EC for future use on 2012 annual report. Problem Stitement Obj~!!t$) Evaluation 73 141408 Deschutes 1790f330 I Add ress the reproductive health disparities of individuals, families and communities through outreach to Oregon's high priority and underserved populations (including Hispanics, limited English proficient (LEP), Native Americans, African Americans, Asian Americans, rural communities, men, uninsured and persons with disabilities) and by partnering with other community-based health and social service providers. Jefferson County has a high population of Hispanics and Native Americans. Health care 1. Increase # of WIN clients by 2-5% from the current 32.4%. 1. Send reminders to clients when annual WH assessment is due. 2. Coordination of care with Mosaic Medical Clinic, Best Care and BCC program for preventative health care and further evaluation or services not provided at JCHD. 3. Maintain adequate bi lingual staff available for interpretation. 4. Provide written information in Spanish 1. Percentage of WIN clients served by 2012 annual report. is provided on the reservation as well as English at the for Native Americans, but they health department. are always welcome at the health department. Our current percentage of WIN served at the health department this year : was down from previous years. I I ()bjcctivcs checklist: o Docs the objectin' relate to the !,'Oal and needs a>se>smcnt findings? o Is the objective deat in terms of what, how, when and where the situation will be changed? o Atc the targets measurable? o Is the objectiye feasible within the stated time frame and appropriately limited in scope? 74 141408 Deschutes 180of330 Progress on Goals I Activities for FY 2012 (Currently in Progress) The annual plan that was submitted for your agency last year is included in this mailing. Please review it and report on progress meeting your objectives so far this Fiscal Year. Goal #1: To assure continued high • NPs have attended trainings/conferences to maintain their quality clinical FP and related credentials. preventative health services to • School RN given information about FP services at JCHD & one visit to high school by FP staff at the health department. improve overall individual and • Good connection with Mosaic Medical Clinic for referral for othercommunity health. preventative services Objectives: • To increase FP clients numbers by 2-5% over 2010 stats • To increase, if possible, the number of FP Clinics per month to 5 or 6, as in 2009-2010. Goal #2: To direct services to • Staffing continues to be an ongoing issue for adequate bilingual address disparities among staffing. Oregon's high priority and • All FP forms, posters, brochures provided in both English and Spanish.underserved populations, including Hispanics, LEP, uninsured and rural community for Jefferson County. Objectives: • To increase these numbers by 2-5% in the FP Clinic setting. • To maintain adequate bilingual staff to provide translating services. 75 141408 Desch utes 1810[330 Attachment 7 -Minimum Standards VII. Minimum Standards For Crook, Deschutes and Jefferson To the best of your knowledge, are you in compliance with these program indicators from the Minimum Standards for Local Health Departments? Organization 1. Yes]_ No _ A Local Health Authority exists which has accepted the legal responsibilities for public health as defined by Oregon Law. 2. Yes _X_ No _ The Local Health Authority meets at least annually to address public health concerns. 3. Yes _X_ No _ A current organizational chart exists that defines the authority. structure and function of the local health department; and is reviewed at least annually. 4. Yes _X_ No _ Current local health department policies and procedures exist which are reviewed at least annually. 5. Yes _X_ No _ Ongoing community assessment is performed to analyze and evaluate community data. 6. Yes _X_ No _ Written plans are developed with problem statements. objectives. activities, projected services. and evaluation criteria. 7. Yes _X_ No_Local health officials develop and manage an annual operating budget. 8. Yes _X_ No _ Generally accepted public accounting practices are used for managing funds. 9. Yes _X_ No All revenues generated from public health services are allocated to public health programs. 10. Yes _X_ No Written personnel policies and procedures are in compliance with federal and state laws and regulations. 11. Yes No _ Personnel policies and procedures are available for all employees. 12. Yes _X_ No _ All positions have written job descriptions. including minimum qualifications. 13. Yes X_ No_Written performance evaluations are done annually. Annual Plan FY 2012 201316 76 141408 Deschutes 1820f330 Evidence of staff development activities exists. 15. Yes _X_ No _ Personnel records for all terminated employees are retained consistently with State Archives rules. 16. Yes _X_ No _ Records include minimum information required by each program. A records manual of all forms used is reviewed annually. 18. Yes _X_ No _ There is a written policy for maintaining confidentiality of all client records which includes guidelines for release of client infonnation. 19. Yes _X_ No _ Filing and retrieval of health records follow written procedures. 20. Yes _X_ No _ Retention and destruction of records follow written procedures and are consistent with State Archives rules. 21. Yes _X_ No _ Local health department telephone numbers and facilities' addresses are publicized. 22. Yes _X_ No _ Health information and referral services are available during regular business hours. 23. Yes _X_ No Written resource information about local health and human services is available, which includes eligibility, enrollment procedures, scope and hours of service. Information is updated as needed. 24. Yes _X_ No 100% of birth and death certificates submitted by local health departments are reviewed by the local Registrar for accuracy and completeness per Vital Records office procedures. 25. Yes _X_ No To preserve the confidentiality and security of non-public abstracts, all vital records and all accompanying documents are maintained. 26. Yes _X_ No Certified copies of registered birth and death certificates are issued within one working day of request 27. Yes _X_ No _ Vital statistics data, as reported by the Center for Health Statistics, are reviewed annually by local health departments to review accuracy and support ongoing community assessment activities. 28. Yes _X_ No _ A system to obtain reports of deaths of public health significance is in place. Annual Plan FY 2012 -201317 29. Yes _X_ No _ Deaths of public health significance are reported to the local health department by the medical examiner and are investigated by the health department 30. Yes _X_ No _ Health department administration and county medical examiner review collaborative efforts at least annually. 77 141408 Deschutes 1830[330 31. Yes _X_ No _ Staff is knowledgeable of and has participated in the development of the county's emergency plan. 32. Yes _X_ No _ Written policies and procedures exist to guide staff in responding to an emergency. 33. Yes _X_ No _ Staff participate periodically in emergency preparedness exercises and upgrade response plans accordingly. 34. Yes _X_ No _ Written policies and procedures exist to guide staff and volunteers in maintaining appropriate confidentiality standards. 35. Yes _X_ No _ Confidentiality training is included in new employee orientation. Staff includes: employees, both permanent and temporary, volunteers, translators, and any other party in contact with clients, services or information. Staff sign confidentiality statements when hired and at least annually thereafter. 36. Yes _X_ No _ A Client Grievance Procedure is in place with resultant staff training and input to assure that there is a mechanism to address client and staff concerns. Control of Communicable Diseases 37. Yes _X_ No _ There is a mechanism for reporting communicable disease cases to the health department. 38. Yes _X_ No _ Investigations of reportable conditions and communicable disease cases are conducted, control measures are carried out, investigation report forms are completed and submitted in the manner and time frame specified for the particular disease in the Oregon Communicable Disease Guidelines. 39. Yes _X_ No _ Feedback regarding the outcome of the investigation is provided to the reporting health care provider for each reportable condition or communicable disease case received. Annual Plan FY 2012 -201318 40. Yes _X_ No _ Access to prevention, diagnosis, and treatment services for reportable communicable diseases is assured when relevant to protecting the health of the public. 41. Yes _X_ No _ There is an ongoing/demonstrated effort by the local health department to maintain and/or increase timely reporting of reportable communicable diseases and conditions. 42. Yes _X_ No _ There is a mechanism for reporting and following up on zoonotic diseases to the local health department. 43. Yes _X_ No _ A system exists for the surveillance and analysis of the incidence and prevalence of communicable diseases. 44. Yes _X_ No _ Annual reviews and analysis are conducted of five year averages of incidence rates reported in the Communicable Disease Statistical Summary, and evaluation of data are used for future program planning. 78 141408 Deschutes 1840f330 45. Yes _X_ No _Immunizations for human target populations are available within the local health department jurisdiction. 46. Yes _X_ No _ Rabies immunizations for animal target populations are available within the local health department jurisdiction. Environmental Health 47. Yes ]_No _ Food service facilities are licensed and inspected as required by Chapter 333 Division 12. 48. Yes _X_ No _ Training is available for food service managers and personnel in the proper methods of storing, preparing, and serving food. 49. Yes _X_ No _ Training in first aid for choking is available for food service workers. 50. Yes _X_ No _ Public education regarding food borne illness and the importance of reporting suspected food borne illness is provided. 51. Yes _X_ No _ Each drinking water system conducts water quality monitoring and maintains testing frequencies based on the size and classification of system. 52. Yes _X_ No _ Each drinking water system is monitored for compliance with applicable standards based on system size, type, and epidemiological risk. Annual Plan FY 2012 -201319 53. Yes]_No Compliance assistance is provided to public water systems that violate requirements. 54. Yes X_ No _ All drinking water systems that violate maximum contaminant levelS are investigated and appropriate actions taken. 55. Yes _X_ No A written plan exists for responding to emergencies involving public water systems. 56. Yes]_ No _Information for developing a safe water supply is available to people using on-site individual wells and springs. 57. Yes _X_ No _ A program exists to monitor, issue permits, and inspect on-site sewage disposal systems. 58. Yes _X_ No _ Tourist facilities are licensed and inspected for health and safety risks as required by Chapter 333 Division 12. 59. Yes _X_ No _ School and public facilities food service operations are inspected for health and safety risks. 60. Yes _X_ No _ Public spas and swimming pools are constructed, licensed, and inspected for health and safety risks as required by Chapter 333 Division 12. 79 141408 Deschutes 1850f330 61. Yes _X_ No A program exists to assure protection of health and the environment for storing, collecting, transporting, and disposing solid waste. Indoor clean air complaints in licensed facilities are investigated. 63. Yes X_ No _ Environmental contamination potentially impacting public health or the environment is investigated. 64. Yes _X_ No _ The health and safety of the public is being protected through hazardous incidence investigation and response. 65. Yes _X_ No Emergency environmental health and sanitation are provided to include safe drinking water, sewage disposal, food preparation, solid waste disposal, sanitation at shelters, and vector control. 66. Yes _X_ No _ All license fees collected by the Local Public Health Authority under ORS 624, 446, and 448 are set and used by the LPHA as required by ORS 624, 446, and 448. Annual Plan FY 2012 -2013 20 80 141408 Deschutes 1860f330 Health Education and Health Promotion 67. Yes No Culturally and linguistically appropriate health education components with appropriate materials and methods will be integrated within programs. 68. Yes _X_ No _ The health department provides and/or refers to community resources for health education/health promotion. 69. Yes _X_ No _ The health department provides leadership in developing community partnerships to provide health education and health promotion resources for the community. 70. Yes _X_ No _ Local health department supports healthy behaviors among employees. 71. Yes _X_ No _ Local health department supports continued education and training of staff to provide effective health education. 72. Yes _X_ No _ All health department facilities are smoke free. Nutrition 73. Yes _X_ No _ Local health department reviews population data to promote appropriate nutritional services. 74. The following health department programs include an assessment of nutritional status: a. Yes _X_ No WIC b. Yes No Family Planning c. Yes _X_ No Parent and Child Health d. Yes _X_ No Older Adult Health Corrections Health 75. Yes X_ No _ Clients identified at nutritional risk are provided with or referred for appropriate interventions. 76. Yes j_No _ Culturally and linguistically appropriate nutritional education and promotion materials and methods are integrated within programs. 77. Yes _X_ No _ Local health department supports continuing education and training of staff to provide effective nutritional education. Annual Plan FY 2012 201321 81 141408 Deschutes 1870[330 Older Adult Health 78. Yes _X_ No _ Health department provides or refers to services that promote detecting chronic diseases and preventing their complications. 79. Yes _X_ No _ A mechanism exists for intervening where there is reported elder abuse or neglect. 80. Yes _X_ No _ Health department maintains a current list of resources and refers for medical care, mental health, transportation, nutritional services, financial services, rehabilitation services, social services, and substance abuse services. 81. Yes _X_ No _ Prevention-oriented services exist for self health care, stress management, nutrition, exercise, medication use, maintaining activities of daily living, injury prevention and safety education. Parent and Child Health 82. Yes _X_ No _ Perinatal care is provided directly or by referral. 83. Yes _X_ No _Immunizations are provided for infants, children, adolescents and adults either directly or by referral. 84. Yes _X_ No _ Comprehensive family planning services are provided directly or by referral. 85. Yes _X_ No _ Services for the early detection and follow up of abnormal growth, development and other health problems of infants and children are provided directly or by referral. 86. Yes _X_ No _ Child abuse prevention and treatment services are provided directly or by referral. 87. Yes _X_ No _ There is a system or mechanism in place to assure participation in multi disciplinary teams addreSSing abuse and domestic violence. 88. Yes _X_ No _ There is a system in place for identifying and following up on high risk infants. 89. Yes _X_ No _ There is a system in place to follow up on all reported SIDS deaths. Annual Plan FY 2012 -2013 22 82 141408 Deschutes 1880f330 90, Yes No Preventive oral health services are provided directly or by referral. 91. Yes _X_ No _ Use of fluoride is promoted, either through water fluoridation or use of fluoride mouth rinse or tablets. 92. Yes _X_ No _Injury prevention services are provided within the community. Primary Health Care 93. Yes _X_ No _ The local health department identifies barriers to primary health care services. 94. Yes _X_ No _ The local health department participates and provides leadership in community efforts to secure or establish and maintain adequate primary health care, 95. Yes _X_ No _ The local health department advocates for individuals who are prevented from receiving timely and adequate primary health care. Primary health care services are provided directly or by referral. 97. Yes _X_ No _ The local health department promotes primary health care that is culturally and linguistically appropriate for community members. 98. Yes No _ The local health department advocates for data collection and analysis for development of population based prevention strategies. Cultural Competency 99. Yes _X_ No _ The local health department develops and maintains a current demographic and cultural profile of the community to identify needs and interventions. 100. Yes _X_ No _ The local health department develops, implements and promotes a written plan that outlines clear goals, policies and operational plans for provision of culturally and linguistically appropriate services. 101. Yes _X_ No _ The local health department assures that adviSOry groups reflect the population to be served. 102. Yes _X_ No _ The local health department assures that program activities reflect operation plans for provision of culturally and linguistically appropriate services. Annual Plan FY 2012 -2013 23 83 141408 Deschutes 1890f330 Attachment 8 Health Department Personnel Qualifications Local health department Health Administrator minimum qualifications: The Administrator must have a Bachelor degree plus graduate courses (or equivalents) that align with those recommended by the Council on Education for Public Health. These are: Biostatistics, Epidemiology, Environmental health sciences. Health services administration, and Social and behavioral sciences relevant to public health problems. The Administrator must demonstrate at least 3 years of increasing responsibility and experience in public health or a related field. Answer the following questions: Administrator name: _Scott Johnson, Muriel DeLaVergne-Brown and Tom Machala Does the Administrator have a Bachelor degree? Yes X_ No _ Does the Administrator have at least 3 years experience in Yes X_ No public health or a related field? Has the Administrator taken a graduate level course in Yes X NoX-Deschutes No_ biostatistics? Has the Administrator taken a graduate level course in Yes X_ No X-Deschutes No epidemiology? Has the Administrator taken a graduate level course Yes X_ No X-Deschutes No in environmental health? Has the Administrator taken a graduate level course Yes X No_ in health services administration? Has the Administrator taken a graduate level course in Yes X No_ social and behavioral sciences relevant to public health problems? a. Yes X No X The local health department Health Administrator meets minimum qualifications: Deschutes County is in the process of reviewing its organization and will have a decision on meeting this standard by September 2012 at the latest b. Yes X NoX-Crook County-The local health department Supervising Public Health Nurse meets minimum qualifications: Licensure as a registered nurse in the State of Oregon, progressively responsible experience in a public health agency; AND Baccalaureate degree in nursing, with preference for a Master's degree in nursing, public health or public administration or related field, with progressively responsible experience in a public health agency. Supervising nurse expects a BSN by May 2012. c. Yes X No _ The local health department Environmental Health Supervisor meets minimum qualifications: Registration as a sanitarian in the State of Oregon, pursuant to ORS 700.030, with progressively responsible experience in a public health agency OR a Master's degree in an environmental science, public health, public administration or related field with two years progressively responsible experience in a public health agency. If the answer is "No", submit an attachment that describes your plan to meet the minimum qualifications. 84 141408 Deschutes 190of330 d. Yes X No__The local health department Health Officer meets minimum qualifications: Licensed in the State of Oregon as M.D. or D.O. Two years of practice as licensed physician (two years after internship and/or residency). Training and/or experience in epidemiology and public health. If the answer is "No", submit an attachment that describes your plan to meet the minimum qualifications. Annual Plan FY 2012 201325 Mental Health Maintance of Effort----To be added Current Use of 2145---To be added WIC-To be added when guidelines come out Maternal/Child, Environmental Health, Emergency Preparedness, Communicable Disease and Health Statistics in the core plan. 85 I I 141408 Deschutes 1910[330 I J Attachment 9 -Tobacco Prevention and Education Programs local Health Department TPEP Grant local Program Plan Form 2012-13 Local Health Department: Deschutes County ! Program component: 0 M Monitor tobacco use and prevention policies policy or pQHcies that have. . . ··e listsor maps of policies; 1 Other city or county properties IIn•.IUUIC current poliW description ~~rr,'@<iillg alloweq in designatE;!d a st,itlltJon type (e.g. Effective 4-17-02. smoking or the use of smokeless tobacco mited to campus parking lots. Hospitals (See the map of Oregon Tobacco Free Campus policy (except smoking in cars is allowed)-2007 Hospitals with Smoke-free policies on the HPCDP Connection Tobacco page, here: http://JJUblic.health.oreqon.qov/p artners/ • HPCDPConnection/Tobacco/ 86 141408 Deschutes 1920[330 Pages/Hospita/s.aspx) Other tobacco-free campus policies (e.g. other health care setting or post-secondary education campus.) Community-wide smokefree worksites (e.g. city or county local i smokefree ordina Mosaic Medical and Volunteers in Medicine are two locations that have gone 100% tobacco free and I have not seen the policy to verify. Outdoor venues (e.g. parks or fair 100% Tobacco Free Bend Metro Parks and Recreation (2011) board tobacco-free policies) [list of policies on HPCDP Connection 100% Smoke free Deschutes County Expo Center and Fairgrounds (need to outdoor venues confirm Other community-wide smokefree Department of Health and Human Services has a 100% tobacco free campus workplaces/public places policy: policy. (2011) (statewide policy status list is , posted at https://partners.hea/th.oregon.go v/Partners/HPCDPConnection/Tob aceo/Pages/Housing. aspx) · Other low-income and affordable Sample properties in CORDA (Central Oregon Rentals and Owners Association) have gone smoke free inside the apartments• MUH policies (e.g. Community · development corporation) 87 141408 Deschutes 1930f330 advertising and promotions 88 141408 Deschutes 1940f330 local Health Department TPEP Grant local Program Plan Form 2012-13 Local Health Department: Deschutes County Health Services Program component: 0 P Protect people from exposure to secondhand smoke. toillilblt:'lra1te wlib Diane Lau8~r:of t{~alth I Activities 89 141408 Deschutes 1950f330 Assessment Education, Outreach & Partnerships Identify different types of affordable multi-unit and affordable public housing in Deschutes County and throughout the tri county region. Determine if smoking policy exists in all properties under their authority. Assess landlord readiness to adopt smoke free policy. Deschutes County will take the lead in surveying tenants regarding their support for smoke free rules. Deschutes, Crook and Jefferson Counties will regularly meet to develop regional strategies to engage community partners with assistance from Diane Laugher (Health InSight). We will continue to partner with CORDA and will offer a training along with local data regarding tenant support of smoke free policies in the regional area (data expected to be collected in the prior work plan). The above partnerships will also result in a presentation to Housing Works. Work to garner a stronger partnership with local fire departments to utilize in any education campaigns. Utilizing the survey data from the previous and current grant cycle will provide opportunities for earned media in marketing the survey and in sharing the results. Media Advocacy Additionally, the regional partnership will continue to submit educational articles in the CORDA monthly newsletter. Policy development Continue to provide technical assistance to housing providers on and analysis policy implementation and enforcement, with one access point of the CORDA newsletter for housing providers to access cou nty coordinators. As landlords and housing properties make the decision t go smoke free, will work with housing providers to promote policy change. Policy Provide technical assistance to housing providers on adopting no implementation and smoking policy. Continue to collaborate with Deschutes and enforcement Jefferson counties to provide trainings to regional rental owners on smoke free policy adoption. 90 141408 Deschutes 1960f330 Local Health Department: Deschutes County Health Services Program component: 0 P Protect people from exposure to secondhand smoke. What we want to achieve this funding period: Indoor Clean Air Act Enforcement Milestones: Respond to alilCAA complaints filed in Deschutes County. Collaborate with the business license renewal for Bend, Redmond, Sisters and laPine to redistribute State 10 foot decals. Present qualitative data to Bend, Sisters, laPine, and Redmond downtown associations to advocate with city to expand 10 foot no smoking rule in the downtown areas. Who will we engage and work with to accomplish this: •LPHDstaff What strategies we will use this funding period Strategy Activities Utilize focus group qualitative data from previous funding year to present to business decision makers on public response and support expanding current downtown smoke free policy. Research and compile information about other cities that have adopted similar ordinances. Assessment Education, Outreach Partner with Chuck Arnold of the Bend Downtown Association to & Partnerships present results of focus group surveys to the board. Work with Therese Madrigal (Healthy Communities) to continue to access key stakeholders (City Council) of Redmond, Bend and Sisters to present results of data-if favorable. Identify, educate and collaborate with community partners to access and educate decision makers of each Deschutes County city and move to support of expanded policy. 91 I I 141408 Deschutes 197of330 Media Advocacy Utilize Bend Bulletin to communicate favorable results of focus group data to influence expanding the policy and build public support. Work with HPCDP to design key talking points from the results of the focus groups and utilize a social marketing campaign to influence public leadership. Policy development and analysis Identify policy examples from other cities and provide technical assistance to city staff and policy makers on concept development and ordinance drafting. Policy I implementation and enforcement Provide technical assistance to city staff in developing an implementation plan, including a plan for communicating the policy and making signage available to businesses. Local Health Department: Deschutes County Health Services i Program component: 0 P Protect people from exposure to secondhand smoke. What we want to achieve this funding period: Build community support to establish tobacco-free outdoor parks in Redmond, Sisters and laPine. Milestones: Will have identified community partners and decision makers for each respective park district to assess readiness to move toward tobacco-free parks. Who will we engage and work with to accomplish this What strategies we will use this funding period Strategy Activities Assessment Work with Bend Metro Parks and Recreation to create a lessons learned from the time they have implemented their tobacco policy to the present day. Work with each of the Think Aga in Parents groups in Sisters, Redmond and laPine to have a table staffed with volunteers to gather photos and quotes and signatures from residents supportive of the policy. 92 141408 Desch utes 1980f330 Education, Outreach & Partnerships Utilize Bend Metro Parks and Recreation to be key spokesperson for each of the city's park board. Utilize Parks expertise to navigate through and speak the language for better access to successful outcomes with contacts. Identify key stakeholders of each parks department and get on the agenda of each parks board to bring the idea forward. Provide technical assistance if each board is looking to gather public opinion before they make a decision. Media Advocacy Presenting at each Park Board meeting will garner media support from each city as media generally attends these sessions. Policy development and analysis Offer technical assistance to each decision makers to develop a local policy. Utilize Bend Metro Parks and Recreation policy to model for Redmond, laPine and Sisters. Policy implementation and enforcement Offer technical assistance to each city to identify steps to proper compliance utilizing Bend Metro Parks and Recreation's model. local Health Department: Program component: 0 P Protect people from exposure to secondhand smoke. What we want to achieve this funding period: Tobacco-Free County Campuses Milestones: Train department managers and staff on how to advocate for the policy to ensure compliance. Utilize policy as an opportunity to get staff and visitors involved in the Quitline. Who will we engage and work with to accomplish this: Deschutes County managers, and department heads. What strategies we will use this funding period Strategy Activities 93 141408 Deschutes 199 of 330 Assessment Offer department managers an opportunity to provide an in- service training to staff on how to advocate for compliance of the policy. Quantify and meet the needs of each training group. Collect various agency approaches to educate clients, staff and visitors about the policy. Education, Outreach Present before the department heads of the county to offer & Partnerships training. Work with communications coordinator to implement internal and external plan to market positive messages to advocate for the policy to ensure compliance. Partner with the Deschutes County Wellness Task Force to design training and recruit members to assist with the training invitations. Media Advocacy Utilize Deschutes County Communication's coordinator to communicate to the media the policy to the public. Policy development and analysis Distribute completed policy to all department heads to distribute to employees. Policy implementation and enforcement Communicate tailored enforcement plan. Train managers and personnel on how to enforce the policy. Include the policy online (public access) and in employee orientation materials. local Health Department: Deschutes County Health Services I Program component: D P Protect people from exposure to secondhand smoke. What we want to achieve thi~fundillgperiod:!00% Tobacco Free Community College w Milestones:" ....•~..•... ..... Re-engage Central Oregon Communjty College on movement toward tobac¢O free . . .campus. COmmumty ColJegeadoptsa no-srnpkmg policy • Who will W!! engage and wQrkwithto accomplish this What strategies we will use~his funding period 94 141408 Deschutes 2000[330 Strategy Activities Assessment Key informant interviews with board members, the college president, administration and campus leaders . Education, Outreach . Coordinate with Jefferson and Crook to strategize on messaging & Partnerships to key stakeholders. Media Advocacy Draft an article in the Broadside student newspaper on the trend towards tobacco free campuses across the State to identify student champions. Policy development Provide technical assistance to campus officials to develop policy. ! and analysis Policy Provide technical assistance for policy implementation. implementation and I enforcement 95 141408 Deschutes 2010f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 local Health Department: Deschutes County Program component: [0 Offer help to quit tobacco use. Healthy Communities cJ~rdinaflt to assist;n g"liirlir,ti'irhg'n"'C:I Task Force. , ':,;:" ,:. ',:,'::; Q~~~~t~CQunty\YiII continue tosJJPport our 10c~!Jesfd~I~~' treltme.,t th~yjmplernent the new AMH tOllCi,cCO freQ~policy $nd prOii~e .. . , - " __ ' <--. • ,"~v,_ , ><;:.,' clients. 1e$I:onlas 2 treatments will go beyond the AMH poliey ,"~lliAiill treat cigarettes as contraband during their,:\tisit in the facilities. Who will we engage and work with to accomplish this: DHS staff and Behavioral Health Staff. 96 141408 Deschutes 2020[330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Deschutes County Program component: 0 W Warn about the dangers oftobacco. 97 ) 41408 Deschutes 2030f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 • Local Health Department: Deschutes County Health Services Program component: 0 E Enforce bans on tobacco advertising, promotion, and •sponsorship. Strategy Activities Assessment Completed assessment of local pharmacies and sale of tobacco Education, Outreach Identify if there is a local pharmacy board and access meeting. & Partnerships Engage pharmacists, health care providers and health teachers. Meet with pharmacist, business owner or manager to assess the . desire to adopt a voluntary policy. I Media Advocacy Work with Media contractor when a voluntary policy is obtained. Will introduce a petition for Pharmacists to support with the goal publicizing the results. Policy development Provide technical assistance if any pharmacy is willing to move and analYSis toward a voluntary policy. Policy Provide technical assistance to help pharmacy with implementation and communication plan, time line and necessary signage when a enforcement • pharmacy moves toward a voluntary policy. 98 J41408 Deschutes 2040f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Deschutes County Program component: 0 R Raise the price of tobacco. 99 141408 Deschutes 2050f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Deschutes County Health Services Component: Training, development and skills maintenance 100 141408 Deschutes 2060[330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Deschutes County Health Services Program Component: Reporting and evaluation plan: Deschutes County Tobacco Control Coordinator 101 141408 Deschutes 2010[330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 • Smoking is prohibited in all interior areas owned by County or occupied by Local Health Department: Jefferson County Public Health Department Program component: [I M Monitor tobacco use and prevention policies County Departments. Smoking is prohibited within 25 feet of building entrances. • Smoking is prohibited in all interior areas owned by County or occupied by County Departments. Smoking is prohibited within 25 feet of building entrances. • Fairgrounds: Smoking allowed in designated areas only • Smoking allowed in designated areas only. • All Mountain View Hospital properties are 100% tobacco-free 102 Hospitals with Smoke-free policies • on the HPCDP Connection Tobacco ! Other city or county properties page, here: http://public.health.oreqon.qov/P artnersl 141408 Deschutes 2080f330 HPCDPConnection/Tobacco/ Pages/Hospitals.aspx) Other tobacco-free campus policies (e.g. other health care setting or post-secondary Community-wide smokefree worksites (e.g. city or county local smokefree workplaces ordinance) Outdoor venues (e.g. parks or fair board tobacco-free policies) [list of policies on HPCDP Connection outdoor venues Other community-wide smokefree workplaces/public places policy: pol~2.p:e$crl~ion iil4fifBnatini . (e.g. COnlmlll1j~ftollege) • Madras Medical Group properties are 100% tobacco-free • Smoking is prohibited in all interior areas owned by County or occupied by County Departments. Smoking is prohibited within 25 feet of building entrances. • Fairgrounds: Smoking allowed in designated areas only • City and County parks have no tobacco-free or smoke-free policies in place. • Department of Human Services has 100% tobacco free campus policy. • Deer Ridge Correctional Institute has a 100% tobacco-free campus policy. Public housing authority (statewide policy status list is posted at https://oartners.health.oregon.go v/Partners/HPCDPConnection/Tob acco/Pages/Housing.aspx) • None (Looks like three different properties are planning on going smoke free in April). Other low-income and affordable MUH policies (e.g. Community development corporation) 103 141408 Deschutes 2090f330 Pol' scription (e:;~.I!A'fphlpertl~~1~\>. gnated areas~nly:')!}; ........ • . (e;g. cgmmunitycoll~~) do~~.~ot exist Tobacco retail licensing ordinance • None -=-------- Tobacco sampling ban • None ----------4-------------------------------------------------------~Other community-wide tobacco • None advertising and promotions policies: 104 141408 Deschutes 210 of330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 P Protect people from exposure to secondhand smoke. Strategy Activities Assessment • Identify different types of affordable public housing in Jefferson County utilizing lists provided by Health InSight. • Determine if smoking policy exists in all properties under their authority. • Assess landlord readiness to 105 141408 Deschutes 2110[330 Education, Outreach & Partnerships • Through regular meetings with Deschutes and Crook counties, develop regional strategies to engage partners with assistance from Health InSight. • Develop presentation to make to Central Oregon Rental Owners Association (COROA) and affordable housing authorities on the benefits of adopting smoke free housing policy. Attend quarterly meetings providing handouts and information on the benefits of smoke free housing policies. • In cooperation with Deschutes and Crook counties, develop article on smoke free policy implementation to submit to COROA for monthly newsletter. • Engage management of PHA & RHA in discussion of smoke free housing. • Share tri-county data on the benefits of smoke free housing with above authorities. • Continue working with Central Oregon Rental Owners Association to offer presentation on smoke free housing policy. Media Advocacy • Utilize opportunities throughout year to provide local angle on state or national story related to smoke free housing.I • Include Quit line information in all earned media. Policy development • Advocate for no-smoking policy through providing and analysis "Benefits of No Smoking Policy in Affordable Housing" and "A Landlord's Guide to No Smoking Policies" to owners and managers who are interested in developing and adopting no smoking policies through COROA. • Provide model policies and successes of smoke free policies from other counties to COROA members. Policy • Provide technical assistance to housing providers on implementation and adopting no smoking policy. enforcement • Collaborate with Deschutes and Crook counties to provide trainings to regional rental owners on smoke free policy adoption. 106 ! ) 4 ) 408 Deschutes 2120f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 local Health Department: Jefferson County Public Health Department Program component: 0 P Protect people from exposure to secondhand smoke. Assessment • Meet with all new businesses in Jefferson County to educate them on the ICAA and offer Quit Line information for their employees who use tobacco. • Participate in all OHA TPEP trainings pertaining to ICAA rules and implementation. • Train new staff on ICAA enforcement when "n,.nll'" • Utilize all statewide earned media for ICAA implementation and compliance to approach local media and share information on the ICAA and tobacco Quit Line. Education, Outreach & Partnerships Media Advocacy 107 ! 141408 Deschutes 213 of 330 Policy development and analysis Policy implementation and enforcement • Collaborate with OHA TPEP staff to mon itor policy as it relates to the ICM and implementation by jefferson County Health Department. • Offer assistance to OHA in policy development related to ICM enforcement. • Participate in the ICAA rules grantee training and communication workgroup to further the efforts of the ICM policy implementation and enforcement. 108 141408 Deschutes 2140[330 local Health Department TPEP Grant local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 P Protect people from exposure to secondhand smoke. Assessment Education, Outreach & Partnerships • Assess current county policies on tobacco use and identify barriers. • Review Change Tool data from ACHIEVE Initiative to identify gaps in current policy. • Once "let's Talk" Diversity Coalition has completed their assessment (populations in the county representing the most disparities) use that data to pursue policies that affect as as • Partner with JCPHD Worksite Well ness Committee on all activities. • Meet monthly with "let's Talk" Coalition members. • Meet quarterly with ACHIEVE Chart members. • Using assessment data meet one-on-one with county decision-makers ntation to BOCC. 109 141408 Deschutes 2150f330 1 Media Advocacy Policy development and analysis Policy implementation and enforcement • Media strategies will include in house quarterly HEAL newsletter to share personal success stories and data results. • Collaborate with other department staff on the . development of a Jefferson County Health Department Facebook page. • Utilize Great American Smokeout, Kick Butts Day and World No Tobacco Day for educational opportunities. • Identify who the relevant people are to be involved in the policy development. • Review other model policies in tri-county region. • Provide technical assistance in developing an implementation plan, including a communication plans. • Provide technical assistance in developing an enforcement plan. Fonnatbld: Bulleted + Level: 1 + Aligned at: 0.25' + Indent at: 0.5', Tab stops: Not at 3.25' + 6.5' 110 Ii 141408 Deschutes 216of330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 P Protect people from exposure to secondhand smoke. Strategy Assessment Activities • Assess who the major users are of the fairgrounds to identify community champions. • Conduct an event-goer survey during 2012 Kids Day event during county fair to assess support of policy change. • Assess tobacco use and cigarette debris during other targeted events at the fairgrounds. • Assess Fair Board member's willingness to adopt tobacco free poliCies. • Collaborate with Crook and Deschutes counties on dr·:.+ot'ties and lessons learned. 111 141408 Deschutes 2170[330 Education, Outreach • Educate community leaders on tobacco use by youth in & Partnerships Jefferson County at every opportunity. • Educate event users on the importance oftobacco-free environments for the youth. • Develop new champions for adopting tobacco-free policies in Jefferson County. • Partner with Crook and Deschutes counties on any tri county opportunities. Media Advocacy • Once the event-goer survey is completed during 2012 Kids Day event publicize the results in the Pioneer. Have newly identified champion submit a letter to editor in support of policy. • Take pictures of tobacco use and cigarette debris to strengthen messaging about the impact of tobacco use on the environment. • Promote Quit line in all earned media activities. I Policy development . and analysis • Identify who the relevant people are to be involved in the policy development and what the policy-making process is. • Access model polices and resources through participation in Outdoor Venues work group and HPCDP website. Policy • Offer assistance to Fair Board to develop a implementation and communication and enforcement plan for policy I enforcement implementation. Offer training for staff on policy implementation. 112 i 141408 Deschutes 21801'330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 0 OtTer help to quit tobacco use • • ce55ation.lelated Formatted: Bulleted + Level: 1 + Aligned at: 0.25' + Indent at: OS, Tab stops: Not at 3.25' + 6.5' • WIC and family Planning staffs receive training referrals to Quit line. • it Line referrals Who we engage and • local WIC and family Planning staff. • Regional Welfness@Work coalition. • Regional Living Well coordinator / Local Tomando Coordinator. • Local healthcare providers. • RP members and staff. 113 ) 4 ) 408 Deschutes 2190f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 W Warn about the dangers of tobacco. Ho!" we use media to supportoJ,lr P9licy objectives .•.•~.•.•·.Infor~ation about the harm:pf tobacc:o use will be included in all earl'led media opp<:>rtunities, ineluding i~f6ftnation about the physi6a1 and ecobomi6alhamtof • tpba~co USe in educatioiull conversations with conimyrlity leaderS andgecision '.. makers. ." . . .. ..... .. Q~~~rib,~;~~y a~.' ~I earned media activities (E;!.~,; participating in;istate!"ide ~'t~dia effort; oper~tlni~ ... unty socialntedia account such as Fac~book). .•.. . . . .• Collaporate,With other department staff on the development of ~)effersoli Cqo nty· '-'-Fonnatted: Space After: 0 pi, Une spacing: .. , "",,' '., .. . . . " .. single, Bulleted + Level: 1 + Aligned at: 0.25" Health Dep~j:trnent Facebook page to promote the harm of tobactp use. '.. ..••.... .. ,--+_I_nde_n_ta_t:_O_.5_"______-' • Maintain a s~parate webpage on the county health department website for tobacco and chronic disease information. Milestones • lPHQ Facebook page developed. .Utidte GreatAmerlcan Smokeout, Kick Butts Day and World No Tobacco Day for edu~tional opportunities as well as local contacts. • Maintain and update county tobacco webpage quarterly or as needed. Who will we engage and work with to accomplish this • Sarah Decker RN, Chelsea Lundy CCF staff in county health department. • Jan Collier (administrative assistant) maintains health department website. • County website technicians. 114 141408 Deschutes 2200f330 local Health Department TPEP Grant local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 E Enforce bans on tobacco advertising, promotion, and sponsorship. Strategy Activity Assessment • Assess community leaders to determine their level of interest in developing a ban on tobacco sampling in commun Education, Outreach • Educate community leaders on tobacco use by youth in & Partnerships Jefferson County. Develop champions for adopting ordinance to prohibit in Jefferson Cou Utilize all earned media opportunities for promoting bans on tobacco advertising, promotion and sponsorship. Partner with Prevention Task Force Peer Court on media Media Advocacy • free tobacco • • Policy development and analysis • Jefferson Cou fai nds. Meet with fairgrounds representatives to determine level of sponsorship by tobacco industry of events held at the 115 141408 Deschutes 2210[330 Policy • Provide technical assistance in developing an implementation and implementation plan, including a communication plan. enforcement • Provide technical assistance in developing an enforcement plan. 116 141408 Deschutes 2220f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program component: 0 R Raise the price of tobacco. pii5sel::rlirlate findings including success,$tori4!$, ·¥pl"'~SEm1altlollS or meetings with conrtm\lOlt1 for increased vvhCl~~~PS\W~will take to eogage '. a~dICl~cat~9" Progr~m " ';.' ••.: .........•.•.... / .;i~i::::un~and ~..teade~il.,to~ ..• ••..•.•.•. • .'. Incltideinformation on the need forTPER'inch.fsi"p irl~!fjsp~~ ofJh~:~g~Ji)~nity nG,""""lnirl,ato revention and wellness efforts. •... ·······v.· ... ....... .. Milestones • Jefferson County Health Department Worksite WellnessTeami: • CHIP/CHRP • "Let's Talk" Diversity Coalition. • 509J School staff. • LPHD staff. 117 141408 Deschutes 2230f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department . Program Component: Training, development and skills maintenance Who will attend aU required trainings >i\car~I~I1~~~ey; Healthy Communities Program Coo~dlnatora~d/~F·· ..~ Colleeri Corbett; Healthy Communities Program Coorginator Assistant >i~ CarbiynHa~ey; Hea~hy ComrTlUnitiesProgram Coordinator arid/or.:: • Colleen Corbett; He~lthy Communities Program Coordinator A~sistahi;~> Who will attend all required webinars . . • Carolyn Harvey; Healthy Communities Program Coordinator and/or • Colleen Corbett; Healthy Communities Program Coordinator Assistant Who will attend all required RSN meetings and trainings • CarolYQHarvey; Healthy Communities Program Coordinator and/or .:. CoUeen Corbett; Healthy Communities Program Coordinator Assistant Are there any leadership activities we will be participating in (e.g. RSN Network facilitation, GCAG participation, special interest group facilitation), list them below. • Outdoor Venues Work group (Colleen) • GCAG (Carolyn) • "let's Talk" Advisory Committee (Carolyn) • Kids@Heart Advisory Committee (Carolyn) • ACHIEVE Chart committee (Carolyn) • Living Well Tri-County!Tomando AdviSOry Committee (Carolyn) • Community Traffic Advisory Committee (Carolyn) 118 141408 Deschutes 22401'330 I t I it I t Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: Jefferson County Public Health Department Program Component: Reporting and evaluation plan I I f 119 141408 Deschutes 2250[330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 M Monitor tobacco use and prevention policies For~ach of the policy types listed below, please note the policy or policies that have beeJladoPted. W~ere applicable, links are provicfed to statE~wjde lists or maps of policies; these may not be cpmpletety up-to.,date. .' .' '" " Policy type PollclE!S adopted-Include current policy description (e.g. I.All t'JJ"QPle~!~)~QQ" :ktOD,aC(:o"l·re.~'~" or "Smoking allowed in designated areas only.") "N/A'tif a specifledlnstitution type (e.g. community college) LPHD shares space in Mosaic Medical facility. Currently, the county "No Smoking within 20 ft." rule a ies. below.) Other city or county properties All City and County owned facilities are no smoking within 20 ft of doors and erable windows as of 2000. Community college (statewide Our community College is an "O pen Campus" jOintly operated by COCC and OSU policy list and map: cascades. It sits on county-owned property and shares the county 20ft. rule http://www.smokefreeoregon.co above. Hospitals (See the map of Oregon Pioneer Memorial Hospital is a tobacco free campus. All properties are 100% Hospitals with Smoke-free poliCies tobacco free. We will continue to monitor the map of Oregon Hospitals and the on the HPCDP Connection Tobacco PMH policy to ensure accuracy. page, here: http://public.health.oregon.gov/P artners/ HPCDPConnection/Tobacco/ Pages/Hospitals.aspx) Other tobacco-free campus NONE 120 141408 Deschutes 226of330 setting or post-secondary . education campus.} Community-wide smokefree worksites (e.g. city or county local i smokefree ordina Outdoor venues {e.g. parks or fair board tobacco-free policies} [list I of policies on HPCDP Connection outdoor venues Public housing authority (statewide policy status list is posted at https:!/partners.health.oregon.go v/Partners/HPCDPConnection/Tob acco/Pages/Housing.aspx) colrtmlimit~icoillegl[!l.does h~.t exist No smoking within 20 feet of any City or County owned facility as stated above. All Crook County Parks and Recreation District properties are 100% tobacco free with a resolution that passed in 2005. Department of Human Services has 100% tobacco free campus policy. NONE Other low-income and affordable NONE MUH policies (e.g. Community ! development corporation) Other community-wide tobacco advertising and promotions ! policies: 121 141408 Deschutes 2270f330 local Health Department TPEP Grant local Program Plan Form 2012-13 ILocal Health Department: CROOK COUNTY HEALTH DEPARTMENT Activities Using lists provided by Health InSight, identify different types of affordable public housing in tri-county area. Determine if smoking policy exists in all properties under their authority. Assess landlord readiness to adopt smoke free policy. i Strategy o P Protect people from exposure to secondhand smoke. Assessment 122 141408 Deschutes 2280f330 Education, Outreach Through regular meetings with Deschutes and Jefferson counties, & Partnerships develop regional strategies to engage partners with assistance from Health InSight. Develop presentation to make to Central Oregon Rental Owners Association (CORDA) and affordable housing authorities on the benefits of adopting smoke free housing policy. In cooperation with Deschutes and Jefferson counties, develop article on smoke free policy implementation to submit to CORDA for monthly newsletter. Engage management of PHA & RHA in discussion of smoke free housing. Share tri-county data on the benefits of smoke free housing with above authorities. Continue working with Central Oregon Rental Owners Association to offer presentation on smoke free housing policy. Media Advocacy Utilize opportunities throughout year to provide local angle on state or national story related to smoke free housing in tri-county media. Include Quit Line information in all earned media. Policy development Advocate for no-smoking policy through providing "Benefits of and analysis No Smoking Policy in Affordable Housing" and "A landlord's Guide to No Smoking Policies" to owners and managers who are interested in developing and adopting no smoking policies through CORDA. Provide model policies and successes of smoke free policies from other counties to CORDA members. I Policy ! implementation and enforcement I Provide technical assistance to housing providers on adopting no smoking policy. Collaborate with Deschutes and Jefferson counties to provide trainings to regional rental owners on smoke free policy adoption. 123 I 141408 Deschutes 2290[330 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 P Protect people from exposure to secondhand smoke. ActivitiesStrategy Utilize information from Chamber of Commerce for new businesses to monitor and assess their knowledge of the ICAA. Assessment Education, Outreach Meet with all new businesses in Crook County to educate them & Partnerships on the ICAA and offer Quit Line information for their employees who use tobacco. Participate in all aHA TPEP trainings pertaining to ICAA rules and implementation. Train LPHD staff on ICAA enforcement when appropriate. Media Advocacy Utilize all statewide earned media for ICAA implementation and compliance to approach local media and share information on the ICAA and tobacco Quit Line. Policy development Collaborate with aHA TPEP staff to monitor policy as it relates to and analysis the ICAA and implementation by Crook County Health Department. Offer assistance to aHA in policy development related to lCAA enforcement. 124 141408 Deschutes 2300f330 Policy Participate in the leAA rules grantee training and implementation and communication workgroup to further the efforts of the ICAA enforcement policy implementation and enforcement. Annually monitor local smoke shop for compliance with ICAA rules and regulations. I 125 231 of330141408 Deschutes Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 P Protect people from exposure to secondhand smoke. Assessment Assess all parks to determine level of promotion of tobacco free policy. Education, Outreach Meet quarterly with CCP&R district director/staff to educate on & Partnerships the best practices for policy enforcement. Media Advocacy In cooperation with Parks and Recreation, develop weather • resistant signs for parks. Work with CCP&RD staff to order signs for parks stating tobacco free policy. Utilize all earned media to promote parks tobacco free policy when appropriate such as event advertising. Policy development In cooperation with CCP&RD staff, analyze the effectiveness of and analysis the current policy and jOintly develop ways to implement policy. Policy Offer monetary assistance to CCP&RD to procure signs to implementation and promote policy on1rnr,,.ornoln1" enforcement 126 141408 Deschutes 232of330 local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 P Protect people from exposure to secondhand smoke. Strategy Assessment Activities Conduct second survey in cooperation with OHA research analyst to determine community interest in policy adoption. Research &compile information on other government tobacco free policies. Education, Outreach & Partnerships In cooperation with Deschutes County, develop list of regional community leaders to recruit as advocates for proposed policy. Based on results of power mapping, organize meetings with key individuals to solicit endorsements and possible champions. Deliver informational presentation and survey results to cou nty cou rt. 127 141408 Deschutes 23301'330 Schedule meeting with local media to promote survey in community. Based on results of Crook and Deschutes surveys, develop messages on benefits of adopting tobacco free policies and to respond to perceived barriers in order to influence local decision makers. Media Advocacy Policy development I Policy already submitted to county court. i and analysis I Policy Provide technical assistance to county staff in developing an i implementation implementation plan, including a communication and and enforcement signage plan. Support communication and signage through TPEP funds. 128 141408 Deschutes 2340f330 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: [J P Protect people from exposure to secondhand smoke. Strategy Activities Assessment Survey Mosaic Medical staff to determine readiness to adopt tobacco free campus policy. Identify champion at Prineville for policy implementation. Meet with Mosaic Medical staff to share results of Crook and & Partnerships Education, Outreach Deschutes county surveys and educate them on the benefits of adopting a tobacco free campus policy. Media Advocacy Utilize local media to promote tobacco free campus policy upon adoption. In cooperation with Mosaic Medical, provide earned media information to local newspaper, radio and cable ad channel on new policy. Policy development Partner with Mosaic Medical Board, Deschutes County TPEP and analysis coordinator and lPHD staff to develop appropriate tobacco free campus policy for medical facility. Present model policy to Mosaic Medical staff. 129 141408 Deschutes 2350f330 Policy Offer assistance to Mosaic Medical and Crook Count y Health implementation and Department to develop a communication and enforcement plan enforcement for policy implementation. Offer training for staff of Mosaic Medical and LPHD on policy implementation. Support communication and signage of new policy through local TPEP 130 141408 Deschu tes 2360[330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 0 Offer help to quit tobacco. Re!'liQArJPI WE'(lftl!tS$ICIll1r,,"'Ic cc'irilitiol', J(tcal VISTA member, OHA Quif lJbe liaison, ", ", stofJ,~ountYWellnessream gad local ft~~~~re_ow~~n~'~~"~~~nmrnlmdsmff. 131 141408 Deschutes 2370f330 local Health Department TPEP Grant local Program Plan Form 2012-13 local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 W Warn about the dangers of tobacco. Facebook pilge IJtiijpn at tj)Cmty hiqlthd~portment,CountY webSi¥e technicians, VISTA Member, 1,,£01 mef!ia, RHA)cHIP and .. ojCtlmmefCe. 132 141408 Deschutes 2380f330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 E Enforce bans on tobacco advertising, promotion, and sponsorship. Strategy Assessment Education, Outreach & Partnerships Media Advocacy Activity Assess community leaders to determine their level of interest in developing a ban on tobacco sampling in community. Educate community leaders on tobacco use by youth in Crook County. Develop champions for adopting ordinance to prohibit free tobacco sampling in Crook County. Utilize all earned media opportunities for promoting bans on tobacco advertising, promotion and sponsorship. 133 141408 Deschutes 2390[330 i Policy development and analysis Policy implementation and enforcement Meet with representative of Crooked River Roundup Board to determine their involvement with tobacco advertising through the PRCA. Meet with fairgrounds representatives to determine level of sponsorship by tobacco industry of events held at the i Crook County fairgrounds. 134 141408 Desehutes 2400[330 Local Health Department TPEP Grant Local Program Plan Form 2012-13 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program component: 0 R Raise the price of tobacco. 135 141408 Deschutes 241of330 local Health Department TPEP Grant local Program Plan Form 2012-13 Local Health Department: CROOK COUNTY HEATLH DEPARTMENT Program Component: Training, development and skills maintenance ;' /-; _ ":~i:,',,, .' : ,:::___ '--">' RSIV:,!tJ"ilitdt'on as q'/"ropririt~. Vic'!<haliol Rimrock Alliance, Co·Cha;r 01 COlnl7liUn;'ttU"let:J,lth Jmpro~ti.ent Partnership, Advisor /orJ[{STA Member. Member/of CHlru',rfu'nnjijl' Disease com,mttee;Tr;.Countywell'1'ss@ W()rk Initiative wdrkgroug' RelJ,ion,tll Policy Workgl~up. ". ' 136 14)408 Deschutes 2420[330 local Health Department TPEP Grant local Program Plan Form 2012-13 Local Health Department: CROOK COUNTY HEALTH DEPARTMENT Program Component: Reporting and evaluation plan: 137 141408 Deschutes 2430[330 MAINTENANCE OF EFFORT AND BEER AND WINE TAX FUNDS ASSURANCE county: Croo~, Deschutes and Jefferson As required by ORS 430.359(4), we certify that the amount of County funds allocated to behavioral health treatment and rehabilitation programs for 2013-2015 is not projected to be lower than the amount of County funds expended during 2011 2013. The amount of beer and wine tax funds received by the Counties is not projected to be lower than the amount received during 2011-2013 and will continue to be allocated for 2013-2015 as they were in 2011-2013. The County Budget process occurs annually and future revenue available to our counties is uncertain. Final amounts are subject to the recommendations by the County Administrators and the annual County Budget Committees processes as well as final action by the Board of Commissioners. The Counties have consistently supported health services with County General Fund and discretionary resources. While the Counties' contributions are not expected to decline, some cuts could occur if circumstances warranted. This information is available in June of each year at the time of budget adoption. March 28, 2012 Scott Willard, Director, lutheran Family Services Northwest (Crook County) Scott Johnson, Director, Deschutes County Health Services Rick Treleaven, Director, BestCare Treatment Services (Jefferson County) H:\My DocumentS\ANNUAl REPORTS\fl.EGIONAl HEALTH IMPROVEMENT PLAN\Ma!ntenance of Effort and Seer and Wine Tax Funds.doOl 138 141408 Desch utes 244of330 CENTRAL OREGON HEALTH COUNCIL AND CENTRAL OREGON HEALTH BOARD Regional Health Improvement Plan: Behavioral Health Update CENTRAL OREGON HEALTH BOARD March 8,2013 Jeffrey Davis 14 2450[330 CENTRAL OREGON HEALTH COUNCIL AND CENTRAL OREGON HEALTH BOARD Regional Health Improvement Plan: Behavioral Health Update CENTRAL OREGON HEALTH COUNCIL (COHC) STRATEGIC INITIATIVES The COHC has identified and is working on funding for eight initiatives for the coming year. These initiatives will drive the effort of the Council, Health Board and the CCO. These indicatives' tie back to needs identified in the Regional Health Improvement Plan and directly involve behavioral health in the region .. These key initiatives are: 1. Person Centered Integrated Care-This involves three componets which are behavioral health and primary care integration; expanding existing integration efforts bring primary care into behavioral health settings and develop a common set of metrics to evaluate efficacy of integrated care models using the Rocky Mountain replication project. a 0:: 2. Chronic Pain-Establishing community guidelines for pain management including patient education C3 co in primary care and co-occurring addiction and pain management program. :::c r-3. Complex Care Coordination-Centralized community -wide care coordination resource; ~ distributed multi-disciplinary care conferences and HealthBridge which is a high-intensity primary :::c z care referral center.o (..!J u.J 4. Workforce Development. 0:: o ...J All of these initiatives have local mental health director involvement on the planning committees. This is to<t 0:: rz assure that that behavioral health is truly integrated across multiple systems with the long term goal of u.J () better care, reduced cost and improved patient satisfaction in all of their health care needs. a z <t The regional health improvement plan does include in its key indicators all of the CCO behavioral health ...J <3 z outcome measures. The Central Oregon Health Board will work with the COHC in monitoring these :::l o outcomes and working to make necessary improvements or changes to achieve the desired end result. () :::c r-The Central Oregon Health Board continues to develop their regional infrastructure and explore:;:J u.J :::c opportunities to work together in a regional manner to improve the population health of the Central o z Oregon Region. These developments are works in progress and will evolve with the changing State and (..!J u.J 0:: CCO systems change. o ...J The follOWing chart will show the spread of flex fund services throughout the counties in the Central Ci rz Oregon Region. u.J D 8141408 De"hu'" 246of330 2013-15 CENTRAL OREGON REGIONAL BEHAVIORAL HEALTH SERVICES Regional Crook Deschutes Jefferson HEALTH PROMOTION AND PREVENTION Mental Health Adults X X X Children X X X Alcohol and Other Drugs Adults X X X Children X X X Problem Gambling X OUTREACH (Early Identification and Screening Assessment and Diagnosis ('I) ..-I 0Mental Health N (X)Adults X X X ~ Children X X X Alcohol and Other Drugs 0 a:: «Adults X X X 0 CD Children X X X J: ~ Problem Gambling X X « ...J UJ J: z 0INITIATION AND ENGAGEMENT (!l UJ Mental Health a:: 0 Adults X X X ...J « a::Children X X X ~ z UJAlcohol and Other Drugs (.) 0Adults X X X z «Children X X X ...J (3 Problem Gambling X X z :::> 0 (.) J:THERAPEUTIC INTERVENTIONS ~ ...J (Outpatient, Crisis, Pre-Commitment « UJ J:Acute Care, PSRB and JPSRB Z Mental Health (!l 0 UJ a::Adults X x X X 0 Children x x x X ...J « a:: ~Alcohol and Other Drugs z UJAdults X X X X (.) 141408 Deschutes 247of330 o a:: ~ III :c ~ ....J ii) :c z o C) UJ a:: o ....J ~ ~ z UJ u o z <: ....J (3 Z :J o u :c:; ii) :c z o C) UJ a:: o ....J ~ ~ z UJ u 141408 Deschutes Children Problem Gambling CONTINUITY OF CARE AND RECOVERY Mental Health Alcohol and Other Drugs Problem Gambling PEER DELIVERED SERVICES Mental Health Alcohol and Other Drugs x X X x X Regional Crook Deschutes Jefferson x X X X X X X X X X X X X X 24801'330 Local Mental Health Authority Biennial Implementation Plan IBIl') Planned Expenditures 2013 -20151Based on historical allocation) Budget Period: July 1, 2013 -June 30, 2015 Date Submitted: Local Carry. AMH Flex Beer and County over Category las Funding" Wine Tax GF Other Total Amount defined In the CFAA) Sub~ategory Population Health Promotion and Prevention Adults $0.00 $0.00 $0.00 $0.00 SO.OO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Alcohol and Other Drug $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Children $140,000.00 $0,00 $000 $0.00 SI40,000,00 $0,00 $0.00 $000 $0.00 $0,00 $0.00 SO,OO $71,034.03 $0.00 $0.00 SO.OO S71,034.03 SO.OO $30,000.00 $0.00 SO.OO SO.OO $30.000.00 $0,00 $0.00 S40.OOO,00 $0.00 SO.OO $40.000,00 $0,00 Children $0,00 $0.00 $0.00 SO.OO $0.00 SO.OO $0.00 $000 $0,00 $0,00 $000 SO.OO Adults $201,958.13 $0.00 $24.000.00 $0.00 $225.958.13 SO.OO $86.176.00 $0,00 $000 $0,00 $98,176.00 $0,00 Alcohol and Other Drug $205,955.84 $0.00 $50,000.00 SO.OO $255,955,84 $0.00 Children $0.00 $0.00 $0.00 $0.00 $0.00 SO,OO $0.00 $0.00 $000 $0.00 $0.00 $0,00 Adults $50,050.00 $0.00 $0.00 $0,00 $50,050.00 $0.00 $0.00 $0.00 $0.00 $000 $0,00 SO.OO Alcohol and Other Drug $0.00 $0.00 $0.00 SO.OO SO.OO $0,00 Children $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $40,000.00 $0.00 $0,00 $0.00 $40,000.00 $0.00 Mental Health $22,30000 $0.00 $000 $0.00 $22,300.00 $0.00 Alcohol and Other Drug $0.00 $000 $0.00 $0,00 $0.00 $000 Problem Gambling $90000 $0.00 SO.OO $0.00 $900.00 $0.00 Peer- Delivered Services $17,000.00 $0.00 $0.00 $0,00 $17,000.00 $0.00 Administratio $25,54000 $0.00 $0.00 $000 $25,540,00 $0,00 (Indude Description Supported Employment $58,686.00 $0.00 $0.00 $0.00 $58,686.00 $0,00 Totat $961,60000 $40,000.00 $74.000.00 $0.00 uu,. lJIIN $0.00 'AMH Flex Funding indudes State General Fund. State Beer and Wine Tax, LoUery Funds, SAPT Block Grant and Menial Health Block Grant Outrllach (Early Identification and Screening. Assessment and Diagnosis) Initiation and Engagement Therapeutic Interventions (Community based Outpatient, Crisis, Pre- Commilment. Acute Care. PSRBand JPSRB) Continuity of care and Recovery Management 141408 Desch utes 2490[330 Local Mental Health Authority Biennial hnplementalion Plan (BIP) Planned Expenditures 2013 -2015 (Based on historical allocation) Deschutes County Budget Period: Date SUbmitted: AMH Flex Local Beer Carry- Funding' AMH SE and Wine Tax County GF Olher Total over Category (as deRned in the CFAA) Sub-C ategory Population Funding Behavioral Health Promotion and Prevention $805,63too lilli', Jib') 'lit $0,00 Jfq#,IJI~~/l!nl 1'f"',II'INIJN'1f1 $0.00 $0.00 $8,145,759.00 $216,916.00 $427,608.00 $0.00 $361,431.00 "'''''''!!,WIlJI $0.00 $0.00 $4,529,542.00 $109,374.00 $9,404.00 $141,500.00 $114,241,00 $120,000,00 $0.00 $0.00 $494,519.00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 TherapeutiC InlerventiOns (Community-based Outpatient, Cfisls, Pre-Commitment, Acute Care, PSRB and JPSRB) $519,465.00 $20,259.00 $0.00 $312,743.00 $193,308.00 $0.00 $0.00 $1,045,775.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0.00 $0.00 $000 $0.00 $0,00 $0,00 $0.00 $000 $0,00 $0.00 $0,00 $0,00 $0,00 $0.00 $0,00 $0,00 $0,00 $0.00 $0.00 $000 $0,00 $0,00 $0.00 $0.00 $0.00 $0.00 $000 $0.00 $0.00 $0.00 Alcohol and Other Drug $632,550.00 $0.00 $0.00 $0,00 $0,00 $0,00 $632,550.00 Problem Gambling $29,000,00 $0.00 $0.00 $000 $0,00 $0.00 $29,000,00 Tolal $0.00 $0,00 $0,00 $0.00 $000 $0,00 $0,00 'AMH Flex Funding includes Stale General Fund, Slate Beer and Wine Tax, Lottery Funds, SAPT Block Grant and Mental Health Block Grant , "'''It; ';''';I''( ! J: ;; $141,500-<)0 ;1" ,It" ,!'t'" ...../''¥l'l' $0.00 $0.00 iIIf Alcohol and Other Drug Children Alcohol and Other Drug Children Continuity of Care and Recovery Management I 141408 Deschutes 2500f330 Local Mental Health Authority BienniallmpJementatlon Plan (BIP) Planned Expenditures 2013 -2015 (Based on hlstoricalaUoeation) Budget Period: Date Submitted: Local Carry- AMHFlex Beeranll County over Funding> WlneTax GF Other Total Amount category (as defined In the CFAA) Sub-Category Population Health Promotion and Prevention Adults $0.00 $0.00 $0.00 $130,000.00 $130,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0.00 Alcohol and Other Drug $0.00 $000 $0.00 $0.00 $0.00 $000 Children $52,20000 $0.00 $0,00 $198,013.00 $250,213.00 $0,00 $5,000.00 $0.00 $O.OO $0.00 $5,000,00 $0.00 Adults $O.OO $0.00 $0.00 $000 $0,00 $0,00 $0,00 $0,00 $0,00 $0.00 $0.00 $0,00 Alcohot and Other Drug $0.00 $0.00 $0,00 $29,700,00 $29,700.00 $0,00 Children $0,00 $OOO $0.00 $0,00 $0,00 $0,00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 lnitiation and Engagement $0.00 SO.OO $41,306.77 $0.00 $0,00 $0,00 $41,306,77 $0,00 $10,886.40 $0.00 $000 $0.00 $10,886.40 $0.00 $0.00 $OOO $0.00 $0.00 $0.00 $0.00 $O.OO Children $5.439.00 $0.00 $0,00 $0,00 $5,439,00 $0,00 $0,00 $0,00 $0.00 $O,OO $0.00 $000 JPSRB) SO.OO $0,00 Adults $144,573.69 $0.00 $O.OO $O.OO $144,573.69 $0.00 $43,545.60 $0.00 $000 $0.00 $43,545.60 $0.00 Alcohol and Other Drug $000 $26,632.00 $18,000.00 $0.00 $OOO $44,632.00 $OOO Children $16,317.00 $0.00 $0.00 $0,00 $16,317.00 $0.00 $18,000.00 $0,00 $0.00 $0.00 $18,000,00 $0.00 Management $0.00 Mental Health $20,653.38 $O.OO $0,00 $000 $20,653,38 $0.00 Alcohol and Other Drug $0,00 $0.00 $0.00 $0,00 $O.OO $0,00 Problem Gambling $0,00 $OOO $O.OO $OOO $000 $0.00 Peer~ Delivered Services $54,953.00 $0.00 $0.00 $5,047,00 $60,000,00 $O,OO Administralio $12,796.44 $Ooo $0.00 $OOO $12,796.44 $0,00 (Include Description $OOO $O,OO $0,00 $0.00 $0.00 $0.00 Total $OOO $0,00 $O.OO $0.00 $0.00 $0,00 $452,30328 $18,000.00 $0.00 $362,760,00 $833.063.28 $0.00 'AMH Flex Funding in<:Iude. S~General Fund, State Beer and Wine T ax. LoIi~ry Funds, $APT Block Gtant and Mental Health Block Granl Outreach (Early Identification and Screening, Assessment and Diagnosis) Therapeutic Interventions (Community based Outpabent. Crisis, Pre- Commitment, Acute Care, PSRB and Continuity of Care and Recovery 141408 Deschutes 2510f330 --------- 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITD-l FINANCIAL ASSISTANCE AWARD CONTRACTOR: _______________ AGREEMENT #: DATE: REFERENCE#: ______ PROGRAM AREA: Start/End Client Approved Approved Servo Unit EXHlB B2 Spec Part Dates Code Service Funds Start-up Units ~Codes Cond # SE#: ___ 141408 Deschutes 252of330 OREGON HEALTH AUTHORITY Financial Assistance Award Amendmen 2013-2015 t (FAAA) CONTRACTOR: DATE: 05/16 DESCHUTES /2013 COUNTY ContractU: Reference#: 141408 001 ALCOHOL AND DRUG SERVICES SECTION: 1 SERVICE REQUIREMENTS MEET EXHIBIT B AND, IF INDICATED,EXHIBIT B-2 Start/End Client Approved Approved Serv. Unit EXHIB B2 Spec Part Dates Code Service Funds Start-up units Type Codes Cond# SEn 60 A&D-SPECIAL PROJECTS C 7/2013-6/2014 N/A $180,000 $0 0. NA N/A AOO01 1 SUBTOTAL SEn 60 $180,000 $0 TOTAL SECTION 1 $180,000 $0 I TOTAL AUTHORIZED FOR ALCOHOL AND DRUG SERVICES $180,000 TOTAL AUTHORIZED FOR THIS FAAA: $180,000 141408 Deschutes 2530f330 OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) CONTRACTOR: DESCHUTES COUNTY Contract#: 14140B DATE: 05/16/2013 REF#: 001 REASON FOR FAAA (for information only): The Financial Assistance Award is for Alcohol or Other Drug Abu~e Treatment within the Governor's 2013-2015 Balanced Budget (GBB). Additional funding categories have been moved out of individual Service Elements and into MHS 37-Flexible Funding in this Agreement. Medicaid-eligible Alcohol and Drug Residential Treatment services were moved to the Coordinated Care organizations (CCO) beginning July 1, 2013. Payment of funds in this Financial Assistance Award is subject to Legislative approval of the Oregon Health Authority's 2013-2015 Budget, at the level proposed in the Governor's Balanced Budget or higher. The following special condition{s) apply to funds as indicated by the special condition number in column 9. Each special condition set forth below may be qualified by a full description in the Financial Assistance Award. AOOOI 1 A) These funds are awarded for the special project described in Exhibit A&D GO-Strategic Prevention Framework (SPF). B) The financial assistance awarded for A&D 60-Strategic Prevention Framework (SPF) will be disbursed in substantially equal quarterly allotments. J4 J408 Deschutes 254of330 OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) FAAA Totals Part C "'" o 20D-20l5"'" 00 ********************* ~NFORMAT~ON ONLY ********************* o ~CONTRACTOR: DESCHUTES COUNTY CONTRACT#: l4l408 a DATE: 05/16/20l3 REF#: 001 CURRENT CURRENT PROPOSED REVISED SE# DESCRIPTION APPROVED PENDING CHANGE TOTAL 60 A&D-SPECIAL PROJECTS $0 $0 $l80,OOO $l80,OOO TOTAL SE# 60 $0 $0 $l80,OOO $l80,OOO $0 $0 $190,000 $l80,OOO NOTE: The amounts in the "REVISED TOTAL" column include amounts reported in the "CURRENT PENDING" column that have not yet been accepted/approved. Therefore, these amounts may change. N v. v. o...., \.oJ \.oJ o OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) FAAA Totals .j::. Summary .j::. o 2013-2015 OQ ********************* XNFORMATXON ONLY ********************* o 1"1 OJ' ~ COl.l.TTRACTOR: DESCHUTES COUNTY CONTRACT#: 141408 'it DATE: 05/16/20B REF#: 001 OJ' CURRENT CURRENT PROPOSED REVISED SE# DESCRIPTION APPROVED PENDING CHANGE TOTAL 60 A&D-SPECXAL PROJECTS $0 $0 $180,000 $180,000 TOTAL SE# 60 $0 $0 $180,000 $180,000 CONTRACT TOTAL $0 $0 $180,000 $180,000 NOTE: The amounts in the "REVISED TOTAL" column include amounts reported in the "CORRENT PENDING" column that have not yet been accepted/approved. Therefore, these amounts may change. N v, 0< o-, w w o OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) 2013-2015 CONTRACTOR: DESCHUTES COUNTY Contract#: 141408 DATE: 05/16/2013 Reference#: 002 MENTAL HEALTH SERVICES SECTION: 1 SERVICE REQUIREMENTS MEET EXHIBIT B AND, IF INDICATED, EXHIBIT B-2 Start/End Client Approved Approved Servo Unit EXHIB B2 Spec Part Dates Code Service Funds Start-up Units Type Codes Cond# SE# 1 LOCAL ADMIN MENTAL HEALTH SVCS A 7/2013-12/2013 M/A $24,960 $0 O. NA N/A MOOOO 1 A 7/2013-12/2013 M/A $103,000 $0 O. NA N/A MOOOO 2 A 7/2013-12/2013 M/A $24,960 $0 O. NA N/A MOOOO 3 A 7/2013-12/2013 N/A $18,447 $0 O. NA N/A MOOOO 4 SUBTOTAL SE# 1 $171,367 $0 SE# 20 NON-RESIDENTIAL ADULT MH SERV A 7/2013-12/2013 N/A $582 $0 O. NA tis/A MOOOO 7 A 7/2013-12/2013 HOMARY-S00609 $8,433 $0 O. NA N/A MOOOO 9 A 7/2013-12/2013 N/A $85,018 $0 96. SLT N/A MOOOO 8 A 7/2013-12/2013 N/A $28,296 $0 30. SLT N/A MOOOO 11 A 7/2013-12/2013 N/A $28,296 $0 30. SLT M/A MOOOO 12 A 7/2013-12/2013 N/A $9,466 $0 30. SLT M/A MOOOO 13 B 7/2013-12/2013 N/A $32,651 $0 O. NA N/A B 7/2013-12/2013 N/A $67,464 $0 48. SLT M/A MOOOO 6 B 7/2013-12/2013 N/A $67,464 $0 48. SLT M/A MOOOO 10 B 7/2013-12/2013 N/A $50,467 $0 60. SLT N/A MOOOO 14 B 7/2013-12/2013 N/A $50,467 $0 60. SLT N/A MOOOO 15 B 7/2013 6/2014 N/A $205,591 $0 O. NA N/A MOOOO 5 B 7/2014-6/2015 N/A $205,591 $0 O. NA N/A MOOOO S SUBTOTAL SE# 20 $839,786 $0 SE# 22 CHILD & ADOLES MH SERVICES B 7/2013-6/2014 N/A $61,145 $0 2. SLT 22A MOOOO 16 B 7/2014-6/2015 M/A $61,145 $0 2. SLT 22A MOOOO 16 SUBTOTAL SE# 22 $122,290 $0 SEi! 28 RESIDENTIAL TREATMENT SERVICES A 7/2013-12/2013 N/A $453,999 $0 96. SLT 28A MOOOO 18 A 7/2013-12/2013 HOMARY-500609 $24,126 $0 6. SLT 28A MOOOO 20 A 7/2013-12/2013 M/A $159,597 $0 30. SLT M/A MOOOO 17 A 7/2013-12/2013 N/A $159,897 $0 30. SLT N/A MOOOO 19 141408 Deschutes 257of330 I CONTRACTOR: DESCHUTES COUNTY Contract#: 141408 DATE: 05/16/2013 Reference#: 002 MENTAL HEALTH SERVICES SECTION: 1 SERVICE REQUIREMENTS MEET EXHIBIT B AND, IF INDICATED, EXHIBIT B-2 Start/End Client Approved Approved Servo Unit EXHIB B2 Spec Part Dates Code Service Funds Start-up units Type Codes Condit B 7/2013-12/2013 N/A $576,000 $0 96. SLT 28A B 7/2013-12/2013 N/A $364,466 $0 90. SLT N/A SUBTOTAL SEIt 29 $1,73!3,095 $0 SEn 31 ENHANCED CARE SERVICES B 7/2013-12/2013 N/A $109,248 $0 13140. CSD N/A SUBTOTAL SE# 31 $109,248 $0 SE# 34 ADUl.T FOSTER CARE MHS B 7/2013-12/2013 N/A $160,349 $0 O. NA N/A SUBTOTAL SEIt 34 $160,349 $0 SE# 35 OLDER/DISABLED ADULT MH SVCS A 7/2013-6/2014 N/A $9,367 $0 O. NA 35A A 7/2014-6/2015 N/A $9,367 $0 O. NA 35A SUBTOTAL SE# 35 $18,734 $0 SEn 36 PASARR MRS B 7/2013-6/2014 N/A $10,036 $0 O. NA N/A B 7/2014-6/2015 N/A $10,036 $0 O. NA N/A SUBTOTAL SEn 36 $20,072 $0 TOTAL SECTION 1 $3,179,931 $0 TOTAL AUTHORIZED FOR MENTAL HEALTH SERVICES $3,179,931 TOTAL AUTHORIZED FOR THIS FAAA: $3,179,931 141408 Deschutes 2580f330 OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) CONTRACTOR: DESCHUTES COUNTY Contract#: 141408 DATE: 05/16/2013 REF#: 002 REASON FOR FAAA (for information only) : The Financial Assistance Award is for Mental Health Services within the Governor's 2013-2015 Balanced Budget (GBB). Additional funding categories have been moved out of individual Service Elements and into MHS 37-Flexible Funding in this Agreement. Mental Health Residential funding has only been included for six months based o~ movement of funding and services to the Coordinated Care Organizations (CCo) beginning January 1, 2014. Payment of funds in this Financial Assistance Award is subject to Legislative approval of the Oregon Health Authority's 2013-2015 Budget, at the level proposed in the Governor's Balanced Budget or higher. The following special condition(s) apply to funds as indicated by the special condition number in column 9. Each special condition set forth below may be qualified by a full description in the Financial Assistance Award. MOOOO 1 A) Local Administration -Mental Health Services (MHS 01) Financial Assistance Associated with Specific Program Area: The financial assistance subject to this special condition is awarded for local administration of services in the Mental Health Services Program Area. If County terminates its obligation to include this Program Area under this Agreement, OHA shall have no obligation, after the termination, to payor disburse to County financial assistance subject to this special condition. B) These funds are for services at 12th Street RTH. MOOOO 2 A) Local Administration -Mental Health Services (MHS 01) Financial Assistance Associated with Specific Program Area: The financial assistance subject to this special condition is awarded for local administration of services in the Mental Health Services Program Area. If County terminates its obligation to include this Program Area under this Agreement, OHA shall have no obligation, after the termination, to payor disburse to County financial assistance subject to this special condition. B) These funds are for services at Deschutes Recovery Center SRTF. MOOOO 3 A) Local Administration -Mental Health Services (MHS 01) Financial Assistance Associated with Specific Program Area: The financial assistance subject to this special condition is awarded for local administration of services in the Mental Health Services Program Area. If County terminates its obligation to include this Program Area under this Agreement, OHA shall have no obligation, after the termination, to payor disburse to County financial assistance subject to this special condition. B) These funds are for services at Edgecliff RTH. MOOOO 4 A) Local Administration -Mental Health Services (MHS 01) Financial Assistance Associated with Specific Program Area: The financial assistance subject to this special condition is awarded 141408 Deschutes 2590[330 t I t i ~ I i I f j I I I f I I l I I for local administration of services in the Mental Health Services Program Area. If County terminates its obligation to include this Program Area under this Agreement, OHA shall have no obligation, after the termination, to payor disburse to County financial assistance subject to this special condition. B} These funds are for services at Hosmer RTH. MOOOO 5 These funds are for Habilitative services for 1915i eligible individuals residing in the community and not in a licensed residential program. MOOOO 6 These funds are for PSRB Rehabilitative Services. MOOOO 7 These funds are for Rental Assistance services. MOOOO 8 These funds are Center SRTF. for Rent Subsidy services at Deschutes Recovery MOOOO 9 These funds are for Treatment Services. 141408 Deschutes 260of330 MOOOO 10 These funds are for Rehabilitative Services. MOOOO 11 These funds are for Rent Subsidy services at 12th Street RTH. MOOOO 12 These funds are for Rent Subsidy services at Edgecliff RTH. MOOOO 13 These funds are for Rent Subsidy services at Hosmer RTH. MOOOO 14 These funds are for Treatment Services at 12th Street RTH. MOOOO 15 These funds are for Treatment Services at Edgecliff RTH. MOOOO 16 These funds are for Foster Care Treatment services. MOOOO 17 A) MHS 28 Rate: For services delivered to individuals during a particular month, ORA will provide financial assistance at the rate of $5,319.91 per month per individual. B) These funds are for 12th Street RTH. MOOOO 18 A) MHS 28 Rate: For services delivered to individuals during a particular month, ORA will provide financial assistance at the rate of $4,729.16 per month per individual. B) These funds are for Deschutes Recovery center SRTF. MOOOO 19 A) MHS 28 Rate: For services delivered to individuals during a particular month, ORA will provide financial assistance at the rate of $5,329.91 per month per individual. B) These funds are for Edgecliff RTH. MOOOO 20 A) MHS 28 Rate: For services delivered to individuals during a particular month, OHA will provide financial assistance at the rate of $4,021 per month per individual. B) These funds are for Deschutes Recovery center SRTF. 141408 Deschutes 261of330 00 """ """ o o (C V> (") ~CONTRACTOR: DESCHUTES COUNTY !j" DATE: 05/16/2013 SE# DESCRIPTION 1 LOCAL ADMIN MENTAL HEALTH SVCS TOTAL SE# 1 20 NON-RESIDENTIAL ADULT MH SERV 20 NON-RESIDENTIAL ADULT MH SERV TOTAL SE# 20 28 28 RESIDENTIAL RESIDENTIAL TREATMENT TREATMENT SERVICES SERVICES TOTAL SE# 28 OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) ********************* CURRENT APPROVED $0 $0 $0 $0 $0 $0 $0 $0 FAAA Totals Part A 2013-2015 INFORMATION ONLY ********************* CONTRACT#: 141408 REF#: 002 CURRENT PROPOSED PENDING CHANGE $0 $171,366 $0 $171,366 $0 $9,015 $0 $151,076 $0 $160,091 $0 $478,125 $0 $319,495 REVISED TOTAL $171,366 $171,366 $9,015 $151,076 $160,091 $478,125 $319,495 $0 $797,620 $797,620 35 OLDER/DISABLED ADULT MH SVCS $0 $0 $18,734 $18,734 TOTAL SE# 35 $0 $0 $lB,734 $18,734 $0 $0 $1,147,811 $1,147,811 NOTE: The amounts in the "REVISED TOTAL" colullUl that have not yet been accepted/approved. include amounts reported in the "CURRENT Therefore, these amounts may change. PENDING" column N a N o...., w w o OREGON HEALTH AUTHORITY Financial Assistance Award Amendment '(FAAA) FAAA Totals .j::. Part B-.j::. o 2013-2015 00 ********************* INFORMATION ONLY ********************* o ('l) ~CONTRACTOR : DESCHUTES COUNTY CONTRACT#: 141408 ~ DATE: 05/16/2013 REF#: 002 CURRENT CURRENT PROPOSED REVISED SE# DESCRIPTION APPROVED PENDING CHANGE TOTAL 20 NON-RESIDENTIAL ADULT MR SERV $0 $0 $443,832 $443,832 20 NON-RESIDENTIAL ADULT MH SERV $0 $0 $235,861 $23S,861 TOTAL SE# 20 $0 $0 $679,693 $679,693 22 CHILD & ADOLES MH SERVICES $0 $0 $122,291 $122,291 TOTAL SE# 22 $0 $0 $122,291 $122,291 28 RESIDENTIAL TREATMENT SERVICES $0 $0 $576,000 $576,000 28 RESIDENTIAL TREATMENT SERVICES $0 $0 $364,466 $364,466 TOTAL SE# 28 $0 $0 $940,466 $940,466 31 ENHANCED CARE SERVICES $0 $0 $109,248 $109,248 TOTAL SE# 31 $0 $0 $109,248 $109,248 34 ADULT FOSTER CARE MRS $0 $0 $160,349 $J.60,349 TOTAL SE# 34 $0 $0 $160,349 $160,349 '36 PASARR MRS $0 $0 $20,071 $20,071 NTOTAL SE# 36 $0 $0 $20,071 $20,071 ~ w 0...., w ~NOTE: The amounts in the "REVISED TOTAL" column include amounts reported in the "CURRENT PENDING" column that have not yet been accepted/approved. Therefore, these amounts may change. OREGON HEALTH AUTHORITY Financial Assistance Award Amendment (FAAA) FAAA Totals .... Part B .... o 2013-20l5 00 ********************* INFORMATION ONLY ********************* o ~ gCONTRACTOR: DESCHUTES COUNTY CONTRACT#: l41408 ~ DATE: 05/l6/2013 REF#: 002 SE# DESCRIPTION CURRENT APPROVED CURRENT PENDING PROPOSED CHANGE REV:r:SED TOTAL $0 9° $2,032,ll8 $2,032,ll8 NOTE: The amounts in the "REVISED TOTAL" column include amounts reported in the "CURRENT PENDING" column that have not yet been accepted/approved. Therefore, these amounts may change. N ~ o-. w w o OREGON HEALTH AUTHORIT~ Financial Assistance Award Amendment (FAAA) FAAA Totals ~ Summary-o ~ 2013-2015 IX> ********************* ~NFORMAT~ON ONLY ********************* ~ g CONTRACTOR: DESCHUTES COUNT~ CONTRACT#: 141408 ~ DATE: 05/16/2013 REF#: 002 CURRENT CURRENT PROPOSED REVISED SE# DESCRIPTION APPROVED PENDING CHANGE TOTAL 1 LOCAL ADMIN MENTAL HEALTH SVCS $0 $0 $171,366 $171,366 TOTAL SE# 1 $0 $0 $171,366 $171,366 20 NON-RESIDENTIAL ADULT ME SERV $0 $0 $452,847 $452,847 20 NON-RESIDENTIAL ADULT ME SERV $0 $0 $386,937 $386,937 TOTAL SE# 20 $0 $0 $839,784 $839,784 22 CHILD & ADOLES MH SERVICES $0 $0 $122,291 $122,291 TOTAL SE# 22 $0 $0 $122,291 $122,291 28 RESIDENTIAL TREATMENT SERVICES $0 $0 $1,054,125 $1,054,125 26 RESIDENTIAL TREATMENT SERVICES $0 $0 $683,961 $683,961 TOTAL SE# 28 $0 $0 $1,738,086 $1,738,086 31 ENHANCED CARE SERVICES $0 $0 $109,248 $109,248 TOTAL SE# 31 $0 $0 $109,248 $109,248 34 ADULT FOSTER CARE MHS $0 $0 $160,349 $160,349 I'-J TOTAL SE# 34 $0 $0 $UiO ,349 $160,349 '" v. S, 35 OLDER/DISABLED ADt."LT MH SVCS $0 $0 $18,734 . $18,734 w w o NOTE: The amounts in the n~-VISED TOTAL" column include amounts reported in the "CURRENT PENDING" column that have not been accepted/approved. Therefore, these amounts may change. OREGON HEALTH AUTHORITY Financial Assistance Award Amendment {FAAA} FAAA Totals ""'" Summary ""'"o 2013-2015 QO 10 ********************* INFORMATION ONLY ********************* I] ~ CONTRACTOR: DESCHUTES COUNTY CONTRACT#: 141408 (D '" DATE: 05/16/2013 REF#: 002 CURRENT CURRENT PROPOSED REVISED SE# DESCRIPTION APPROVED PENDING CHANGE TOTAL TOTAL SE# 35 $0 $0 $18,734 $18,734 36 PASARR MRS $0 $0 $20,071 $20, on TOTAL SE# 36 $0 $0 $20,071 $20, on CONTRACT TOTAL $0 $0 $3,179,929 $3,179,929 NOTE: The amounts in the "REVISED TOTAL" column include amounts reported in the "CURRENT PENDING" column that have not yet been accepted/approved. Therefore, these amounts may change. N 0 0 o-,"',"',o EXPLANATION OF FINANCIAL ASSISTANCE AWARD The Financial Assistance Award set forth above and any Financial Assistance Award amendment must be read in conjunction with this explanation for purposes of understanding the rights and obligations ofOHA and County reflected in the Financial Assistance Award. 1. Format and Abbreviations in Financial Assistance Award a. Heading. The heading of the Financial Assistance Award consists of the following information (I) County name, (2) the identification number ofthe Agreement of which the Financial Assistance Award is a part, and (3) the date of the Financial Assistance Award (which should be on or about the date of this Agreement). The Financial Assistance Award is then broken down by Program Area, with all Services in a particular Program Area that are awarded funds grouped together under the Program Area heading. The Financial Assistance Award may also be labeled as Section 1. This Section designation has no relevance to the original Financial Assistance Award and should be ignored. The Financial Assistance Award also contains a reference number which is used for administrative tracking purposes only and has no legal significance. b. Financial and Service Information. Each Service awarded funds is listed by its Service number and name (full or abbreviated). The amount of financial assistance awarded for the Service and certain other Service information is listed below the Service number and name on one or more lines. Financial assistance awarded for a particular Service may not be used to cover the costs of any other Service, except as permitted by section 3.a of Exhibit F ofthis Agreement. The funds set forth on a particular line will be disbursed in accordance with and are subject to the restrictions set forth on that line. The awarded funds, disbursement information and restrictions on a particular line are displayed in a columnar format as follows: (1) Column 1, Part: This column will contain the character A, B or C to indicate the method by which OHA will disburse the awarded funds. The disbursement method indicated in this column will usually be consistent with the disbursement method set forth in the Service Description for the particular Service. Occasionally, a disbursement method different than that set forth in the Service Description is necessary. And if a disbursement method specified in this column is different than the method set forth in the Service Description, the method specified in this column shall control. This column only identifies the disbursement method and is not relevant to determining whether County is ultimately entitled to payment. Payment entitlement is determined in accordance with the basis of payment set forth in the applicable Service Description and any disbursements to County in excess ofthe payments County is entitled to, as determined in accordance with the applicable basis of payment and through the Agreement Settlement process, will be recovered by OHA in accordance with the terms of this Agreement. The characters A, Band C signify the following disbursement methods: 141408 Deschutes 2670f330 (2) (3) (4) (5) (6) (a) The character A means OHA will disburse the awarded funds to County in substantially equal monthly allotments during the period set forth in column 2. (b) The character B means the funds are disbursed and paid under another agreement and are set forth in this Agreement for tracking purposes. (c) The character C means OHA will disburse the awarded funds in the manner specified in column 9. Column 2, Start/End dates: These dates speci fy the period during which it is expected that the Service or Service capacity, as applicable, will be delivered utilizing the approved service funds set forth on that line of the Financial Assistance Award. For purposes of disbursement method A (described above), these dates also specify the period during which the approved service funds will be disbursed to County. Column 3, Client Code: When a Client Code appears in this column the approved service funds set forth on that line of the Financial Assistance Award may only be expended on the delivery ofthe specified Service to the specified individual. When the approved service funds are not intended for any particular individual, an N/A designation will appear in this column. Column 4, Approved Service Funds: This is the amount awarded for delivery of the Service and is OHA's maximum obligation during the period specified on that line in support ofthe Services described on that line of the Financial Assistance Award Column 5, Approved Start-up: Iffunds appear in this column they may only be used to cover one-time expenses incurred in initiating, expanding or upgrading the specified Service or for other special one-time expenses related to the Service. Start-up funds may only be spent for the purposes specified in the special conditions appearing in column 9. Start-up funds may only be expended in accordance with Exhibit K ofthis Agreement and with start-up procedures within the applicable Service Elements. Column 6, Service Units: This is the amount of Service or Service capacity, as applicable, that OHA anticipates County to deliver during the period specified and utilizing the approved Service funds set forth on that line of the Financial Assistance Award. The Service or Service capacity, as applicable, must be delivered in relatively equal amounts over the course of the period specified on that line of the Financial Assistance Award. This column will read zero if the basis of payment set forth in the applicable Service Description is not tied to actual delivery of Services or Service capacity. This column must be read in conjunction with column 7. 141408 Deschutes 2680[330 I (7) Column 7, Unit Type: The unit type is the unit of measurement associated with the Service units set forth in column 6. The unit types are Iexpressed in three character designations that have the following meanings: I (a) CSD: One CSD (or Client Service Day) is one day of Service or I Service capacity, as applicable, delivered to one individual or t lmade available for delivery to one individual, as applicable. J f (b) N/A: N/A means unit type is not applicable to the particular line t(c) SLT: One SLT (or Slot) is the delivery or capacity to deliver, as lapplicable, the Service to an individual during the entire period Ispecified in the corresponding line of the Financial Assistance IAward. ! (8) Column 8, Exhibit B-2 Codes: The codes appearing in this column correspond to the Specialized Service Requirement Codes for the ISpecialized Service Requirements described in Exhibit 8-2. If a Specialized Service Requirement Code appears in this column, the Service I must be delivered in accordance with the Specialized Service I Requirements when the Service is delivered with approved service funds Iset forth on that line of the Financial Assistance Award. !(9) Column 9, Special Conditions: These are the special conditions, if any, that must be complied with when providing the Service using approved service funds set forth on that line of the Financial Assistance Award. For certain Services, the special conditions specify the rate at which financial I assistance will be calculated for delivery of that Service or delivery of capacity for that Service. The special conditions are identified by an alphanumeric code. A table or tables listing the special conditions by I alphanumeric code is included in the Financial Assistance Award I2. Format and Abbreviations in Financial Assistance Award Amendments. The format I and abbreviations in a Financial Assistance Award amendment are the same as those used in the initial Financial Assistance Award. If a Financial Assistance Award amendment amends the financial and service information in the Financial Assistance Award, each Ifinancial and service information line in the amendment will either amend an existing ! l line in the financial and service information of the Financial Assistance Award or constitute a new line added to the financial and service information of the Financial Assistance Award. A financial and service information line in a Financial Assistance Award amendment (an "Amending Line") amends an existing line of the Financial l Assistance Award (a "Corresponding Line") if the line in the Financial Assistance Award ; amendment awards funds for the same Service, specifies the same CPMS Name (if I applicable), and specifies the same Exhibit 8-2 code as an existing line (as previously t amended, if at all) in the Financial Assistance Award and specifies a date range falling within the date range specified in that existing line (as previously amended, if at all). If f an Amending Line has a positive number in the approved service funds column, those I funds are added to the approved service funds of the Corresponding Line for the period specified in the Amending Line. If an Amending Line has a negative number in the I i I 141408 Deschutes 2690f330 approved service funds column, those funds are subtracted from the approved service funds of the Corresponding Line for period specified in the Amending Line. If an Amending Line has a positive number in the service units column, those service units are added to the service units in the Corresponding Line for the period specified in the Amending Line. If an Amending Line has a negative number in the service units column, those units are subtracted from the service units in the Corresponding Line for the period specified in the Amending Line. All Special Conditions identified in a Corresponding Line apply to funds identified on an Amending Line (unless a Special Condition or portion thereof on an Amending Line specifies a rate). Ifan Amending Line contains a Special Condition or portion of a Special Condition that specifies a rate, that Special Condition or portion thereof replaces, for the period specified in the Amending Line, any Special Condition or portion thereof in the Corresponding Line that specifies a rate. If a financial and service information line in a Financial Assistance Award amendment is not an Amending Line, as described above, it is a new line added to the Financial Assistance Award. 141408 Deschutes 2700f330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES OWITS Financial Assistance Award EXHffiITD-2 OREGON HEALTH AUTHORITY OWITS FINANCIAL ASSISTANCE A WARD 2013-2015 CONTRACTEE: CONTRACT#: DATE: BASE/AMENDMENT# (This line will be labeled "Base for initial Agreement or "Amendment #" for amendments) ADDICTIONS AND MENTAL HEALTH SERVICES SERVICE REQUIREMENTS MEET EXHIBIT B, MHS 37 -FLEXIBLE FUNDING Fund Source Description Start Date End Date Approved Funding Payment Special Level Frequency Condition TOTAL AUTHORIZED AMOUNT: $ (This line will be used for initial Agreement, will be blank for amendments ) TOTAL AUTHORIZED AMOUNT OF THIS AMENDMENT: $(This line will be used for amendments only) BASE FUNDING PURPOSE: (This line will be used for initial Agreement, will be blank for amendments) AMENDMENT REASON: (This line will be used for amendments only) 141408 Deschutes 271 of330 00 OREGON HEALTH AUTHORITY """ owrrs FINANctAL ASSfSTANCEAWARD """ 2013-2015o o (1) ~ ::r-Exhibit 0-2S. (1) V> 141408CONTRACT Deschutes County CONTRACT#; NAME: EFFECTIVE 07/01/2013 BASE/AMENDMENT #; Base Funding DATE: ADDICTIONS AND MENTAL HEALTH SER'I.lCES SERVICE REQUIREMENTS MEET EXHlBrr B, MHS ':!i7-FLexIBLE FUNDING Deschutes Count}c-141408 t-) -.JIv o...., w w o Fund Source Description Start Date End Date Approved Funding Level Payment Frequency Special Condition 0300 COMM MH BLOCK EVEN YR FF 93.958 SUB RECIPIENT 07/0112013 0313112014 $79,650.36 Monthly These funds may only be used in accordance with federal regulations related to MH Block Grant 10420 BEER AND WlNE 200k TREATMENT OF VENDOR 07/0112013 06/3012014 $33,745.50 Monthly These funds may only be used in accordance with state statutes related to Beer and Wine 20. 0421 BEER AND WINE 40% TREATMENT OF VENDOR 07/0112013 0613012014 $60,741.50 Monthly These funds may only be used in accordance with state statutes related to Beer and Wine 40. 0422 BEER AND WINE 40% PREVENTION OF VENDOR 07/0112013 06130/2014 $7,779.00 Monthly These funds may only be used in accordance with state statutes related to Beer and Wine 40. 0424A&D IDP-OUTPAllENT OF VENDOR 07/0112013 0613012014 $50,496.00 Monthly These funds are for IDPF Outpatient Services. 0426 A&D CFA-PREVENTION OF VENDOR 0710112013 0613012014 $468.00 Monthly These funds are for IDPF Outpatient Services. 0520 SAPT GR TREATMENT FF 93.959 SUa.. RECIPIENT 07/0112013 06130/2014 $340,856.00 Monthly -- These funds may only be used in accordance with federal regulations related to SAPT Block Grsnl ---... ~- --' "----.. ---" .._-- EXPLANATION OF OWITS FINANCIAL ASSISTANCE AWARD The Financial Assistance Award set forth above and any Financial Assistance Award amendment must be read in conjunction with this explanation for purposes of understanding the rights and obligations of aHA and County reflected in the OWITS Financial Assistance Award. 1. Format in OWITS Financial Assistance Award a. Heading. The heading of the OWITS Financial Assistance Award consists of the following information: (]) County name, (2) the identification number of the Agreement of which the Financial Assistance Award is a part, (3) the date of the Financial Assistance Award (which should be on or about the date of this Agreement) and (4) "BASE" as an indicator of initial funding of this Agreement or "AMENDMENT" for subsequent Amendments followed by Amendment number. b. Financial and Service Information The funds set forth on a particular line will be disbursed in accordance with and are subject to the restrictions set forth in a special condition on that line. The awarded funds, fund source, service dates, payment frequency and conditions on a particular line are displayed in a columnar format as follows: (1) Column 1, Fund Source Description: This column will contain a description of the fund source which includes the AMH fund number and title of the fund source. (2) Columns 2 and 3, Start and End dates: These dates specifY the period during which it is expected that the Services will be delivered utilizing the approved service funds set forth on that line ofthe OWITS Financial Assistance Award. For purposes of disbursement these dates also specifY the period during which the approved service funds will be disbursed to County (3) Column 4, Approved Funding Level: This is the amount awarded for delivery of Service from a specified funding source and is aHA's maximum obligation during the period specified on that I ine in support of Services described on that line ofthe OWlTS Financial Assistance Award. (4) Column 5, Payment Frequency: This column only identifies the payment frequency on that line and is not relevant to determining whether County is ultimately entitled to payment. Payment entitlement is determined in accordance with the basis of payment set forth in Exhibit MHS 37 -Flexible Funds. (5) Column 6, Special Conditions: These are the special conditions, if any, that must be complied with when providing Services using approved funds set forth on that line ofthe OWITS Financial Assistance Award. 141408 Deschutes 2750f330 c. OWITS Financial Assistance Award Calculations. This amount is a calculation of all funding lines in this OWITS Financial Assistance Award. (1) If Exhibit 0-2 is for funding ofthe initial Agreement, the calculated amount will be labeled "Total Authorized Amount" If Exhibit 0-2 is for amended funding ofthis Agreement, the calculated amount will be labeled "Total Authorized Amount for this Amendment." (2) If Exhibit 0-2 is for funding of the initial Agreement, the purpose ofthis funding will be preceded by "Base Funding Purpose." If Exhibit 0-2 is for amended funding of this Agreement, the purpose will be preceded by "Amendment Reason." 14) 408 Deschutes 276of330 Deschutes County-141408 ..,. -..,. o 00 o OJ n ::T ~ tv "'-I W o...., w w o Fund Source Description 0530 SAPT GR PREVENTION FF 93.959 SUB-RECIPIENT 0804 MH GENERAL FUND GF VENDOR oaoa AM> PREVENTION GF VENDOR 0908 A&D ITRS TANF (GF MATCH) GF VENDOR 0804 MH GENERAL FUND GF VENDOR 0301 COMM MH BLOCK ODD YR FF 93.958 SUB-RECIPIENT 0301 COMM MH BLOCK ODD YR FF 93.958 SUB-RECIPIENT 0420 BEER AND WINE 20% TREATMENT OF, VENDOR 0421 BEER'AND WINE 40% TREATMENT OF VENDOR 0422 BEER AND WINE 40% PREVENTION OF VENDOR 0424 A&D IDP-oUTPATIENT OF VENDOR 0426 A&D CFA-PREVENTION OF VENDOR 0520 SAPT GR TREATMENT Ff 93.959 SUB- RECIPIENT 0530 SAPT GR PREVENTION FF 93.959 SUB-RECIPIENT 0804 MH GENERAL FUND GF VEMDOR OB08 A&D PREVENTION GF VENDOR 0908A&D ITRSTANF (GF MATCH) GF VENDOR Start Date End Date 07101/2013 06130/2014 07/0112013 12/31/2013 07/0112013 0613012014 07/01/2013 06.13012014 01/0112014 06.13012014 04/0112014 0613012014 07/0112014 0313112015 07/01/2014 0613012015 07/0112014 0613012015 0710112014 06.13012015 07/0112014 06.13012015 07/0112014 0613012015 '0710112014 0613012015 07/0112014 06.13012015 $340,856.00 07/0112014 0613012015 07/0112014 0613012015 $2,139,731.19 07/01/2014 0613012015 Approved Payment Special Condition IFunding Level Frequency $87,781.00 Monthly These funds may only be used in accordance with federal regulations related to SAPT Block Grant. $1,720,254.84 Monthly $4,597.00 Monthly I $147,788.00 Monthly $1.069,865.59 Monthly $26,550.12 Monthly These funds may only be used in accordance with federal regulations related to MH Block Grant $79,650.36 Monthly These funds may only be used in accordance. with federal regulations related to MH Block: Grant $33,745.50 Monthly These funds may only be used in accordance with state siatutes related to Beer and Wine 20. $60,741.50 Monthly These funds may only be used in accordance with state statutes related to Beer and Wine 40. $7,779.00 Monthly These funds may only be used in accordance with state stawtes related to Beer and Wine 40. ' $50,496.00 Monthly These funds are for IDPF Outpatient Services. $468.00 Monthly These funds are for IDPF Outpatient Services. Monthly These funds may only be used in accordance with federal regulations related to $APT Block Grant. Monthly These funds may only be used in accordance with federal regulations related to SAPT Block Grant. Monthly Monthly $147,788.00 $87,781.00 $4,597.00 Monthly 00 Desd'tutes County-14140S ..,. ~ o ('V Vl (") ;:; c: 1i Fund Source Description Start Date End Date Approved Funding Level Payment Frequency Special Condition : , 0300 COMM MH BLOCK EVEN YR FF 93.958 SUB RECIPrENT 04/01/2015 0613012015 $26,550.12 Monthly These funds may only be used in accordance with federal regulations related to MH Block Grant Total Authori2:ed Amount $6,610,756.58 . Base Funding Purpose: The Financial Assistance Award in MHS 37~Flexible Funding is within the Governor's 2013-2015 Balanced Budget and is subject to Legislative approval of OHA's 2013-2015 Budget, at the level proposed in the Governor's Balanced Budget or higher. . N ..,. o....., vJ VJ o ---•.. ------------~.------------------- -.l 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITE SPECIAL TERMS AND CONDITIONS 1. County Expenditures on Addiction Services. In accordance with ORS 430.345 to 430.380 (the "Mental Health Alcoholism and Drug Services Account" also known as the "Beer and Wine Tax Account"), County shall maintain its 2013-2014 financial contribution to alcohol and other drug treatment and prevention services at an amount not less than that for fiscal year 2012-2013. Furthermore, and in accordance with the Beer and Wine Tax Account, County shall maintain its 2014-2015 financial contribution to alcohol and other drug treatment and prevention services at an amount not less than that for fiscal year 2013-2014. OHA may waive all or part of the financial contribution requirement in consideration of severe financial hardship or any other grounds permitted by law. 2. Limitations on use of Financial Assistance Awarded for Addiction Services. Financial assistance awarded under this Agreement for Addiction Services (as reflected in the Financial Assistance Award), may not be used: a. To provide inpatient hospital services; b. To make cash payments to intended recipients of health services; c. To purchase or improve land, to purchase, construct or permanently improve (other than minor remodeling) any building or other facility or to purchase major medical equipment; d. To satisfY any requirement for expenditure of non-federal funds as a condition for receipt of federal funds (whether the federal funds are Federal Funds under this Agreement or otherwise); or e. To carry out any program prohibited by section 256(b) of the Health Omnibus Programs Extension Act of 1988 (codified at 42 U.S.C. 300ee-5). 3. County shall maintain separate fund balances for the Mental Health, Alcohol and Drug and Problem Gambling Services. 141408 Deschutes 271 of330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITF GENERAL TERMS AND CONDITIONS 1. Disbursement and Recovery of Financial Assistance. a. Disbursement Generally. Subject to the conditions precedent set forth below, OHA shall disburse the financial assistance described in the Financial Assistance A ward to County in accordance with the procedures set forth below and, as applicable, in the Service Descriptions and the Financial Assistance A ward. Disbursement procedures may vary by Service. (1) Disbursement of Financial Assistance Awarded for Services in Financial Assistance Award. As set forth in the Service Description for a particular Service, OHA will generally disburse financial assistance that is described in the Financial Assistance A ward to County in monthly allotments in advance of actual delivery of the Service. (2) Disbursements Remain Subject to Recovery. All disbursements of financial assistance under this Agreement, including disbursements made directly to Providers, remain subject to recovery from County, in accordance with Section l.c.(1), as an Underexpenditure, Overexpenditure or Misexpenditure. b. Conditions Precedent to Disbursement. OHA's obligation to disburse financial assistance to County under this Agreement is subject to satisfaction, with respect to each disbursement, of each of the following conditions precedent: (1) No County default as described in Section 6 of Exhibit G has occurred. (2) County's representations and warranties set forth in Section 4 of Exhibit G are true and correct on the date of disbursement with the same effect as though made on the date of disbursement. c. Recovery of Financial Assistance. (1) Notice of Underexpenditure, Overexpenditure or Misexpenditure. If OHA believes there has been an Underexpenditure or Overexpenditure (as defined in Exhibit A) of moneys disbursed under this Agreement, OHA shall provide County with written notice thereof and OHA and County shall engage in the process described in Section l.c.(2) below. If OHA believes there has been a Misexpenditure (as defined in Exhibit A) of moneys disbursed to County under this Agreement, OHA shall provide County with written notice thereof and OHA and County shall engage in the process described in Section 1.c.(3) below. 14 J408 Deschutes 2780f330 (2) Recovery of Underexpenditure or Overexpenditure. (a) County's Response. County shall have 90 calendar days from the effective date of the notice of Under expenditure or Overexpenditure to pay OHA in full or notify OHA that it wishes to engage in the appeals process set forth in Section ] .c.(2)(b) below. IfCounty fails to respond within that 90 day time period, County shall promptly pay the noticed Underexpenditure or Overexpenditure. (b) Appeals Process. IfCounty notifies OHA that it wishes to engage in the appeals process, County and OHA shall engage in non binding discussions to give the County an opportunity to present reasons why it believes that there is no Underexpenditure or Overexpenditure, or that the amount of the Underexpenditure or Overexpenditure is different than the amount identified by OHA, and to give OHA the opportunity to reconsider its notice. County and OHA may negotiate an appropriate apportionment of responsibility for the repayment of an Underexpenditure or Overexpenditure. At County request, OHA will meet and negotiate with County in good faith concerning appropriate apportionment of responsibility for repayment of an Underexpenditure or Overexpenditure. In determining an appropriate apportionment of responsibility, County and OHA may consider any relevant factors. An example of a relevant factor is the extent to which either party contributed to an interpretation of a statute, regulation or rule prior to the expenditure that was officially reinterpreted after the expenditure. IfOHA and County reach agreement on the amount owed to OHA, County shall promptly repay that amount to OHA by issuing payment to OHA or by directing OHA to withhold future payments pursuant to Section 1.(c)(2)(c) below. IfOHA and County continue to disagree as to whether there has been an Underexpenditure or Overexpenditure or as to the amount owed, the parties may agree to consider further appropriate dispute resolution processes, including, subject to Department of Justice and County Counsel approval, arbitration. (c) Recovery From Future Payments. To the extent that OHA is entitled to recover an Underexpenditure or Overexpenditure pursuant to Section] .c.(2), OHA may recover the Underexpenditure or Overexpenditure by offsetting the amount thereof against future amounts owed to County by OHA, including, but not limited to, any amount owed to County by OHA under any other contract or agreement between County and OHA, present or future. OHA shall provide County written notice of its intent to recover the amount of the Underexpenditure or Overexpenditure from amounts owed County by OHA as set forth in this Section, and shall identify the amounts owed by OHA which OHA intends to offset, (including the contracts or J41408 Deschutes 2790f330 agreements, if any, under which the amounts owed arose and from those OHA wishes to deduct payments from). County shall then have 14 calendar days from the date of OHA's notice in which to request the deduction be made from other amounts owed to County by OHA and identified by County. OHA shall comply with County's request for alternate offset. In the event that OHA and County are unable to agree on which specific amounts, owed to County by OHA, OHA may offset in order to recover the amount of the Underexpenditure or Overexpenditure, then OHA may select the particular contracts or agreements between OHA and County and amounts from which it will recover the amount of the Underexpenditure or Overexpenditure, after providing notice to the County and within the following limitations: OHA shall first look to amounts owed to County (but unpaid) under this Agreement. If that amount is insufficient, then OHA may look to any other amounts currently owing or owed in the future to County by OHA. In no case, without the prior consent of County, shall OHA deduct from anyone payment due to County under the contract or agreement from which OHA is offsetting funds an amount in excess of twenty-five percent (25%) of that payment. OHA may look to as many future payments as necessary in order to fully recover the amount of the Underexpenditure or Overexpenditure. (3) Recovery of Misexpenditure. (a) County's Response. From the effective date ofthe notice of Misexpenditure, County shall have the lesser of (l) 60 calendar days, or (2) if a Misexpenditure relates to a federal government request for reimbursement, 30 calendar days fewer than the number of days (if any) OHA has to appeal a final written decision from the federal government, to either: i. Make a payment to OHA in the full amount of the noticed Misexpenditure identified by OHA; or ii. Notify OHA that County wishes to repay the amount of the noticed Misexpenditure from future payments pursuant to Section I.c.(3)( c). below; or iii. NotifY OHA that it wishes to engage in the applicable appeal process set forth in Section 1.c.(3)(b). below. If County fails to respond within the time required by this Section, OHA may recover the amount of the noticed Misexpenditure from future payments as set forth in Section I.c.(3)(b). below. (b) Appeal Process. IfCounty notifies OHA that it wishes to engage in an appeal process with respect to a noticed Misexpenditure, the parties shall comply with the following procedures, as applicable: \. Appeal from OHA-Identified Misexpenditure. IfOHA's notice of Mis expenditure is based on a Misexpenditure solely of the type described in Section 21(b) or (c) of 141408 Deschutes 2800[330 Exhibit A, County and OHA shall engage in the process described in this Section to resolve a dispute regarding the noticed Misexpenditure. First, County and OHA shall engage in non-binding discussions to give the County an opportunity to present reasons why it believes that there is, in fact, no Misexpenditure or that the amount of the Misexpenditure is different than the amount identified by OHA, and to give OHA the opportunity to reconsider its notice. County and OHA may negotiate an appropriate apportionment of responsibility for the repayment of a Misexpenditure. At County request, OHA will meet and negotiate with County in good faith concerning appropriate apportionment of responsibility for repayment of a Misexpenditure. In determining an appropriate apportionment of responsibility, County and OHA may consider any relevant factors. An example of a relevant factor is the extent to which either party contributed to an interpretation of a statute, regulation or rule prior to the expenditure that was officially reinterpreted after the expenditure. IfOHA and County reach agreement on the amount owed to the OHA County shall promptly repay that amount to OHA by issuing payment to OHA or by directing OHA to withhold future payments pursuant to Section 1.c.(3)(c) below. IfOHA and County continue to disagree as to whether there has been a Misexpenditure or as to the amount owed, the parties may agree to consider further appropriate dispute resolution processes, including, subject to Department of Justice and County Counsel approval, arbitration. ii. Appeal from Federal-Identified Misexpenditure. A. IfOHA's notice of Misexpenditure is based on a Misexpenditure of the type described in Section 21(a) of Exhibit A and the relevant federal agency provides a process either by statute or administrative rule to appeal the determination of improper use of federal funds, the notice of I disallowance or other federal identification of improper use of funds, and if the disallowance is not f based on a federal or state court judgment founded in allegations of Medicaid fraud or abuse, then County may, prior to 30 days prior to the applicable federal appeals deadline, request that OHA appeal the determination of improper use, notice of disallowance or other federal identification of improper use of funds in accordance with the process established or adopted by the federal agency. If County so requests that OHA appeal the determination of improper use of federal funds, 141408 Deschutes 28t 0[330 B. federal notice of disallowance or other federal identification of improper use of funds, the amount in controversy shall, at the option of County, be retained by the County or returned to OHA pending the final federal decision resulting from the initial appeal. If the County does request, prior to the deadline set forth above, that OHA appeal, OHA shall appeal the determination of improper use, notice of disallowance or other federal identification of improper use of funds in accordance with the established process and shall pursue the appeal until a decision is issued by the Departmental Grant Appeals Board of the Department of Health and Human Services (the "Grant Appeals Board") pursuant to the process for appeal set forth in 45 C.F .R. Subtitle A, Part 16, or an equivalent decision is issued under the appeal process established or adopted by the federal agency. County and OHA shall cooperate with each other in pursuing the appeal. If the Grant Appeals Board or its equivalent denies the appeal then either County, OHA, or both may, in their discretion, pursue further appeals. Regardless of any further appeals, within 90 days of the date the federal decision reSUlting from the initial appeal is final, County shall repay to OHA the amount of the noticed Misexpenditure (reduced, ifat all, as a result of the appeal) by issuing payment to OHA or by directing OHA to withhold future payments pursuant to Section l.c.(3)(c) below. To the extent that County retained any of the amount in controversy while the appeal was pending, the County shall pay to OHA the interest, if any, charged by the federal government on such amount. If the relevant federal agency does not provide a process either by statute or administrative rule to appeal the determination of improper use of federal funds, the notice of disallowance or other federal identification of improper use of funds or County does not request that OHA pursue an appeal 30 days prior to the applicable federal appeals deadline, and ifOHA does not appeal, then within 90 days of the date the federal determination of improper use of federal funds, the federal notice of disallowance or other federal identification of improper use of funds is final County shall repay to OHA the amount of the noticed Misexpenditure by issuing a payment to 141408 Deschutes 2820f330 OHA or by directing OHA to withhold future payments pursuant to Section l.c.(3)(c) below. C. If County does not request that OHA pursue an appeal of the determination of improper use of federal funds, the notice of disallowance or other federal identification of improper use of funds, prior to 30 days prior to the applicable federal appeals deadline but OHA nevertheless appeals, County shall repay to OHA the amount of the noticed Misexpenditure (reduced, if at all, as a result of the appeal), within 90 days of the date the federal decision resulting from the appeal is final, by issuing payment to OHA or by directing OHA to withhold future payments pursuant to Section l.c.(3)(c). below. D. Notwithstanding Section l.c.(3)(a)(i) through iii., if the Misexpenditure was expressly authorized by a OHA rule or an OHA writing that applied when the expenditure was made, but was prohibited by federal statutes or regulations that applied when the expenditure was made, County will not be responsible for repaying the amount of the Misexpenditure to OHA, provided that: (i) Where post-expenditure official reinterpretation of federal statutes or regulations results in a Misexpenditure, County and OHA will meet and negotiate in good faith an appropriate apportionment of responsibility between them for repayment of the Misexpenditure. (ii) For purposes ofthis Section, an OHA writing must interpret this Agreement or an OHA rule and be signed by the Director of OHA or by the Assistant Director of Addictions and Mental Health Services Division. OHA shall designate an alternate officer in the event the Addictions and Mental Health Services Division is abolished. Upon County request, OHA shall notify County of the names of the individual officers listed above. OHA shall send OHA writings described in this paragraph to County by mail and email and to CMHP directors by email. 141408 Deschutes 2830f330 (c) (iii) The writing must be in response to a request from County for expenditure authorization, or a statement intended to provide official guidance to County or counties generally for making expenditures under this Agreement. The writing must not be contrary to this Agreement or contrary to law or other applicable authority that is clearly established at the time of the writing. (iv) IfOHA writing is in response to a request from County for expenditure authorization, the request must be in writing and signed by the director of a County department with authority to make such a request or by the County Counsel. It must identify the supporting data, provisions of this Agreement and provisions of applicable law relevant to determining if the expenditure should be authorized. (v) An OHA writing expires on the date stated in the writing, or if no expiration date is stated, six years from the date ofthe writing. An expired OHA writing continues to apply to County expenditures that were made in compliance with the writing and during the term of the writing. (vi) OHA may revoke or revise an OHA writing at any time if it determines in its sole discretion that the writing allowed expenditure in violation of this Agreement or law or any other applicable authority. (vii) OHA rule does not authorize an expenditure that this Agreement prohibits. Recovery From Future Payments. To the extent that OHA is entitled to recover a Misexpenditure pursuant to Section l.c.(3)(b)(i) and (ii)., OHA may recover the Misexpenditure by offsetting the amount thereof against future amounts owed to County by OHA, including, but not limited to, any amount owed to County by OHA under this Agreement or any amount owed to County by OHA under any other contract or agreement between County and OHA, present or future. OHA shall provide County written notice of its intent to recover the amount of the Misexpenditure from amounts owed County by OHA as set forth in this Section, and shall identify the amounts owed by OHA which OHA intends to offset (including the contracts or agreements, if any, under which the amounts owed arose and from ) 4) 408 Deschutes 284of330 those OHA wishes to deduct payments from). County shall then have 14 calendar days from the date of OHA's notice in which to request the deduction be made from other amounts owed to County by OHA and identified by County. OHA shall comply with County's request for alternate offset. In the event that OHA and County are unable to agree on which specific amounts, owed to County by OHA, OHA may offset in order to recover the amount of the Misexpenditure, then the OHA may select the particular contracts or agreements between OHA and County and amounts from which it will recover the amount of the Misexpenditure, after providing notice to the County, and within the following limitations: OHA shall first look to amounts owed to County (but I unpaid) under this Agreement. If that amount is insufficient, then OHA may look to any other amounts currently owing or owed in the future to County by OHA. In no case, without the prior consent of County, shall OHA deduct from anyone payment due I County under the contract or agreement from which OHA is offsetting funds an amount in excess of twenty-five percent (25%) of that payment. OHA may look to as many future payments as necessary in order to fully recover the amount of the Misexpenditure. (4) Additional Provisions related to parties rights/obligations with respect to Underexpenditures, Overexpenditures and Misexpenditures. (a) County shall cooperate with OHA in the Agreement Settlement process. (b) OHA's right to recover Underexpenditures, Overexpenditures and Misexpenditures from County under this Agreement is not subject to or conditioned on County's recovery of any money from any other entity. (c) If the exercise ofOHA's right to offset under this provision requires the County to complete a re-budgeting process, nothing in this provision shall be construed to prevent the County from fully complying with its budgeting procedures and obligations, or from implementing decisions resulting from those procedures and obligations. (d) Nothing in this provision shall be construed as a requirement or agreement by the County to negotiate and execute any future contract with OHA. (e) Nothing in this Section shall be construed as a waiver by either party of any process or remedy that might otherwise be available. 2. Use of Financial Assistance. County shall use the financial assistance disbursed to County under this Agreement solely to cover actual Allowable Costs reasonably and f necessarily incurred to deliver Services during the term of this Agreement. I I I 141408 Deschutes 2850f330 3. Award Adjustments a. Except for MHS 37-Flexible Funding pursuant to Exhibit 0-2, County may use funds awarded in a Program Area to cover actual Allowable Costs reasonably and necessarily incurred to deliver Services in that Program Area, from the effective date of this Agreement through the termination or expiration ofthis Agreement. In addition to the financial assistance provided to County under this Agreement expressly for those Services, up to 10 percent of the aggregate financial assistance awarded to County at the time the use occurs (as such award is reflected in the Financial Assistance Award without giving effect to any prior adjustments under this Section 3 and other than from Federal Funds) County may use funds for other Services in that Program Area (other than financial assistance provided to County for MHS 26, MHS 27, MHS 37-Start-Up, A&D 61, A&D 60-Start-Up, and A&D 82 which is not subject to this 10 percent use adjustment). IfCounty uses financial assistance described in the Financial Assistance Award in reliance on this Section 3.a, County shall promptly notifY in writing of such use. b. Financial Assistance disbursed to County under this Agreement that County would be entitled to retain if used prior to the termination or expiration of this Agreement (as calculated in accordance with the methodologies set forth in the applicable Service Descriptions), may be retained by County even ifnot used prior to the termination or expiration of this Agreement provided that other provisions of this Agreement do not require the financial assistance to be used by County prior to termination or expiration of this Agreement and provided further that County uses the financial assistance solely to deliver future Services for the purpose it was originally awarded. 4. Amendments Proposed by OHA. a. Amendments of Financial Assistance Award. County shall review all proposed amendments to the Financial Assistance Award prepared and presented to County by OHA in accordance with this Section promptly after County's receipt thereof. Amendments to the Financial Assistance Award will be presented to County in electronic form. OHA may withdraw a proposed amendment by and effective upon written notice to County. lfnot sooner accepted or rejected by County, or withdrawn by OHA, a proposed amendment shall be deemed rejected by County 60 days after County's receipt thereof and OHA's offer to amend the Financial Assistance Award shall be automatically revoked. IfCounty chooses to accept a proposed amendment presented in electronic form, County shall return the proposed amendment to OHA signed by the County Financial Assistance Administrator. Upon OHA's actual physical receipt and signature ofa proposed amendment signed by the County Financial Assistance Administrator but otherwise unaltered, the proposed amendment shall be considered accepted by the parties and the Financial Assistance Award as amended by the proposed amendment, shall become the Financial Assistance Award under this Agreement. IfCounty returns a proposed amendment altered in any way (other than by signature ofthe County Financial Assistance Administrator), OHA may, in its discretion, accept the proposed amendment as altered by County but only if the County Financial Assistance Administrator has initialed each alteration. A proposed amendment altered by County and returned to OHA shall be considered 141408 Deschutes 286of330 accepted by OHA on the date OHA initials each alteration and on that date the Financial Assistance Award, as amended by the proposed amendment (as altered), shall become the Financial Assistance Award. b. Other Amendments. County shall review all proposed amendments to this Agreement prepared and presented to County by OHA, other than those described in Section 4.a. of this Exhibit, promptly after County's receipt thereof. If County does not accept a proposed amendment within 60 days of County's receipt thereof, County shall be deemed to have rejected the proposed amendment and the offer to amend the Agreement, as set forth in the proposed amendment, shall be automatically revoked. IfCounty chooses to accept the proposed amendment, County shall return the proposed amendment to OHA signed by a duly authorized County official. Upon OHA's actual physical receipt and signature ofa proposed amendment signed by a duly authorized County official but otherwise unaltered, the proposed amendment shall be considered accepted by the parties and this Agreement shall be considered amended as set forth in the accepted amendment. IfCounty returns a proposed amendment altered in any way (other than by signature of a duly authorized County official), OHA may, in its discretion, accept the proposed amendment as altered by County but only if a duly authorized County official has initialed each alternation. A proposed amendment altered by County and returned to OHA shall be considered accepted by OHA on the date OHA initials each alteration and on that date this Agreement shall be considered amended as set forth in the accepted amendment. S. Provider Contracts. Except when the Service expressly requires the Service or a portion thereofto be delivered by County directly and subject to Section 6 of this Exhibit F, County may use financial assistance provided under this Agreement for a particular Service to purchase that Service, or a portion thereof, from a third person or entity (a "Provider") through a contract (a "Provider Contract"). Subject to Section 6 of this Exhibit F, County may permit a Provider to purchase the Service, or a portion thereof, from another person or entity under a subcontract and such subcontractors shall also be considered Providers for purposes of this Agreement and the subcontracts shall be considered Provider Contracts under this 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 Service. Except for MHS 20 emergency services, ifCounty purchases a Service, or portion thereof, from a Provider, the Provider Contract must be in writing and contain each of the provisions set forth on Exhibit I, in substantially the form set forth therein, in addition to any other provisions that must be included to comply with applicable law, that must be included in a Provider Contract under the terms of this Agreement or that are necessary to implement Service delivery in accordance with the applicable Service Descriptions, Specialized Service Requirements and special conditions. County shall maintain an originally executed copy of each Provider Contract at its office and shall furnish a copy of any Provider Contract to OHA upon request. County may purchase MHS 20 emergency services according to County's policies and pay for these services upon receipt of an itemized invoice, purchase order, or other proper billing instrument evidencing the services rendered, or by a Provider Contract containing the provisions set forth in Exhibit I, if required by County policy. 141408 Deschutes 2870f330 6. Provider Monitoring. County shall monitor each Provider's delivery of Services and promptly report to OHA when County identifies a deficiency in a Provider's delivery of a Service or in a Provider's compliance with the Provider Contract between the Provider and County. County shall promptly take all necessary action to remedy any identified deficiency. County shall also monitor the fiscal performance of each Provider and shall take all lawful management and legal action necessary to pursue this responsibility. In the event of a deficiency in a Provider's delivery of a Service or in a Provider's compliance with the Provider Contract between the Provider and County, nothing in this Agreement shall limit or qualifY any right or authority OHA has under state or federal law to take action directly against the Provider. 7. Alternative Formats and Translation of Written Materials, Interpreter Services. In connection with the delivery of Services, County shall: a. Make available to a Client, without charge to the Client, upon the Client's or OHA's request, any and all written materials in alternate, if appropriate, formats as required by OHA's administrative rules or by OHA's written policies made available to County. b. Make available to a Client, without charge to the Client, upon the Client's or OHA's request, any and all written materials in the prevalent non-English languages in the area served by County's CMHP. c. Make available to a Client, without charge to the Client, upon the Client's or OHA's request, oral interpretation services in all non-English languages in the area served by County's CMHP. d. Make available to Clients with hearing impairment, without charge to the Client, upon the Client's or OHA's request, sign language interpretation services and telephone communications access services. For purposes of the foregoing, "written materials" includes, without limitation, all written materials created or delivered in connection with the Services and all Provider Contracts related to this Agreement. 8. Reporting Requirements. IfCounty delivers a Service directly, County shall prepare and furnish the following information to OHA when that Service is delivered: a. Client, Service and financial information as specified in the Service Description. b. All additional information and reports that OHA reasonably requests. 9. Operation of CMHP. County shall operate or contract for the operation of a CMHP during the term ofthis Agreement. (fCounty uses funds provided under this Agreement for a particular Service, County shall include that Service in its CMHP from the date it begins using the funds for that Service until the earlier of (a) termination or expiration of this Agreement, (b) termination by OHA ofOHA's obligation to provide financial assistance for that Service in accordance with Section 8 of Exhibit G or (c) termination by the County, in accordance with Section 8 of Exhibit G, of County's obligation to include in its CMHP a Program Area that includes that Service. 141408 Deschutes 2880f330 10. OBA Reports. a. To the extent resources are available to OHA to prepare and deliver the infonnation, OHA shall, during the tenn ofthis Agreement, provide County with the following reports: (l) Summary reports to County and County's Providers from the CPMS, AMH Measures and Outcomes Tracking System (MOTS) data and other Client data reported to OHA under this Agreement; and (2) Monthly reports to County that detail disbursement of financial assistance under the Financial Assistance Award in Exhibit D-I and D-2 for the delivery of Services. b. OHA shall prepare and send to each Provider to whom OHA makes direct payments on behalf of County under this Agreement during a calendar year, an IRS Fonn 1099 for that year specifying the total payments made by OHA to that Provider. 11. Technical Assistance. During the tenn ofthis Agreement, OHA shall provide technical assistance to County in the delivery of Services to the extent resources are available to OHA for this purpose. If the provision of technical assistance to the County concerns a Provider, OHA may require, as a condition to providing the assistance, that County take all action with respect to the Provider reasonably necessary to facilitate the technical assistance. 12. Payment of Certain Expenses. IfOHA requests that an employee of County or a Provider or a citizen of County attend OHA training or an OHA conference or business meeting and County has obligated itself to reimburse the individual for travel expenses incurred by the individual in attending the training or conference, OHA may pay those travel expenses on behalf of County but only at the rates and in accordance with the reimbursement procedures set forth in the Oregon Accounting Manual ( www.oregon.gov/DAS/SCD/SARS/policies/oam/10.35.00.PR.pdf?ga=t ) as of the date the expense was incurred and only to the extent that OHA detennines funds are available for such reimbursement. 13. Effect of Amendments Reducing Financial Assistance. If County and OHA amend this Agreement to reduce the amount of financial assistance awarded for a particular Service, County is not required by this Agreement to utilize other County funds to replace the funds no longer received under this Agreement as a result ofthe amendment and County may, from and after the date of the amendment, reduce the quantity of that Service included in its CMHP commensurate with the amount of the reduction in financial assistance awarded for that Service. Nothing in the preceding sentence shall affect County's obligations under this Agreement with respect to financial assistance actually disbursed by OHA under this Agreement or with respect to Services actually delivered. 14. Resolution of Disputes over Additional Financial Assistance Owed County After Termination or Expiration. If, after tennination or expiration of this Agreement, County believes that OHA disbursements of financial assistance under this Agreement for a particular Service are less than the amount of financial assistance that OHA is obligated to provide to County under this Agreement for that Service, as detennined in 141408 Deschutes 2890f330 accordance with the applicable financial assistance calculation methodology, County shall provide OHA with written notice thereof. OHA shall have 90 calendar days from the effective date of County's notice to pay County in full or notify County that it wishes to engage in a dispute resolution process. IfOHA notifies County that it wishes to engage in a dispute resolution process, County and OHA's Deputy Director for Addictions and Mental Health Services Division shall engage in non-binding discussion to give OHA an opportunity to present reasons why it believes that it does not owe County any additional financial assistance or that the amount owed is different than the amount identified by County in its notices, and to give County the opportunity to reconsider its notice. IfOHA and County reach agreement on the additional amount owed to County, OHA shall promptly pay that amount to County. IfOHA and County continue to disagree as to the amount owed, the parties may agree to consider further appropriate dispute resolution processes, including, subject to Department of Justice and County Counsel approval, binding arbitration. Nothing in this Section shall preclude the County from raising underpayment concerns at any time prior to termination or expiration of this Agreement under Section 15 below. 15. Alternative Dispute Resolution. The parties should attempt in good faith to resolve any dispute arising out of this agreement. This may be done at any management level, including at a level higher than persons directly responsible for administration of the agreement. In addition, the parties may agree to utilize a jointly selected mediator or arbitrator (for non-binding arbitration) to resolve the dispute short oflitigation. 16. Purchase and Disposition of Equipment. a. For purposes of this section, "Equipment" means tangible, non-expendable personal property having a useful life of more than one year and a net acquisition cost of more than $5,000 per unit. However, for purposes of information technology equipment, the monetary threshold does not apply. Information technology equipment shall be tracked for the mandatory line categories listed below: Network Personal Computer Printer/Plotter Server Storage Software b. For any Equipment authorized by DHS/OHA for purchase with funds from this Agreement, ownership shall be in the name of the County and County is required to accurately maintain the following Equipment inventory records: (I) description of the Equipment; (2) serial number; (3) where Equipment was purchased; (4) acquisition cost and date; and (5) location, use and condition of the Equipment County shall provide the Equipment inventory list to the Contract Administrator annually by June 30th of each year. County shall be responsible to safeguard any 141408 Deschutes 290of330 Equipment and maintain the Equipment in good repair and condition while in the possession of County or any subcontractors. County shall depreciate all Equipment, with a value of more than $5,000, using the straight line method. c. Upon termination of this Contract, or any service thereof, for any reason whatsoever, County shall, upon request by DHS/OHA, immediately, or at such later date specified by DHS/OHA, tender to DHS/OHA any and all Equipment purchased with funds under this Contract as DHS/OHA may require to be returned to the State. At DHS'/OHA's direction, County may be required to deliver said Equipment to a subsequent contractor for that contractor's use in the delivery of services formerly provided by County. Upon mutual agreement, in lieu of requiring County to tender the Equipment to DHS/OHA or to a subsequent contractor, DHS/OHA may require County to pay to DHS/OHA the current value I l IEquipment inventory reporting and residual value shall be negotiated and the t agreement reflected in a special condition authorizing the purchase. e. Notwithstanding anything herein to the contrary, County shall comply with 45 CFR 92.32, which, generally, describes the required maintenance, documentation, and allowed disposition of equipment purchased with federal grant funds. 17. Nothing in this Agreement shall cause or require County or OHA to act in violation of state or federal constitutions, statutes, regulations or rules. The parties intend this limitation to apply in addition to any other limitation in this Agreement, including limitations in Section I of this Exhibit F. of the Equipment. Equipment value will be determined as ofthe date of Contract or service termination. d. If funds from this Contract are authorized by DHS/OHA to be used as a portion of the purchase price of Equipment, requirements relating to title, maintenance, 141408 Deschutes 2910f330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITG STANDARD TERMS AND CONDITIONS 1. Governing Law, Consent to Jurisdiction. This 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 the parties that arises from or relates to this Agreement shall be brought and conducted solely and exclusively within a circuit court for the State of Oregon of proper jurisdiction. THE PARTIES, BY EXECUTION OF THIS AGREEMENT, HEREBY CONSENT TO THE IN PERSONAM JURISDICTION OF SAID COURTS. Except as provided in this section, neither party waives any fonn of defense or immunity, whether sovereign immunity, governmental immunity, immunity based on the eleventh amendment to the Constitution ofthe United States or otherwise, from any Claim or from the jurisdiction of any court. The parties acknowledge that this is a binding and enforceable Agreement and, to the extent pennitted by law, expressly waive any defense alleging that either party does not have the right to seek judicial enforcement ofthis Agreement. 2. Compliance with Law. Both parties shall comply with laws, regulations and executive orders to which they are subject and which are applicable to the Agreement or to the delivery of Services. Without limiting the generality of the foregoing, both parties expressly agree to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: (a) all applicable requirements of state civil rights and rehabilitation statutes, rules and regulations; (b) all state laws governing operation of Community Mental Health Programs, including without limitation, all administrative rules adopted by OHA related to Community Mental Health Programs, as may be revised; (c) all state laws requiring reporting of Client abuse; (d) ORS 659A.400 to 659A.409, ORS 659A.145 and all regulations and administrative rules established pursuant to those laws 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. 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. All employers, including County and OHA that employ subject workers who provide Services in the State of Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation coverage, unless such employers are exempt under ORS 656.126. 3. Independent Contractors. The parties agree and acknowledge that their relationship is that of independent contracting parties and that County is not an officer, employee, or agent of the State of Oregon as those terms are used in ORS 30.265 or otherwise. J41408 Deschutes 292 of330 4. Representations and Warranties. a. County represents and warrants as follows: (1) Organization and Authority. County is a political subdivision ofthe State of Oregon duly organized and validly existing under the laws of the State of Oregon. County has full power, authority and legal right to make this Agreement and to incur and perform its obligations hereunder. (2) Due Authorization. The making and performance by County of this Agreement (a) have been duly authorized by all necessary action by County and (b) do not and will not violate any provision of any applicable law, rule, regulation, or order of any court, regulatory commission, board, or other administrative agency or any provision of County's charter or other organizational document and (c) do not and will not result in the breach of, or constitute a default or require any consent under any other agreement or instrument to which County is a party or by which County may be bound or affected. No authorization, consent, license, approval ot: filing or registration with or notification to any governmental body or regulatory or supervisory authority is required for the execution, del ivery or performance by County of this Agreement. (3) Binding Obligation. This Agreement has been duly executed and delivered by County and constitutes a legal, valid and binding obligation of County, enforceable in accordance with its terms subject to the laws of bankruptcy, insolvency, or other similar laws affecting the enforcement of creditors' rights generally. (4) County has the skill and knowledge possessed by well-informed members of its industry, trade or profession and County will apply that skill and knowledge with care and diligence to perform the Work in a professional manner and in accordance with standards prevalent in County's industry, trade or profession; (5) County shall, at all times during the term of this Agreement, be qualified, professionally competent, and duly licensed to perform the Work; and (6) County prepared its proposal related to this Agreement, if any, independently from all other proposers, and without collusion, fraud, or other dishonesty. (7) Services. To the extent Services are performed by County, the delivery of each Service will comply with the terms and conditions of this Agreement and meet the standards for such Service as set forth herein, including but not limited to, any terms, conditions, standards and requirements set forth in the Financial Assistance Award and applicable Service Description. b. OHA represents and warrants as follows: (1) Organization and Authority. OHA has full power, authority and legal right to make this Agreement and to incur and perform its obligations hereunder. (2) Due Authorization. The making and performance by OHA of this Agreement (a) have been duly authorized by all necessary action by OHA 141408 Deschutes 29301'330 and (b) do not and will not violate any provision of any applicable law, rule, regulation, or order of any court, regulatory commission, board, or other administrative agency and (c) do not and will not result in the breach of, or constitute a default or require any consent under any other agreement or instrument to which OHA is a party or by which OHA may be bound or affected. No authorization, consent, license, approval of, filing or registration with or notification to any governmental body or regulatory or supervisory authority is required for the execution, delivery or performance by OHA of this Agreement, other than approval by the Department of Justice if required by law. (3) Binding Obligation. This Agreement has been duly executed and delivered by OHA and constitutes a legal, valid and binding obligation of OHA, enforceable in accordance with its terms subject to the laws of bankruptcy, insolvency, or other similar laws affecting the enforcement of cred itors' rights generally. c. Warranties Cumulative. The warranties set forth in this section are in addition to, and not in lieu of, any other warranties provided. 5. Ownership of Intellectual Property. a. Except as otherwise expressly provided herein, or as otherwise required by state or federal law, OHA will not own the right, title and interest in any intellectual property created or delivered by County or a Provider in connection with the Services. With respect to that portion of the intellectual property that the County owns, County grants to OHA a perpetual, worldwide, non-exclusive, royalty-free and irrevocable license, subject to any provisions in the Agreement that restrict or prohibit dissemination or disclosure of information, to (1) use, reproduce, prepare derivative works based upon, distribute copies of, perform and display the intellectual property, (2) authorize third parties to exercise the rights set forth in Section 5.a.(1) on OHA's behalf, and (3) sublicense to third parties the rights set forth in Section 5.a.(I). b. If state or federal law requires that OHA or County grant to the United States a license to any intellectual property, or if state or federal law requires that the OHA or the United States own the intellectual property, then County shall execute such further documents and instruments as OHA may reasonably request in order to make any such grant or to assign ownership in the intellectual property to the United States or OHA. To the extent that OHA becomes the owner of any intellectual property created or delivered by County in connection with the Services, OHA will grant a perpetual, worldwide, non-exclusive, royalty-free and irrevocable license, subject to any provisions in the Agreement that restrict or prohibit dissemination or disclosure of information, to County to use, copy, distribute, display, build upon and improve the intellectual property. c. County shall include in its Provider Contracts terms and conditions necessary to require that Providers execute such further documents and instruments as OHA may reasonably request in order to make any grant of license or assignment of ownership that may be required by federal or state law. 141408 Deschutes 2940f330 6. County Default. County shall be in default under this Agreement upon the occurrence of any of the following events: a. County fails to perform, observe or discharge any of its covenants, agreements or obligations set forth herein. b. Any representation, warranty or statement made by County herein or in any documents or reports made in connection herewith or relied upon by OHA to measure the delivery of Services, the expenditure of financial assistance or the performance by County is untrue in any material respect when made; c. County (1) applies for or consents to the appointment of, or taking of possession by, a receiver, custodian, trustee, or liquidator of itself or all of its property, (2) admits in writing its inability, or is generally unable, to pay its debts as they become due, (3) makes a general assignment for the benefit ofits creditors, (4) is ~ adjudicated a bankrupt or insolvent, (5) commences a voluntary case under the ~ Federal Bankruptcy Code (as now or hereafter in effect), (6) files a petition seeking to take advantage of any other law relating to bankruptcy, insolvency, [ reorganization, winding-up, or composition or adjustment of debts, (7) fails to controvert in a timely and appropriate manner, or acquiesces in writing to, any petition filed against it in an involuntary case under the Bankruptcy Code, or (8) takes any action for the purpose of effecting any of the foregoing; or d. A proceeding or case is commenced, without the application or consent of ICounty, in any court of competent jurisdiction, seeking (1) the liquidation, dissolution or winding-up, or the composition or readjustment of debts, of l County, (2) the appointment of a trustee, receiver, custodian, liquidator, or the like of County or of all or any substantial part of its assets, or (3) similar relief in I respect to County under any law relating to bankruptcy, insolvency, reorganization, winding-up, or composition or adjustment of debts, and such Iproceeding or case continues undismissed, or an order, judgment, or decree approving or ordering any ofthe foregoing is entered and continues unstayed and Iin effect for a period of sixty consecutive days, or an order for relief against County is entered in an involuntary case under the Federal Bankruptcy Code (as now or hereafter in effect). e. The delivery of any Service fails to comply with the terms and conditions of this Agreement or fails to meet the standards for Service as set forth herein, including but not limited to, any terms, condition, standards and requirements set forth in the Financial Assistance A ward and applicable Service Description. J 7. OHA Default. OHA shall be in default under this Agreement upon the occurrence of any of the following events: Ia. OHA fails to perform, observe or discharge any of its covenants, agreements, or obligations set forth herein; or Ib. Any representation, warranty or statement made by OHA herein or in any f documents or reports made in connection herewith or relied upon by County to measure performance by OHA is untrue in any material respect when made. I t ( 141408 Deschutes 2950f330 I I i I I 8. Termination. a. County Termination. County may tenninate this Agreement in its entirety or may terminate its obligation to include a particular Program Area in its CMHP: (1) For its convenience, upon at least three calendar months advance written notice to OHA, with the termination effective as of the first day of the month following the notice period; (2) Upon 45 days advance written notice to OHA, if County does not obtain funding, appropriations and other expenditure authorizations from County's governing body, federal, state or other sources sufficient to pennit County to satisfY its perfonnance obligations under this Agreement, as detennined by County in the reasonable exercise of its administrative discretion; (3) Upon 30 days advance written notice to OHA, ifOHA is in default under this Agreement and such default remains uncured at the end of said 30 day period or such longer period, if any, as County may specifY in the notice; or (4) Immediately upon written notice to OHA, if Oregon statutes or federal laws, regulations or guidelines are modified, changed or interpreted by the Oregon Legislative Assembly, the federal government or a court in such a way that County no longer has the authority to meet its obligations under this Agreement. b. OHA Termination. OHA may tenninate this Agreement in its entirety or may terminate its obligation to provide financial assistance under this Agreement for one or more particular Services described in the Financial Assistance Award: (I) For its convenience, upon at least three calendar months advance written notice to County, with the tennination effective as ofthe first day of the month fol1owing the notice period; (2) Upon 45 days advance written notice to County, ifOHA does not obtain funding, appropriations and other expenditure authorizations from federal, state or other sources sufficient to meet the payment obligations ofOHA under this Agreement, as determined by OHA in the reasonable exercise of its administrative discretion. Notwithstanding the preceding sentence, OHA may terminate this Agreement in its entirety or may tenninate its obligation to provide financial assistance under this Agreement for one or more particular Services, immediately upon written notice to County or at such other time as it may determine if action by the Oregon Legislative Assembly or Emergency Board reduces OHA's legislative authorization for expenditure of funds to such a degree that OHA will no longer have sufficient expenditure authority to meet its payment obligations under this Agreement, as determined by OHA in the reasonable exercise of its administrative discretion, and the effective date for such reduction in expenditure authorization is less than 45 days from the date the action is taken; 141408 Deschutes 2960f330 (3) Immediately upon written notice to County if Oregon statutes or federal laws, regulations or guidelines are modified, changed or interpreted by the Oregon Legislative Assembly, the federal government or a court in such a way that OHA no longer has the authority to meet its obligations under this Agreement or no longer has the authority to provide the financial assistance from the funding source it had planned to use; (4) Upon 30 days advance written notice to County, if County is in default under this Agreement and such default remains uncured at the end of said 30 day period or such longer period, if any, as OHA may specifY in the notice; (5) Immediately upon written notice to County, if any license or certificate required by law or regulation to be held by County or a Provider to deliver a Service described in the Financial Assistance Award is for any reason denied, revoked, suspended, not renewed or changed in such a way that County or a Provider no longer meets requirements to deliver the Service. This termination right may only be exercised with respect to the particular Service or Services impacted by loss of necessary licensure or certification; (6) Immediately upon written notice to County, ifOHA determines that County or any of its Providers have endangered or are endangering the health or safety of a Client or others in performing the Services covered in this Agreement. c. OHA and County agree that this Agreement extends to September 1,2015, but only for the purpose of amendments to adjust the allocated budget (Exhibit D) for Services performed, or not performed, by County during the 2013-2015 biennium and prior to July 1,2015. Ifthere is more than one amendment modifying Exhibit D, the amendment shall be applied to Exhibit D in the order in which the amendments are executed by County and OHA. In no event is the County authorized to provide any Services under this Agreement, and County is not required to provide any Services under this Agreement, after June 30, 20 IS. 9. Effect of Termination. a. Entire Agreement. (1) Upon termination of this Agreement in its entirety, OHA shall have no further obligation to payor disburse financial assistance to County under this Agreement, whether or not OHA has paid or disbursed to County all financial assistance described in the Financial Assistance Award except (a) with respect to funds described in the Financial Assistance Award, to the extent OHA's disbursement of financial assistance for a particular Service, the financial assistance for which is calculated on a rate per unit of service or service capacity basis, is less than the applicable rate multiplied by the number of applicable units of Service or Service capacity of that type performed or made available from the effective date ofthis Agreement through the termination date, and (b) with respect to funds described in the Financial Assistance Award, to the extent OHA's disbursement offinancial assistance for a particular Service, the financial 141408 Deschutes 297of330 assistance for which is calculated on a cost reimbursement basis, is less than the cumulative actual Allowable Costs reasonably and necessarily incurred with respect to delivery of that Service, from the effective date of this Agreement through the termination date. (2) Upon termination of this Agreement in its entirety, County shall have no further obligation under this Agreement to operate a CMHP. b. Individual Program Area or Service. (I) Upon termination ofOHA's obligation to provide financial assistance under this Agreement for a particular Service, OHA shall have no further obligation to payor disburse any financial assistance to County under this Agreement for that Service, whether or not OHA has paid or disbursed to County all financial assistance described in the Financial Assistance A ward for that Service except (a) with respect to funds described in the Financial Assistance Award and if the financial assistance for that Service is calculated on a rate per unit of service or service capacity basis, to the extent that OHA's prior disbursement of financial assistance for that Service is less than the applicable rate multiplied by the number of applicable units of Service or Service capacity of that type performed or made available during the period from the first day ofthe period for which the funds were awarded through the earlier of the termination ofOHA's obligation to provide financial assistance for that Service or the last day of the period for which the funds were awarded, and (b) with respect to funds described in the Financial Assistance Award and if the financial assistance for that Service is calculated on a cost reimbursement basis, to the extent that OHA' s prior disbursement of financial assistance for that Service is less than the cumulative actual Allowable Costs reasonably and necessarily incurred by County with respect to delivery ofthat Service, during the period from the effective date ofthis Agreement through the termination ofOHA's obligation to provide financial assistance for that Service. (2) Upon termination ofOHA's obligation to provide financial assistance under this Agreement for a particular Service, County shall have no further obligation under this Agreement to include that Service in its CMHP. (3) Upon termination of County's obligation to include a Program Area in its CMHP, OHA shall have (a) no further obligation to payor disburse financial assistance to County under this Agreement for Local Administration (LAO 1) of Services in that Program Area whether or not OHA has paid or disbursed to County all financial assistance described in the Financial Assistance Award for local administration of Services in that Program Area and (b) no further obligation to payor disburse any financial assistance to County under this Agreement for Services in that Program Area, whether or not OHA has paid or disbursed to County all financial assistance described in the Financial Assistance Award for those Services except (1) with respect to funds described in the Financial Assistance Award, to the extent OHA's disbursement of financial 141408 Deschutes 2980f330 assistance for a particular Service falling within that Program Area, the financial assistance for which is calculated on a rate per unit of service or service capacity basis, is less than the applicable rate multiplied by the number of applicable units of Service or Service capacity ofthat type performed or made available during the period from the effective date of this Agreement through the termination of County's obligation to include the Program Area, in which that Service falls, in County's CMHP, and (2) with respect to funds described in the Financial Assistance Award, to the extent OHA's disbursement of financial assistance for a particular Service falling within that Program Area, the financial assistance for which is calculated on a cost reimbursement basis, is less than the cumulative actual Allowable Costs reasonably and necessarily incurred by County with respect to delivery ofthat Service, during the period from the effective date ofthis Agreement through the termination of County's obligation to include the Program Area, in which that Service falls, in County's CMHP. (4) Upon termination of County's obligation to include a Program Area in its CMHP, County shall have no further obligation under this Agreement to include that Program Area in its CMHP. c. Disbursement Limitations. Notwithstanding subsections (a) and (b) above: (1) Under no circumstances will OHA be obligated to provide financial assistance to County for a particular Service in excess of the amount awarded under this Agreement for that Service as set forth in the Financial Assistance Award; and (2) Under no circumstances will OHA be obligated to provide financial assistance to County from funds described in the Financial Assistance Award in an amount greater than the amount due County under the Financial Assistance Award for Services, as determined in accordance with the financial assistance calculation methodologies in the applicable Services Descriptions. d. Survival. Exercise of a termination right set forth in Section 8 of this Exhibit or expiration of this Agreement in accordance with its terms, shall not affect County's right to receive financial assistance to which it is entitled hereunder, as described in subsections a. and b. above and as determined through the Agreement Settlement process, or County's right to invoke the dispute resolution processes under Sections 14 and 15 of Exhibit F. Notwithstanding subsections a. and b. above, exercise ofthe termination rights in Section 8 of this Exhibit or expiration of this Agreement in accordance with its terms, shall not affect County's obligations under this Agreement or OHA's right to enforce this Agreement against County in accordance with its terms, with respect to financial assistance actually disbursed by OHA under this Agreement, or with respect to Services actually delivered. Specifically, but without limiting the generality of the preceding sentence, exercise of a termination right set forth in Section 8 of this Exhibit or expiration ofthis Agreement in accordance with its terms shall not affect County's representations and warranties, reporting obligations, record keeping and access obligations, confidentiality obligations, obligation to comply 141408 Desch utes 2990f330 with applicable federal requirements, the restrictions and limitations on County's use of financial assistance actually disbursed by OHA hereunder, County's obligation to cooperate with OHA in the Agreement Settlement process, or OHA's right to recover from County, in accordance with the terms of this Agreement, any financial assistance disbursed by OHA under this Agreement that is identified as an Underexpenditure, Overexpenditure or Misexpenditure. If a termination right set forth in Section 8 of this Exhibit is exercised, both parties shall make reasonable good faith efforts to minimize unnecessary disruption or other problems associated with the termination. 10. Limitation of Liabilities. NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR RELA TED TO THIS 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. 11. Insurance. County shall require Providers to maintain insurance as set forth in Exhibit J, which is attached hereto. 12. Records Maintenance, Access and Confidentiality. a. Access to Records and Facilities. OHA, the Secretary of State's Office of the State of Oregon, the Federal Government, and their duly authorized representatives shall have access to the books, documents, papers and records of the County that are directly related to this Agreement, the financial assistance provided hereunder, or any Service for the purpose of making audits, examinations, excerpts, copies and transcriptions. In addition, County shall permit authorized representatives of OHA to perform site reviews of all Services delivered by County. b. Retention of Records. County shall retain and keep accessible all books, documents, papers, and records that are directly related to this Agreement, the financial assistance provided hereunder or any Service, for a minimum of six years, or such longer period as may be required by other provisions of this Agreement or applicable law, following the termination or expiration of this Agreement. Ifthere are unresolved audit or Agreement Settlement questions at the end of the applicable retention period, County shall retain the records until the questions are resolved. c. Expenditure Records. County shall document the use and expenditure of all financial assistance paid by OHA under this Agreement. Unless applicable federal law requires County to utilize a different accounting system, County shall create and maintain all use and expenditure records in accordance with generally accepted accounting principles and in sufficient detail to permit OHA to verify how the financial assistance paid by OHA under this Agreement was used or expended. d. Client Records. IfCounty delivers a Service directly, County shall create and maintain a Client record for each Client who receives that Service, unless the Service Description precludes delivery of the Service on an individual Client 141408 Deschutes 300of330 basis and reporting of Service commencement and termination information is not required by the Service Description. The Client record shall contain: (1) Client identification; (2) Problem assessment; (3) Treatment, training or care plan; (4) Medical information when appropriate; and (5) Progress notes including Service termination summary and current I t assessment or evaluation instrument as designated by OHA in administrative rules. County shall retain Client records in accordance with OAR 166-150-0005 through 166-150-0215 (State Archivist). Unless OAR 166-150-0005 through 166-150-0215 requires a longer retention period, Client records must be retained for a minimum of t six years from termination or expiration of this Agreement. e. Safeguarding of Client Information. County shall maintain the confidentiality of Client records as required by applicable state and federal law, including without limitation,ORS 179.495 to 179.507,45 CFR Part 205, 42 CFR Part 2, any administrative rule adopted by OHA implementing the foregoing laws, and any I written policies made available to County by OHA. County shall create and maintain written policies and procedures related to the disclosure of Client information, and shall make such policies and procedures available to OHA for review and inspection as reasonably requested by OHA. 13. Information Privacy/Security/Access. If the Work performed under this Agreement requires County or its subcontractor(s) to have access to or use of any OHA computer system or other OHA Information Asset for which OHA imposes security requirements, and OHA grants County or its subcontractor(s) access to such OHA Information Assets or Network and Information Systems, County shall comply and require all subcontractor(s) to which such access has been granted to comply with OAR 943-014 0000 through OAR 943-014-0320, as such rules may be revised from time to time. For purposes of this section, "Information Asset" and "Network and Information System" have the meaning set forth in OAR 943-014-0305, as such rule may be revised from time to time. 14. Force Majeure. Neither OHA nor County shall be held responsible for delay or default caused by fire, civil unrest, labor unrest, natural causes, or war which is beyond the reasonable control ofOHA or County, respectively. 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 this Agreement. OHA may terminate this Agreement upon written notice to the other party after reasonably determining that the delay or breach will likely prevent successful performance of this Agreement. 15. Assignment of Agreement, Successors in Interest. a. County shall not assign or transfer its interest in this Agreement without prior written approval ofOHA. Any such assignment or transfer, if approved, is subject to such conditions and provisions as OHA may deem necessary. No l I I 14 J408 Deschutes 301 of330 approval by OHA of any assignment or transfer of interest shall be deemed to create any obligation ofOHA 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. 16. No Third Party Beneficiaries. OHA and County are the only parties to this 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 OHA to assist and enable OHA to accomplish its statutory mission. Nothing in this 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 ofthis Agreement. 17. Amendment. No amendment, modification or change of terms of this Agreement shall bind either party unless in writing and signed by both parties and when required by the Department of Justice. Such amendment, modification or change, if made, shall be effective only in the specific instance and for the specific purpose given. 18. Severability. The parties agree that if any term or provision of this 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. 19. Notice. Except as otherwise expressly provided in this Agreement, any communications between the parties hereto or notices to be given hereunder shall be given in writing by personal delivery, facsimile, or mailing the same, postage prepaid to County or OHA 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 mailed shall be effective five days after mailing. Any communication or notice delivered by facsimile shall 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, iftransmission was outside normal business hours of the recipient. To be effective against the other party, any notice transmitted by facsimile must be confirmed by telephone notice to the other party at number listed below. Any communication or notice given by personal delivery shall be effective when actually delivered to the addressee. OHA: April D. Barrett or delegate Office of Contracts & Procurement 250 Winter Street NE, Room 306 Salem, OR 97301 COUNTY: 1}e5c..\rlo.-k.c;.. (.O..L~ HeQ(t.; SJ!.rvICts. 25q~ ~£..,. C""OvJ'~ -ry\.-I<. ~o\I c:::> (.2. C\':f ~\ A~: 5C-o-tt" j 1>'" nSH", \:)Nt:. t.:::f-<::, (' oR ~*,,'. ~"t..'-\ 1"Yt:O ~I Cont<ec.L+~ ) 41408 Deschutes 3020[330 20. Headings. The headings and captions to sections of this Agreement have been inserted for identification and reference purposes only and shall not be used to construe the meaning or to interpret this Agreement. 21. Counterparts. This Agreement and any subsequent amendments 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 this Agreement and any amendments so executed shall constitute an original. 22. Integration and Waiver. This Agreement, including all Exhibits, 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 this Agreement. The failure of either party to enforce any provision of this Agreement shall not constitute a waiver by that party of that or any other provision. No waiver or consent shall be effective unless in writing and signed by the party against whom it is asserted. 23. Construction. This Agreement is the product of extensive negotiations between OHA and representatives of county governments. The provisions ofthis 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. 24. Contribution. If any third party makes any claim or brings any action, suit or proceeding alleging a tort as now or hereafter defined in ORS 30.260 ("Third Party Claim") against a party (the "Notified Party") with respect to which the other party ("Other Party") may have liability, the Notified Party must promptly notifY the Other Party in writing of the Third Party Claim and deliver to the Other Party a copy of the claim, process, and all legal pleadings with respect to the Third Party Claim. Either party is entitled to participate in the defense of a Third Party Claim, and to defend a Third Party Claim with counsel of its own choosing. Receipt by the Other Party ofthe notice and copies required in this paragraph and meaningful opportunity for the Other Party to participate in the investigation, defense and settlement of the Third Party Claim with counsel of its own choosing are conditions precedent to the Other Party's liability with respect to the Third Party Claim. With respect to a Third Party Claim for which the State is jointly liable with the County (or would be ifjoined in the Third Party Claim ), the State shall contribute to the amount of expenses (including attorneys' fees), judgments, fines and amounts paid in settlement actually and reasonably incurred and paid or payable by the County in such proportion as is appropriate to reflect the relative fault of the State on the one hand and ofthe County on the other hand in connection with the events which resulted in such expenses, judgments, fines or settlement amounts, as well as any other relevant equitable considerations. The relative fault of the State on the one hand and ofthe County on the other hand shall be detennined by reference to, among other things, the parties' relative intent, knowledge, access to information and opportunity to correct or prevent the circumstances resulting in such expenses, judgments, fines or settlement amounts. The 141408 Deschutes 3030[330 State's contribution amount in any instance is capped to the same extent it would have been capped under Oregon law if the State had sole liability in the proceeding. With respect to a Third Party Claim for which the County is jointly liable with the State (or would be ifjoined in the Third Party Claim), the County shall contribute to the amount of expenses (including attorneys' fees), judgments, fines and amounts paid in settlement actually and reasonably incurred and paid or payable by the State in such proportion as is appropriate to reflect the relative fault ofthe County on the one hand and ofthe State on the other hand in connection with the events which resulted in such expenses, judgments, fines or settlement amounts, as well as any other relevant equitable considerations. The relative fault of the County on the one hand and of the State on the other hand shall be determined by reference to, among other things, the parties' relative intent, knowledge, access to information and opportunity to correct or prevent the circumstances resulting in such expenses, judgments, fines or settlement amounts. The County's contribution amount in any instance is capped to the same extent it would have been capped under Oregon law if it had sole liability in the proceeding. 25. Indemnification by Providers. County shall take all reasonable steps to cause its Provider(s) that are not units oflocal government as defined in ORS 190.003, if any, to indemnify, defend, save and hold harmless the State of Oregon and its officers, employees and agents ("Indemnitee") from and against any and all claims, actions, liabilities, damages, losses, or expenses (including attorneys' fees) arising from a tort (as now or hereafter defined in ORS 30.260) caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of County's Provider or any ofthe officers, agents, employees or subcontractors ofthe contractor( "Claims"). It is the specific intention of the parties that the Indemnitee shall, in all instances, except for Claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified by the contractor from and against any and all Claims. 141408 Deschutes 3040[330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITH foregoing laws, (i) all other applicable requirements of federal civil rights and rehabilitation statutes, rules and regulations, and 0) all federal law governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring reporting ofCHent abuse. 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. No federal funds may be used to provide Services in violation of 42 U.S.C. ] 4402. 2. Equal Employment Opportunity. If this Agreement, including amendments, is for more than $]0,000, then County shall comply and require all Providers to comply with Executive Order I] 246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented in Department of Labor regulations (4] CFR Part 60). 3. Clean Air, Clean Water, EPA Regulations. If this Agreement, including amendments, exceeds $] 00,000 then County shall comply and require all Providers to comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 7606), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) (33 U.S.c. ] 25] to 1387), specifically including, but not limited to Section 508 (33 U.S.c. ] 368), Executive Order 11738, and Environmental Protection Agency regu lations (2 CFR Part 1532), 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 OHA, United States Department of Health and Human Services and the appropriate Regional Office of the Environmental f REQUIRED FEDERAL TERMS AND CONDITIONS I In addition to the requirements of section 2 of Exhibit G, County shall comply, and as indicated, require all Providers to comply with the following federal requirements. For purposes of this Agreement, all references to federal and state laws are references to federal and state laws as they may be amended from time to time. 1. Miscellaneous Federal Provisions. County shall comply and require all Providers to comply with all federal laws, regulations, and executive orders applicable to the Agreement or to the delivery of Services. Without limiting the generality of the foregoing, County expressly agrees to comply and require all Providers to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: (a) Title VI and VII of the Civil Rights Act of 1964, as amended, (b) Sections 503 and 504 ofthe Rehabilitation Act of 1973, as amended, (c) the Americans with Disabilities Act of 1990, as amended, (d) Executive Order 11246, as amended, (e) the Health Insurance Portability and Accountability Act of 1996, as amended, (f) the Age Discrimination in Employment Act of 1967, as amended, and the Age Discrimination Act of 1975, as amended, (g) the Vietnam Era Veterans' Readjustment Assistance Act of ] 974, as amended, (h) all regulations and administrative rules established pursuant to the I I I f i I I, 141408 Deschutes 3050[330 Protection Agency. County shall include and require all Providers to include in all contracts with subcontractors receiving more than $100,000, language requiring the subcontractor to comply with the federal laws identified in this section. 4. Energy Efficiency. County shall comply and require all Providers to 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 42 U.S.C. 6201 et.seq. (Pub. L. 94-163). 5. Truth in Lobbying. By signing this Agreement, the County certifies, to the best of the County's knowledge and beliefthat: 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, the County shall complete and submit Standard Form LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions. c. The County shall require that the language ofthis 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. d. 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 of the 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. No part of any federal funds paid to County under this Agreement shall be used, other than for normal and recognized executive legislative relationships, for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to support or defeat the enactment of legislation before the United States Congress or any State or local legislature or legislative body, except in presentation to the Congress or any State or local legislature itself, or designed to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any State or local government, except in presentation to the executive branch of any State or local government itself. 141408 Deschutes 306of330 f. No part of any federal funds paid to County under this Agreement shall be used to pay the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before the United States Congress or any State government, State legislature or local legislature or legislative body, other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a State, local or tribal government in policymaking and administrative processes within the executive branch of that government. g. The prohibitions in subsections (e) and (f) of this section shall include any activity to advocate or promote any proposed, pending or future Federal, State or local tax increase, or any proposed, pending, or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control. h. No part of any federal funds paid to County under this Agreement may be used for any activity that promotes the legalization of any drug or other substance Iincluded in schedule I of the schedules of controlled substances established under l section 202 of the Controlled Substances Act except for normal and recognized executive congressional communications. This limitation shall not apply when there is significant medical evidence of a therapeutic advantage to the use of such drug or other substance or that federally sponsored clinical trials are being conducted to determine therapeutic advantage. I 6. HIPAA Compliance. OHA is a Covered Entity with respect to its healthcare components as described in OAR 943-014-0015 for purposes of the Health Insurance Portability and Accountability Act and the federal regulations implementing the Act (collectively referred to as HIPAA), and OAR 125-055-0100 through OAR 125-055 0130. OHA must comply with HIPAA to the extent that any Services or obligations of OHA arising under this Agreement are covered by HIPAA. County shall determine if County will have access to, or create any protected health information in the performance of any Service or other obligations under this Agreement. To the extent that County will have access to, or create any protected health information to perform functions, activities, or Services for, or on behalf of, a health care component ofOHA in the performance of any Service required by this Agreement, County shall comply and require all Providers to comply with OAR 125-055-0100 through OAR 125-055-0130 and the following: a. Privacy and Security of Individually Identifiable Health Information. Individually Identifiable Health Information about specific individuals is confidential. Individually Identifiable Health Information relating to specific individuals may be exchanged between County and OHA for purposes directly related to the provision of Services to Clients which are funded in whole or in part under this Agreement. To the extent that County is performing functions, activities, or services for, or on behalf of, a healthcare component ofOHA in the performance of any Services required by this Agreement, County shall not use or disclose any Individually Identifiable Health Information about specific individuals in a manner that would violate OHA Privacy Rules, OAR 943-014 0000 et. seq., or OHA Notice of Privacy Practices. A copy ofthe most recent OHA Notice of Privacy Practices may be obtained by contacting OHA or by 141408 Deschutes 3070[330 looking up form number 2090 on the OHA web site at htlps:llaws.state.or.us/cfl/FORMS/. b. Data Transactions Systems. IfCounty intends to exchange electronic data transactions with a health care component ofOHA in connection with claims or encounter data, eligibility or enrollment information, authorizations or other electronic transaction, County shall execute an EDI Trading Partner Agreement with OHA and shall comply with OHA EDI Rules. c. Consultation and Testing. IfCounty reasonably believes that the County's or OHA's data transactions system or other application ofHIPAA privacy or security compliance policy may result in a violation ofHIPAA requirements, County shall promptly consult the OHA Information Security Office. County or OHA may initiate a request for testing ofHIPAA transaction requirements, subject to available resources and the OHA testing schedule. 7. 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 U.S.c. 6901 et. seq.). Section 6002 of that Act (codified at 42 U.S.c. 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 Part 247. 8. Audits. a. County shall comply, and require all Providers to comply, with applicable audit requirements and responsibilities set forth in this Agreement and applicable state or federal law. b. Sub-recipients shall also comply with applicable Code of Federal Regulations (CFR) and OMB Circulars governing expenditure of federal funds Including, but not limited to, OMB A-133 Audits of States, Local Governments and Non-Profit Organizations. 9. Debarment and Suspension. County shall not permit any person or entity to be a Provider ifthe 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. 12549 and No. 12689, "Debarment and Suspension". (See 2 CFR Part 180). 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. 10. Drug-Free Workplace. County shall comply and require all Providers to comply with the following provisions to maintain a drug-free workplace: (i) County certifies that it will provide a drug-free workplace by publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensation, possession or use of a controlled substance, except as may be present in lawfully prescribed or over-the-counter medications, is prohibited in County's workplace or while providing services to OHA clients. County's notice shall specify the actions that will be taken by County against its 141408 Deschutes 308of330 employees for violation of such prohibitions; (ii) Establish a drug-free awareness program to inform its employees about: The dangers of drug abuse in the workplace, County's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations; (iii) Provide each employee to be engaged in the performance of services under this Agreement a copy of the statement mentioned in paragraph (i) above; (iv) NotifY each employee in the statement required by paragraph (i) above that, as a condition of employment to provide services under this Agreement, the employee will: abide by the terms of the statement, and notifY the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five (5) days after such conviction; (v) Notify OHA within ten (l0) days after receiving notice under subparagraph (iv) above from an employee or otherwise receiving actual notice of such conviction; (vi) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program by any employee who is so convicted as required by Section 5154 of the Drug-Free Workplace Act of 1988; (vii) Make a good-faith effort to continue a drug-free workplace through implementation of subparagraphs (i) through (vi) above; (viii) Require any Provider to comply with subparagraphs (i) through (vii) above; (ix) Neither County, or any of County's employees, officers, agents or Provider may provide any service required under this Agreement while under the influence of drugs. For purposes of this provision, "under the influence" means: observed abnormal behavior or impairments in mental or physical performance leading a reasonable person to believe the County or County's employee, fofficer, agent or Provider or has used a controlled substance, prescription or non prescription medication that impairs the County or County's employee, officer, agent or Provider's performance of essential job function or creates a direct threat to OHA clients or others. Examples of abnormal behavior include, but are not limited to: hallucinations, paranoia or violent outbursts. Examples of impairments in physical or mental performance include, but are not limited to: slurred speech, difficulty walking or performing job activities; and (x) Violation of any provision of this subsection may result in termination of this Agreement. 11. Pro-Children Act. County shall comply and require all Providers to comply with the Pro-Children Act of 1994 (codified at 20 U.S.c. section 6081 et. seq.). 12. Medicaid Services. To the extent County provides any Service whose costs are paid in whole or in part by Medicaid, County shall comply with all applicable federal and state laws and regulation pertaining to the provision of Medicaid Services under the Medicaid Act, Title XIX, 42 U.S.c. Section 1396 et. seq., including without limitation: a. Keep such records as are necessary to fully disclose the extent of the services provided to individuals receiving Medicaid assistance and shall furnish such information to any state or federal agency responsible for administering the Medicaid program regarding any payments claimed by such person or institution for providing Medicaid Services as the state or federal agency may from time to time request. 42 U.S.c. Section 1396a(a)(27); 42 CFR 431.1 07(b)(1) & (2). b. Comply with all disclosure requirements of 42 CFR 1002.3(a) and 42 CFR 455 Subpart (8). I I t J J 141408 Desch utes 3090f330 c. Maintain written notices and procedures respecting advance directives in compliance with 42 U.S.C. Section 1 396(a)(57) and (w), 42 CFR 43 t.t07(b)(4), and 42 CFR 489 subpart l. d. Certify when submitting any claim for the provision of Medicaid Services that the information submitted is true, accurate and complete. County shall acknowledge County's understanding that payment of the claim will be from federal and state funds and that any falsification or concealment of a material fact may be prosecuted under federal and state laws. e. Entities receiving $5 million or more annually (under this Agreement and any other Medicaid Agreement) for furnishing Medicaid health care items or services shall, as a condition of receiving such payments, adopt written fraud, waste and abuse policies and procedures and inform employees, Providers and agents about the policies and procedures in compliance with Section 6032 of the Deficit Reduction Act of2005, 42 U.S.C. § 1396a(a)(68). 13. ADA. County shall comply with Title II of the Americans with Disabilities Act of 1990 (codified at 42 U.S.C. 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. 14. Agency-Based Voter Registration. If applicable, County shall comply with the Agency-based Voter Registration sections of the National Voter Registration Act of 1993 that require voter registration opportunities be offered where an individual may apply for or receive an application for public assistance. 15. Disclosure. a. 42 CFR 455.104 requires the State Medicaid agency to obtain the following information from any provider of Medicaid or CHIP services, including fiscal agents of providers and managed care entities: (t) the name and address (including the primary business address, every business location and P.O. Box address) of any person (individual or corporation) with an ownership or control interest in the provider, fiscal agent or managed care entity; (2) in the case of an individual, the date of birth and Social Security Number, or, in the case ofa corporation, the tax identification number of the entity, with an ownership interest in the provider, fiscal agent or managed care entity or of any subcontractor in which the provider, fiscal agent or managed care entity has a 5% or more interest; (3) whether the person (individual or corporation) with an ownership or control interest in the provider, fiscal agent or managed care entity is related to another person with ownership or control interest in the provider, fiscal agent or managed care entity as a spouse, parent, child or sibling, or whether the person (individual or corporation) with an ownership or control interest in any subcontractor in which the provider, fiscal agent or managed care entity has a 5% or more interest is related to another person with ownership or control interest in the provider, fiscal agent or managed care entity as a spouse, parent, child or sibling; (4) the name of any other provider, fiscal agent or managed care entity in which an owner of the provider, fiscal agent or managed care entity has an ownership or control interest; and, (5) the name, address, date of birth and Social Security 141408 Deschutes 310 of330 Number of any managing employee of the provider, fiscal agent or managed care entity. b. 42 CFR 455.434 requires as a condition of enrollment as a Medicaid or CHIP provider, to consent to criminal background checks, including fingerprinting when required to do so under state law, or by the category of the provider based ion risk of fraud, waste and abuse under federal law. As such, a provider must disclose any person with a 5% or greater direct or indirect ownership interest in Ithe provider whom has been convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid, or title XXI program in the f last 10 years. c. OHA reserves the right to take such action required by law, or where OHA has discretion, it deems appropriate, based on the information received (or the failure to receive) from the provider, fiscal agent or managed care entity. I 16. Special Federal Requirements Applicable to Addiction Services. a. Women's Services. If County provides A&D 61 or A&D 62 Services, County must: I(I) Treat the family as a unit and admit both women and their children if appropriate. I (2) Provide or arrange for the following services to pregnant women and t women with dependent children: (a) Primary medical care, including referral for prenatal care; (b) Pediatric care, including immunizations, for their children; (c) Gender-specific treatment and other therapeutic interventions, e.g. sexual and physical abuse counseling, parenting training, and child I fcare; (d) Therapeutic interventions for children in custody of women in treatment, which address, but are not limited to, the children's I [developmental needs and issues of abuse and neglect; and I t (e) Appropriate case management services and transportation to ensure that women and their children have access to the services in (a) through (d) above. b. Pregnant Women. If County provides any A&D Services other than A&D 70 Services, County must: I(I) Within the priority categories, if any, set forth in a particular Service Description, give preference in admission to pregnant women in need of treatment who seek, or are referred for, and would benefit from, such Services; I (2) Perform outreach to inform pregnant women of the availability of t treatment Services targeted to them and the fact that pregnant women Ireceive preference in admission to these programs; (3) IfCounty has insufficient capacity to provide treatment Services to a I pregnant woman, refer the women to another Provider with capacity or if I 141408 Deschutes 3110f330 no available treatment capacity can be located, refer the women to OHA's Addictions and Mental Health Division for referral to another provider in the state. If capacity cannot be located, AMH will make available interim services within 48 hours, including a referral for prenatal care. c. Intravenous Drug Abusers.lfCounty provides any A&D Services other than A&D 70 Services, County must: (1) Within the priority categories, ifany, set forth in a particular Service Description and subject to the preference for pregnant women described above, give preference in admission to intravenous drug abusers; (2) Programs that receive funding under the grant and that treat individuals for intravenous substance abuse, upon reaching 90 percent of its capacity to admit individuals to the program, must provide notification of that fact to the State within seven days. (3) IfCounty receives a request for admission to treatment from an intravenous drug abuser, County must, unless it succeeds in referring the individual to another Provider with treatment capacity, admit the individual to treatment not later than: (a) 14 days after the request for admission to County is made; or (b) 120 days after the date of such request if no Provider has the capacity to admit the individual on the date of such request and, if interim Services are made available not less than 48 hours after such request (4) For purposes of (3) above, "Interim Services" means: (a) Services for reducing the adverse health effects of such abuse, for promoting the health of the individual, and for reducing the risk of transmission of disease, including counseling and education about HIV and tuberculosis, the risks of needle sharing, the risks of transmission of disease to sexual partners and infants, and steps that can be taken to ensure that HIV and tuberculosis transmission does not occur; (b) Referral for HIV or TB treatment Services, where necessary; and (c) Referral for prenatal care if appropriate, until the individual is admitted to a Provider's Services. (d) IfCounty treats recent intravenous drug users (those who have injected drugs within the past year) in more than one-third of its capacity, County shall carry out outreach activities to encourage individual intravenous drug abusers in need of such treatment to undergo treatment, and shall document such activities. d. Infectious Diseases. If County provides any A&D Services other than A&D 70 Services, County must: (1) Complete a risk assessment for infectious disease including Human Immunodeficiency Virus (HIV) and tuberculosis, as well as sexually 141408 Deschutes 3120f330 I , h. Oregon Residency. A&D Services funded through this Agreement may only be provided to residents of Oregon. Residents of Oregon are individuals who live in Oregon. There is no minimum amount of time an individual must live in Oregon to qualify as a resident so long as the individual intends to remain in Oregon. A child's residence is not dependent on the residence of his or her parents. A child I living in Oregon may meet the residency requirement if the caretaker relative with t whom the child is living is an Oregon resident. I. Tobacco Use. IfCounty has A&D Services treatment capacity that has been designated for children, adolescents, pregnant women, and women with dependent children, County must implement a policy to eliminate smoking and I other use oftobacco at the facilities where the Services are delivered and on the t grounds of such facilities. I t transmitted diseases, based on protocols established by OHA, for every individual seeking Services from County; and (2) Routinely make tuberculosis services available to each individual receiving Services for alcohol/drug abuse either directly or through other arrangements with public or non-profit entities and, ifCounty denies an individual admission on the basis of lack of capacity, refer the individual to another provider of tuberculosis Services. (3) For purposes of (2) above, "tuberculosis services" means: (a) Counseling the individual with respect to tuberculosis; (b) Testing to determine whether the individual has contracted such disease and testing to determine the form of treatment for the disease that is appropriate for the individual; and (c) Appropriate treatment services. c. OHA Referrals. IfCounty provides any A&D Services other than A&D 70 services, County must, within the priority categories, if any, set forth in a particular Service Description and subject to the preference for pregnant women and intravenous drug users described above, give preference in A&D service delivery to persons referred by OHA. f. Barriers to Treatment. Where there is a barrier to delivery of an A&D Service due to culture, gender, language, illiteracy, or disability, County shall develop support services available to address or overcome the barrier, including: (I) Providing, if needed, hearing impaired or foreign language interpreters. (2) Providing translation of written materials to appropriate language or method of communication. (3) Providing devices that assist in minimizing the impact of the barrier. (4) Not charging clients for the costs of measures, such as interpreters, that are required to provide nondiscriminatory treatment. g. Misrepresentation. County shall not knowingly or willfully make or cause to be made any false statement or representation of a material fact in connection with the furnishing of items or Services for which payments may be made by OHA. 141408 Deschutes 3130[330 j. Client Authorization. County must comply with 42 CFR Part 2 when delivering an Addiction Service that includes disclosure ofClient information for purposes of eligibility determination. County must obtain Client authorization for disclosure of billing information, to the extent and in the manner required by 42 CFR Part 2, before a Disbursement Claim is submitted with respect to delivery of an Addiction Service to that individual. 17. Community Mental Health Block Grant. All funds, if any, awarded under this Agreement for MHS 20, MHS 22, MHS 37 or MHS 38 Services are subject to the federal use restrictions and requirements set forth in Catalog of Federal Domestic Assistance Number 93.958 and to the federal statutory and regulatory restrictions imposed by or pursuant to the Community Mental Health Block Grant portion of the Public Health Services Act, 42 U.S.c. 300x-l et. seq., and County shall comply with those restrictions. 18. Substance Abuse Prevention and Treatment. To the extent County provides any Service whose costs are paid in whole or in part by the Substance Abuse, Prevention, and Treatment Block Grant, County shall comply with federal rules and statutes pertaining to the Substance Abuse, Prevention, and Treatment Block Grant, including the reporting provisions ofthe Public Health Services Act (42 U.S.C. 300x through 300x-66). Regardless of funding source, to the extent County provides any substance abuse prevention or treatment services, County shall comply with the confidentiality requirements of 42 CFR Part 2. J4 J408 Deschutes 31401'330 I I i2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES I I ! EXHIBIT I REQUIRED PROVIDER CONTRACT PROVISIONS I I 11. Expenditure of Funds. Provider may expend the funds paid to Provider under this , ~ Contract solely on the delivery of , subject to the following flimitations (in addition to any other restrictions or limitations imposed by this Contract): I I !a. Provider may not expend on the delivery of any funds paid to Provider under this Contract in excess of the amount reasonable and necessary to " provide quality delivery of ______ ~b. If this Contract requires Provider to deliver more than one service, Provider may \ not expend funds paid to Provider under this Contract for a particular service on tthe delivery of any other service. f c. If this Contract requires Provider to deliver alcohol, drug abuse and addiction t services, Provider may not use the funds paid to Provider under this Contract for isuch services: (I) To provide inpatient hospital services; (2) To make cash payments to intended recipients of health services; (3) To purchase or improve land, to purchase, construct or permanently improve (other than minor remodeling) any building or other facility or to purchase major medical equipment; (4) To satisfy any requirement for expenditure of non-federal funds as a condition for receipt of federal funds (whether the federal funds are received under this Contract or otherwise); (5) With respect to federal Substance Abuse Prevention and Treatment Block Grant moneys only, to purchase services from any person or entity other than a public or non-profit entity; or (6) To carry out any program prohibited by section 245(b) of the Health Omnibus Programs Extension Act of 1988 (codified at 42 U.s.c. 300ee(5». d. Provider may expend funds paid to Provider under this Contact only in accordance with federal OMB Circular A-87 as that circular is applicable on allowable costs. 2. Records Maintenance, Access and Confidentiality. a. Access to Records and Facilities. County, the Oregon Health Authority, the Secretary of State's Office ofthe State of Oregon, the Federal Government, and their duly authorized representatives shall have access to the books, documents, papers and records of Provider that are directly related to this Contract, the funds paid to Provider hereunder, or any services delivered hereunder for the purpose of 141408 Deschutes 3150f330 making audits, examinations, excerpts, copies and transcriptions. In addition, Provider shall permit authorized representatives of County and the Oregon Health Authority to perform site reviews of all services delivered by Provider hereunder. b. Retention of Records. Provider shall retain and keep accessible all books, documents, papers, and records, that are directly related to this Contract, the funds paid to Provider hereunder or to any services delivered hereunder, for a minimum of 6 years, or such longer period as may be required by other provisions ofthis Contract or applicable law, following the termination or expiration ofthis Contract. If there are unresolved audit or other questions at the end of the six year period, Provider shall retain the records until the questions are resolved. c. Expenditure Records. Provider shall document the expenditure of all funds paid to Provider under this Contract. Unless applicable federal law requires Provider to utilize a different accounting system, Provider shall create and maintain all expenditure records in accordance with generally accepted accounting principles and in sufficient detail to permit County and the Oregon Health Authority to verifY how the funds paid to Provider under this Contract were expended. d. Client Records. Unless otherwise specified in this Contract, Provider shall create and maintain a client record for each client who receives services under this Contract. The client record must contain: (I) Client identification; (2) Problem assessment; (3) Treatment, training and/or care plan; (4) Medical information when appropriate; and (5) Progress notes including service termination summary and current assessment or evaluation instrument as designated by the Oregon Health Authority in administrative rules. Provider shall retain client records in accordance with OAR 166-150-0005 through 166-150-0215 (State Archivist). Unless OAR 166-150-0005 through 166-150-0215 requires a longer retention period, client records must be retained for a minimum of six years from termination or expiration of this contract. e. Safeguarding of Client Information. Provider shall maintain the confidentiality of client records as required by applicable state and federal law, including without Iimitation,ORS 179.495 to 179.507, 45 CFR Part 205, 42 CFR Part 2, any administrative rule adopted by the Oregon Health Authority, implementing the foregoing laws, and any written policies made available to Provider by County or by the Oregon Health Authority. Provider shall create and maintain written policies and procedures related to the disclosure of client information, and shall make such policies and procedures available to County and the Oregon Health Authority for review and inspection as reasonably requested by County or the Oregon Health Authority. 141408 Deschutes 3160f330 f. Data Reporting. I f All individuals receiving services with funds provided under this Contract must enroll and maintain that client's record in either: (1) the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: 1 http://www.oregon.gov/OHA/amh/training/cpms/index.shtml.asit may be t revised from time to time; or (2) the Measures and Outcome Tracking System (MOTS) as specified in OHA's MOTS manual located at: http://www.oregon.gov/ohalamh/pages/compass/electronic-data capture.aspx, as may be revised from time to time. I Over the next two years AMH will be closing the CPMS system and replacing it t with the MOTS system. Providers will be notified ofthe change. i3. Alternative Formats of Written Materials. In connection with the delivery of Services, Provider shall: a. Make available to a Client, without charge to the Client, upon the Client's, the County's or the Oregon Health Authority's request, any and all written materials in alternate, if appropriate, formats as required by the Oregon Health Authority's administrative rules or by the Oregon Health Authority's written policies made available to Provider. b. Make available to a Client, without charge to the Client, upon the Client's, County's or the Oregon Health Authority's request, any and all written materials in the prevalent non-English languages in the area served by Provider. c. Make available to a Client, without charge to the Client, upon the Client's, County's or the Oregon Health Authority's request, oral interpretation services in all non-English languages in the area served by Provider. d. Make available to a Client with hearing impairments, without charge to the Client, upon the Client's, County's or the Oregon Health Authority's request, sign language interpretation services and telephone communications access services. For purposes of the foregoing, "written materials" includes, without limitation, all written materials created or delivered in connection with the services and all provider contracts related to this Agreement. 4. Reporting Requirements. Provider shall prepare and furnish the following information to County and the Oregon Health Authority when a service is delivered under this Contract: a. Client, service and financial information as specified in the applicable Service Description attached hereto and incorporated herein by this reference. b. All additional information and reports that County or the Oregon Health Authority reasonably requests, including, but not limited to, the information or disclosure described in Exhibit H, Required Federal Terms and Conditions, Section 15. Disclosure. 141408 Deschutes 317of330 5. Compliance with Law. Provider shall comply with all state and local laws, regulations, executive orders and ordinances applicable to the Contract or to the delivery of services hereunder. Without limiting the generality of the foregoing, Provider expressly agrees to comply with the following laws, regulations and executive orders to the extent they are applicable to the Contract: (a) all applicable requirements of state civil rights and rehabilitation statutes, rules and regulations; (b) all state laws governing operation of community mental health programs, including without limitation, all administrative rules adopted by the Oregon Health Authority related to community mental health programs; (c) all state laws requiring reporting of client abuse; (d) ORS 659A.400 to 659A.409, ORS 659A.145 and all regulations and administrative rules established pursuant to those laws 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 under this Contract. These laws, regulations and executive orders are incorporated by reference herein to the extent that they are applicable to the Contract and required by law to be so incorporated. All employers, including Provider, that employ subject workers who provide services in the State of Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation coverage, unless such employers are exempt under ORS 656.126. In addition, Provider shall comply, as if it were County thereunder, with the federal requirements set forth in Exhibit H to the certain 2013-2015 Intergovernmental Agreement for the Financing of Community Addictions and Mental Health Services between County and the Oregon Health Authority dated as of , which Exhibit is incorporated herein by this reference. For purposes ofthis Contract, all references in this Contract to federal and state laws are references to federal and state laws as they may be amended from time to time. 6. Unless Provider is a State of Oregon governmental agency, Provider agrees that it is an independent contractor and not an agent of the State of Oregon, the Oregon Health Authority or County. 7. To the extent permitted by applicable law, Provider shall defend (in the case of the state of Oregon and the Oregon Health Authority, subject to ORS Chapter 180), save and hold harmless the State of Oregon, the Oregon Health Authority, County, and their officers, employees, and agents from and against all claims, suits, actions, losses, damages, liabilities, costs and expenses of any nature whatsoever resulting from, arising out of or relating to the operations ofthe Provider, including but not limited to the activities of Provider or its officers, employees, subcontractors or agents under this Contract. S. Provider understands that Provider may be prosecuted under applicable federal and state criminal and civil laws for submitting false claims, concealing material facts, misrepresentation, falsifying data system input, other acts of misrepresentation, or conspiracy to engage therein. 9. Provider shall only conduct transactions that are authorized by the County for transactions with the Oregon Health Authority that involve County funds directly related to this Contract. 10. First tier Provider(s) that are not units of local government as defined in ORS 190.003 shall obtain, at Provider's expense, and maintain in effect with respect to all occurrences taking place during the term of the contract, insurance requirements as specified in Exhibit J of the certain 2013-2015 Intergovernmental Agreement for the Financing of Community Addictions and Mental Health Services between County and the Oregon 141408 Deschutes 3180f330 I I Health Authority dated as of _____, which Exhibit is incorporated herein by this reference. 11 Provider(s) that are not units of local government as defined in ORS 190.003, shall indemnifY, defend, save and hold harmless the State of Oregon and its officers, I employees and agents ("Indemnitee") from and against any and all claims, actions, liabilities, damages, losses, or expenses (including attorneys' fees) arising from a tort (as now or hereafter defined in ORS 30.260) caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of Provider or any of the officers, I agents, employees or subcontractors ofthe contractor( "Claims"). It is the specific i intention of the parties that the Indemnitee shall, in all instances, except for Claims t arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified by the Provider from and against any and all Claims I I !12. Provider shall include sections 1 through 11, in substantially the form set forth above, in all permitted Provider Contracts under this Agreement. f I I 141408 Deschutes 3190f330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBIT J PROVIDER INSURANCE REQUIREMENTS County shall require its first tier Providers(s) that are not units of local government as defined in ORS 190.003, if any, to: i) obtain insurance specified under TYPES AND AMOUNTS and meeting the requirements under ADDITIONAL INSURED, "TAIL" COVERAGE, NOTICE OF CANCELLATION OR CHANGE, and CERTIFICATES OF INSURANCE before the Providers perform under contracts between County and the Providers (the "Provider Contracts"), and ii) maintain the insurance in full force throughout the duration of the Provider Contracts. The insurance must be provided by insurance companies or entities that are authorized to transact the business of insurance and issue coverage in the State of Oregon and that are acceptable to OHA. County shall not authorize Providers to begin work under the Provider Contracts until the insurance is in full force. Thereafter, County shall monitor continued compliance with the insurance requirements on an annual or more frequent basis. County shall incorporate appropriate provisions in the Provider Contracts permitting it to enforce Provider compliance with the insurance requirements and shall take all reasonable steps to enforce such compliance. Examples of "reasonable steps" include issuing stop work orders (or the equivalent) until the insurance is in full force or terminating the Provider Contracts as permitted by the Provider Contracts, or pursuing legal action to enforce the insurance requirements. In no event shall County permit a Provider to work under a Provider Contract when the County is aware that the Provider is not in compliance with the insurance requirements. As used in this section, a "first tier" Provider is a Provider with whom the County directly enters into a Provider Contract. It does not include a subcontractor with whom the Provider enters into a contract. TYPES AND AMOUNTS. 1. WORKERS COMPENSATION. Insurance in compliance with ORS 656.017, which requires all employers that employ subject workers, as defined in ORS 656.027, to provide workers' compensation coverage for those workers, unless they meet the requirement for an exemption under ORS 656.126(2). Employers Liability insurance with coverage limits of not less than $500,000 must be included. 2. PROFESSIONAL LIABILITY ~Required by OHA D Not required by OHA. Professional Liability Insurance covering any damages caused by an error, omission or negligent act related to the services to be provided under the Provider Contract, with limits not Jess than the following, as determined by OHA, or such lesser amount as OHA approves in writing: 141408 Deschutes 3200[330 [gJ Per occurrence for all claimants for claims arising out of a single accident or occurrence: Provider Contract not-to-exceed under this Agreement: Required Insurance Amount: $0 -$1,000,000. $1,000,000. $1,000,001. -$2,000,000. $2,000,000. $2,000,001. -$3,000,000. $3,000,000. In excess of $3,000,001. $4,000,000. 3. COMMERCIAL GENERAL LIABILITY r f r I , I[gJ Required by OHA Not required by OHA. Commercial General Liability Insurance covering bodily injury, death, and property damage in a form and with coverages that are satisfactory to OHA. This insurance shall include personal injury liability, products and completed operations. Coverage shall be written on an occurrence form basis, with not less than the following amounts as determined by OHA, or such lesser amount as OHA approves in writing: Bodily Injury, Death and Property Damage: [:gJ Per occurrence for all claimants for claims arising out of a single accident or occurrence: Provider Contract not-to-exceed under this Agreement: Required Insurance Amount $0 -$1,000,000. $1,000,000. $1,000,001. -$2,000,000. $2,000,000. $2,000,001. -$3,000,000. $3,000,000. In excess of$3,000,001. $4,000,000. 4. AUTOMOBILE LIABILITY INSURANCE [:gJ Required by OHA Not required by OHA. Automobile Liability Insurance covering all owned, non-owned and hired vehicles. This coverage may be written in combination with the Commercial General Liability Insurance (with separate limits for "Commercial General Liability" and "Automobile Liability"). Automobile Liability Insurance must be in not less than the following amounts as determined by OHA, or such lesser amount as OHA approves in writing: 141408 Deschutes 321of330 7 Bodily Injury, Death and Property Damage: I:sJ Per occurrence for all claimants for claims arising out of a single accident or occurrence: Provider Contract not-to-exceed under this Agreement: Required Insurance Amount: $0 -$1,000,000. $1,000,000. $1,000,001. -$2,000,000. $2,000,000. $2,000,00 I. -$3,000,000. $3,000,000. In excess of$3,000,001. $4,000,000. 5. ADDITIONAL INSURED. The Commercial General Liability insurance and Automobile Liability insurance must include the State of Oregon, its officers, employees and agents as Additional Insureds but only with respect to the Provider's activities to be performed under the Provider Contract. Coverage must be primary and non-contributory with any other insurance and self-insurance. 6. "TAIL" COVERAGE. Ifany of the required insurance policies is on a "claims made" basis, such as professional liability insurance, the Provider shall maintain either "tail" coverage or continuous "claims made" liability coverage, provided the effective date of the continuous "claims made" coverage is on or before the effective date of the Provider Contract, for a minimum of24 months following the later of: (i) the Provider's completion and County's acceptance of all Services required under the Provider Contract or, (ii) the expiration of all warranty periods provided under the Provider Contract. Notwithstanding the foregoing 24-month requirement, if the Provider elects to maintain "tail" coverage and if the maximum time period "tail" coverage reasonably available in the marketplace is less than the 24-month period described above, then the Provider may request and OHA may grant approval of the maximum "tail" coverage period reasonably available in the marketplace. IfOHA approval is granted, the Provider shall maintain ''tail'' coverage for the maximum time period that "tail" coverage is reasonably available in the marketplace. NOTICE OF CANCELLATION OR CHANGE. The Provider or its insurer must provide 30 days' written notice to County before cancellation of, material change to, potential exhaustion of aggregate limits of, or non-renewal of the required insurance coverage(s). 8. CERTIFICATE(S) OF INSURANCE. County shall obtain from the Provider a certificate(s) of insurance for all required insurance before the Provider performs under the Provider Contract. The certificate(s) or an attached endorsement must specify: i) all entities and individuals who are endorsed on the policy as Additional Insured and ii) for insurance on a "claims made" basis, the extended reporting period applicable to "tail" or continuous "claims made" coverage. 141408 Deschutes 3220[330 2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES EXHIBITK START-UP PROCEDURES A&D Special Projects (AD 60-Start-Up) MHS Special Projects (MHS 37-Start-Up) INTRODUCTION Start-Up funds are awarded for expenses necessary to begin, expand, or improve services. These expenses are distinct from routine operating expenses incurred in the course of providing ongoing services. Start-Up funds are typically disbursed prior to initiation of services. Funds are used to cover costs such as employee salaries and training, furnishings and supplies, renovation of facilities under $5,000, and purchase of vehicles and other capital items that will be needed to provide the services planned and delivered at the specified sites. Requirements for Start-Up Payment Payment of Start-Up funds is subject to the following requirements and any special conditions which are specified in Exhibit D. 1. Basis and Method of Payment a. Funds are paid for actual allowable expenses up to the limit specified for Start Up. Allowable expenses for each service element are limited to those listed under Allowable Start-Up Expenditures in this Exhibit K. OHA must approve payment for all Start-Up funds. b. After execution of the Contract or any amendment(s) awarding Program Start-Up funds, County may request an advance of funds it anticipates using in the subsequent 120 days. Ordinarily, OHA will not release funds earlier than 90days prior to the projected first day of service. However, under justifiable circumstances, OHA may release funds earlier. c. A request for payment of Start-Up funds may only be made using forms and procedures prescribed by OHA. Special instructions are applicable as follows: (I) When OHA Start-Up funds in the amount of$I,OOO and above are to be used for purchase of a vehicle, as security for the County's performance of its obligations under this Agreement, the County grants to the OHA a security interest in, all of the County's right, title, and interest in and to the goods, i.e. the vehicle. The County agrees that from time to time, at its expense, the County will promptly execute and deliver all further , 141408 Deschutes 3230[330 I l instruments and documents, and take all further action, that may be necessary or desirable, or that the OHA may reasonably request, in order to perfect and protect the security interest granted under this Agreement or to enable the OHA to exercise and enforce its rights and remedies under this Agreement with respect to the vehicle. County must forward a copy of the title registration application showing Addictions and Mental Health Division as the Security Interest Holder to OHA within five (5) days of the acquisition from the seller. File Security Interest Holder information as follows: Oregon Health Authority Addictions and Mental Health Division 500 Summer Street NE, E86 Salem, OR 97301 (2) When County requests payment of Start-Up funds, the request must be made on forms prescribed by OHA. 2. Special Written Approval Authorizations When using Start-Up funds the following circumstances require special written authorization from OHA prior to acquisition. These circumstances should be communicated to OHA within 14 days of the anticipated acquisition date. a. WHEN LEASING: (1) Acquisition of real property, vehicles or capital items pursuant to a Lease; (2) Acquisition of real property, vehicles, or capital items where another party, in addition to OHA, will also become a secured party (lienholder) at the time of acquisition; (3) Renovations or alterations of real property where County is not the owner of the property and OHA has no security interest in the property. b. OTHER: (1) A change in the intended use of Start-Up funds or a change in the amount or date of anticipated acquisition indicated on County's request for payment of Start-Up funds, for those acquisitions requiring OHA's interest to be secured. 3. Release of Payments Following review and approval of County's request for payment of Start-Up funds and any ancillary documentation, OHA will issue an advance of funds to County as applicable. These funds will generally be issued as a separate check on a weekly basis; however, requests processed in time for the monthly allotment process will be included in the allotment. The request for funds should be communicated to OHA within 14 days of 141408 Deschutes 3240[330 the anticipated acquisition date. Approval of special requests will be made on a limited basis only. County will keep a copy of all Requests for Payment of Start-Up funds and report actual expenditures to OHA on the same form using procedures prescribed by OHA. 4. Start-Up Expenditure Documentation Maintained by County County shall maintain an Expenditure Report for Start-Up payments. County also is responsible for requiring its Providers to comply with expenditure reporting requirements and furnishing evidence offiling OHA's security interest on applicable items. OHA may inspect these reports. The reports must include the following by service element: a. The amount advanced; b. The amount expended on each allowable category, and the amount expended on each item listed as required in section 2 above and pre-approved by OHA; c. Copies of all Provider Contracts awarding Start-Up funds. Such Provider Contracts must require Providers to have executed dedicated use agreements and the other security documentation described in this Exhibit K. County must maintain supporting documentation for all expenditures (i.e., receipts). 5. Expenditure Reports to OHA County must submit Start-Up expenditure reports separately for each OHA Start-Up request. Expenditure reports are due within 90 days following the effective date of the award, or within 60 days of termination or expiration of the Agreement. County shall report actual expenditure of Start-Up funds, using forms and procedures prescribed by OHA, and forward expenditure reports to OHA. 6. Recovery of Start-Up Funds In the event County fails to submit an expenditure report when due for itself or its Provider(s), fails to submit security interests, vehicle titles, or other instrument as required by OHA to secure the State's interest, or reports unauthorized expenditures, or reports under expenditures without accompanying repayment, OHA may act, at its option, to recover Start-Up funds as follows: a. Bill County for subject funds; b. Following 30 days nonresponse to the billing, initiate an allotment reduction schedule against any current payments or advances being made to County; or c. Take other action needed to obtain payment. 141408 Deschutes 3250[330 7. Dedicated Use Requirement Vehicles costing $1,000 or more must be used to provide the service for which OHA approved the Start-Up funds. Dedicated use must continue for the useful life ofthe vehicle or five years whichever is less. 8. Removal of Liens The following steps describe the process for removal of liens: a. To release a vehicle title on which OHA is listed security interest holder, County or any of its' Providers, must make a request in writing to OHA. The request must specify why the vehicle is being disposed of and the intended use of any funds realized from the transaction. If approved, the original title is signed off by OHA and forwarded to County. 141408 Deschutes 32601'330 ALLOWABLE START-UP EXPENDITURES Addictions and Mental Health Division Policies: Start-Up funds: 1. Must be expended consistent with County's request for payment of Start-Up funds, and/or any required itemized budget, as approved by aHA. l 2. Must be expended only for items and services listed below. i 3. Must not be used for personnel costs, facility costs (as defined below) or equipment lease costs (including vehicle leases) in any month in which the provider receives aHA-funded I service payments, or room and board payments for clients. If, however, some or all lclients in a new program are not enrolled when a program opens, and this delay results in fa loss of service payment or room and board revenue, Phase-In funds may be used to r make up for those lost revenues up to 30 days. I I i 4. Are subject to dedicated use requirements and other procedures for securing the State's interest, as described within this Exhibit K. Exceptions to the policies stated above and/or the itemized list below must be approved in writing by AMH. I Allowable Costs (includes costs incurred during client trial visits) i ~ ~ l 1. Personnel Costs: Costs for personnel hired to work at program/facility incurred prior to I the date clients are enrolled. I r a. Salaries and wages; b. OPE costs; and c. Professional contract services (e.g., Psychiatrist, Specialized Treatment Providers, etc.). ~ I 2. Facility Costs: ,t I ~ a. Lease/mortgage payments and deposits; b. Property taxes and maintenance fees not included in, lease or mortgage payments; c. Utility costs, including hook-up fees; or, J d. Equipment rental costs. 13. Program Staff Training: i a. Training materials; b. Training fees; I c. Trainer fees; and d. Travel costs (excluding out of state). I I J141408 Deschutes 3270[330 , 4. Services and Supplies: a. Program and office supplies; b. Initial supplies of food, maintenance, and housekeeping items; or c. Initial insurance premiums, (general, liability, and professional liability insurance; 5. Capital Outlay a. Furnishings and equipment appropriate for the type of service being provided, e.g., household furnishings and appliances for residential programs, work-related equipment for vocational programs; b. Technical or adaptive equipment needed by clients but not available through the Adult and Family Services (client medical card), Vocational Rehabilitation, or other appropriate service agency; c. Office furnishings and equipment proportionate to size of residential program/staff being implemented; d. Vehicle purchases or down payment; lease payments and deposits; as well as costs for purchase and/or installation of necessary adaptive equipment such as lifts or ramps; e. Renovation of real property costing less than $5,000. 141408 Deschutes 328of330 2013-2015 INTERGOVERNMENTAL AGREEMENT I FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENT AL HEALTH SERVICES I EXHIBIT L l Catalogue of Federal Domestic Assistance (CFDA) Number Listing I I f 1 I t I I t t ,i f I i I I I I,141408 Deschutes 3290f330 Deschutes County Service Service DeSCription Name Vendor or All Funding Sources FDA#{sDescription # Sub-recipient Local Administration -Mental Vendor 93.778 MHS01 Health Services Ge Local Administration A&D03 Addictions Services (Problem N/A Gamblng) A&D60 Special Projects I N/A A&D60 Strategic Prevention Vendor I SPF-SIG 93.243 A&D61 Adult Alcohol and Drug N/AResidential Treament Housing Services For A&D62 Dependent Children Whose N/AParents are in Alcohol and Drug Residential Treatment A&D67 Alcohol and Drug Residential N/A. Services Gambling Residential NIA Non-Residential Mental Health Vendor Medicaid 93.778 MHS20 Services For Adults -General General Fund Match MH General Fund Child and Adolescent Mental Vendor Medicaid 93.778 MHS22 Health Services Treatment General Fund Match Foster Care MHS24 Regional Acute Psychiatric NIAInpatience Services Non Residential Youth and MHS26 Young Adults Mental Health MH General Fund Services In Transition II Designated) Residential Mental Health MHS27 Treatment Services for Youth NIA and Young Adults In Transition Vendor Medicaid 93.778 MHS28 Residential Treatment Services General Fund Match MH General Fund MHS31 Enhanced CarelEnhanced Vendor Medicaid 93.778 Care Outreach Services General Fund Match Vendor Medicaid 93.778 MHS 34 Adult Foster Care Services MH General Fund General Fund Match MHS35 Older/Disability Adult Mental MH General Fund Health Services MHS36 Pre-Admission Screening and Vendor Medicaid 93.778 Resident Review Services General Fund Match MHS37 MHS Special Projects Sub-recipient MH Block Grant 93.958 MH General Fund , AD General Fund Vendor (Prev) 93.558 TANF Match (GF) Beer & Wine 20 MHS37 Flex Funds Sub-recipient Beer & Wine 40 93.959 Sub-reapient SAPT Block Grant 93.959 (Trmt) SAPT Block Grant (Prev) IDPF Lottery Projects For Assistance In MHS39 Transition From Homelessness Sub-recipient PATH Grant 93.150 I{PATH) Services • 141408 Deschutes 3300f330