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HomeMy WebLinkAboutDoc 619 - St Charles - Psychiatric SvcsDeschutes 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 December 4, 2013 November 27,2013 FROM: Lori Hill, Adult Treatment Program Manager Nancy Mooney, Contract Specialist Phone: 322-7516 TITLE OF AGENDA ITEM: Consideration of Board Signature of Document #2013-619, Agreement between St. Charles Health System, Inc. and Deschutes County Health Services (DCHS). PUBLIC HEARING ON THIS DATE? No BACKGROUND AND POLICY IMPLICATIONS: St. Charles Health System Inc. operates a facility that can serve up to fifteen (15) clients in need of short-term psychiatric care, also referred to as acute psychiatric care services. Acute psychiatric care services are services delivered to individuals who are suffering from a mental illness, or mental or emotional disturbance and are posing a danger to the health and safety of the individual or others. The intention of these services is to control or reduce the psychiatric symptoms or behaviors in order that the individual can return to a less restrictive environment. Since 2005, Deschutes County, on behalf of Crook and Jefferson counties has contracted with St. Charles to ensure indigent residents of our three counties have access to these services and the Sage View facility. The resources are subject to funding from the State of Oregon Office of Mental Health and Addiction Services. Under the terms of this contract, St. Charles agrees to provide acute psychiatric care services on an in-patient basis. (In-patient meaning that the individual remains at the facility until transferred to another facility or discharged.) Acute psychiatric care services may include: twenty-four (24) hour supervision and nursing care; health screening or medical care; psychiatric assessment; medication management; individual and group therapy; education regarding mental health and addiction issues; family involvement and transportation services between Sage View and St. Charles Hospital (Bend) as needed for medical or other services. In additional to the acute psychiatric care, St. Charles also agrees to provide post-commitment care for individuals who are civilly committed by a judge. This includes clients already admitted and return to the Sage View facility after a commitment hearing. Post-commitment care includes professional psychiatrist staff time, psychiatric medications, lab work and medical care. This amendment extends the term of the original contract and modifies the funding. Although the original contract's expiration date is June 30, 2013, Deschutes County will need to pay for services provided by St. Charles retroactive to July 1, 2013. The delay in amending the original contract was due to language negotiation between Deschutes County and St. Charles. Deschutes County and St. Charles are expecting to execute a PES/SageView contract with an effective date of January 1, 2014. FISCAL IMPLICATIONS: Maximum compensation is $219,839.50 for acute psychiatric care services and $132,312 for post­ commitment care services. RECOMMENDATION & ACTION REQUESTED: Behavioral Health requests approval and signature ATTENDANCE: Michelle Cox, Adult Treatment Supervisor DISTRIBUTION OF DOCUMENTS: Executed copies to: Nancy Mooney, Contract Specialist. Health Services DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be on a Board agenda or can be signed by the County Administrator or; Department Director. If the document is to be on a Board agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the County Administrator or the Commissioners. In addition to submitting this form with your documents. please submit this form electronically to the Board Secretary.) Please complete all sections above the Official Review line. Date: IOctober 28, 20131 Department: IDeschutes County Health Services, Behavioral Healthl Contractor/Supplier/Consultant Name: 1st. Charles Health System, Inc.1 Contractor Contact: I Maryclair Jorgensen I Phone #: I 541-280-1141 Type of Document: Amendment #1 to 2012-408 Goods and/or Services: Secure inpatient acute psychiatric care is provided to indigent residents of Deschutes, Crook and Jefferson counties at Sage View, a facility and program of St. Charles Health System, Inc. (St. Charles) Background & History: St. Charles operates Sage View as a secure inpatient psychiatric facility, serving residents of Central Oregon and others in need of acute psychiatric care. The facility has fifteen (15) beds to serve patients. Since 2005, Deschutes County, on behalf of Crook and Jefferson counties, has contracted with St. Charles to ensure indigent residents of our three (3) counties have access to these services and this facility. Under the terms of this contract, St. Charles agrees to provide in-patient psychiatric services to any and all indigent residents of our three (3) counties who need short term acute stabilization. Acute care services may include: twenty-four (24) hour supervision and nursing care; health screening or medical care; psychiatric assessment; medication management; individual and group therapy; psycho-education regarding mental health and addiction issues; family involvement; case management and transporation services between Sage View and St. Charles Hospital (Bend) as needed for medical or other services. St. Charles also agrees to provide Post-Commitment Care for individuals who are civilly committed by a judge. This includes individuals who are already admitted and return to the facility after a civil commitment hearing. This service includes professional staff time (psychiatristlMD), psychiatric medications, lab work and medical care. Post­ Commitment Care shall be provided until transfer to a long-term care facility at the state hospital or discharge from the facility. This amendment extends the term of the original contract and modifies the funding. Although the original contract's expiration date is June 30, 2013, Deschutes County will need to pay for services provided by St. Charles retro-active to July 1, 2013. The delay in amending the original contract was due to language negotiation between Deschutes County and St. Charles. Deschutes County and st. Charles are expecting to execute a PES/SageView contract with an effective date of January 1,2014. 10/2812013 Agreement Starting Date: IJuly 1,20121 Ending Date: 1 December 31,20131 Annual Value or Total Payment: $219,839.50 for acute s chiatric care and $132,312 for ost-commitment care. 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 0 No If No, has budget amendment been submitted? 0 Yes o No Is this a Grant Agreement providing revenue to the County? 0 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: 0 Yes 0 No Contact information for the person responsible for grant compliance: Name: Phone#:D Departmental Contact and Title: I Nancy Mooney, Contract Specialist Phone #: I 541-322-7516 I Deputy Director Approval: Date Department Director Approval: ---~t:.t-I~-----\0. 1;(.13 Date Distribution of Document: Is to Nancy Mooney, Health Services Department. Official Review: County Signature Required (check one): 00 BOCC 0 Department Director (if <$25K) o Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ____-I) Legal Review Date 1/ -Zt. -l JAt... ru Document Number _2=.0::;..1.:..;;3'--6.::;..1"'-'9"--______ 10/28/2013 EVIE l.. ' ­~ L GAL COUNSEL For Recording Stamp Only DESCHUTES COUNTY SERVICES CONTRACT AMENDMENT #1 DOCUMENT NO. 2013-619 AMENDING DESCHUTES COUNTY CONTRACT NO. 2012-408 THAT CERTAIN AGREEMENT, Deschutes County Contract No. 2012-381 dated July 1,2012, by and between DESCHUTES COUNTY, a political subdivision of the State of Oregon ("County") and St. Charles Health System, Inc., an Oregon non-profit corporation ("Contractor"), is amended, effective upon signing of all parties, as set forth below. Except as provided herein, all other provisions of the contract remain the same and in full force. County's performance hereunder is conditioned upon Contractor's compliance with provisions of ORS 279B.220, 279B.225, 2798.230, and 279B.235, which are hereby incorporated by reference. In addition Standard Contract Provisions contained in Deschutes County Code Section 2.37.150 are hereby incorporated by reference. Such code section may be found at the following URL address: www.deschutes.org/County-Code.aspx. Contractor certifies that the representations, warranties and certifications contained in the original Contract are true and correct as of the effective date of this Amendment and with the same effect as though made at the time of this Amendment. The above listed contract is amended as follows (new language is indicated by bold font and deleted language is indicated by strikeout font): DESCHUTES COUNTY SERVICES CONTRACT CONTRACT NO. 2012-408 This Contract (the "Contract") is made and entered into by and between Deschutes County, a pOlitical subdivision of the State of Oregon, by and through Deschutes County Health Services, Behavioral Health Division, hereinafter referred to as "County," and St Charles Health System, Inc., an Oregon non-profit corporation (hereinafter referred to as "Hospital"), doing business as Sage View, Federal Tax Identification No. 93-0602940, hereinafter referred to as "Contractor." WHEREAS, County and Hospital (or its predecessor in interest, Cascade Health Services, Inc.) have caused to be constructed an acute psychiatric treatment facility (hereinafter referred to as "Sage View") for Individuals in need of mental health services, including indigent individuals residing in Crook, Deschutes and Jefferson Counties and served under this Contract; and WHEREAS, the parties agree that a crisis center and facility for acute psychiatric care and treatment of acute mental health patients is the preferred acute care model for mental health care and treatment in Central Oregon; WHEREAS, Contractor operates the facilities therein; and WHEREAS, County is authorized pursuant to ORS 430.670 to obtain, by contract, the services necessary to conduct and operate a community mental health and developmental disabilities program; and WHEREAS, Contractor has available, or can provide Sage View facilities and staff for the performance of the services described in this Contract; and WHEREAS, Contractor has obtained and shall continue to qualify for approval from the Oregon Health Authority ("OHA") for purposes of providing services under this Contract; now, therefore, Page 1 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 DC-2013-619 WHEREAS, County is authorized pursuant to ORS 426.241 and Service Element 24 (State of Oregon grant ­ Exhibit 5) to obtain, by contract, the emergency psychiatric care necessary for indigent residents of Crook, Deschutes and Jefferson counties (collectively, "Counties"); and IT IS HEREBY AGREED by and between the parties above mentioned, for and in consideration of the mutual promises hereinafter stated as follows: 1. Effective Date. This Contract is effective July 1, 2012 and, except as otherwise specifically provided herein, shall expire on June 30, 2013 December 31, 2013 unless earlier terminated or renewed by agreement of the parties. 2. Contractor's Services. This Contract will cover services as outlined below for: A. Acute Psychiatric Care: Both Contractor and County agree to adhere to the principles and agreements for this Contract as outlined in Exhibit 1. Contractor shall perform the services described as Acute Psychiatric Care in Exhibit 2 attached hereto and incorporated herein, as funded by and through the County's contract with the Oregon Health AuthOrity (OHA). Services shall be financed in accordance with a schedule contained in Exhibit 2. For the full term of this Contract, Contractor agrees to the payment methodology as outlined in Section 8 and Exhibits 1 and 2 to provide service to all indigent Individuals residing in Crook, Deschutes, and Jefferson Counties who meet admission criteria as defined in Exhibit 2. Contractor agrees to maintain this arrangement for the Contract period. Acute Psychiatric Care will include all bed days up to and including day of commitment if applicable. All days post-commitment will be covered under payment and services outlined in paragraph 2(b) below. If Individual is not committed, payment will include all bed days excluding day of discharge. B. Post-Commitment Care: Contractor shall perform the services described as Post Commitment Care in Exhibit 3 attached hereto and incorporated herein, as funded by and through the County's contract with the Oregon Health Authority (OHA). Services shall be financed in accordance with a schedule contained in Exhibit 3. For the period of July 1, 2012 -June, ao, 2013 December 31,2013, Contractor agrees to the payment methodology outlined in Section 8 and Exhibit 3 to provide post-commitment service to all indigent Individuals residing in Central and Eastern Oregon Counties as defined in Exhibit 3. Any services funded beyond June 30, 2013 December 31,2013, if approved, would be made by separate amendment to this Contract. 3. Regulations and Duties. Contactor shall comply with all applicable provisions of the County Financial Assistance Contract, including applicable Service Descriptions attached thereto, in place at the time this Contract is executed and effective July 1, 2011, Contract #134309 and July 1, 2013, Contract #141408 (Contr=aGt #134309, the "Contract") between the Oregon Health Authority ("OHA") and Deschutes County, as the same may be amended, replaced and/or renewed from time to time. Contractor agrees to comply with the rules and regulations of County, applicable provisions in the Contract between County and the OHA, incorporated herein by reference, as of the effective date of such regulations, applicable provisions of the Administrative Rules and Procedures of the OHA, applicable Federal regulations and all provisions of Federal and State statutes, rules and regulations relating to Contractor's performance of services under this Contract. Any act or duty of County, imposed upon County by OHA, which, by the nature of this Contract, County determines to be within the scope of this Contract and is to be performed by Contractor, Contractor shall perform on behalf of County. No federal funds may be used to provide services in violation of 42 USC 14402. 4. Reporting. A. Contractor shall document the expenditure of all funds paid to Contractor under this Contract. Unless applicable federal law requires Contractor to utilize a different accounting system, Contractor 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 Contractor under this Contract were expended. Page 2 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 B. Contractor agrees to prepare and furnish such reports and data as may be required by County and the Oregon Health Authority, including but not limited to records of Individuals which contain Individual's identification, problem assessment, Individual Service and Support Plan (including any training and/or care plan), appropriate medical information, and Individual Service Notes, including a service termination summary and current assessment or evaluation instrument as designated by the Oregon Health Authority in the administrative rules. Contractor shall retain records of Individuals in accordance with OAR 166-150-0005 through 166-150-0215 (State Archivist). Unless OAR 166-150-0005 through 116-150-0215 requires a longer retention period, records of Individuals must be retained for a minimum of ten (10) years from termination or expiration of this Contract. It is understood that due to the limited nature of Contractor's services under this Contract, not all of these documents will have been prepared by Contractor and therefore need not be furnished. Oregon Health AuthOrity Client Process Monitoring System (CPMS) data, Community Mental Health Provider Report, and Termination Service Recording Form shall, if necessary, be completed in accordance with Oregon Health Authority requirements and submitted to Oregon Health Authority through County. Contractor agrees to, and does hereby grant County and the Oregon Health Authority the right to reproduce use and disclose for County or Oregon Health Authority purposes, all or any part of the reports, data, and technical information furnished to County under this Contract. Contractor shall make available to County, Oregon Health Authority and any patient of Contractor as defined in Exhibit 1, of this Contract, any and all written materials in alternate formats in compliance with Oregon Health Authority's policies or administrative rules. For purposes of the foregoing, "written materials" includes, without limitation, all work product and contracts related to this Contract. C. Contractor shall prepare and fumish the following information to Oregon Health Authority when a Service is delivered: 1) Patient Individual, Service and financial information as specified in the Service Description. 2) All additional information and reports that Oregon Health Authority or County reasonably requests. D. Contractor shall submit reports as requested by County. All notices, bills and payments shall be made in writing and may be given by personal delivery or by mail. Notices, bills, and payments sent by mail should be addressed as follows: Contractor: St. Charles Health System, Inc. 2500 NE Neff Road Bend, OR 97701 Attn: Karen M. Shephard County: Deschutes County Health Services 2577 NE Courtney Dr. Bend, OR 97701 Phone: (541) 322-7535 Attn: Lori Hill 5. Access to Records. Contractor shall maintain fiscal records and all other records pertinent to this Contract. A. All fiscal records shall be maintained pursuant to generally accepted accounting standards, and other records shall be maintained to the extent necessary to clearly reflect actions taken. 1) Contractor shall retain and keep accessible all books, documents, papers and records that are directly related to this Contract, the funds paid to Contractor hereunder or to any services delivered hereunder, for a minimum of ten (10) years, or such longer period as may be required. 2) If an audit, litigation or other action involving this Contract is started before the end of the ten-year (10) period, the records shall be retained until all issues arising out of the action are resolved. B. County, the Oregon Health Authority, the Secretary of State's Office of the State of Oregon, the Federal Government, and their duly authorized representatives shall have the right to direct access to all of Contractor's books, documents, papers and records related to this Contract, the funds paid to Contractor hereunder, or any services delivered hereunder for the purpose of conducting audits and examinations, making copies, excerpts and transcripts. In addition, Contractor shall permit authorized representatives of Page 3 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 County and the Oregon Health Authority to perform site reviews of all services delivered by Contractor hereunder. 1) These records also include licensed software and any records in electronic form, including but not limited to computer hard drives, tape backups and other such storage devices. County shall reimburse Contractor for Contractor's cost of preparing copies. 2) At Contractor's expense, the County, the Secretary of State's Office of the State of Oregon, the Federal Government, and their duly authorized representatives, shall have license to enter upon Contractor's premises to access and inspect the books, documents, papers, computer software, electronic files and any other records of the Contractor which are directly pertinent to this Contract. 3) If Contractor's dwelling is Contractor's place of business, Contractor may, at Contractor's expense, make the above records available at a location acceptable to the County. 6. Confidentiality. Contractor shall maintain confidentiality of information obtained pursuant to this Contract as follows: A. Contractor shall not use, release or disclose any information concerning any employee, patient, applicant or person doing business with the County for any purpose not directly connected with the administration of County's or the Contractor's responsibilities under this Contract except upon written consent of the County, and if applicable, the employee. patient, applicant or person. B. The Contractor shall ensure that its agents, employees, officers and subcontractors with access to County and Contractor records understand and comply with this confidentiality provision. C. Contractor shall treat all information as to personal facts and circumstances obtained on Medicaid eligible individuals as privileged communication, shall hold such information confidential, and shall not disclose such information without the written consent of the individual. his or her attorney. the responsible parent of a minor child, or the child's guardian. except as required by other terms of this Contract. D. Nothing prohibits the disclosure of information in summaries, statistical information, or other form that does not identify particular individuals. E. Personally identifiable health information about applicants and Medicaid reCipients will be subject to the transaction, security and privacy provisions of the Health Insurance Portability and Accountability Act ("HIPAA"). F. Contractor shall cooperate with County in the adoption of poliCies and procedures for maintaining the privacy and security of records and for conducting transactions pursuant to HIPAA requirements. G. This Contract may be amended in writing in the future to incorporate additional requirements related to compliance with HIPAA. H. If Contractor receives or transmits protected health information, Contractor shall enter into a Business Associate Contract with County, which, if attached hereto, shall become a part of this Contract. I. 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 Individuals which are funded in whole or in part under this Contract. Contractor shall maintain the confidentiality of Individuals' 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 the Oregon Health Authority, implementing the foregoing laws. and any written policies made available to Contractor by County or by the Oregon Health Authority. Contractor shall create and maintain written poliCies and procedures related to the disclosure of Individuals' 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. Page 4 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 7. County Monitoring and Site Visits. Contractor agrees that services provided under this Contract by Contractor, Facilities used in conjunction with such services, Individuals' records, Contractor's policies, procedures, performance data, financial records, and other similar documents and records of Contractor, that pertain, or may pertain, to services under this Contract, shall be open for inspection by County, or its agents, at any reasonable time during business hours. Contractor agrees to retain such records and documents for a period of ten (10) years, or such longer period as may be prescribed for such records and documents by the State of Oregon Archivist or until the conclusion of any dispute or proceeding related to the services under this Contract or involving the records of Contractor, whichever is longer. Contractor shall permit County and Department to make site visits upon reasonable notice to monitor the delivery of services under this Contract. 8. Payment of Contract. a. Acute Psychiatric Care County shall provide quarterly payments to Contractor as outlined in Exhibit 2 for rendering the services listed in this Contract. Funds may only be used for the delivery of the service or services set out in this paragraph unless written permission is granted to use the funds for other services in accordance with this Contract. Subject to Annl:lal Payment Reconciliation and adjustment, for the period between and including July 1, 2012 through June 30, 2013, Contractor shall receive a total of $439,679 in four quarterly payments (Exhibit 2) from County for Acute Psychiatric Care services to all indigent Individuals served during tOOse twelve months the months of July 1, 2012 through June 30,2013. This payment arrangement for ~ 4d requires Contractor to comply with the conditions outlined in Exhibit 1 and 2 for all services described in this Contract. Reconciliation based on actual utilization of bed days will be made in accordance with uAnnl:lal Payment Reconciliation" in Exhibit 2. Subject to Payment Reconciliation and adjustment, for the period between and including July 1, 2013 through December 31, 2013, County shall pay Contractor a total of $219,839.50 in two quarterly payments (dates outlined in Exhibit 2 of this Contract) for Acute Psychiatric Care services to all indigent Individuals served during the months July 1, 2013 through December 31, 2013. This payment arrangement requires Contractor to comply with the conditions outlined in Exhibit 1 and 2 for all services described in this Contract. Reconciliation based on actual utilization of bed days will be made in accordance with "Payment Reconciliation" in Exhibit 2. b. Post-Commitment Care County shall provide monthly payments to Contractor as outlined in Exhibit 3 for rendering the services listed in this Contract. Funds may only be used for the delivery of the service or services set out in this paragraph unless written permission is granted to use the funds for other services in accordance with this Contract. Notwithstanding the foregoing, for the period between and including July 1, 2012 through June 30, 2013, Contractor shall receive no more than $529,250 in twelve (12) monthly payments (Exhibit 3) from County for Post-Commitment services to all indigent Individuals as defined in Exhibit 3 served during those twelve (12) months. This payment arrangement for 2012 13 requires Contractor adhere to the conditions outlined in Exhibit 3 for all services described in this Contract. Notwithstanding the foregoing, for the period between and including July 1, 2013 through December 31, 2013, County shall pay Contractor no more than $132,312 in six (6) monthly payments (dates outlined in Exhibit 3 of this Exhibit) for Post-Commitment services to all indigent Individuals as defined in Exhibit 3 served during those six (6) months. This payment arrangement requires Contractor adhere to the conditions outlined in Exhibit 3 for all services described in this Contract. Page 5 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 9. Bed Day Rate. A. Acute Psychiatric Care: For the purpose of this Contract for Acute Psychiatric Care and extensions or renewals of this Contract, the Contractor and the County have established a Bed Day Rate to assist in calculating future payments if both parties agree to discontinue the heretofore described method of calculating compensation payable to Contractor and replace the same with a fee-for-service payment method. This calculation is based on a 2012-13 bed day rate of $695, (July 1, 2012 -June 30, 2013) and a July 1, 2013 -December 31,2013 bed day rate of $695. This Bed Day Rate will be utilized to calculate any 'Annual Reconciliation Based on Actual Bed Day Usage' as outlined in Exhibit 2. Any change to this bed day rate will be indicated by amendment to this Contract. By mutual agreement between Contractor and County at time of initial contract for Sage View Acute Psychiatric Care services, an annual bed day rate increase will not exceed 5% in any calendar year through December 31, 2024. This provision, as well as the provisions of Section 32, shall survive termination of this Contract. B. Post-Commitment Care: For the purpose of this Contract for Post-Commitment Care and extensions or renewals of this Contract, the Contractor and the County have established a Bed Day Rate to assist in calculating future payments based on actual usage under this portion of the Contract and future negotiations with the OHA for continued services. This calculation is based on a 2012-13 (July 1, 2012 -June 30, 2013) bed day rate of $725 and a July 1, 2013 -December 31, 2013 bed day rate of $725. This Bed Day Rate will not affect payment or service levels for the 2012-13 service period. 10. Payments in Future Years beyond June 30, 2013. Not later than April 2013, Contractor and County shall meet to review the Contract and negotiate the program and reporting requirements, protocols and payment to be paid by County to Contractor beginning on and immediately after July 1, 2013. The parties may at that time also negotiate payment methods and amounts for one or more years after 2013. The County shall furnish Contractor with relevant information concerning OHA funds anticipated to be provided for services covered under this Contract, together with budgeted amounts, if any, of the County General Fund for such services. Contractor shall furnish relevant information concerning Contractor's costs and overhead related to performance of services covered by this Contract. The parties shall consider amounts previously paid by County under this Contract and determine whether and to what extent such payments have fairly compensated Contractor for such services. The parties shall also consider amounts paid and received by similar providers of acute psychiatric care for indigent mental health patients. In deciding the appropriate compensation level for future services, the parties shall consider adjustments in service levels or funding or both. 11. Mediation. If the parties cannot reach agreement in matters other than Section 4.§ 13 of this Contract, they shall submit the matter to mediation. The parties shall agree upon a single mediator who is experienced in the area involving the dispute. If the parties are unable to agree on a mediator, each party shall submit two (2) to three (3) names of people acceptable as mediator to the Presiding Judge of the Deschutes County Circuit Court, who shall select the mediator from the list provided. Thereafter, the parties shall participate in the mediation process in good faith. If mediation fails to resolve the issue then either party may proceed to arbitration. 12. Arbitration. If the parties are unable to resolve the dispute over compensation by mediation, they shall submit the matter to arbitration as follows: Either party may at any time request final and binding arbitration of the matter, provided the parties have first tried in good faith to settle the matter by nonbinding mediation. A party may request arbitration by giving notice to that effect to the other party. The dispute shall be determined in Deschutes County, Oregon, by three (3) arbitrators, one selected by each party and the two (2) arbitrators selecting a third arbitrator. The arbitration shall be conducted in accordance with the rules of the Deschutes County Circuit Court Arbitration Program, except to the extent provided otherwise under Oregon laws on arbitration and as otherwise provided Page 6 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 herein. All arbitrators shall be people having at least 10 years experience with health or behavioral health business transactions. Each party shall submit its position to the arbitrators, together with evidence thereon, and the arbitrators shall decide the issue and determine the prevailing party, which decision is final. The arbitrator's fees and costs shall be shared equally by the parties. Each party shall bear its own attorney fees, expenses and costs for preparing and presenting its case to the arbitrator. On the application of either party, the award in the arbitration may be enforced by the order of judgment of a court of competent jurisdiction. 13. Recovery of Funds. Expenditures of Contractor may be charged to this Contract only if they: (1) are in payment for services performed under this Contract; (2) conform to applicable State and Federal regulations and statutes; (3) are in payment of an obligation incurred during the period of this Contract; and (4) when added to other compensation pursuant to this Contract are not in excess of 100% of the maximum amount detailed in Exhibit 1. If Contractor fails to provide an acceptable audit performed by a certified public accountant for federal funds received under this Contract, or if federal authorities demand the repayment of federal funds received under this Contract, County may recover all federal funds paid under this Contract, unless a smaller amount is disallowed or demanded. If Department disallows or requests repayment for any funds paid under this Contract due to Contractors' acts or omissions, Contractor shall make payment to the County of the amount disallowed or requested. In the event that the Department determines that County is responsible for the repayment of any funds owed to the Department by Contractor, Contractor agrees to make such payment within ten (10) days of notification by County or the Department of said determination by the Department. 14. Retention of Revenue and Earned Interest. Fees and third-party reimbursements, including all amounts paid pursuant to Title XIX of the Social Security Act by the OHA, for services rendered by Contractor, and interest earned on such funds in the possession of Contractor, shall be retained by Contractor provided that it is expended for a mental health service which meets the standards of the OHA. 15. Withholding of Payments. Notwithstanding any other payment provision of this Contract, should Contractor fail to submit required reports required by Section 4(A) and Exhibits 1, 2 and 3 when due, or fail to perform or document the performance of contracted services, County shall immediately withhold payments under this Contract. 16. Termination. All or part of this Contract may be terminated by mutual consent of both parties, or by either party at any time for convenience upon three (3) months notice in writing to the other party. If the County initiates the termination, payment of the usual and customary expenses of termination shall be made to the Contractor. If the initial provider investment is substantial, this Contract may not be terminated by the County for convenience. The County may also terminate all or part of this Contract as specified below: A. With thirty (30) days written notice, if funding to the County from Federal, State, or other sources is not obtained or is not continued at levels sufficient to allow for purchase of the indicated quantity of services. The County will give more notice whenever possible. B. With thirty (60) days written notice, if Federal or State regulations are modified or changed in such a way that services are no longer allowable for purchase under this Contract. C. Upon notice of denial, revocation, or non-renewal of any letter of approval, license, or certificate required by law or regulation to be held by the Contractor to provide a service element under this Contract. D. With thirty (30) days written notice, if Contractor fails to provide services, or fails to meet any performance standard as specified by the County in this Contract (or subsequent modifications to this Contract) within the time specified herein, or any extensions thereof. E. Upon written or oral notice, if County has evidence that the Contractor has endangered or is endangering the health and safety of Individuals, residents, staff, or the public. Page 7 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 F. Failure of the Contractor to comply with the provisions of this Contract and all applicable Federal, State and local laws and rules which may be cause for termination of this Contract. The circumstances under which this Contract may be terminated by either party under this paragraph may involve major or minor violations. Major violations include, but are not limited to: 1. Acts or omissions that jeopardize the health, safety, or security of Individuals. 2. Misuse of funds. 3. Intentional falsification of records. In the case a failure to perform jeopardizes the safety and security of the Counties' (Deschutes, Crook and Jefferson) Individual(s), the Contractor and the County shall jOintly conduct an investigation to determine whether an emergency exists and what corrective action will be necessary. Such an investigation shall be completed within five (5) working days from the date the County determines that such failure exists. In those circumstances where a major violation is substantiated, continued performance may be suspended by the County immediately. In all cases involving a major violation, a written notice of intent to terminate this Contractor shall be sent to the OHA and the Contractor found to be in violation. Minor violations usually involve less than substantial compliance with the general or special conditions of this Contractor. Continued substantial minor violations that threaten adequacy of services may be treated like a major violation. Prior to termination for major or minor violations, the Contractor shall be given a reasonable opportunity to refute the findings. If the problem is not corrected or remedied within thirty (30) days after the County has given written notice to the Contractor, or in the case the problem cannot be corrected or remedied within the thirty-day period the Contractor fails to commence and pursue corrective action with reasonable diligence and good faith, then the County may terminate this Contract or initiate other remedial action. Termination shall be without prejudice to any obligations or liabilities of either party accrued prior to such termination. 17. Encumbrance or Expenditure After Notice of Termination. Contractor shall not make expenditures, enter into contracts, or encumber funds in its possession that belong to the County, after notice of termination or termination as set out above, without prior written approval from County. County will continue to be obligated to pay for authorized services to the date on which termination takes effect. After the date on which termination takes effect, County will have no further obligation to pay for services. 18. Independent Contractor. Contractor is engaged hereby as an independent contractor, and will be so deemed for purposes of the following: A. Contractor will be solely responsible for payment of any Federal or State taxes required as a result of this Contract. B. Contractor shall be solely responsible for and shall have control over the means, methods, techniques, sequences and procedures of performing the work, and shall be solely responsible for the errors and omissions of its employees, subcontractors and agents. For goods and services to be provided under this Contract, Contractor agrees to: a. perform the work in a good, workmanlike, and timely manner; b. comply with all applicable legal requirements; c. take all precautions necessary to protect the safety of all persons at or near Sage View, including employees and patients of Contractor and County; d. take full responsibility for wages and entitlements of Contractor's employees assigned to or furnishing services at Sage View. C. It is agreed by and between the parties that Contractor is not carrying out a function on behalf of the County, OHA or State of Oregon, and County, OHA and State of Oregon do not have the right of direction or control of the manner in which Contractor delivers services under this Contract or exercise any control over the Page 8 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 activities of the Contractor. Contractor is not an officer, employee or agent of County as those terms are used in ORS 30.265. D. County is not, by virtue of this Contract, a partner or joint venturer with Contractor in connection with activities carried on under this Contract, and shall have no obligation with respect to Contractor's debts or any other liabilities of each and every nature. E. The Contractor is an independent contractor for purposes of the Oregon Workers' Compensation law (ORS Chapter 656) and is solely liable for any Workers' Compensation coverage under this Contract. 19. Contractor and Subcontractors. Contractor agrees to make all provisions of this Contract with the County applicable to any subcontractor performing work under this Contract. Contactors who perform the work without the assistance of labor or any employee, as determined under ORS Chapter 656 and rules adopted pursuant thereto, need not obtain Workers Compensation coverage. 20. Constraints. A. The provisions of ORS 279B.220, 279B.230, and 279B.235, are by this reference incorporate and made a part of this Contract: a. Contractor shall pay employees for overtime work performed under this Contract in accordance and otherwise comply with applicable provisions of ORS 653.010 to 653.261 and the Fair Labor Standards Act of 1938 ("FLSA") (29 U.S.C 201 et. seq.). B. This Contract is expressly subject to the debt limitation of Oregon counties set forth in Article XI, Section 10, of the Oregon Constitution, and is contingent upon funds being appropriated therefore. Any provisions herein, which would conflict with law, are deemed inoperative to that extent. C. Unless exempted under the rules, regulations and relevant orders of the Secretary of Labor, 41 CFR, Chapter 60, Contractor agrees to comply with aU provisions of Executive Order No. 11246, as amended by Executive Order No. 11375 of the President of the United States dated September 24, 1965 as supplemented in Department of Labor regulations (41 CFR Part 60), Titles VI and VII of the Civil Rights Act of 1964 as amended, Sections 503 and 504 of the Rehabilitation Act of 1973 as amended and 45 CFR 84.4, which states, "No qualified person shall, on the basis of handicap, be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination under any program or activity which receives or benefits from Federal financial assistance." Contractor will also comply with all applicable rules, regulations and orders of the Secretary of Labor concerning equal opportunity in employment and the provisions of ORS Chapters 659 and 659A. D. If the limitation amount specified in this Contract for Title XIX Clinic Services exceeds $100,000, Contractor shall provide the State of Oregon with written assurance that Contractor will comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 USC 1857 (h), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) including but not limited to Section 508 of the Clean Water Act (33 USC 1368) Executive Order 11738 and Environmental Protection Agency regulations (40 CFR Part 15) which prohibit the use under non-exempt Federal contracts, grants or loans of facilities included on the EPA List of Violating Facilities. Violations shall be reported to the OHA, HHS and the appropriate Regional Office of the Environmental Protection Agency. E. Contractor shall comply with Federal rules and statutes pertaining to the Addictions and Mental Health (AMH) and Social Security (formerly Title XX) Block Grant(s); including the Public Health Services Act, especially sections 1914 (b)(1-5), 1915 (c)(12), 1916 (b)(2) and Public Law 97-35. F. The individual Signing on behalf of Contractor hereby certifies and swears under penalty of perjury that she/he is authorized to act on behalf of Contractor. Page 9 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 21. Hold Harmless. Contractor shall indemnify, save and hold harmless and defend the State of Oregon, Human Resources Department, the County, and their Departments and their officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses, of any nature Whatsoever, resulting from, arising out of or relating to the operations of Contractor, including, but not limited to the activities of Contractor, its officers, employees, subcontractors and agents under this Contract. To the extent permitted by Article XI, Section 10, of the Oregon Constitution and subject to the limits of the Oregon Tort Claims Act. ORS 30.260 through 30.300, County shall defend, save, hold harmless and indemnify Contractor and its officers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities costs and expenses of any nature resulting from or arising out of, or relating to the activities of County or its officers, employees, contractors, or agents under this Contract. 22. Insurance. Prior to the effective date of this Contract, Contractor shall obtain, at Contractor's expense, and maintain in effect all insurance requirements as outlined in Exhibit 4. Contractor may satisfy the requirements for liability insurance by obtaining from Hospital a defense, indemnity and hold harmless agreement, together with evidence of coverage under Hospital's program of self insurance and umbrella insurance policies for the defense and satisfaction of claims. In the event of unilateral cancellation or restriction by the insurance company of any insurance policy referred to in this paragraph, Contractor shall immediately notify County verbally and in writing. 23. Settlement of Disputes. Differences between a Contractor and County, or between contractors, will be resolved when possible at appropriate management levels, followed by consultation between boards, if necessary. Where resolution of such disputes is not achieved after consultation with the respective Boards of Contractor and County, the parties shall proceed with mediation and binding arbitration in accordance with Sections 10 and 11 of this Contract. 24. Financial Audit. Contractor shall provide County with a copy of each and every audit which it prepares in order to comply with the applicable audit requirements and responsibilities set forth in the Office of Management and Budget Circular A-133 entitled "Audits of States, Local Governments and Non-Profit Organizations." 25. Assignment. Contractor shall not assign this Contract, except to Hospital, without the prior written consent of County. 26. Renewal. This Contract may be renewed, subject to the following conditions: (1) renewal will be based on the County Annual Implementation Plan approved by the OHA, and (2) renewal is subject to the availability of funding. 27. Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules, regulations, executive orders and policies. This Contract is expressly subject to the debt limitation of Oregon counties set forth in Article XI, Section 10, of the Oregon Constitution, and is contingent upon funds being appropriated therefore. 28. Debt Limitation. This Contract is expressly subject to the debt limitation of Oregon counties set forth in Article XI, Section 10, of the Oregon Constitution, and is contingent upon funds being appropriated therefore. A Any provisions herein, which would conflict with law, are deemed inoperative to that extent. B. Contractor shall comply with all federal, state and local laws, regulations, executive orders and ordinances applicable to the Contract. C. Without limiting the generality of the foregoing, Contractor expressly agrees to comply with the following laws, regulations and executive orders to the extent they are applicable to the Contract: 1) Titles VI and VII of the Civil Rights Act of 1964, as amended; 2) Sections 503 and 504 of the Rehabilitation Act of 1973, as amended; 3) the Americans with Disabilities Act of 1990, as amended and ORS 659A 112 through 659A.139; 4) Executive Order 11246, as amended; 5) the Health Insurance Portability and Accountability Act of 1996; Page 10 of47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 6) the Age Discrimination in Employment Act of 1967, as amended, and the Age Discrimination Act of 1975, as amended; 7) the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended; 8) ORS Chapter 659A, as amended; 9) all regulations and administrative rules established pursuant to the foregoing laws; and 10) all other applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. 11) all federal law governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring reporting of patient abuse. 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. No federal funds may be used to provide services in violation of 42 USC 14402. 12) Contractor shall comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented in Department of Labor regulations (41 CFR Part 60). 13) If Contract maximum compensation, including amendments, exceeds $100,000 then Contractor shall comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but not limited to Section 508 (33 U.S.C. 1368). Executive Order 11738, and Environmental Protection Agency regulations (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 the Oregon Health Authority, Human Services (HHS) and the appropriate Regional Office of the Environmental Protection Agency. 14) Contractor shall comply with applicable mandatory standards and policies relating to energy efficiency that are contained in the Oregon energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163). 15) Contractor shall not knowingly and 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 Department. 16) Contractor may not use the funds paid under this Contract for the following services: a) To make cash payments to intended recipients of health services; b) 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; c) 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); d) With respect to 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 e) To carry out any program prohibited by section 245(b) of the Health Onmibus Programs Extension Act of 1988 (codified at 42 USC 300ee(E). 17) Contractor may expend funds paid to Contractor under this Contract only in accordance with federal OMB Circular A-87 as that circular is applicable to allowable costs. 18) Contractor shall comply with the Pro-Children Act of 1995 (codified at 20 USC Section 6081 et. seq.). 19) The above listed laws, regulations and executive orders and all regulations and administrative rules established pursuant to those laws are incorporated by reference herein to the extent that they are applicable to the Contract and required by law to be so incorporated. 20) Contractor shall comply with all mandatory standards and policies that relate to resource conservation and recovery pursuant to the Resource conservation and Recovery Act (codified at 42 USC 6901 et. seq.) Section 6002 of that Act (codified at 42 USC 6962) requires that preference be given in procurement programs to the purchase of specific products containing recycled material identified in guidelines developed by the Environmental Protection Agency. Current guidelines are set forth in 40 CFR Parts 247­ 253. 27. Non-Discrimination. Contractor agrees that no person shall, on the grounds of race, color, creed, national origin, sex, marital status, disability, association, or age, suffer discrimination in the performance of this Contractor when employed by Contractor. Contractor agrees to comply with title VI of the Civil Rights Act of 1964, with section V of the Rehabilitation Act of 1973 as implemented by 45 CFR Section 84.4, with the Age Discrimination Act of 1975 as Page 11 of47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 amended, the Age Discrimination Act of 1974 as amended, the Vietnam Era Veterans' Readjustment Assistance Act of 1975 as amended and with all applicable regulations, administrative rules and requirements of federal and state civil rights and rehabilitation statues. Additionally, Contractor shall comply with Title II of the Americans with Disabilities Act of 1990 as amended (42 USC 12131 et. Seq.), ORS 30.670 to 30.685, ORS 659.425, ORS 659.430, 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 services delivered under the Contract. Unless exempted under 41 C.F.R. 60-1.1 to 60.999.1 (1997), the Contractor agrees to comply with all provisions of Executive Order No. 11,246, 30 F.R. 12319 (1965), as amended by Executive Order No. 11,375, 32 F.R. 14303 (1967), reprinted in 42 U.S.C. 2000e (1994) and Executive Order No. 12,086, as supplemented by 41 CFR Part 60, and all applicable rules, regulations, and orders of the Secretary of Labor concerning equal opportunity in employment and the provisions of ORS Chapter 659. Contractor shall comply with all federal law governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring the reporting of patient abuse. 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. 28. Reductions in Contract Funding. A. Any funds spent by Contractor tor purposes not authorized by this Contract shall either be paid directly by the Contractor to the County or, if not so paid, at the discretion of County, shall be deducted from future payments from County to the Contractor. Payments by County in excess of authorized amounts that have not been repaid by the Contractor within thirty (30) days after the Contract's expiration or after notification by the County, whichever date is earlier, shall be deducted from future payments from County to the Contractor. B. In the event that a statutorily required operating license or letter of approval is not extended or is suspended, County's obligation to provide reimbursement for services or program expenses hereunder related to services rendered without the necessary license or approval will cease on the date of termination of this Contract (whether in whole or in part) or the date of expiration or suspension of the license or letter of approval, whichever date is earlier. C. Any funds awarded to the Contractor pursuant to a fee-tor-service payment method under this Contract that are not obligated and/or spent within the term of this Contract shall be cancelled and revert to the County. 29. Attorney Fees. In the event an action, suit or proceeding, including appeal there from, is brought for breach of any of the terms of this Contract, or for any controversy arising out of this Contract, each party shall be responsible for its own attorney's fees, expenses, costs and disbursements for said action, suit, proceeding or appeal. 30. Entire Contract. This Contract constitutes the entire Contract between the parties on the subject matter hereof. There are no understandings, Contracts, or representations, oral or written, not speCified herein regarding this Contract. 31. Survival. The provisions of paragraphs 3 to 12. 17 to 20,23 to 27, and 29 and 30. shall survive the termination or expiration of this Contract. 32. 20-Year Dedicated Use. Notwithstanding any other provision of this Contract, Contractor and Hospital agree that the Sage View facility will for a period of not less than twenty (20) years be operated and maintained for the principal purpose of providing a psychiatric treatment program for mental health patients, including indigent mental health patients who are residents of Crook, Deschutes and Jefferson Counties. This provision. as well as the provisions of Section 8, shall survive termination of this Contract. Page 12 of 47 -Document No. 2013-619. Amending Deschutes County Contract No. 2012-408 Dated this ___ of ________, 2013 ALAN UNGER, Chair TAMMY BANEY, Vice Chair ANTHONY DEBONE, County Commissioner DATED this __ day of ________, 2013. CONTRACTOR: Page 13 of47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 EXHIBIT 1 SE24 Funding for Local Acute Care Access Proposed Plan for 2012-13 Principles: 1. Maintain a shared risk management payment method for Acute Psychiatric Care as outlined in Section 8 of main body of the Contract. 2. Increase oversight and focus on diversion (when clinically appropriate). Establish process for admission authorization and utilization management for length of stay that is consistent with fee for service model. Exact details of process will be determined by mutual agreement of the Directors of Deschutes, Crook and Jefferson Counties and St. Charles Health System, Inc. or designees. 3. The approach is regional with all three (3) Central Oregon counties committing to this Contract. 4. Each of the three (3) counties will have designated diversion funds to assist with such things as motels, transportation, and medication as clinically appropriate, Bed days for the duration of July 1,2012 through June 30,2013: 1. Number -6321year 2. Bed Day Rate -$695/day Bed days for the duration ofJuly 1, 2013 through December 31, 2013: 3. Number -316/6 months 4. Bed Day Rate -$6951day Contract for Successful Management of Resources within Risk Agreement: 1. Hospital and Community Mental Health Program (CMHP) staff will follow admission authorization protocol as outlined in "County Acute Care Authorization" in Exhibit 2 for voluntary and involuntary admissions to Sage View that fall under this Contract. 2. In order to best facilitate the potential for diversion, Hospital staff will contact the responsible CMHP when admission is being considered and prior to the subject being given an indication of admission intent. All admissions, both voluntary and involuntary, must be pre-authorized by the appropriate CMHP crisis staff. 3. CMHP and Hospital staff will actively work on diversion. CMHP staff will access designated diversion funds when needed through processed outlined in individual counties. 4. Deschutes Crisis team staff will have daily (Monday-Friday) in-person contact with Sage View to participate in the review of all Deschutes County admissions and assist in discharge planning. Crook and Jefferson county staff will have daily contact with Sage View via telephone. The Regional Utilization Manager (UM) will attend team meetings on a weekly basis. The Regional UM will provide authorizations for continued stay based on clinical necessity for all Central Oregon admissions covered under this Contract. (Same process as for Individuals participating on the Oregon Health Plan) 5. Protocol for initial authorization and utilization management may be modified during the Contract by written agreement between and among the Manager of Hospital and the three (3) Central Oregon Directors. 6. For Individuals anticipated to need a long term stay -an Extended Care Management Unit (ECMU) referral packet will be completed by SCMC staff immediately after an Individual is civilly committed by a judge (i.e. within 1-2 days) 7. MCAT supervisor will continue to work with local law enforcement to improve contact with MCAT prior to a person being brought to ER -goal will be to divert when possible. Additional Considerations: In addition to the adjusted payment rate, Contractor agrees to the following additional considerations: 1. To provide the counties with a financial report showing total revenue and expenses by category (including salary/benefits, materials and services, capital costs, etc)and the operating deficit for the facility as well as the bed day rate associated with the Medicare cost report, a financial report will be provided every twelve (12) months at I the Central Oregon Regional Acute Care Committee (CORACC) meeting; J 2. To jointly sponsor training(s) and planning to strengthen the system in its use of beneficial interventions for suicidal Individuals seeking hospital, crisis or outpatient services; I Page 14 of47 Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 J i 3. To join with Jefferson, Crook and Deschutes counties in advocating for improvements in the State and Regional acute care system, with shared advocacy for State reimbursement for the cost of care for indigent Individuals on the State wait list for long term care; 4. To advocate and offer support for the development of hold room services and hospital diversion options at area hospitals; and 5. To not charge Central Oregon counties for transport costs between the Psychiatric Emergency Services unit at St. Charles Health System, Inc., and Sage View. Page 15 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 EXHIBIT 2 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 SE24 Funding for Local Acute Care Access Description of Covered Services &Authorization Process for Acute Psychiatric Care Preamble The Central Oregon Acute Care Region consists of Crook, Deschutes and Jefferson counties operating through Lutheran Community Services Northwest, Deschutes County Health Services Department and Best Care Treatment Services respectively and collectively referred to herein as "Counties". Within available resources, consistent with ORS 426.241 and Service Element 24, and subject to funding from the Office of Mental Health and Addiction Services, Counties assume the fiduciary accountability and ethical obligation to meet the acute care mental health service needs of those Central Oregon residents, who lack the financial resources and I or insurance to cover payment for such mental health services. In an effort to ensure the judicious use of scarce resources, this Exhibit defines those urgent mental health services and outlines the processes involved in accessing authorization for those services rendered under this Contract. Sqge View Services: Contractor agrees to admit all eligible, indigent Individuals from Crook, Deschutes and Jefferson counties who meet medical necessity criteria (as defined in this exhibit) as long as Sage View has available bed space. In recognition that Contractor also provides Psychiatric Emergency Services as outlined in separate contract, it is agreed that Individuals will receive treatment at the least restrictive level of care possible. Medical Necessity is defined as follows: o Individual has a primary DSM-IV mental health diagnosis AND meets one of more of the following factors describing the Individual's condition: o Individual presents as a significant danger as evidenced by person is at imminent risk to self or others or unable to meet their basic needs due to a major mental illness OR o Individual is at high risk for self destructive acts secondary to severe psychiatric symptoms (i.e. command hallucinations or persecutory delusions, severe depression); OR o Individual is at significant risk of committing violent, aggressive or impulsive acts that can best be explained as resulting from a severe emotional state or exacerbation of an existing psychiatric condition; OR o Individual has acute onset of psychosis, severe thought disorganization or deterioration of a chronic psychotic condition so that the Individual is unmanageable and unable to cooperate in treatment in a less restrictive, less intensive setting; OR o Individual needs psychiatric medication adjustment that cannot be managed in the community including monitored administration of medication; OR o Individual presents severe functional impairment resulting from an acute psychiatric condition such that the member is unable to provide for basic self-care without 24-hour supervision; OR o The Individual's condition is such that proposed treatments require 24 hour nursing observation (ie. side effects of atypical complexity, presence of a medical condition that complicates psychiatric treatment) which are not appropriate outside of a hospital setting and are not primarily for a substance abuse or medical condition. OR o It is considered likely that the Individual will require restraint or seclusion o AND in addition to one or more of the criteria outlined above, there are no available less restrictive out-patient alternatives to provide for the safety and supervision of Individual's needs Contractor will maintain accreditation from the Joint Commission on the Accreditation of Hospital Organizations as an inpatient facility. Furthermore, they will maintain compliance with the Center for Medicare and Medicaid Services standards as applicable. Page 16 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 Services available will include but not be limited to: • 24 -hour supervision and nursing care. • Any required health screening or medical care (including medications and lab work). • Multidisciplinary assessment initiated at the time of admission and completed within two (2) days of admission. • Service coordination with appropriate CMHP. • Development of an appropriate treatment plan that addresses service needs, desired outcomes and strategies to be implemented to resolve the crisis. • A variety of treatment modalities to meet Individual's needs including: psychiatric assessment; medication management and supervision; individual and group therapy; psycho-education regarding mental health and addiction issues; skill development in the areas of self-care, social-emotional adjustment, behavioral concerns, independent living and community navigation; family involvement; case management. • Transportation between Sage View and St Charles Hospital -Bend as needed for medical or other services Payment for Acute Psychiatric Care at Sage View (SV): Contractor agrees to the payment methodology outlined in this Contract to provide acute psychiatric care at Sage View to all indigent Individuals residing in Crook, Deschutes, and Jefferson counties who meet admission criteria, with the only exception of bed space being unavailable. The payment will cover all charges associated with the admission of indigent Individuals for Sage View services, including but not limited to room rate, associated staff time and professional fees (including psychiatrist I MD), psychiatric medications, lab work and medical care. This Contract will include all bed days excluding day of discharge. Contractor shall neither bill nor expect payment for any additional services as part of Sage View service and payment authorization from any of the three (3) counties, except as outlined below under "Annual Reconciliation Based on Actual Bed Day Usage". County shall provide quarterly payments to Contractor, for rendering the services listed in this Contract. Funds may only be used for the delivery of the service or services set out in this Contract unless written permission is granted to use the funds for other services in accordance with this Contract. Subject to Annual Payment Reconciliation, for the period between and including July 1, 2012 through June 30, 2013, Contractor shall receive $439.679 for Sage View services in four (4) quarterly payments as outlined below. The total amount will cover all Sage View services to all Central Oregon indigent Individuals served during those twelve (12) months. October 15,2012 $109.919.75 April 15, 2013 $109.919.75 January 15, 2013 $109.919.75 June 30,2013 $109.919.75 For the period between and including July 1, 2013 through December 31, 2013, County shall pay Contractor $219,839.50 for Sage View services in two (2) quarterly payments as outlined below. The total amount will cover all Sage View services to all Central Oregon indigent Individuals served during those six (6) months. October 15, 2013 $109.919.75 December 15,2013 $109,919.75 Annual Reconciliation Based on Actual Bed Day Usage: Pit the close of the fiscal year (June 30, 2013), As of June 2013 three provisions related to a financial reconciliation will be considered to determine the final payment to St Charles Health System, Inc. Annual bed day usage will be calculated based on fiscal year the Contract term July 1, 2012 through -June 30 December 31, 2013. At the close of Contract, December 31, 2013, three (3) provisions related to a financial reconciliation will be considered to determine whether to adjust the final 6-month (July 1, 2013 -December 31,2013) payment to Contractor. Annual bed day usage will be based on the 6-month period July 1, 2013 -December 31,2013. Page 17 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 1. If the total 2012-2013 bed days under this Contract (for the period July 1, 2012 through June 30, 2013) is less than 632: The actual number of days under 632 will be valued at the bed day rate for that fiscal year. The dollar amount of this savings due to a lower level of service will be shared equally (50%) by both Deschutes County and Contractor. Contractor will refund amount to Deschutes County equal to 50% value of bed days less than 632. a. If the bed day (term July 1,2013 through December 31,2013) under this Contract are less than 316: In this circumstance, the actual number of days under 316 will be valued at the bed day rate of $695, as outlined in Section 8 and 9 of this Contract. The dollar amount of this savings due to a lower level of service will be shared equally (50%) by both County and Contractor. Contractor will refund an amount to County equal to 50% value of unused bed days. 2. If the total 2012-13 bed days under this Contract (for the period Ju Iy 1, 2012 through June 30, 2013) is more than 632 and less than 790: No additional compensation will be expected by either party and the stated payment level will prevail. a. If the total bed days used under this Contract (for the period July 1, 2013 through December 31, 2013) is equal to or greater than 316 and less than 395: No adjustment in the payment will be owing to either party and the stated payment level will remain unchanged. 3. If the total 2012-13 bed days used under this Contract (for the period July 1, 2012 through June 30, 2013) equal or exceed 790: County will pay Contractor at the bed day rate for each day at 790 days and above. a. If the bed days used under this Contract (for the period July 1, 2013 through December 31,2013) is equal to or greater than 395: County will pay Contractor at the bed day rate of $695 for each day in excess of this amount. If there are any discrepancies in the number of actual bed days covered under this Contract: Any discrepancies will be referred to the Utilization Management Committee for resolution utilizing guidelines of this Contract. If services are provided without authorization as outlined in Exhibit 2: Any discrepancies will be brought to the Utilization Management Committee for discussion and resolution. Process for Obtaining Authorization for Covered Mental Health Services Authorization Process: In order to track bed day utilization and assure optimum usage of resources, it is agreed that Contractor and County will adhere to an admission authorization process that is mutually agreed upon between and among Contractor, the County, Best Care Treatment Services (on behalf of Jefferson County) and Lutheran Community Services Northwest (on behalf of Crook County). Contractor will contact the appropriate county when admission is being considered, and prior to the subject being given an indication of admission intent. to obtain authorization on all patients who meet indigent status (both voluntary and involuntary) as outlined by: 1) At the time of admission, patient has no third party insurance and has no ability to pay as defined by federal guidelines; or 2) At the time of admission, patient has exhausted their Medicare and/or Commercial insurance benefits for mental health; or Page 18 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 3) During the course of care, patient has exhausted all ability to pay for services under this Contract and is receiving involuntary treatment. Contractor agrees to contact appropriate county with update regarding *Pended Patients status and county will authorize services depending upon county continued stay criteria; or 4) During the course of care if Contractor discovers that at the time of admission, the patient had no third party insurance as reported and there is no other ability to pay for services, Contractor agrees to contact appropriate county with update regarding *Pended Patients status and county will decide whether to authorize services depending upon county continued stay criteria. 5) Contractor agrees to utilize the same ability-te-pay criteria, as well as make the same efforts to collect payment as for any other patient admitted for hospital services. 6) Contractor is responsible for providing to County a monthly *Pended Patients and **Posted Patients list, due on the 15th day of each month. The report will include pended and posted patients for all three (3) counties. *Pended Patients: This status is descriptive of the period of time the Contractor is engaging in due diligence to determine the patient's ability to pay as outlined by Contractor guidelines. **Posted Patients: Patients that have been approved for indigent care through the County. Report Data from SCMC Each person admitted under approved indigent funding, must also meet Contractor's internal reqUirements (as stated above in Paragraph 6) for "free care" and go through Contractor's process to make this determination. In essence the patient is "pended" to indigent funding, contingent upon the outcome of Contractor's due diligence process for funding under this Contract. The following process outlines the approval process for Individuals to be Upended" to indigent contract as well as the finalization of the list of Individual's bed days that will be actually "paid" or credited to usage under this Contract. Upon authorization for admission under indigent funds (pended), the intake worker for SV will notify the Regional UM Manager (UM) via telephone with the following information: Individual's Name, DOB, Admit Date, Funding, Level of Care (LOC), Hold Status ELOS (Estimated Length of Stay). LIM will then access Hospital EHR for any additional information needed specific to authorization. This Regional UM will utilize this data to compile the Regional Case List Report. Contractor will provide a monthly list of the posted patients who also have met Contractor's internal requirements for "free care" and whose admission will be "paid" or credited under this Contract. These lists will be provided by the 15th of each month and include "free care" Individuals from admissions one month prior (i.e. on 3/15 a report would be provided for Individuals meeting free care criteria between 1/15-2/15) This report will run off of the admission date (i.e. a patient admitted April 30 and discharged May 5 will show up on April list). The required date by which this list is to be emailed or faxed allows the "lag time" it takes for internal hospital due diligence for posting cost to the risk based agreements. The report will contain Protected Health Information, thus must either be faxed or encrypted if sent via e-mail. This report will go to the Regional LIM. The required data elements in this report will be: 1. Patient Name (last, first) 2. Hospital internal record number 3. Admit date 4. Discharge date 5. Follow-up care 6. Location of service PES or SV Once the Regional UM has the patient list from Contractor, he/she will access Contractor electronic medical records (TIER and/or CERNER) to ascertain qualitative data required for the Regional Case List. This Case List will be reviewed at the monthly Central Oregon Regional Acute Care Committee (CORACC) UM group meeting. The Regional UM will follow established Contractor procedures for access to the Contractor's electronic medical records. Page 19 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 Modification of Exhibit 2 It is understood and agreed that this Exhibit will be revised periodically. Authority to change this Exhibit shall rest with the, Deschutes County Health Services and the St. Charles Health System, Inc. Community Directors. Both parties must agree for the Exhibit to be modified. Page 20 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 EXHIBIT 3 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 SE24 Funding for Local Acute Care Access Post-Commitment Care Payment for Post-Commitment Care: Contractor agrees to the payment methodology outlined in this Contract for post-commitment care at Sage View (SV) or Psychiatric Emergency Services (PES) at St. Charles Health System, Inc. to all indigent Individuals residing in Deschutes, Crook or Jefferson ("Central Oregon") counties as well as Individuals who reside in Eastern Oregon counties who are civilly committed by a judge. Eastern Oregon Counties are defined as: Wasco, Sherman, Hood River, Lake, Wheeler, Morrow, Harney, Grant, Malheur, Baker, Gilliam, Union, Wallowa, and Umatilla. This includes Individuals who are already admitted to either SV or PES and return to the facility after civil commitment hearing, as well as Individuals who are committed elsewhere in the state and are clinically appropriate for transfer post-commitment, with the only exception of bed space being unavailable. Central Oregon residents have first priority for admission, followed by residents of Eastern Oregon counties. This portion of the Contract will cover all services as of the day post-commitment until transfer to long-term care at the state hospital or other discharge from the facility. Residents of other Oregon counties may be served under this Contract on a case by case basis and with joint approval of Director of Behavioral Health Services at Cascade Healthcare Community and Deschutes County Health Services Director. The payment will cover all charges associated with the admission of indigent Individuals for SV or PES services, including but not limited to room rate, associated staff time and professional fees (including psychiatrist I MD), psychiatric medications, lab work and medical care. This Contract will include all bed days beginning the first day post-commitment until transfer to long-term care or other discharge Contractor shall neither bill nor expect payment for any additional services as part of this Contract. County shall provide monthly payments to Contractor, for rendering the services listed in this Contract. Funds may only be used for the delivery of the service or services set out in this Contract unless written permission is granted to use the funds for other services in accordance with this Contract.. For the period between and including July 1, 2012 through June 30,2013, County shall pay Contractor shall receive a maximum compensation of $529,250 for all post-commitment services regardless of whether admission is at SV or PES unit in twelve (12) payments as outlined below. This payment is calculated at a bed day rate of $725 for 730 bed days. For the period between and including July 1,2013 through December 31,2013, County shall pay Contractor a maximum compensation of $132,312 for all post-commitment services regardless of whether admission is at SV or PES unit in six (6) payments as outlined below. This payment is calculated at a bed day rate of $725 for 182 bed days. The total amount will cover all SVIPES services to all post-commitment indigent Individuals served during those twelve (12) eighteen (18) months. July 15, 2012 $44,104.16 August15,2012 $44,104.16 September 15, 2012 $44,104.16 October 15,2012 $44,104.16 November 15,2012 $44,104.16 December 15,2012 $44,104.16 January 15, 2013 $44,104.16 February 15, 2013 $44,104.16 March 15, 2013 $44,104.16 April 15,2013 $44,104.16 May 15, 2013 $44,104.16 June 15, 2013 $44,104.16 July 15, 2013 $22,052 August 15, 2013 $22,052 September 15,2013 $22,052 October 15,2013 $22,052 November 15,2013 $22,052 December 15, 2013 $22,052 Page 21 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 Reporting Requirements: Contractor shall provide monthly reports to the County for all usage under this portion of the Contract. Monthly reports shall include the following: Individual's Name County of Responsibility/Residence Date of Commitment Date Extended Care Management Unit (ECMU) application was approved Date of Discharge Discharge location (i.e. state hospital or other) Total bed days for the month Cumulative bed days Page 22 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 EXHIBIT 4 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 INSURANCE REQUIREMENTS Contractor shall at all times maintain in force at Contractor's expense, each insurance noted below. Insurance coverage must apply on a primary or non-contributory basis. All insurance poliCies, except Professional Liability, shall be written on an occurrence basis and be in effect for the term of this contract. Policies written on a "claims made" basis must be approved and authorized by Deschutes County. Contractor Name: St. Charles Health SYstem Inc. Workers Compensation insurance in compliance with ORS 656.017, requiring Contractor and all subcontractors to provide workers' compensation coverage for all subject workers, or provide certification of exempt status. Worker's Compensation Insurance to cover claims made under Worker's Compensation, disability benefit or any other employee benefit laws, including statutory limits in any state of operation with Coverage B Employer's Liability coverage all at the statutory limits. In the absence of statutory limits the limits of said Employer's Liability Insurance with coverage shall not be less than $1,000,000 each accident, disease and each employee. This insurance must be endorsed with a waiver of subrogation endorsement, waiving the insured's right of subrogation against County. Professional Liability insurance with an occurrence combined single limit of not less than: Per Occurrence limit Annual Aggregate limit [8J $1,000,000 0 $2,000,000 o $2,000,000 [8J $3,000,000 o $3,000,000 0 $5,000,000 Professional Liability insurance covers damages caused by error, omiSSion, or negligent acts related to professional services provided under this Contract. The policy must provide extended reporting period coverage, sometimes referred to as "tail coverage" for claims made within two years after the contract work is completed. [8J Re uired b Count 0 Not re uired b Count one box must be checked I Commercial General Liability insurance with a combined single limit of not less than: Per Single Claimant and Incident All Claimants Arising from Single Incident [8J $1,000,000 0 $2,000,000 o $2,000,000 [8J $3,000,000 o $3,000,000 0 $5,000,000 Commercial General Liability insurance includes coverage for personal injury, bodily injury, advertising injury, property damage, premises, operations, products, completed operations and contractual liability. The insurance coverages provided for herein must be endorsed as primary and non-contributory to any insurance of County, its officers, employees or agents. Each such policy obtained by Contractor shall provide that the insurer shall defend any suit against named insured and additional insureds, their officers, agents or employees, even if such suit is frivolous or fraudulent. Such insurance shall provide County with the right, but not the obligation, to engage its own attorney for the purpose of defending any legal action against County, its officers, agents, or employees, and that Contractor shall indemnify County for costs and expenses, including reasonable attorneys' fees, incurred or ariSing out of the defense of such action. The policy shall be endorsed to name Deschutes County, the State of Oregon, the Oregon Health Authority, their officers, agents, employees and volunteers as an additional insured. The additional insured endorsement shall not include declarations that reduce any per occurrence or aggregate insurance limit. The contractor shall provide additional coverage based on any outstanding claim(s) made against policy limits to ensure that minimum insurance limits required by the County are maintained. Construction contracts may include aggregate limits that apply on a "per location" or "per project" basis. The additional insured protection shall extend equal protection to County as to Contractor or subcontractors and shall not be limited to vicarious liability only or any similar limitation. To the extent any aspect of this Paragraph shall be deemed unenforceable, then the additional insurance protection to County shall be narrowed to the maximum amount of protection allowed by law. [8J Required by County 0 Not required by County (one box must be checked) Page 23 of 47 -Document No. 2013·619, Amending Deschutes County Contract No. 2012-408 Automobile Liability insurance with a combined single limit of not less than: Per Occurrence o $500,000 x $1,000,000 o $2,000,000 Automobile Liability insurance includes coverage for bodily injury and property damage resulting from operation of a motor vehicle. Commercial Automobile Liability Insurance shall provide coverage for any motor vehicle (symbol 1 on some insurance certificates) driven by or on behalf of Contractor during the course of providing services under this Contract. Commercial Automobile Liability is required for contractors that own business vehicles registered to the business. Examples include: plumbers, electricians or construction contractors. An Example of an acceptable personal automobile policy is a contractor who is a sole proprietor that does not own vehicles registered to the business. o Required by County lSI Not required by County (one box must be checked) Additional Requirements. Contractor shall pay all deductibles and self-insured retentions. A cross-liability clause or separation of insured's condition must be included in all commercial general liability policies required by this Contract. Contractor's coverage will be primary in the event of loss. Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contract. The Contractor shall notify the County in writing at least thirty (30) days in advanceof any cancellation, termination, material change, or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. Contractor shall be responsible for any deductible or self-insured retention. If requested, complete copies of insurance policies shall be provided to the County. Page 24 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 EXHIBIT 5 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 Regional Acute Psychiatric Inpatient Services Service Name: REGIONAL ACUTE PSYCHIATRIC INPATIENT SERVICES Service ID Code: MHS 24 I. Service Description Regional Acute Psychiatric Inpatient Services (MHS 24) are inpatient psychiatric services delivered to individuals who are suffering from an acute mental illness, or other mental or emotional disturbance posing a danger to the health and safety of the individual or others. The services are primarily delivered on an inpatient basis and are intended to stabilize, control or ameliorate acute psychiatric dysfunctional symptoms or behaviors in order to return the individual to a less restrictive environment at the earliest possible time. MHS 24 Services also include ancillary services such as regional coordination and enhancements to Community Mental Health Program (CMHP) services that serve to expedite the movement of individuals into and out of facilities where inpatient psychiatric services are delivered and to divert persons from acute care services. II. Performance Requirements MHS 24 Services funded through this Agreement may only be delivered to the following individuals: A An individual in need of emergency hold services under ORS 426.232 and ORS 426.233; or B. An individual committed to Oregon Health Authority (OHA) under ORS 426.130; or C. An individual voluntarily seeking MHS 24 Services provided that service capacity is available and the individual satisfies one or more of the following criteria: 1. The individual is at high risk for an emergency hold or civil commitment without voluntary inpatient psychiatric services; or 2. The individual has a history of psychiatric hospitalization and is beginning to decompensate and for whom a short period of intensive inpatient psychiatric treatment would reverse the decompensation process; or 3. The individual is an appropriate candidate for inpatient psychiatric treatment but other inpatient psychiatric treatment resources are unavailable. D. Hospital and Providers at Secure Residential Treatment Facilities of MHS 24 Services funded through this Agreement must comply with OAR 309-031-0200 to 309-031-0255as such rules may be revised from time to time. Facilities in which a Provider delivers MHS 24 Services funded through this Agreement must: 1. If a hospital, be licensed under ORS 441.015 or certified by the Joint Commission on Accreditation of Health Care Organization ("JCAHO") for the hospital services; or 134309 Deschutes County Approved 5/9/2011 79 of 220 OHA 11-13 GT0217-11 2. Be approved under applicable portions of OAR 309-033-0500 through 309-033-0560, as such rules may be revised from time to time, for emergency hold beds. E. Secured Transportation services under MHS 24 will be approved under OAR 309-033-0432 through 309­ 033-0440, as such rules may be revised from time to time. Page 25 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 III. Special Reporting Requirements A. Reports of JCAHO reviews of the facility where a Provider delivers MHS 24 Services funded through this Agreement must be submitted to OHA within sixty (60) days after the Provider's receipt of such reports or reviews. 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. Hospital and Providers at Secure Residential Treatment Facilities of MHS 24 Services funded through this Agreement must submit the following information to OHA electronically through the Oregon Patient and Resident Care System (OP/RCS) within 12 hours of an individual's admission to and discharge from the Provider's facility for MHS 24 Services, as outlined in the OPIRCS Manual located at http://www.oregon.qov/OHAlmentalhealth/publications/oprcs/oprcs-manual.pdf?ga=t. C. Contractor must submit an annual accounting report of MHS 24 funds using forms prescribed by OHA by August 31 for the prior state fiscal year. IV. Financial Assistance Calculation and Disbursement Procedures A. Calculation of Financial Assistance: OHA will provide financial assistance for MHS 24 Services identified in a particular line of the Financial Assistance Award from funds identified on that line in an amount equal to the amount set forth in that line of the Financial Assistance Award; provided, however, that OHA's obligation to provide financial assistance for MHS 24 Services under a particular line of the Financial Assistance Award is conditioned on delivery, during the period specified on that line, of the number of units of MHS 24 Services service capacity specified on that line B. Disbursement of financial assistance: OHA will disburse the funds awarded for MHS 24 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 agreed otherwise) written notice to County, reduce the monthly allotments based on under used allotments identified through 134309 Deschutes County Approved 5/9/2011 80 of 220 OHA 11-13 GT0217-11 Oregon PatienUResident Care System (OP/RCS) or through other method permitted or required 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 funds awarded for MHS 24 Services on that line of the Financial Assistance Award. 134309 Deschutes County Approved 5/9/2011 81 of 220 OHA 11-13 GT0217-11 Attachment 1 (revised 'Level of Need Determination Data' 1/2010) -Level of Service IntenSity Determination Data Providers of MHS 22 Services funded through this Agreement must use the CASII as the statewide tool In order to assist in the determination for ISA Services for children age six (6) and older and the ECSII for children birth through age five (5). Page 26 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 Provider shall submit a report to aHA, within sixty (60) calendar days after the end of each calendar quarter of the Level of Service Intensity Determination Data screenings completed in that quarter. o 1st Quarter (Jan-Mar) 0 2nd Quarter (Apr-Jun) o 3rd Quarter (Jul-Sep) 0 4th Quarter (Oct-Dec) Formatting CASII and ECSII data for submission to aHA: Data shall be in a comma-delimited format; Each child shall be represented by a Medicaid ID number and Level of Service Intensity Determination Date; Complete Data Set: A complete data set will be comprised of a minimum of the following elements: rJ Eight alphanumeric character Medicaid ID number o Child's date of birth 00/00/0000) o Child's gender [ Date of referral Referral Source [ Date of Determination c Contractor r:.: Scores for CASII Domains I to VI-B (each score must be in the range 1-5) or ECSII Domains I to V. c Composite CAS II score or ECSII score. ISA eligibility YIN (circle one). [, Levels of Care recommended -(Note: Base the recommended level of care on both CASII or ECSII data and other data indicative of the child's and family's needs andlor functioning o Date the child is determined not to be ISA eligible or the last day the child is considered ISA eligible. Field will be blank if the child continues to be ISA eligible. A blank field will be considered complete. Instructions for submission and validation of Level of Service Intensity Determination Data shall be provided by aHA as a separate document. 134309 Deschutes County Approved 5/9/2011 82 of 220 aHA 11-13 GT0217-11 Attachment 2 (revised 'Integrated Service Array' 1/2010) -Integrated Service Array (ISA) Progress Review Report The ISA Progress Review is to be administered for each child found eligible for ISA services upon admission and discharge to that level of service. A child shall be reviewed no less than annually, should the child remain in ISA longer than one (1) year. Contractor must submit a Complete Data Set to aHA on those children that were reviewed during the quarter within sixty (60) calendar days following the end of the calendar quarter. Complete Data Set: A complete data set will be comprised of the following elements: 1. Child's last name, first name. 2. Child's date of birth (00/00/0000). 3. Date ISA Progress Review was completed using 0010010000 format. 4. ISA status of child at time of progress review: "New", first review. "Open", continuing review. "Close", final review. 5. Child's current residence: Biological/adoptive family member. Other than relative/friend (Not foster care). Long-term foster care placement. Temporary foster care placement. Residential treatment center. Other (include statement describing type of residence). Page 27 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 6. Number of times child changed residence for any reason within the last 90 days. a. Indicate the number of times that the child has changed residence, for any reason, in the past 90 calendar days. Do not include planned respite. Do not include Acute Care hospitalizations. Do not include vacations or recreational stays with friends or relatives that are unrelated to changes in the child's condition or the Family's circumstances. Do include any planned or unplanned stay with friends or relatives, if the stay lasted more than seven (7) days and was: (a) precipitated by a worsening of the child's condition, a change in the Family's circumstances, or increased stress in the child's environment and; (b) the parent or legal guardian was made aware of and permitted the stay. (Note: Unplanned stays with others not permitted by the parent or legal guardian should be regarded as runaways rather than changes of residence). Each time that a child moves out of and then back to, his or her primary residence is counted as two (2) moves. b. Parent or legal guardian were made aware of and permitted to stay. Each time that a child moves out of and back to hislher primary residence, count as two (2) stays. 134309 Deschutes County Approved 5/9/2011 83 of 220 OHA 11-13 GT0217 -11. 7. Did parent or adult caregiver participate in current and most recent Child and Family Team (CFT) meeting? (Include those whose primary role with child is that of paid provider of services, i.e. clinical, educational or case management services.) 8. Caregiver Rating: a. Social network over the past thirty (30) calendar days: (1) No family or social network that could help with raising the child. (2) Some family or friend social network that could help with raising the child. (3) Some family or friend social network that actively helps with the raising of the child. (4) Significant family and friend social network that actively helps with raising the child. (5) NK (Not Known). b. Child has been producing schoolwork of acceptable quality for his or her ability level over the past twenty (20) scheduled school days: (1) Never. (2) Seldom. (3) Sometimes. (4) Frequently. (5) Very Frequently or Always. (6) Not applicable (if child has not been in school over past 20 days). c. Substance abuse over the past thirty (30) days: O. None. 1. Suspicion of substance abuse. 2. Clear evidence of substance abuse that is interfering with child's ability to function in at least one role or setting. 3. Clear evidence of substance dependence and lor child requires detoxification. d. Risk of delinquency in consideration of all acts of delinquency (misdemeanors, felonies and all status offenses except runaways), with or without awareness by legal authorities: O. No History. 1. None in past thirty (30) days. 2. Some in past thirty (30) days. 3. Several in past thirty (30) days. e. Risk of self-harm (includes reckless or intentional risk taking behavior that may endanger the child): O. No history. 1. None in past thirty (30) days. 2. Some in past thirty (30) days. 3. Several in past thirty (30) days. Page 28 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 f. History of and risk of danger to others: O. No history. 1. None in past thirty (30) days. 134309 Deschutes County Approved 5/9/2011 84 of 220 OHA 11-13 GT0217-11 2. Some in past thirty (30) days. g. History and risk of running away: O. No history. 1. None in past thirty days. 2. Some in past thirty (30) days. 3. Several in past thirty (30) days. 9. Behavioral and Emotional Rating Scale, 2nd Edition (Bers2) ParenUCaregiver Rating Scale, Raw Scores of Subscales. Formatting the ISA Progress Review Data for Submission to OHA: Instructions for submission of the ISA Progress Review Report data shall be provided by OHA as a separate document. Modification of Exhibit 5, State Requirements for Mental Health Subcontract In the event the State of Oregon modifies the terms of SE 24, it is understood that this Contract will be revised accordingly. Authority to change this Exhibit to comply fully with Deschutes County's State Contract shall rest with the Director of Behavioral Health Services, St. Charles Medical Center and the Deschutes County Health Services Director. Both parties must agree for the Exhibit to be modified. Page 29 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 Exhibit 6 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules, regulations, executive orders and policies. Contractor shall comply with the following federal requirements. For the purposes of this Contract, 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. Contractor shall comply with all federal laws, regulations, and executive orders applicable to the Contract or to the delivery of Services. Without limiting the generality of the foregoing, Contractor expressly agrees to comply with the following laws, regulations and executive orders to the extent they are applicable to the Contract: (a) Title VI and VII of the Civil Rights Act of 1964, as amended, (b) Sections 503 and 504 of the Rehabilitation Act of 1973, 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 1974, as amended, (h) all regulations and administrative rules established pursuant to the foregoing laws, (i) all other applicable requirements of federal civil rights and rehabilitation statutes, rules and regulations, and (j) all federal law governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring reporting of Client 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. 14402. 2. Equal Employment Opportunity. If this Contract, including amendments, is for more than $10,000, then Contractor shall comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented in Department of Labor regulations (41 CFR Part 60). 3. 'telean Air, Clean Water, EPA Regulations. If this Contract, including amendments, exceeds "$100,000 then Contractor shall 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. 1251 to 1387), specifically including, but not limited to Section 508 (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency regulations (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 Protection Agency. Contractor shall 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. Contractor shall comply with applicable mandatory standards and policies relating to energy efficiency that are contained in the Oregon energy conservation plan issued in compliance with the Energy Policy and Conservation Act 42 U.S.C. 6201 et. seq. (Pub. L. 94-163). 5. Truth in Lobbying. By signing this Contract, the Contractor certifies under penalty of perjury that the following statements are true to the best of the Contractor's knowledge and belief that: a. No federal appropriated funds have been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting 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 Page 30 of4? -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 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 Contractor shall complete and submit Standard Form LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions. c. The Contractor shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients and subcontractors shall certify and disclose accordingly. d. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by section 1352, Title 31 of the U.S. Code. Any person who ails 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 Contractor under this Contract 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 Stage 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 Sate or local government itself. f. No part of any federal funds paid to Contractor 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 (b) and (c) 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 Contractor under this Contract may be used for any activity that promotes the legalization of any drug or other substance included In schedule I of the schedules of controlled substances established under 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. 6. HIPAA Compliance. Contractor 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 Page 31 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 HIPAA), and OAR 125-055-0100 through OAR 125-055-0130. Contractor must comply with HIPAA to the extent that any Services or obligations of Contractor arising under this Contract are covered by HIPAA. County shall determine if County will have access to, or create and protected health information in the performance of any Service or any other obligations under this Contract. To the extent that Contractor will have access to, or create any protected health information to perform functions, activities, or Services for, or on behalf of a healthcare component of OHA in the performance of any Service required by this Contract, County shall comply and Contractor shall 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 Contract. To the extent that Contractor is performing functions, activities, or services for, or on behalf of, a healthcare component of OHA in the performance of Services required by this Contract, Contractor shall not use or disclose any Individual 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 of the most recent OHA Notice of Privacy Practices may be obtained by contacting OHA or by looking up form number 2090 on the OHA web site at https:llapps.state.or.us/cf1/FORMS/. b. Data Transactions Systems. If County and Contractor intends to eXChange electronic data transactions with a health care component of OHA in connection with claims or encounter data, eligibility or enrollment information, authorizations or other electronic transaction, County and Contractor shall execute an EDI Trading Partner Agreement and shall comply with OHA EDI Rules. c. Consultation and Testing. If County or Contractor reasonably believes that the County's or Contractor's data transactions system or other application of HIPAA privacy or security compliance policy may result in a violation of HIPAA requirements, County or Contractor shall promptly consult the OHA Information Security Office. County or Contractor may initiate a request for testing of HIPAA transaction requirements, subject to available resources and the OHA testing schedule. 7. Resource Conservation and Recovery. Contractor shall 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. Contractor shall comply with applicable audit requirements and responsibilities set forth in this Contract and applicable state or federal law. b. Contractor 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 contractor if the person or entity is listed on the non-procurement portion of the General Service Administration's "List of Parties Excluded from Federal Procurement or Nonprocurement Programs" in accordance with Executive Orders No. 12549 and No. 12689, "Debarment and Suspension". (See 2 CFR Part 180). This list contains names of parties debarred, suspended, or otherwise excluded by agencies, and contractors declared ineligible under statutory authority other than Executive Order No. 12549. Contractors with awards that exceed the simplified Page 32 of4? -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 acquisition threshold shall provide the required certification regarding their exclusion status and that of their principals prior to award. 10. Drug-Free Workplace. Contractor shall comply with the following provisions to maintain a drug­ _. free workplace: (i) Contractor 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 Contractor's workplace or while providing services to OHA clients. Contractor's notice shall specify the actions that will be taken by Contractor against its 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 contract 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 Contract, 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 (10) 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 (vii) above; (ix) Neither County, Contractor nor any of County's or Contractor's employees, officers, agents may provide any service required under this Contract 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 Contractor's employee, officer, agent has used a controlled substance, prescription or non-prescription medication that impairs the County or Contractor, County or Contractor's employees, officers, agents 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 section my result in termination of this Contract. 11. Pro-Children Act. Contractor shall comply with the Pro-Children Act of 1994 (codified at 20 U.S.C. section 6081 et. seq.). 12. Medicaid Services. To the extent Contractor provides any service whose costs are paid in whole or in part by Medicaid, Contractor 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 1396 a(a)(27); 42 CFR 431.107(b)(1) & (2). b. Comply with all disclosure requirements of 42 CFR 1002.3(a) and 42 CFR 455 Subpart (B). c. Maintain written notices and procedures respecting advance directives in compliance with 42 U.S.C. Section 1396(a)(57) and (w), 42 CFR 431.107(b)(4), and 42 CFR 489 subpart I. Page 33 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 d. Certify when submitting any claim for the provision of Medicaid Services that the information submitted is true, accurate and complete. Contractor shall acknowledge Contractor'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 Contract 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, contractors and agents about the policies and procedures in compliance with Section 6032 of the Deficit Reduction Act of 2005,42 U.S.C. § 1396a(a)(68). 13. ADA. Contractor 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, Contractor 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 contractor of Medicaid or CHIP services, including fiscal agents of providers and managed care entities: (1) 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 of a 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 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; (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 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 on 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 the 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 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. 16. Special Federal Requirements Applicable to Addiction Services. a. Women's Services. If Contractor provides A&D 61 or A&D 62 Services, Contractor must: (1) Treat the family as a unit and admit both women and their children if appropriate. Page 34 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 (2) Provide or arrange for the following services to pregnant women and 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 care. (d) Therapeutic interventions for children in custody of women in treatment, which address, but are not limited to, the children's developmental needs and issues of abuse and neglect; and (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 Contractor provides any A&D Services other than A&D 70 Services, Contractor must: (1) 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; (2) Perform outreach to inform pregnant women of the availability of treatment services targeted to them and the fact that pregnant women receive preference in admission to these programs; (3) If Contractor has insufficient capacity to provide treatment services to a pregnant woman, refer the women to another provider with capacity or if 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. If Contractor provides any A&D Services other than A&D 70 Services, Contractor must: (1) Within the priority categories, if any, 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) If Contractor receives a request for admission to treatment from an intravenous drug abuser, Contractor 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 Contractor 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 the purposes of (3) above, "Interim Services" means: Page 35 of 47 -Document No. 2013-619. Amending Deschutes County Contract No. 2012-408 (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) If Contractor treats recent intravenous drug users (those who have injected drugs within the past year) in more than one-third of its capacity, Contractor 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 Contractor provides any A&D Services other than A&D 70 Services, Contractor must: (1) Complete a risk assessment for infectious disease including Human Immunodeficiency Virus (HIV) and tuberculosis, as well as sexually 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, if Contractor denies individual admission on the basis of lack of capacity, refer the individual to another provider of tuberculosis Services. (3) For the 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. e. OHA Referrals. If Contractor provides any A&D Services other than A&D 70 services, Contractor 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, Contractor shall develop support services available to address or overcome the barrier, including: (1) 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. Page 36 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 g. Misrepresentation. Contractor 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 of OHA. h. Oregon Residency. A&D Services funded through this Contract 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 living in Oregon may meet the residency requirement if the caretaker relative with whom the child is living is an Oregon resident. i. Tobacco Use. If Contractor has A&D Services treatment capacity that has been designated for children, adolescents, pregnant women, and women with dependent children, Contractor must implement a policy to eliminate smoking and other use of tobacco at the facilities where the Services are delivered on the grounds of such facilities. j. Client Authorization. Contractor must comply with 42 CFR Part 2 when delivering an Addiction Service that includes disclosure of Client information for purposes of eligibility determination. Contractor 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 Contract 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-1 et. seq., and Contractor shall comply with those restrictions. 18. Substance Abuse Prevention and Treatment. To the extent Contractor provides any Service whose costs are paid in whole or in part by the Substance Abuse, Prevention, and Treatment Block Grant, Contractor shall comply with federal rules and statutes pertaining to the Substance Abuse, Prevention, and Treatment Block Grant, including the reporting provisions of the Public Health Services Act (42 U.S.C. 300x through 300x-66). Regardless of funding source, to the extent Contractor provides any substance abuse prevention or treatment services, Contractor shall comply with the confidentiality requirements of 42 CFR Part 2. Conflicts of Interest Contractor certifies under penalty of perjury that the following statements are true to the best of Contractor's knowledge: 1. If Contractor is currently performing 'Nerk for the County, State of Oregon or federal go¥ernment, Contractor by Signature to this Contract declares certifies that; Contractor's VVork to be performed under this Contract create no potential or actual conflict of interest as defined by ORS 244 and no rules or regulations of Contractor's employee agency (County State or Federal) 'Nould prohibit Contractor's VVork under this Contract. Contractor is not an "officer," "employee," or "agent" of the County, as those terms are used in ORS 30.265. 2. Audits. a. Contractor shall comply, if applicable, with the applicable audit requirements and responsibilities set forth in the Office of Management and Budget Circular A 133 entitled "Audits of States, bocal Go'/emments and Non Profit Organizations. " b. Contractor shall also be required to comply with applicable Code of Federal Regulations (CFR) sections and OMB Circulars go ..'eming expenditure of federal funds. State, local and Indian Tribal Governments and governmental hospitals must follow OMB A 102. Non profits, hospitals, colleges and Page 37 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 uni'.'ersities must follow 2 CFR Part 215. Sub recipients shall be required to monitor any organization to which funds are passed for compliance 'Nith CFR and OMB requirements. 3. No federally appropriated funds have been paid or shall be paid, by or on behalf of Contractor, 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 'Nith the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperati'Je agreement, and the extension, continuation, renevJal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. a. If any funds other than federally appropriated funds have been paid or shall 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 \, ..ith this federal contract, grant, loan, or cooperative agreement, Contractor agrees to complete and submit Standard Form LLL "Disclosure Form to Report Lobbying," in accordance with its instructions. 1) Standard Form LLL and instructions are located in 45 CFR Part 93 Appendix B. 2) If instructions require filing the form with the applicable federal entity, Contractor shall then as a material condition of this Contract also file a copy of the Standard Form LLL with the Oregon Health Authority. 3) This filing shall occur at the same time as the filing in accordance with the instructions. b. Contractor understands this certification is a material representation of fact upon which the County and the Oregon Health Authority has relied in entering into this Contract. Contractor further understands that submission of this certification is a prerequisite, imposed by 31 USC 1352 for entering into this Contract. c. ,A,ny person who fails to file the required certification shall be sblbject to a ci'/il penalty of not less than $10,000 and not more than $100,000 for each such failure. d. Contractor shall include the langblage of this certification in the a'Nard documents for all sub awards at all tiers (inclblding subcontracts, sblb grants, and contracts under grants, loans and cooperati'le agreements) and that all sblb recipients shall certify and disclose accordingly. e. Contractor is solely responsible for all liability arising from a failure by Contractor to comply 'Nith the terms of this certification. f. Contractor promises to indemnify County for any damages suffered by County as a result of Contractor's failure to comply with the terms of this certification. 4. Contractor tmderstands that, if this Contract in·.'olves federally appropriated funds, this certification is a material representation of facts blpon 'Nhich reliance 'Nas placed when this Contract 'Nas made OF entered into, sblbmission of this certification is a prereqblisite for make or entering into this Contract imposed by ~~~~Ya:~#~:Q==:faS;;:!"I",n shall .. o tractor Signature Dat Page 38 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 EXHIBIT 7 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 CONFIDENTIALITY AGREEMENT County will make available and/or transfer to Contractor certain Information, in conjunction with goods or services that are being provided by Contractor to County that is confidential and must be afforded special treatment and protection. Contractor will have access to and/or receive from County certain Information that can be used or disclosed only in accordance with this Agreement and the HHS Privacy Regulations. To the extent required by 42 U.S.C. 1171 et seq. enacted by the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, Contractor assures County that Contractor will appropriately safeguard protected health information made available to or obtained by Contractor. Contractor further agrees to comply with applicable laws relating to protected health information and with respect to any task or other activity Contractor performs on behalf of County, to the extent County would be required to comply with such requirements. For purposes of this Agreement, the following terms shall apply: A. Contractor shall be considered a Contractor; B. County shall be considered a COVERED ENTITY; C. HHS Privacy Regulations shall mean the Code of Federal Regulations (C.F.R.) at Title 45, Sections 160 and 164; D. Individual shall mean the person who is the subject of the Information, and has the same meaning as the term 'individual' is defined by 45 C.F.R. 164.501; and E. Secretary shall mean the Secretary of the Department of Health and Human Services (HHS) and any other officer or employee of HHS to whom the authority involved has been delegated; F. Information shall mean any health information provided and/or made available by County to Contractor, and has the same meaning as the term 'health information' as defined by 45 C.F.R. 160.102. Contractor agrees it shall: 1. Not use or further disclose such information other than as permitted or required by this Agreement. Contractor shall not, except as necessary for the proper management, administration and performance of its duties under this Agreement, use, reproduce, disclose, or provide to third parties, any confidential document or information relating to the County, its members or to Individuals seeking services from County or its members without the prior written consent or authorization of the County or of the Individual. If Contractor uses such information for the purposes set forth above, it will only do so if the disclosure is required by law or Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purpose for which Contractor disclosed it to the person. Contractor shall ensure that its personnel, employees, affiliates and agents maintain the confidentiality of patient health information and business information of County. 2. Not use or further disclose the information in a manner that would violate the requirements of applicable law, if done by County; Page 39 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 3. Use appropriate safeguards to prevent use or disclosure of such information other than as provided for by this Agreement; 4. Report to County any use or disclosure of such information not provided for by this Agreement of which Contractor becomes aware; 5. Ensure that any subcontractors or agents to whom Contractor provides protected health information received from County agree to the same restrictions and conditions that apply to Contractor with respect to such information; 6. Make available protected health information in accordance with applicable law, i.e., the Code of Federal Regulations (C.F.R.) at Title 45, Sections 160 and 164; 7. Maintain standard records, pursuant to this Agreement, and to provide such records and other necessary information to the County as may be requested in writing and as permitted by law. Contractor agrees that all records kept in connection with this agreement are subject to review and audit by the County upon reasonable notice of a minimum of 14 work days from the date of written request by the County. 8. Make Contractor's internal practices, books, and records relating to the use and disclosure of protected health information received from County available to the Secretary of the United States Health & Human Services for purposes of determining County's compliance with applicable law (in all events, Contractor shall immediately notify County upon receipt by Contractor of any such request, and shall provide County with copies of any such materials); 9. Upon termination of this Agreement, Contractor shall promptly return all protected health information received from County. If the return of protected health information is not feasible, Contractor shall continue the protections required under this contract to the protected health information consistent with the requirements of this Attachment and the HIPAA privacy standards. Page 40 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 Exhibit 8 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2012-408 REQUIRED PROVIDER CONTRACT PROVISIONS Oregon Health Authority Exhibit I of 2013-201Slntergovernmental Agreement 1. Expenditure of Funds. Contractor may expend the funds paid to Contractor under this Contract solely on the delivery of services as described in Exhibit 1 of this Contract ("Services"), subject to the following limitations (in addition to any other restrictions or limitations imposed by this Contract): a. Contractor may not expend on the delivery of Services any funds paid to Contractor under this Contract in excess of the amount reasonable and necessary to provide quality delivery of Services. b. If this Contract requires Contractor to deliver more than one service, Contractor may not expend funds paid to Contractor under this Contract for a particular service on the delivery of any other service. c. If this Contract requires Contractor to deliver alcohol, drug abuse and addiction services, Contractor may not use the funds paid to Contractor under this Contract for such services: (1) 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); (S) 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 24S(b) of the Health Omnibus Programs Extension Act of 1988 (codified at 42 U.S.C. 300ee(S». d. Contractor may expend funds paid to Contractor 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 of the State of Oregon, the Federal Government, and their duly authorized representatives shall have access to the books, documents, papers and records of Contractor that are directly related to this Contract, the funds paid to Contractor hereunder, or any services delivered hereunder for the purpose of making audits, examinations, excerpts, copies and transcriptions. In addition, Contractor shall permit authorized representatives of County and the Oregon Health Authority to perform site reviews of all services delivered by Contractor hereunder. b. Retention of Records. Contractor shall retain and keep accessible all books, documents, papers, and records, that are directly related to this Contract, the funds paid to Contractor hereunder or to any services delivered hereunder, for a minimum of six (6) years, or such longer period as may be required by other provisions of this Contract or applicable law, following the termination or expiration of this Contract. If there are unresolved audit or other questions at the end of the six-year period, Contractor shall retain the records until the questions are resolved. Page 41 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 c. Expenditure Records. Contractor shall document the expenditure of all funds paid to Contractor under this Contract. Unless applicable federal law requires Contractor to utilize a different Accounting system, Contractor 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 Contractor under this Contract were expended. d. Client Records. Unless otherwise specified in this Contract, Contractor shall create and maintain a client record for each client who receives services under this Contract. The client record must contain: (1) 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. Contractor 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, records of Individual's must be retained for a minimum of ten (10) years from termination or expiration of this Contract. e. Safeguarding of Client Information. Contractor 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 the Oregon Health Authority, implementing the foregoing laws, and any written poliCies made available to Provider by County or by the Oregon Health Authority. Contractor 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. f. Data Reporting. 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 specific in OHA's CPMS manual located at: http://www.oregon.gov/OHAlamh/training/cpms/index.shtml.asit 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.as 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. 3. Alternative Formats of Written Materials. In connection with the delivery of Services, Contractor shall: a. Make available to an Individual, without charge to the Individual, upon the Individual'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 Contractor. Page 42 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 b. Make available to an Individual, without charge to the Individual, upon the Individual'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 Contractor. c. Make available to an Individual, without charge to the Individual, upon the Individual's, County's or the Oregon Health Authority's request, oral interpretation services in all non· English languages in the area served by Contractor. d. Make available to an Individual with hearing impairments, without charge to the Individual, upon the Individual'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 subcontractor contracts related to this Contract. 4. Reporting Requirements. Contractor shall prepare and furnish the following information to County and the Oregon Health Authority when a service is delivered under this Contract: a. Individual, 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 disclosures described in Exhibit 6, Required Federal Terms and Conditions, Section 15, Disclosure. 5. Compliance with Law. Contractor 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, Contractor 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 abuse of an Individual; (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 Contractor, 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, Contractor 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 July 1,2013, which Exhibit is incorporated herein by this reference. For purposes of this 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. Page 43 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 6. Unless Contractor is a State of Oregon governmental agency, Contractor 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 fullest extent permitted by applicable law, Contractor 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 of the Contractor, including but not limited to the activities of Contractor or its officers, employees, subcontractors or agents under this Contract. 8. Contractor understands that Contractor 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. Contractor 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. Contractor(s) that are not units of local government as defined in ORS 190.003 shall obtain, at Contractor'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 2 of this Contract. 11 Contractor(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, 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, agents, employees or subcontractors of the 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. 12. Contractor shall include sections 1 through 11, in substantially the form set forth above, in all permitted Contractor contracts under this Contract. Contractor: Oregon Health Authority Exhibit H of 2011 2013 Intergovernmental Agreement #134309 1. Expenditure of Funds. Contractor may expend the funds paid to Contractor under this Contract solely on the delivery of services as described in Exhibit 1 of this Contract ("Services"), subject to the following limitations (in addition to any other restrictions or limitations imposed by this Contract): a. Contractor may not expend on the delivery of Services any funds paid to Contractor under this Contract in excess of the amount reasonable and necessary to provide quality delivery of Services. b. If this Contract requires Contractor to deliver more than one service, Contractor may not expend funds paid to Contractor under this Contract for a particular service on the delivery of any other service. Page 44 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 c. If this Contract reql:Jires Contractor to deliver alcohol, drl:Jg abl:Jse and addiction services, Contractor may not l:Jse the fl:Jnds paid to Contractor l:Jnder this Contract for sl:Jch services: (1) To provide inpatient hospital services; (2) To make cash payments to intended recipients of health services; (3) To pl:Jrchase or improve land, to pl:Jrchase, constrl:Jct or permanently improve (other than minor remodeling) any bl:Jilding or other facility or to pl:Jrchase major medical eql:Jipment; (4) To satisfy any reql:Jirement for expenditl:Jre of non federal fl:Jnds as a condition for receipt of federal fl:Jnds (whether the federal funds are received l:Jnder this Contract or otherwise); (5) '1'1ith respect to federal Sl:Jbstance Abl:Jse Prevention and Treatment Block Grant moneys only, to pl:Jrchase services from any person or entity other than a pl:Jblic or non profit entity; or (6) To carry Ol:Jt any program prohibited by section 245(b) of the Health Omnibl:Js Programs Extension Act of 1988 (codified at 42 USC 300ee(5). d. Contractor may expend funds paid to Contractor l:Jnder this Contact only in accordance with federal OMB Circl:Jlar A 87 as that circl:Jlar is applicable on allowable costs. 2. Records Maintenance, Access and Confidentiality. a. Access to Records and Facilities. COl:Jnty, the Oregon Health ,'\l:Jthority, the Secretary of State's Office of the State of Oregon, the Federal GOI/emment, and their dl:Jly al:Jthorized representatives shall have access to the books, docl:Jments, papers and records of Contractor that are directly related to this Contract, the funds paid to Contractor herel:Jnder, or any services delivered herel:Jnder for the pl:Jrpose of making al:Jdits, examinations, excerpts, copies and transcriptions. In addition, Contractor shall permit al:Jthorized representatives of COl:Jnty and the Oregon Health Al:Jthority to perform site revielNS of all services delivered by Contractor herel:Jnder. b. Retention of Records. Contractor shall retain and keep accessible all books, docl:Jments, papers, and records, that are directly related to this Contract, the funds paid to Contractor herel:Jnder or to any services delivered herel:Jnder, for a miniml:Jm of six (6) years, or sl:Jch longer period as may be reql:Jired by other provisions of this Contract or applicable law, follO'.'ling the termination or expiration of this Contract. If there are l:Jnresolved al:Jdit or other ql:Jestions at the end of the six year period, Contractor shall retain the records l:Jntil the ql:Jestions are resolved. c. Expenditl:Jre Records. Contractor shall docl:Jment the expenditl:Jre of all fl:Jnds paid to Contractor l:Jnder this Contract. Unless applicable federal law reql:Jires Contractor to l:Jtilize a different Accol:Jnting system, Contractor shall create and maintain all expenditl:Jre records in accordance with generally accepted accol:Jnting principles and in sl:Jfficient detail to permit COl:Jnty and the Oregon Health Al:Jthority to verify how the funds paid to Contractor l:Jnder this Contract were expended. d. Individl:Jal Records. Unless otherwise specified in this Contract, Contractor shall create and maintain an Individl:Jal record for each Individl:Jal who receil/es services l:Jnder this Contract. The Individl:Jal record ml:Jst contain: (1) Individl:Jal identification; (2) Problem assessment; (3) Services and Sl:Jpports, training and/or care plan; (4) Medical information when appropriate; and (5) Service notes incll:Jding service concll:Jsion sl:Jmmary and Cl:Jrrent assessment or evall:Jation instmment as designated by the Oregon Health Al:Jthority in administrative rl:Jles. Contractor shall retain Individl:Jal records in accordance with OAR 166 1500005 through 166 1500215 (State Archivist). Unless OAR 166 150 0005 throl:Jgh 116 150 0215 requires a longer retention period, I ndividl:Jal records ml:Jst be retained for a miniml:Jm of ten (10) years from termination or expiration of this Contract. e. Safegl:Jarding of Individl:Jal Information. Contractor shall maintain the confidentiality of Individl:Jal records as required by applicable state and federal law, including without limitation, ORS 179.495 to 179.507, Page 45 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 45 CFR Part 205,42 CFR Part 2, any administrati'Je rule adopted by the Oregon Health Authority, implementing the foregoing la'Ns, and any written policies made a'l8i1able to Contractor by CO(;lnty or by the Oregon Health A(;lthority. Contractor shall create and maintain \'lritten policies and procedures related to the disclosure of Individual information, and shall make such policies and procedures available to County and the Oregon Health Authorit)f for re'liew and inspection as reasonably requested by Count)' or the Oregon Health Authority. f. CPMS Enrollment (If Applicable to Contract). As specified in the Oregon Health Authority's Client Process Monitoring System rCPMS") manual (for Alcohol, Drug Abuse and Addiction Services or Mental Health Services, as appropriate), Contractor shall enroll in CPMS, eash Individual receiving a seF\'ice under this Contract and maintain that Individual's CPMS record as specified in the CPMS manual available at http://>.wNI.oregon.go'.<fOH.AJmentalhealth/publications/main.shtml 3. Alternative Formats of Written Materials. In sonnection '.vith the delivery of Services, Contractor shall: a. Make a'.failable to an Indi'lidual, Ylithout charge to the Individual, upon the Individual's, the County's or the Oregon Health Authorit)f's request, any and all written materials in altornate. if appropriate, formats as required by the Oregon Health Authority's administrative rules or by the Oregon Health Authority's 'Nritten policies made a\failable to Contractor. b. Make a\failable to an Individual, without charge to the Individual, upon the Indi'/idual's, County's or the Oregon Health Authorit)f's request, any and all '.vritten materials in the prevalent non English languages in the area served by Contractor. c. Make a'.'ailable to a Individual, 'Nithout charge to the Indi'lidual, upon the Individual's, County's or the Oregon Health Authorit)I's request, oral interpretation services in all non English languages in the area served by Contractor. d. Make available to a Individual'Nith hearing impairments, without charge to the Individual, upon the Indi\'idual's, County's or the Oregon Health Authority's request, sign language interpretation services and telephone communications access seF\'ices. For purposes of the foregoing, U'Nritten materials" includes, I....ithout limitation, all written materials created or delivered in connection 'Nith the services and all subcontractor contracts related to this Contract. 4. Reporting Requirements. Contractor shall prepare and furnish the following information to County and the Oregon Health Authority when a service is delivered under this Contract: a. Individual, service and financial information as specified in the applicable seF\lice description attached hereto and incorporated herein by this reference. b. All additional information and reports that County or the Oregon Health ,A,uthorit)' reasonably requests. 5. Compliance with Law. Contractor shall comply with all state and local laws, regulations, executive orders and ordinances applicable to the Contract or to the delivery of seF\fices hereunder. Without limiting the generality of the foregoing, Contractor expressly agrees to comply 'Nith 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 stat(;ltes, r(;lles and regulations; (b) all state la' ....s governing operation of community mental health programs, including 'Nithout limitation, all administrative rules adopted by the Oregon Health Authorit)f related to community mental health programs; (c) all state la .....s requiring reporting of Indjyidual abuse; (d) ORS 659A400 to 65QA40Q, ORS 659A145 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 Page 46 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 conduct of all programs, services and training associated with the delivery of services under this Contract. These la'/.'s, 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 Contractor, that employ subject workers 'Nho provide services in the State of Oregon shall comply with ORS 656.017 and pro'lide the required VVorkers' Compensation cO'.'erage, unless such employers are exempt under ORS 656.126. In addition, Contractor shall comply, as if it were County thereunder, with the federal requirements set forth in Exhibit G to the certain 2011 2013 Intergo'lernmental Agreement for the Financing of Community Addictions and Mental Health Services between County and the Oregon Health Authority dated as of July 1, 2011, which Exhibit is incorporated herein by this reference. For purposes of this Contract, all references in this Contract to federal and state laws are references to federal and state la'Ns as they may be amended from time to time. 6. Unless Contractor is a State of Oregon governmental agency, Contractor 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 la'N, Contractor 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 of the Contractor, including but not limited to the activities of Contractor or its officers, employees, subcontractors or agents under this Contract. 8. Contractor understands that Contractor 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. Contractor shall only conduct transactions that are authorized by the County for transactions with the Oregon Health Authority that invol'le County funds directly related to this Contract. 10. Contractor(s) that are not units of local government as defined in ORS 190.003 shall obtain, at Contractor'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 I of the certain 2011 2013 Intergo\'ernmental Agreement for the Financing of Community Addictions and Mental Health Services between County and the Oregon Health Authority dated as of July 1, 2011, which Exhibit is incorporated herein by this reference. 11 Contractor(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, 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 INiliful acts or omissions of Pro\'ider or any of the officers, agents, employees or subcontractors of the contractor( "Claims"). It is the specific intention of the parties that the Indemnitee shall, in all instances, e*cept 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. 12. Contractor shall include sections 1 through 10, in substantially the form set forth above, in all permitted Contractor contracts under this Contract. Date: Signature: Title Contractor: Page 47 of 47 -Document No. 2013-619, Amending Deschutes County Contract No. 2012-408 I ·~e I DATE (MMIODlYYYYIACORD CERTIFICATE OF LIABILITY INSURANCE 07/01/2013"---" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED. the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. certain policieS may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER ~~~~~CT I Nicole Nouhra CHIVAROLI & ASSOCIATES INC. ~..:':, Ext): I 805.371.3680 I ~..: No) I 805.371.3684 200 N Westlake Blvd Ste 101 ~~~$$: I nicolen@chivaroli.com Westlake Village, CA 91362 INSURERISI AFFORDING COVERAGE HAle # INSURER A: Lexington Insurance Company 19437 INSURED INSURERS: St. Charles Health System, Inc. INSURERC: 2500 NE Neff Rei INSURERD: Bend, OR 97701 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER' REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOlWlTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AfFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ~ TYPE OF INSURANCE AGOL ~6 POUCVEFF POLICY EXP INSR POLICY NUMBER IMMIOOIYYYYI IMMIODII'YYYI LIMITS GENERAL lIASILITY EACH OCCURRENCE jf'OOO.ooo-DAMAGE TO RENTEDX COMMERCIAL GENERAL LIABILITY PREMISES eel occurrencel X tID CLAIMS MADE 0 OCCUR MED EXP (Ally on. person) $...:...:. A 6792944 07/01/2013 07/01/2014 PERSONAL & AOV INJURY $-GENERAL AGGREGATE $3,000.000 ! ~N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS ­COMPIOP AGG $!xl POLICY n ~gT n LOC AUTOMOBILE LIABiliTY COMBINED SINGLE LIMIT $lEa_ont)I-­ANY AUTO $BOOILY INJURY (per pen;on) I-­ALL OWNED r-SCHEDULED AUTOS AUTOS BOOILY INJURY (per aceldent) $ !-­ !-­NON-OWNED PROPERTY DAMAGEHIRED AUTOS AUTOS (Per_ntl $ !-- UMBRElI.A UAB HOCCUR EACH OCCURRENCll $I-­EXCESSLIAB CLAIMS-MADE $AGGREGATE DED I I RETENTION $ WORKERS COMPENSATION AND we STATUTORY I OTHER $EMPLOYERS' LIABILITY YIN LIMITS NN PROPRI€TORIPARTNERB<ECUTI'iEI D E.L EACH ACCIDENT $OFFICEAAoIEMBER EXCLUDED? NIA (",.",,~lnNK) E.L. DISEASE-EACH $" yes, descfib& \H'1der EMPLOYEE DESCRIPTION OF OFERATIONS below E.L. DISEASE ­POLICY LIMIT $ A Claims-Made 6792944 07/0112013 07/01/2014 $1,000,000 Each Claim Professional Liability Insurance $3,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule,lf mole spaee is lequlledl Evidence of Professional and General Liability insurance as respects the Psychiatric Emergency Services agreement effective September 1, 2006 between St. Charles Health System, Inc and Deschutes County. It is agreed that the State of Oregon, Human Resources Department. Deschutes County and its divisions, officers. agents, employees. and volunteers are added as an Additional Insured but only as respects their interests as respects this Psychiatric Emerge CERTIFICATE HOLDER CANCELLATION Deschutes County 2577 NE Courtney Health Services Dr SHOULD ANY OF THE ABOVE DESCRIBED POUClES BE CANCELLED BEFORE THE EXPlRAllON DATE THEREOF, NOllCE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Bend, OR 97701 AUTHORIZED REPRESENTATIVE aI'....¥I.•,•.•••~.......... © 1988-2010 ACORD CORPORATION. All nghts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ENDORSEMENT NO.19 This endorsement, effective 12:01 AM: July 1, 2013 Forms a part of policy no.: 6792944 Issued to: ST CHARLES HEALTH SYSTEM, INC. By: LEXINGTON INSURANCE COMPANY ADDITIONAL INSUREDS ENDORSEMENT -PRIMARY AND NON-CONTRIBUTORY It is agreed the coverage provided under the Coverage Part(s) indicated by an 'x' below is amended by adding the following as Additional Insured but only with respect to any claim or suit arising out of the conduct of your business: ~ EXCESS HEAL THCARE PROFESSIONAL LIABILITY CLAIMS MADE COVERAGE PART ~ HEALTHCARE UMBRELLA POLICY CLAIMS MADE COVERAGE PART Deschutes County, its Officers, Agents, Employees and Volunteers c/o Deschutes County Health Services 2577 NE Courtney Dr. Bend. OR 97701 It is also agreed that the insurance afforded by this policy for the benefit of the Additional Insured shall be primary insurance, subject to any underlying insurance or self insured retention scheduled on this policy, and any insurance maintained by the Additional Insured shall be non-contributory. All other terms, conditions and exclusions of the policy remain unchanged. MNSCPT (06/13) Authorized Representative or countersignature (where required by law)