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Doc 261 - Svcs Agrmt - Lutheran NW - Crisis Program
Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Send, OR 97701-1960 (541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org AGENDA REQUEST & STAFF REPORT For Board Business Meeting of July 21, 2014 DATE: July 08, 2014 FROM: Nancy Mooney, Contract Specialist Phone: 322-7516 Health Services--Behavioral Health Division TITLE OF AGENDA ITEM: Consideration of Board Signature of Document #2014-261, personal services contract between Lutheran Community Services Northwest and Deschutes County Health Services. PUBLIC HEARING ON THIS DATE? No BACKGROUND AND POLICY IMPLICATIONS: Lutheran Community Services Northwest and Deschutes County Health Services intend to work collaboratively on the Central Oregon Crisis Services Program Expansion and Improvement Project for the purposes of expanding the scope and jurisdiction of the Mobile Community Assessment Team (MCAT) within Deschutes and Crook County. Lutheran Community Services Northwest (LCSNW) is a nonprofit human services agency that provides a wide variety of services to adults, adolescents, children, families, schools, businesses, congregations, neighborhoods and communities. The Central Oregon Crisis Services Program Expansion and Improvement Project seeks to resolve issues such as: duplication of effort and resources; confusion among first-responders as to who to contact; inability to efficiently integrate individuals into the community mental health system; lack of consistency in service delivery; lack of clarity in clinical roles and duties; and unacceptable response times. To assist in addreSSing these issues, LCSNW will operate an MCAT based in Prineville to respond to crisis calls and coordinate service delivery in Crook County. LCSNW will closely follow Deschutes County's MCAT model and will replicate structure, staffing, policies, procedures, protocols and guidelines for MCAT operation. Upon execution of this contract and receipt of funds from the Oregon Health Authority, Deschutes County shall pay LCSNW a maximum compensation: (a) for the 2013-2014 fiscal year (July 1 to June 30) $73,672, (b) for the 2014-2015 fiscal year (July 1 to June 30) $144,972. Funds provided shall be used to help support the two QMHP positions, the LCSNW Director position and to cover the cost of expenses including: travel, office supplies, computer and telephone equipment. FISCAL IMPLICATIONS: Maximum compensation for the duration of the contract is $218,644. RECOMMENDATION & ACTION REQUESTED: Behavioral Health requests approval. ATTENDANCE: Lori Hill, Behavioral Health Program Manager DISTRIBUTION OF DOCUMENTS: Executed originals 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: Department: Health Services, Behavioral Health Contractor/Supplier/Consultant Name: I Lutheran Community Services Northwes~ Contractor Contact: I Scott Willard I Contractor Phone #: I 541-447-7441 Type of Document: Personal Services Agreement Goods and/or Services: Lutheran Community Services Northwest and Deschutes County Health Services intend to work collaboratively on the Central Oregon Crisis Services Program Expansion and Improvement Project for the purposes of expanding the scope and jurisdiction of the Mobile Community Assessment Team (MCAT) within Deschutes and Crook County. Background & History: Lutheran Community Services Northwest (LCSNW) is a nonprofit human services agency that provides a wide variety of services to adults, adolescents, children, families, schools, businesses, congregations, neighborhoods and communities. The Central Oregon Crisis Services Program Expansion and Improvement Project seeks to resolve issues such as: duplication of effort and resources; confusion among 'first-responders as to who to contact; inability to efficiently integrate individuals into the community mental health system; lack of consistency in service delivery; lack of clarity in clinical roles and duties; and unacceptable response times. To assist in addressing these issues, LCSNW will operate an MCAT based in Prineville, Oregon to respond to crisis calls and coordinate service delivery in Crook County. LCSNW will closely follow Deschutes County's MCAT model and will replicate structure, staffing, policies, procedures, protocols and guidelines for MCAT operation. Upon execution of this contract and receipt of funds from the Oregon Health Authority, Deschutes County shall pay LCSNW a maximum compensation: (a) for the 2013-2014 fiscal year (July 1 to June 30) $73,672, (b) for the 2014-2015 fiscal year (July 1 to June 30) $144,972. Funds provided shall be used to help support the two QMHP positions, the LCSNW Director position and to cover the cost of expenses including: travel, office supplies, computer and telephone equipment. Agreement Starting Date: I January 1, 2014 I Ending Date: ~::.;...;..;:.....:..;:;...:.....;;;;...;;...;...;:---' Annual Value: I Total maximum compensation is $218,644. I 611012014 [g] I nsurance Certificate Received (check box) Insurance Expiration Date: 1"-----____-----' Check all that apply: D RFP, Solicitation or Bid Process D Informal quotes «$150K) [g] Exempt from RFP, Solicitation or Bid Process (specify see DCC §2.37) Funding Source: (Included in current budget? [g] Yes D No If No, has budget amendment been submitted? DYes D No Is this a Grant Agreement providing revenue to the County? DYes [g] No Special conditions attached to this grant: Deadlines for reporting to the grantor: L-I_----' If a new FTE will be hired with grant funds, confirm that Personnel has been notified that it is a grant-funded position so that this will be noted in the offer letter: DYes D No Contact information for the person responsible for grant compliance: Name: D Phone#:D Departmental Contact and Title: Nancy Mooney, Contract Specialist 1 Phone #: 1 541-322-7516 1 Deputy Director Approval: ~~ Signature to -/O -t1 Date Department Director Approval: ~~ ~/JII )Lj Signature date Distribution of Document: Return both originals to Nancy Mooney, Behavioral Health Department. I I Official Review: County Signature Required (check onel ¥ socc 0 Department Director (~<$25K) o Administrator (if >$25K ut <$150K; if >$150K, BOCC Order No. ) Legal Review Date 0./ "'& k' ~ I Y Document Number 2014-261 ==~==~------- 6110/2014 REVIEWED ~rvY LE COUNSEL DESCHUTES COUNTY SERVICES CONTRACT CONTRACT NO. 2014-261 This Contract ("Contract") is made and entered into by and between Deschutes County, a political subdivision of the State of Oregon , acting by and through its department of Health Services, hereinafter referred to as "DCHS" and Lutheran Community Services Northwest, hereinafter referred to as "Contractor"; collectively referred to as "PARTY" OR "PARTIES". WHEREAS, PARTIES intend to work in collaboration on the Central Oregon Crisis Services Program Expansion and Improvement project ("Project") for the purposes of expanding the scope and jurisdiction of the Mobile Community Assessment Team (MCAT) within Deschutes and Crook County. WHEREAS, PARTIES wish to enter into a contract that outlines each entities roles and responsibilities in cooperation of the Project ; THEREFORE , the PARTIES agree as follows : 1.0 DEFINITIONS. As used in this Contract, words and phrases will have the meanings set forth in Exhibit 1. 2.0 TERM OF CONTRACT. Upon signature of each PARTY, This Contract will become retroactively effective on: January 1,2014 and will terminate on June 30, 2015 unless terminated earlier in accordance with its terms . 3 .0 SERVICES TO BE PROVIDED. Services to be provided and compensation is outlined in Exhibit 1 of this Contract. 4 .0 PAYMENT DCHS will issue payments as outlined in Exhibit 1 of this Contract. Each Party accepts payment from DCHS as specified in Exhibit 1 of this Contract provided herein as full payment for such services. 5.0 SEVERANCE. If any aspect of this Contract is found to be illegal or invalid for any reason, such illegality or invalidity will not affect the validity of the remainder of this Contract. 6.0 STATUS OF PARTIES. The PARTIES intend that in performing the services specified in this Contract, PARTIES will act as an independent contractor(s) and will have the control of the work and the manner in which it is performed . PARTIES are not to be considered an agent or employee of each other and are not entitled to participate in any pension plan, insurance, bonus, or other benefits each PARTY provides their employees. 7 .0 INDEMNIFICATION. The PARTIES have relied upon the professional ability and training of each other as a material inducement to enter into this Contract. Each PARTY warrants that its work will be performed in accordance with generally accepted professional practices and standards as well as the requirements of applicable federal, state and local laws , it being understood that acceptance of Contractor's work by DCHS will not operate as a waiver or release. The PARTIES agree that each PARTY will hold harmless , indemnify, and defend the other PARTY, its officers , agents and employees from any and all liability , actions, claims, losses , damages, or other costs that may be asserted by any person or entity arising from, during , or in connection with the performance of the work described in this Contract, for the actions of the PARTY, or the PARTY's own officers, agents and employees . This indemnification, defense and hold harmless will include attorney's fees and witness costs that arise in preparation for or in the course of an administrative process, trial or appeal, whether or not a hearing, trial, or appeal ever takes place. Such indemnification will include, without limitation, claims brought against either PARTY under state or federal laws. Notwithstanding the above , neither PARTY will have any duty OC - 2 0 1 4 - 2 6 1 Personal Servi ces Contract No . 2014 -261 Page 1-of 22 •• to indemnify, defend or hold harmless the other PARTY for liability, actions, claims, losses, damages, or other costs that are asserted or arise solely from the negligence of the other PARTY. 8.0 INSURANCE. Contractor shall obtain and throughout the term of this Contract maintain the amounts and types of insurance (which may be provided through a system of self-insurance), together with required endorsements as more fully set forth in Exhibit 3, attached hereto. 8.1 Additional Insured: The Commercial General Liability insurance and Automobile Liability insurance required under this Contract will include the Deschutes County and their officers, employees and agents as Additional Insureds but only with respect to activities to be performed under this Contract. Coverage will be primary and non contributory with any other insurance and self-insurance. 8.2 Notice of Cancellation or Change: Contractor will assure that no cancellation, material change, potential exhaustion of aggregate limits or non-renewal of insurance coverage(s) occurs without sixty (60) days prior written notice from Contractor or Contractor's insurer{s) to DCHS. Any failure to comply with this clause constitutes a material breach of this Contract and is grounds for immediate termination of this Contract by DCHS. 8.3 Proof of Insurance: Contractor will provide to DCHS information requested, for all required insurance before delivering any goods and performing any services required under this Contract. Contractor will pay for all deductibles, self-insured retentions, and self-insurance, if any. 8.4 Self-insurance: Contractor may fulfill one or more of its insurance obligations herein through a program of self-insurance, provided that Contractor's self-insurance program complies with all applicable laws, provides coverage equivalent in both type and level to that required in this Section 8, and is reasonably acceptable to DCHS. Contractor will furnish an acceptable insurance certificate to DCHS for any insurance coverage required by this Contract that is fulfilled through self-insurance. 9.0 METHOD AND PLACE OF GIVING NOTICE, SUBMITTING ENCOUNTER DATA AND MAKING PAYMENTS. All notices will be made in writing and may be given by personal delivery or by mail. Notices sent by mail should reference DCHS' Contract Number and be addressed as follows: Deschutes Deschutes County Health Services Phone: (541) 322-7500 County: 2577 NE Courtney Drive FAX: (541) 322-7565 Bend, OR 97701 Jane Smilie, Director Attn: Nancy Mooney, Contracts Phone: (541) 322-7502 Lutheran Lutheran Community Services Northwest Phone: (206) 816-3211 Community 4040 S. 188th Street, Suite 300 FAX: (206) 244-7547 Services SeaTac, WA 98188 Northwest: Attn: Roberta Nestaas, President/CEO When so addressed, notices will be deemed given upon deposit in the United States mail, postage prepaid. In all other instances, notices, bills, and payments will be deemed given at the time of actual delivery. Changes in contact information are to be given by providing notice pursuant to this paragraph. 10.0 ASSIGNMENT. Neither this Contract nor any of the rights, interests, or obligations under this Contract may be assigned by any party without the prior written consent of DCHS. Further, the Contractor will not assign or transfer its interest in this Contract, voluntarily or involuntarily, whether by merger, consolidation, dissolution, operation of law, or in any other manner, without prior written consent of DCHS. Personal Services Contract No. 2014-261 Page 2 of 22 11.0 TERMINATION. 11.1 Termination of this Contract without Cause. Either PARTY may terminate this Contract without cause at any time by providing at least sixty (60) days prior written notice of termination to the other PARTY. DCHS may terminate all or part of this Contract immediately, if funding to DCHS from Federal, State, or other sources is not obtained or is not continued at levels sufficient to allow funding of the provision of services. In this instance, DCHS will give notice if possible. 11.2 Termination with Cause. DCHS may also terminate this Contract effective delivery of written notice to the Contractor, or at such later date as may be established. Such notice of termination will state the circumstances constituting cause for termination and may be under any of the following conditions: a. "Cause" means breach of any material term or condition of this Contract that is not cured within thirty (30) days of receipt of written notice. b. This Contract may be modified to accommodate the change in available funds. c. This Contract may be terminated if state laws, regulations or guidelines are modified, changed or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this Contract or are no longer eligible for the funding proposed for payments authorized by this Contract. d. This Contract may be terminated if any license or certificate required by law or regulation to be held by the Contractor to provide the services required by this Contract is for any reason denied, revoked, suspended, not renewed or changed in such a way that the Contractor no longer meets requirements for such license or certificate. 11.3 Contractor Default or Breach. DCHS, by written notice to the Contractor, may immediately terminate the whole or any part of this Contract under any of the following conditions: a. If the Contractor fails to provide services called for by this Contract within the time specified or any extension thereof. b. If the Contractor fails to perform any of the other requirements of this Contract or so fails to pursue the work so as to endanger performance of this Contract in accordance with its terms, and after receipt of written notice from the County specifying such failure, the Contractor fails to correct such failure within ten (10) calendar days or such other period as the County may authorize. c. Contractor institutes or has instituted against it insolvency, receivership or bankruptcy proceedings, makes an assignment for the benefit of creditors, or ceases doing business on a regular basis. 12.0 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, County may recover all federal funds paid under this Contract, unless a smaller amount is disallowed or demanded. If Oregon Health Authority (OHA) disallows or requests repayment for any funds paid under this Contract due to Contractor's acts or omissions, Contractor shall make payment to County of the amount OHA disallows or requests repayment. In the event that OHA determines that County and Contractor are responsible for the repayment of any funds owed to OHA by Contractor, Contractor agrees to make such payment within ten (10) days of notification by County or OHA of said determination by OHA. Personal Services Contract No. 2014-261 Page 301 22 13.0 NON-DISCRIMINATION. DCHS is committed to providing services that are respectful and sensitive to age, gender and sexual orientation, economic status, racial/ethnic background, cultural identity, and other factors. PARTIES agree that neither they nor the employees, officers, volunteers or agents will discriminate against individuals in violation of any local, state or federal law with respect to care and will provide services to individuals in the same manner, in accordance with the same standards and within the same time availability as those services are provided by PARTY to other individuals. PARTIES will not discriminate in the care or quality of services on the basis of age, race, religion, color, sex, marital status, familial status, national origin, age, behavioral or physical disability, sexual orientation, source of income, political affiliation, or other status protected by law. 14.0 COMPLIANCE WITH APPLICABLE LAWS AND LICENSES. Contractor will comply with all applicable federal, state or local laws, rules and regulations applicable to the work performed under this Contract. Contractor will comply with all applicable standards of professional ethics and will perform services within the scope of their licenses. Contractor will adhere to and comply with all provisions of the False Claims Act established under Sections 3729 through 3733 of Title 31, United States Code, administrative remedies for false claims and statements established under Chapter 38 of Title 31, United States Code, any Oregon laws pertaining to civil or criminal penalties for false claims and statements, and whistleblower protections under such laws, with respect to the role of such laws in preventing and detecting fraud, waste, and abuse in Federal health care programs (as defined in 42 USC § 1320a-7b.) Contractor will have in place internal controls, quality assurance processes, policies or procedures capable of preventing and detecting fraud, waste and abuse activities as they relate to the Oregon Health Plan (OHP) and taking corrective actions. 15.0 CONFIDENTIALITY AND HIPAA PROVISIONS: Each PARTY agrees to hold all individually identifiable patient health information ("Protected Health Information") that may be shared, transferred, transmitted, or otherwise obtained pursuant to this Contract strictly confidential, and provide all reasonable protections to prevent the unauthorized use or disclosure of such information, including, but not limited to the protection afforded by applicable federal, state and local laws and/or regulations regarding the security and the confidentiality of patient health care information. Each PARTY further agrees to make every reasonable effort to comply with any regulations, standards, or rules promulgated pursuant to the authority of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") as amended, including those provision listed below, as soon as possible, but in no event later than the mandatory HIPAA compliance date. Each PARTY may use and disclose Protected Health Information when necessary for PARTY or PARTIES' proper management and administration (if such use or disclosure is necessary), or to carry out PARTY or PARTIES' specific legal responsibilities pursuant to this Contract. 16.0 ACCESS TO RECORDS. Upon thirty (30) days' written notice and at an agreed-upon date and time, Contractor will provide (subject to the provisions of Section 14.0 above) to DCHS or any governmental agency with regulatory authority over Contractor, access to all PHI records and other information relating to services provided to individuals subject to this Contract, in such form and containing such information as required by applicable state law (and in accordance with usual and customary practices in the United States), including medical and behavioral health histories, records and reports from other providers, discharge summaries, and such other information as either DCHS, the State of Oregon, OHA or other governmental agency, may require. Contractor will maintain such records for the greater of seven (7) years or the length of time Contractor is required to maintain PHI records under applicable state law. 17.0 AUDIT. Contractor will maintain records to assure conformance with the terms and conditions of this Contract, and to assure adequate performance and appropriate expenditures within the term of this Contract. Contractor agrees to permit DCHS, the State of Oregon, the federal government, or their duly authorized representatives, upon reasonable notice, to audit all records pertaining to this Contract to assure compliance with the terms of this Contract. Personal Services Contract No. 2014-261 Page40f 22 18.0 Contractor agrees that any dispute or claim that arises out of or relates to this Contract, or to the interpretation or breach of this Contract, shall be resolved by arbitration and judgment upon the award rendered to such arbitration may be entered in any court having jurisdiction over this Contract. Contractor acknowledges that mediation usually helps parties resolve their disputes; therefore, any PARTY may propose mediation whenever appropriate through mediation services the PARTIES agree upon. 19.0 VENUE, JURISDICTION AND APPLICABLE LAW. The venue for any action arising out of or relating to this Contract will be in Deschutes County, Oregon. Any court action arising out of or relating to this Contract will be filed in the Circuit Court of Deschutes County, Oregon. The applicable laws for any action arising out of or relating to this Contract will be the laws of the State of Oregon. 20.0 PARTICIPATION IN QUALITY MANAGEMENT: Contractor will participate in the applicable Quality Management Programs that DCHS may deem necessary to improve the quality of services provided. 21.0 [RESERVED]. 22.0 REQUIRED FEDERAL AND STATE CONDITIONS. Contractor will comply with all required federal terms and conditions as specified in Exhibit 5 of this Contract. 23.0 MERGER CLAUSE. This Contract and the Exhibits (Exhibits 1-6) constitute the entire agreement between the Parties. a. All understandings and agreements between the PARTIES and representations by either PARTY concerning this Contract are contained in this Contract. b. No waiver, consent, modification or change in the terms of this Contract shall bind either PARTY unless in writing signed by both PARTIES. c. Any written waiver, consent, modification or change shall be effective only in the specific instance and for the specific purpose given. IN WITNESS WHEREOF, the Parties hereto have caused this instrument to be executed in three (3) duplicate originals by their officers, thereunto duly authorized. THE PARTIES, BY EXECUTION OF THIS CONTRACT, HEREBY ACKNOWLEDGE THAT THEY HAVE READ THIS CONTRACT, UNDERSTAND IT, AND AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS. Dated this 175 of.i..f<'rl.</' , 2014 Dated this ___ of ________, 2014 / LUTHERAN COMMUNITY SERVICES DESCHUTES COUNTY N~U ..----PresJeflt/CEO TAMMY BANEY, Chair ANTHONY DEBONE, Vice Chair ALAN UNGER, Commissioner Personal Services Contract No. 2014-261 Page 50f 22 EXHIBIT 1 ~ STATEMENT OF WORK AND COMPENSATION Crisis Services Program Expansion and Improvement ("Project") is intended to serve all Deschutes and Crook County residents in need of emergency intervention through the use of existing Mobile Crisis Assessment Team (MCAT) and expanding to a second MCAT team which is operated by Lutheran Community Services Northwest (LCSNW). Program description and objectives are outlined in the 2013-2015 Application for Crisis Services Funding (Application) which is part of this Contract as Exhibit 6 and hereto incorporated by reference herein. In addition to what is specifically outlined in this Contract, Contractor is responsible for all project aspects related to Contractor as outlined in Exhibit 6. 1. Roles and Responsibilities. Each Party to this Contract will be responsible for the provision of supervision and oversight of the Party's Project supervisor, management and support staff. a. Deschutes County Health Services ("DCHS"): DCHS is acting as applicant to the Project and will serve as..tiscal agent once the Oregon Health Authority (aHA) disburses the funds to DCHS. -' i. DCHS will provide Adult Behavioral Health Program Manager ("DCHS Manager") as a single point of contact for Contractor. ii. DCHS will hire a Qualified Mental Health Associate(QMHA) to the existing MCAT within Deschutes County. The QMHA will work with MCAT and Contractor staff and provide same or next day outreach and follow-up to individuals who have received crisis evaluations and/or hospital discharges to facilitate on-going services and supports. QMHA will conduct outreach, provide case management, administrative support services under the supervision of DCHS MCAT Qualified Mental Health Professional (QMHP). iii. DCHS will receive funds from aHA and disburse funds to Contractor according to Paragraph 2 of this Exhibit 1, "Maximum Compensation". iv. LCSNW and DCHS will cooperate on a regional basis, sharing information, training opportunities, strategic planning, and resources to ensure that Deschutes County and Crook County's crisis response needs are met. b. Lutheran Community Services Northwest (LCSNW): LCSNW will operate an MCAT based in Prineville, Oregon (Crook County) to respond to crisis calls and coordinate service delivery in Crook County. LCSNW will have full authority over LCSNW personnel. i. LCSNW will assign one individual to be Community Outreach Program Director to be point of contact (LCSNW Director) and work in coordination with DCHS Manager or designee. LCSNW Director will provide LCSNW staff supervision and oversight. ii. LCSNW MCA T will operate twenty-four (24) hours a day, seven (7) days a week. iii. LCSNW MCAT will closely follow DCHS MCAT model for successful Project coordination. LCSNW MCAT will replicate DCHS MCAT structure, staffing, policies, procedures, protocols and guidelines for MCAT operation. iv. LCSNW MCAT staff will consist of a LCSNW Director, two (2) QMHPs trained in crisis response and administrative support staff. v. LCSNW and DCHS will cooperate on a regional baSis, sharing information, training opportunities, and strategic planning, to ensure that Deschutes County and Crook County's crisis response needs are met. vi. LCSNW MCAT will link individuals in crisis to services provided by: outpatient treatment programs, MosaicMedical, the Family Care Clinic at Pioneer Memorial Hospital and other Personal Services Contract No. 2014-261 Page 6 of 22 community based and regional behavioral health and substance abuse treatment providers, as applicable. Outreach will be conducted to strengthen relationships with current community partners and develop new affiliations with others. vii. LCSNW will provide training in specialized crisis response and treatment services to local law enforcement and public safety officials, MosaicMedical, Pioneer Memorial Hospital staff, community recovery centers, regional crisis agencies and supportive service providers. viii. LCSNW will collect data and report to DCHS QMHA the following: Mobile crisis contacts; hospitalizations of individuals using mobile crisis services; contacts involving law enforcement and any other data as required by OHA The frequency and format of the report shall be determined by DCHS Manager. 2. Maximum Compensation. a. Upon execution of this Contract and receipt of funds from the OHA, Deschutes County shall pay Contractor a maximum compensation: (a) fgr the 2013-2014 fiscal year (July 1 to June 30) $73,672, (b) for the 2014-2015 fiscal year (July 1 to June 30) $144,972. Funds provided shall be used to help support the two QMHP positions, the LCSNW Director position and to cover the cost of expenses including: travel, office supplies, computer and telephone equipment. The table shown below details the use of the funds paid: Budget Compensation for January 1, 2014 through June 30, 2014 2 QMHP Salary and Benefits $59,739 Program Director Salary and Benefits $4,138 Travel $1,500 Office Supplies $150 Computer Equipment $1,200 Telephone Service $300 Internal Service Charges $6,645 Total $73,672 Budget Compensation for July 1, 2014 through June 30, 2015 2 QMHP Salary and Benefits $119,477 Program Director Salary and Benefits $8,275 Travel $3,000 Office Supplies $300 Computer Equipment $0 Telephone Service $600 Internal Service Charges $13,290 Total $144,972 3. Data Reporting to Oregon Health Authority. a. The following reporting is required as applicable: 1. All individuals receiving services with funds provided under this Contract must be enrolled and the individual's record maintained in either: i. the Client Processing Monitoring System (CPMS) as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHAlamh/Pages/reporting-regs.aspx; or ii. the Measures and Outcomes Tracking System (MOTS) as speCified in OHA's MOTS manual located at: http://www.oregon.gov/OHAlamh/Pages/reporting-regs.aspx. b. SubmiSSion of applicable substance abuse prevention data via the Minimum Data Set for Prevention (MDS). All substance abuse prevention services delivered by Contractor must be entered into MDS on a quarterly basis. The MDS system can be found on the internet at: https:llmds.hr.state.or.us. Personal Services Contract No. 2014-261 Page 7 of 22 c. The reporting schedule is as follows: 1. Claims paid data from January 1 through June 30,2014 due August 15, 2014. 2. Claims paid data from July 1, 2014 through June 30, 2015 due August 15, 2015. d. It is Contractor's responsibility utilize funding in accordance with Contract and to submit reporting, (as applicable) to the Oregon Health Authority and/or DCHS pertaining to the use of funds paid to Contractor by County under this Contract. * * * End of Exhibit 1 * * * Personal Services Contract No. 2014-261 Page 8 of 22 EXHIBIT 2 DEFINITIONS For purposes of this Contract, the following terms will have the meanings indicated below: 1. 2013-2015 Application for Crisis Services Funding (Application): That certain application, including all attachments and exhibits, created in cooperation with PARTIES and submitted to the Oregon Health Authority (OHA) by Deschutes County Health Services in response to OHA's Request for Proposal for Crisis Services Funding. 2. Mobile Community Assessment Team (MCAT): Consists of Qualified Mental Health Professionals who are certified civil commitment investigators designated by DCHS and LCSNW to respond to crisis calls in both Crook and Deschutes County. The MCAT works closely with law enforcement, hospital staff, community providers, local and regional crisis lines and family members to provide crisis mental health and initial substance abuse assessments, risk assessments, brief crisis intervention, and referrals for follow-up social services. MCAT provides crisis services 24 hours a day, seven days a week, and is accessed through a single telephone line that is answered at all hours. 3. Crisis Services Program Expansion and Improvement project (Project): Project intended to serve all Deschutes and Crook County residents in need of emergency intervention, without regard to age, ethnicity, cultural, linguistic or economic status. 4. Coordinated Care Organization (CCO): Local networks of all types of health providers working together as one entity to deliver care for people in the Oregon Health Plan. Care is coordinated at every point from where services are delivered to how the bills are paid. PacificSource Community Health Solutions, Inc. has been designed by OHA as the CCO for the region. 5. Culturally Competent: The capacity to provide services in an effective manner that is sensitive to the culture, race, ethnicity, language and other characteristics of an individual. Such services may include, but are not limited to, use of bilingual and bicultural staff, provision of services in culturally appropriate alternative settings, and use of bicultural paraprofessionals as intermediaries with professional staff. 6. Emergent or Emergency Situation: A health condition manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in (1) serious jeopardy to the health of the individual, (2) serious impairment of bodily function, or (3) serious dysfunction of any bodily organ or part. An "Emergency Medical Condition" is determined based on the presenting symptoms (not the final diagnosis) as perceived by a prudent layperson (rather than a Health Care Professional) and includes cases in which the absence of immediate medical attention would not in fact have had the adverse results described in the previous sentence. 7. Oregon Health Plan (OHP): The managed care plan for providing Medicaid services to covered members in Oregon. 8. OHA: The Oregon Health Authority. 9. OHP: The Oregon Health Plan. 10. Reasonable Accommodation: Consistent with the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973, a modification to policies, practices, or procedures when the modification is necessary to avoid discrimination on the basis of Disability unless the service provider can demonstrate after engaging in an interactive process with the Member that making the modification would fundamentally alter the nature of the service, program or activity. Reasonable Accommodations may include, but are not limited to, activities such as the following: (1) reading, or providing a tape of, material otherwise provided in written format to a person with a visual impairment; (2) providing a service in a more accessible location for a person with a mobility and other impairment; (3) providing assistance to a person with a Disability in completing applications and other paperwork necessary to receipt of services; and (4) modifying a waiting area layout to accommodate a person in a wheelchair. 11. State: The State of Oregon. * * * End of Exhibit 2 * * * Personal Services Contract No. 2014-261 Page90f 22 EXHIBIT 3 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 DCHS. 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 Employers liability 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 DCHS. Professional Liability insurance with an occurrence combined single limit of not less than: Per Occurrence limit Annual Aggregate limit o $1,000,000 0 $2,000,000 [3'] $2,000,000 [3'] $4,000,000 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 this Contract is completed. [3'] Required by DCHS D Not required by DCHS (one box must be checked) Commercial General Liability insurance with a combined single limit of not less than: Per Single Claimant and Incident All Claimants Arising from Single Incident 0$1,000,000 0 $2,000,000 [3'] $2,000,000 [3'] $4,000,000 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 Lutheran Community Services Northwest, Deschutes County, their officers, employees or agents. Each such policy obtained by PARTY shall provide that the insurer shall defend any suit against the named insured and the additional insureds, their officers, agents, or employees, even if such suit is frivolous or fraudulent. Such insurance shall provide each PARTY the right, but not the obligation, to engage its own attorney for the purpose of defending any legal action against either PARTY, their officers, agents, or employees, and that each PARTY shall indemnify each other 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, 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. Contractor shall provide additional coverage based on any outstanding claim(s) made against policy limits to ensure that minimum insurance limits required by this Contract are maintained. The additional insurance protection shall extend equal protection to Contractor as to the 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 shall be narrowed to the maximum amount of protection allowed by law. [3'] Required by DCHS 0 Not required by DCHS (One box must be checked) Personal Services Contract No. 2014-261 Page 10 of 22 Automobile Liability insurance with a combined single limit of not less than: Per Occurrence [8J $500,000 o $1,000,000 o $2,000,000 Automobile Liability insurance 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. [8J Required by DCHS D Not required by DCHS (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 DCHS with the signed Contract. Contractor shall notify DCHS in writing at least thirty (30) days in advance of 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 their own deductible(s) or self-insured retention. If requested, completed copies of insurance policies shall be provided to DCHS. , ~, * * * End of Exhibit 3 * * * Personal Services Conlracl No . 2014-261 Page 11 of 22 EXHIBIT 4 CONFIDENTIALITY AGREEMENT 1. INTRODUCTION This Confidentiality Agreement (the "Agreement") is entered into as of January 1, 2014 by and between Lutheran Community Services Northwest ("Contractor") and Deschutes County, a political subdivision of the State of Oregon, acting by and through its Health Services Department ("County"). WHEREAS, in connection with the performance of the Services, PARTIES may receive from each other or otherwise have access to certain information that is required to be kept confidential in accordance with the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, as may be amended from time to time (collectively, "HIPAA"); and WHEREAS, as a part of the American Recovery and Reinvestment Act, the federal Health Information Technology for Economic and Clinical Health Act (the "HITECH Acn was signed into law, imposing certain privacy and security obligations on Covered Entities in addition to the obligations created by the Privacy Standards and Security Standards; and WHEREAS, the HITECH Act revises many of the requirements of the Privacy Standards and Security Standards concerning the confidentiality of Protected Health Information (PHI) and Electronic Protected Health Information (EPHI), including extending certain HIPAA and HITECH Act requirements directly to business associates; and WHEREAS, the HITECH Act requires that certain of its provisions be included in contractor agreements, and that certain requirements of the Privacy Standards be imposed contractually upon Covered Entities as well as contractors; Therefore, in consideration of the foregoing premises and the mutual covenants and conditions set forth below and in the agreement between Contractor and County for Contractor's provision of services, intending to be legally bound, agree as follows. 2. DEFINITIONS 2.1 "Disclosure" means the release, transfer, provision of access to, or divulging in any other manner, of PHI, outside PARTY'S organization, i.e., to anyone other than its employees who have a need to know or have access to the PHI. 2.2 "Electronic Protected Health Information" or "EPHI" means protected health information (as defined below) that is transmitted, stored, or maintained by use of any electronic media. For purposes of this definition, "electronic media" includes, but is not limited to, memory devices in computers (hard drives); removableitransportable digital memory media (such as magnetic tape or disk, removable drive, optical disk, or digital memory card); the internet; the extranet; leased lines; dial-up lines; private networks; or e mail. 2.3 "Protected Health Information" or "PHI" means information transmitted by or maintained in any form or medium, including demographic information collected from an individual, that (a) relates to the past, present, or future phYSical or mental health or condition of an individual; the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual; (b) individually identifies the individual or, with respect to which, there is a reasonable basis for believing that the information can be used to identify the individual; and (c) is received by a PARTY from or on behalf of a PARTY, or is created by a PARTY, or is made accessible to a PARTY by a PARTY. 2.4 "Secretary" means the Secretary of the United States Department of Health and Human Services or any other officer or employee of the Department of Health and Human Services to whom the authority involved has been delegated. 2.5 "Services" means the scope of work and responsibilities as outlined in Exhibit 1 of this Contract. Personal Services Contract No. 2014-261 Page 12 of 22 2.6 "Use" (whether capitalized or not and including the other fonns of the word) means, with respect to PHI, the sharing, employment, application, utilization, transmission, examination, or analysis of such information to. from or within Contractor's organization. 3. AGREEMENT PARTIES shall: 3.1 not use PHI except as necessary to provide the Services. 3.2 not disclose PHI to any third party without each County's prior written consent. 3.3 not use or disclose PHI except as required by law. 3.4 implement appropriate safeguards to prevent unauthorized use or disclosure of PHI. 3.5 comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of EPHI other than as provided for by this Agreement. 3.6 mitigate. as much as possible, any harmful effect of which it is aware of any use or disclosure of PHI in violation of this Agreement. 3.7 promptly report to County any use or disclosure of PHI not permitted by this Agreement of which Contractor becomes aware. 3.8 make its internal practices, books, and records (including the pertinent provisions of this Agreement) relating to the use and disclosure of PHI, available to the Secretary for the purposes of determining County's compliance with HIPAA 3.9 return to County, or destroy, any PHI of County still in Contractor's possession upon conclusion or termination of the Services. 3.10 ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Contractor agree to the same restrictions, conditions, and requirements that apply to the Contractor with respect to security and privacy of such information. 3.11 make PHI available to County as necessary to satisfy County's obligation with respect to individuals' requests for copies of their PHI, as well as make available PHI for amendments (and incorporate any amendments, if required) and accountings. 3.12 make any amendment(s) to PHI in a designated record set as directed or agreed to by the County pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy County's obligations under 45 CFR 164.526. 3.13 to the extent the each PARTY is to carry out one or more of County's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the PARTY in the performance of such obligation(s). 3.14 to the extent the Contractor is to carry out one or more of County's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the County in the perfonnance of such obligation(s). 3.15 If Contractor (a) becomes legally compelled by law, process, or order of any court or governmental agency to disclose PHI, or (b) receives a request from the Secretary to inspect Contractor's books and records relating to the use and disclosure of PHI, Contractor, to the extent it is not legally prohibited from so doing, shall promptly notify County and cooperate with County in connection with any reasonable and appropriate action County deems necessary with respect to such PHI. 3.16 If any part of Contractor's performance of business functions involves creating, receiving, storing, maintaining, or transmitting EPHI: Personal Services Contract No. 2014-261 Page 130f22 A. implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of EPHI that it creates, receives, stores, maintains, or transmits on behalf of County, in accordance with the requirements of 45 CFR Part 160 and Part 164, Subparts A and C; and B. report to County any security incident relating to the EPHI that Contractor maintains for County. 4. HIPAA DATA BREACH NOTIFICATION AND MITIGATION 4.1 Contractor agrees to implement reasonable systems for the discovery and prompt reporting of any "breach" of "unsecured PHI" as those terms are defined by 45 C.F.R. §164.402 (hereinafter a "HIPAA Breach"). The parties acknowledge and agree that 45 C.F.R. §164.404, as described below in this Section, governs the determination of the date of a HIPAA Breach. Contractor will, following the discovery of a HIPAA Breach, notify County immediately and in no event later than seven business days after Contractor discovers such HIPAA Breach, unless Contractor is prevented from doing so by 45 C.F.R. §164.412 concerning law enforcement investigations. 4.2 For purposes of reporting a HIPAA Breach to County, the discovery of a HIPAA Breach shall occur as of the first day on which such HIPAA Breach is known to the Contractor or, by exercising reasonable diligence, would have been known to the Contractor. Contractor will be considered to have had knowledge of a HIPAA Breach if the HIPAA Breach is known, or by exercising reasonable diligence would have been known, to any person (other than the person committing the HIPAA Breach) who is an employee, officer or other agent of the Contractor. No later than seven business days following a HIPAA Breach, Contractor shall provide County with sufficient information to permit County to comply with the HIPAA Breach notification requirements set forth at 45 C.F.R. §164.400, et seq. 4.3 Specifically, if the following information is known to (or can be reasonably obtained by) Contractor, Contractor will provide County with: (i) contact information for individuals who were or who may have been impacted by the HIPAA Breach; (ii) a brief description of the circumstances of the HIPAA Breach, including its date and the date of discovery; (iii) a description of the types of unsecured PHI involved in the HIPAA Breach; (iv) a brief description of what the Contractor has done or is doing to investigate the HIPAA Breach, mitigate harm to the individual impacted by the HIPAA Breach, and protect against future HIPAA Breaches; and (v) a liaison (with contact information) so that Contractor may conduct further investigation concerning the HIPAA Breach. Following a HIPAA Breach, Contractor will have a continuing duty to inform County of new information learned by Contractor regarding the HIPAA Breach, including but not limited to the information described herein. 4.4 Data Breach Notification and Mitigation Under Other Laws. In addition to the requirements above, Contractor agrees to implement reasonable systems for the discovery and prompt reporting of any breach of individually identifiable information (including but not limited to PHI, and referred to hereinafter as "Individually Identifiable Information") that, if misused, disclosed, lost or stolen, Contractor believes would trigger an obligation under one or more State data breach notification laws (each a "State Breach") to notify the individuals who are the subject of the information. 4.5 Breach Indemnification. Contractor shall indemnify, defend and hold County harmless from and against any and all actual losses, liabilities, damages, costs and expenses (collectively, "Information Disclosure Claims") arising directly from (i) the use or disclosure of Individually Identifiable Information (including PHI) in violation of the terms of this Agreement or applicable law, and (ii) any HIPAA Breach of unsecured PHI and/or any State Breach of Individually Identifiable Information. Contractor will assume the defense of any Information Disclosure Claim; County may participate, at its expense, in the defense of such Information Disclosure Claim. Contractor shall not take any final action with respect to any Information Disclosure Claim without the prior written consent of County. OTHER PROVISIONS 5.1 A breach under this Agreement shall be deemed to be a material default in Contractor's agreement with Deschutes County to provide Services. Personal Services Contract No. 2014-261 Page 11 of 22 5.2 Contractor authorizes termination of this Agreement by County if County determines Contractor has violated a material term of this Agreement. 5.3 Upon conclusion or termination of the Services, Contractor shall promptly return or destroy all PHI that Contractor maintains in any form and retain no copies of such information. If the return or destruction of such PHI is not feasible, the obligations under this Agreement shall continue in effect for so long as Contractor retains such information, and any further use or disclosure of such PHI shall be limited to those purposes that make the return or destruction of the PHI infeasible . 5.4 To the extent there are any inconsistencies between this Agreement and the terms of any other agreement, either written or oral , between County and Contractor , the terms of this Agreement shall prevail. Deschutes County ~~h~12~Northwest Signature Name: Roberta Nestaas Type Name Title : PresidenUCEO * * * End of Exhibit 4 * * * Jane Smilie Type Name Title : Director Personal Services Contract No. 2014 -261 Page 14 of 22 EXHIBIT 5 REQUIRED FEDERAL TERMS AND CONDITIONS Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules, regulations, executive orders and policies. Lutheran Community Services Northwest and Deschutes County Health Services, collectively referred to as "PARTY" or "PARTIES" 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 Contract 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 shalt 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. Clean 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 Contractors 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 the extension, continuation, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. Personal Services Contract No. 2014-261 Page 16 of 22 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 fails to file the required certification shall be subject to a civil penalty of not less than $10.000 and not more than $100.000 for each such failure. e. No part of any federal funds paid to 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 State or local legislature itself, or designed to support or defeat any proposed or pending regulation, administrative action. or order issued by the executive branch of any State or local government, except in presentation to the executive branch of any State or local government itself. f. No part of any federal funds paid to Contractor under this Contract 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 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 Personal Services Contract No. 2014-261 Page 17 of 22 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 cons.YJt 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 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 Personal Services Contract No. 2014-261 Page 18 of 22 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. 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, Personal Services Contract No. 2014-261 Page 190f 22 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. (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; Personal Services Contract No. 2014-261 Page 20 of 22 (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: (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. Personal Services Contract No. 2014-261 Page 21 of 22 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. 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. * * * End of Exhibit 5 * * * Personal Services Contract No. 2014-261 Page 22of22 LUTH-09 OP 10' KPHI ACORD-I DATE (MMIDDIYYYY) ~ CERTIFICATE OF LIABILITY INSURANCE 06116/2014 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 policy(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 Brown & Brown of Washington P. O. Box 1718 Tacoma, WA 98401 Kim Wilson CONTACTNAME: ~ -INSURER(S) AFFORDING COVERAGE ER A : Philadelphia Indemnity Ins. Co I FAXiAIC, No): - ' NAICII .... 18058 INSURED Lutheran Community Services NW Kay Reed 4040 S 188th St #300 SeaTac, WA 98188 INSURERB: INSURERC: INSURERD: ... ... INSURERE: I 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 POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'lNsR. TYPE OF INSURANCE IIN~llMIn POLICY NUMBER Il:gi:\%~1 il~gi:\%~ll LIMITSLTR : , GENERAL LIABILITY I I EACH OCCURRENCE 1$ 1,000,000 A [Xl COjMERCIAL GENERAL LIABILITY X PHPK1041695 07/01/2013 07/01/2014 • ~~~~~~~e':=~ncel 1$ 100.00~ CLAIMS-MAnE 00 OCCUR I MED EX., (Anyone pers",,) $ 5,00~ · ' 1$ 1,OOO,OOtPERSONAL & AnV INJURY ......... .... ~---~ I GENERAL AGGREGATE : $ 3,0~ -"i~r""~'" I I PRODUCTS CO";P/oP AGG I $ 3,000,000 · . POLICY ~~ , LOC IEmp Ben •..... $ 1,000,000 AUTOMOBILE LIABILITY I I I 07/01/2013 I S~MBlNED SINGLE LIMIT 1$ 1,OO~~aaccident) A ~ANY AUTO PHPK1041695 07/01/2014 I BODILY INJURY (Per person) I $ ~ow," ~'''"''""'' I I ' BODILY INJURY (Per accident): $ ~. AUTOS AUTOS ~PROPERTY DAWGE .NON.()WNED IS:~_ HIRED AUTOS , AUTOS I I (PER ACCIDENT • i I IS A~UMBRELLA LIAB • X • OCCUR ,I I I : EACH OCCURRENCE h 5.000,OO~ EXCESS LIAB II CLAIMS-MADE PHUB426336 • 07/01/2013 07/01/20141 AGGREGATE $ 5,OOO,OO( I DED I X I RETENTIONS ... 1$ ..... 10,000: WORKERS COMPENSATION :. I I .T~~~m.Ws· 10TH-I AND EMPLOYERS' LIABILITY YIN I I : ER A ANY PROPRIETORIPARTNERlEXECUTIVE PHPK1041695· WA STOP GAP I 07/01/2013 07/01/2014 • E.L EACH ACCIDENT :$ 1.000.00~ OFFICE RIM EMBER EXCLUDED? D : N I A I I E.L. DISEASE· EA EMPLOYEEj $ 1,OOO,OO~: (Mandatory In NHI ' . EMPLOYERS LIABILITY ·~rssc~~~~'g'~'f)PERATIONS below I I • E.L DISEASE· POLICY LIMIT I $ 1,OOO.OO~ A I~rime 1Employee ! PHPK1041695 I 07/01/2013' 07/01/2014 ILimit 500,OO~ Dishonesty IDeduct. 5,OO~ : DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mOle space Is lequlred) Deschutes County, Contract No. 2014-261 See attached holder notes ••• CERTIFICATE HOLDER CANCELLATION DESC-01 Deschutes County ATTN: Nancy Mooney SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2577 NE Courtney Drive Bend, OR 97701 I AUTHORIZED REPRESENTATIVE Kim Wilson © 1988-2010 ACORD CORPORATION. All rtghts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD HOLDER CODE OESC-01 LUTH-09 PAGE 2NOTEPAD: INSURED'S NAME Lutheran Community Services NW OP 10: KPHI Dale 06/16/2014 State of Oregon, the Oregon Health Authority, and Deschutes count!, their officers, agents, employees and volunteers are included as an add tional insured. General Liability policy includes the Separation of Insureds and Prirna~ & Non-Contributory wording. Certificate replaces prev10usly issued certificate dated 10/31/2013 Lutheran Community Services NW Policy No.: PHPKI041695 Policy Period: 7/1/13 -7/1114 PI-GLD-HS (10111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABIUTY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indIcated loss exposure is provided under this policy. If such specific coverage applies, the terms. conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Umits of Insuram:e and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Limit of Insurance Page #Coverage Applfcable Included 2Extended Property Damage $50,000 limit 2limited Rental lease Agreement Contractual liability Less than 58 feet 2Non·Owned Watercraft $30,000 limitDamage to Property You Own, Rent. or Occupy 2 $1,000,000Damage to Premises Rented to You 3 ClarificationH1PAA 4 $20,000Medical Payments 5 Medical Payments -Extended Reporting Period 3 years 5 Athletic Activities Amended 5 $5,000Supplementary Paymenls -Ball Bonds 5 Supplementary Payment -loss of Earnings $1,000 per day 5 Employee .Indemnlfrcation Defense Coverage $25.000 5 Key and lock Replacement -Janitorial Services Client Coverage $10,000 limit 6 Additional Insured -Newly Acquired TIme Period Amended 6 Additional Insured -Medical Directors and AdminIstrators Included 7 Additional rnsured -Managers and Supervisors (with Fellow Included 7 Employee Coverage) Additional Insured -Broadened Named Insured Included 7 Additional Insured -Funding Source Included 7 Additional Insured -Home Care Providers Included 7 ! Additional Insured -Managers, Landlords. or Lessors of Premises Included 7 Additional Insured -Lessor of Leased Equipment Included 7 Additional Insured -Grantor of Pennits Included 8 Additional Insured -Vendor Included 8 Additional Insured -Franchisor Included 9 Additional Insured -When Required by Contract Included 9 Additional Insured -Owners, lessees, or Contractors Included 9 Additional Insured -State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity lnsurance Company -----------------------------~-.------.-..... PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional FaHure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury inc/udes Mental Anguish Included 11 Personal and Advertising Injury -includes Abuse of Process. Discrimination Included 11 , I J I i A. Extended Property Damage SECTION 1-COVERAGES, COVERAGE A BOOllY INJURY AND PROPERTY DAMAGE liABILITY. Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily inju~ or property damage· expected or intended from the standpoint of the insured. This exclusi6h does not apply to "bodily injury" or 'property damage" resulting from the use of reasonable force to protect persons or property. B. limited Rental Lease Agreement Contractual liability SECTION 1-COVERAGES, COVERAGE A. BODilY INJURY AND PROPERTY DAMAGE LIABILITY. Subsection 2. Exclusions. Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim, we agree to indemnify the named insured for their Hability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. This coverage Is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION 1-COVERAGES. COVERAGE A BOOllY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or Is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office. Inc .• with its permission. © 2011 Philadelphia Indemnity Insurance Company PI-GL~HS (10/11) LIABILITY, Subsection 2. Exclusions. Paragraph J. Damage to Property, Item {1) is deleted in its entirety and replaced with the folloV'JIng: (1) Property you own, rent. or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement. restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word "fire" Is changed to "fire, lightning, explosion. smoke, or leakage from automatic fire protective systems· where it appears in: a. The last paragraph of SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE I..IABILlTY, Subsection 2. exclusions; is deleted in its entirety and replaced by the following: Exdusions c. through n. do not apply to damage by fire, lightning, explosion. smoke. or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION 111-LIMITS OF INSURANCE. b. SECTION 111-LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we wiD pay under Coverage A for damages because of "property damage~ to any one premises, while rented to you, or in the case of damage by fire, lightning. explosion, smoke, or reakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V -DEFINITIONS. Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However. that portion of the contract fora lease of premIses that indemnifies any person or organization for damage by fire. lightning. explosion, smoke. or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS. Subsection 4. Other Insurance. Paragraph b. Excess Insurance. (1) (a) (Ii) is deleted in its entirety and replaced by the following: That is insurance for fire, lightning. explosion, smoke. or leakage from automatic fire protective systems for premises rented to you or temporalily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office. Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company PI·GLD·HS (10/11) a. $1,000.000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion. smoke. or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION 1-COVERAGES. COVERAGE e PERSONAL AND ADVERr'SING INJURY LIABILITY. is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a ·violalion(sr of the Health Insurance Portability and Accountabmty Act (HIPAA). We have the right and the duty to defend the insured against any ·suit,· "investigation,' or "civil proceeding" seeking these damages. However, we will have no duty to defend the insured againSt any 'suit' seeking damages, "investigation,' or ·civil proceeding" to which this insurance does not apply. 2. Paragraph 2. exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional, Willful. or Deliberate Violations Any willful, intentional, or deliberate ·violation(s)" by any insured. b. Criminal Acts Any 'violation~ which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits My compliance reviews by the Department of Health and Human Services. 3. SECTION V -DEFINITIONS is amended to include the following additional definitions: a. ·Civil proceeding" means an action by the Department of Health and Human Services (HHS) arising out of "violations." b. "Investigation" means an examination of an actual or alleged "violation(s)" by HHS. However, "Investigation" does not include a Compliance Review. c. "Violationn means the actual or alleged failure to comply with the regulations included in the HIPAA. Page40f12 Includes copyrighted material of Insurance Services Office, Inc .• with its permisSion. @ 2011 Philadelphia Indemnity Insurance Company PI~GLD-HS (10/11) G, Medical Payments -Limit Increased to $20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense l.imit is changed subject to all of the tenns of SECTION 111-LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION 1-COVERAGE. COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement. a. (3) (b) is deleted in Its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident H. Athletic Activities SECTION 1-COVERAGES. COVERAGE C MEDICAL PAYMENTS. Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION 1-COVERAGES, SUPPLEMENTARY PAYMENTS· COVERAGE A AND Bare amended as follows: 1. b. is deleted in its entirety and replaced by the following: 1. b. Up to $5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Uability Coverage applies. We do not have to fum ish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION 1-COVERAGES, SUPPLEMENTARY PAYMENTS -COVERAGES A AND B the following is added: We will pay. on your behalf, defense costs incurred by an "employee" in a criminal proceeding occurring in the course of employment. The most we will pay for any "employee" who is alleged to be directly involved in a criminal proceeding Is $25,000 regardless of the numbers of#employees," claims or·suits· brought or persons or organizations making claims or bringing ·suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office. Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company PI-GlD-HS (10/11) K. Key and Lock Replacement -Janitorial Services Client Coverage SECTION 1-COVERAGES, SUPPLEMENTARY PAYMENTS -COVERAGES A AND 8 is amended to include the following: We will pay for the cost to replace keys and locks at the ·clients· premises due to theft or other loss to keys entrusted to you by your 'client: up to a $10.000 limit per occurrence and $10.000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members. offICers, "employees", "managers", directors. trustees, authorized representatives or anyone to whom you entrust the keys of a Aclient" for any purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: .a. "Clientft means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary. wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined in Paragraph (1) above. who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm. factor. commission merchant. consignee. independent contractor or representat1ve of the same general character; or (b) Any -manager," director or trustee except while performing acts coming within the scope of the usual ckIties of an "employee." c. "Manager" means a person serving in a directorial capacity for a limited liability company. Additional Insureds SECTION 11-WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not othelWise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office. Inc .• with its permission. © 2011 Philadelphia Indemnity Insurance Company L Pl-GlD-HS (10/11) Coverage Part. Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators -Your medical directors and administrators. bul only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors -Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your "employees· are also insureds for "bodily injury" to a 00 "employee" while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1){a) as it applies to managers of a limited liability company. c. Broadened Named Insured -Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However. coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured. if they are also insured under another similar policy. but for its termination or the exhaustion of its limits of insurance. d. Funding Source -Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they ~_wn. maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations. new construction and demolition operations performed by or for thai person or organization. e. Home Care Providers -At the first Named Insured's option. any person or organization under your direct supervision and control while providing for you private home respite or . foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises -Any person or organization with respect to their liability ariSing out of the ownership, maintenance or use of that part of the premises leased or renled to you subject to the following additional exclusions: This insurance does not apply to; (1) Any 'occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment -Automatic Status When Required in Lease Agreement With You -Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office. Inc.• with its permission. © 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) organization i$ an insured only with respect to liability for "bodily injury: "property damage" or ·personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use ot equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any ·occurrence" which takes place atter the eqUipment lease expires. h. Grantors of Permits -Any state or political subdivision granting you a permit In connection with your premises subject to the following additional prOvision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence. maintenance, repair, construction. erection. or removal ot advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees. hoist away openings, sidewalk vaults, street banners or decorations and sim~ar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance. or use of any elevators covered by this insurance. i. Vendors -Only with respect to "bodily injury" or 'property damage" arising out of "your products' which are distributed or sold in the regular course of Ihe vendor's business. subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply 10: (a} "Bodily injury" or "property damage-for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence ot the contract or agreement: (b) Any express warranty unauthorized by you; (e} Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging. except when unpacked solely for the purpose of inspection. demonstration. testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such Inspections, adjustments. tests or seNicing as the vendor has agreed to make or normally undertakes to make in the usual course of bUSiness, in connection with the distribution or sale of the products; (f) Demonstration, installation. servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance SeNices Office, tnc .• with its permission. @ 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11} (9) Products which. after distribution or sale by you. have been labeled or relabeled or used as a container. part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sale negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs (d) or (1); or (ii) Such inspections. adjustments, tests or servicing as the vendor has agreed to make or normaHy undertakes to make in the usual course of business. in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products. or any ingredient, part or container, entering into. accompanying or containing, j. Franchisor -Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract -Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for "bodily injury,· "property damage" or 'personal and advertising injury" but only for liability arising out of the negligence of the named Insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations I, Owners. Lessees or Contractors -Any person or organization, but only with respect to liability for "bodily injury," ·property damage" or "personal and advertising injury" caused, in whole or in part. by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: {a) All work, including materials, parts or equipment furnished in connection with such work. on the project (other than s6l".1ice. maintenance or repairs) to be performed by or on behalf of the additional insured(s} at the location of the covered operations has been completed; or {b) That portion of "your work-out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Sel".lices Office, Inc.• with its permission. (£) 2011 Philadelphia Indemnity Insurance Company ----------------------------->----->- PI-GlD-HS (10/11 ) m. State or Political Subdivisions -Any state or political subdivision as required, subject to the following provisions: (1) This Insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. > (2) This insurance does not apply to: (a) "Bodily injury: "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality: or (b) "Bodily injury" or Hproperty damage" included within the 'products-completed operations hazard." M. Duties In the Event of Occurrence, Claim or Suit SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS. Paragraph 2.is amended as follows: a. is amended to include: This condition applies only When the 'occurrence" or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations Is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards. if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company -------_......._........... . PI·GLD-HS (10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the Insured has rights to recover all or part of any payment we have made under this Coverage Part. those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the Insured will bring "suit" or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided lhe waiver is made in a written contract. P. Liberalization SECTION IV -COMMERCiAl GENERAL lIABILITY CONDITIONS. is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury -Mental Anguish SECTION V - DEFINITIONS, Paragraph 3. Is deleted In its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and Includes mental anguish resulting from any of these; and b.Except for mental angUish, includes death resulting from the foregoing (Item a. above) at any time. R. Persona. and Advertising Injury -Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of wpersonal and advertising injury" is amended as follows: 1. SECTION V -DEFINmONS. Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V -DEFINITIONS, Paragraph 14. Is amended by adding the following: Discrimination based on race. color, religion. sex. age or national origin, except when: a. Done intentionally by or at the direction of. or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer. director. stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, terminatlon of employment. or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office. Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance tor such discrimination is prohibited by or held In violation of law. public policy. legislation. court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office. Inc .• with its permission. © 2011 Philadelphia Indemnity Insurance Company EXHIBIT 6 Oregon Health Authority Division of Addictions and Mental Health 2013-15 Request for AppHeation for Crisis Services Funding AppUcant 1Df0r....tion and Response to Quesdons ApplicdoaIDformation Sheet Name ofAgency or Organization: Deschutes County Health Services DepartmeDt Address: ,2S7.7NE.CouttneyDriy.e City, State, Zip: Bend. OR . 97701 Contact Person: DcAnn Catr, Behavioral Health Deputy Director Phone #: AlJ;322..'Z633.. Fax #: 541.,.322·7565. E-mail Address: Deann.Carr@deschutes.org Tax JD #: 93-6002292 B. Deserlbe the AppUcant's LepJ. Entity status, whel'e domlclled, me, array of Iei'vices, and Dumber of yean providing the servieel. Deschutes County Health Services (DCHS) is an entity operating under the authority ofthe Deschutes County governmental agency, a politi~l subdivision ofthe State ofOregon led by a three-member Board of Commissioners. PCHS's administrative offices are located. in the county seat of Bend, Oregon. bCHS, the Local Public Health Agency (LPHA) was established in 1936, twenty years after Deschutes County was incorporated. The Department currently maintains a total of218.60 FiE and operates with an annual budget ot$32;759,984. In 2009, DeHS incorporated both public health and behavioral health services into a single department to better integrate the range ofcare available to residents. The proposed Central Oregon Crisis Services Program Expansion and Improvement project will take place under the oversight of the Behavioral Health Services Division (DCBH). Created in 1962 to serve residents of Deschutes County, DCBH is the Community Mental Health Program (CMHP) and has held state licenses for mental health and alcohol and drug treatment ·services for over 30 years. DCBH employs 145.35 FI'E, and, in:fiscal year 2013-14, will operate with a total budget of$22, 758,349. Approxitnately 37% oftbis amount represents state government payments. Federal grants and contracts, fees for service, and County general funds make up much ofthe balance. DCBH helps County residents facing serious mental health and addiction issues, with special emphasis on those suffering from a disparity in services, and people in crisis, who are often in unstable situations and a danger to themselves or others. It accomplishes this through an array of services offered through three primary program areas as follows: •• Adult Treatment: Adult complex care, adult brief intervention, community support services, assertive community treatment (ACT), and seniors trea1ment and consultation. . Page lof20 • Child and Family; Outpatient services, school-based services, intensive wrap-around services, early assessment and support alliance (EASA), parent-child interaction therapy, parent mediation. • ,Crisis Services: Community assessment and mobile community assessment. DCBH also coordinates services for County residents in care at the State Hospital or 8elVed through other agencies, facilities, or treatment homes. These services alleviate community problems, assist people in need, promote individual health and recovery, and prevent more costly care and interventions. DCBH is expected to assist more than 4,500 individuals in FY 2013-14. b. Describe Applicant's AflIItates as relevant to the Contract. .. Although DCHS is acting as applicant to the 2013-1S Crisis Services Funding program and will serve as fiscal agentt the proposed project represents a collaborative effort between multiple agencies, including DCBH; Lutheran Community Services Northwest, Crook County's contractual CMHP; and BestCare Treatment Services, operator ofout-patient and reSidential addictions treatment programs and the local detoxification facility. These agencies worked together with PacificSource Community Solutio~ the local Coordinated Care Organization (CCO), and the Wellness and Education Board of Central Oregon (WEBCO), formerly the Central Oregon Health Board, to plan the project and develop this proposal. At such time as funds are awarded, these affiliate organizations will enter into service contracts that define the roles, relationships, and responsibilities of each party as relevant to the proposed project. i:. What is the organization's current service area? DCBH primarily serves residents living within all ofDeschutes County, an area of3,OS5 square miles and located aJmost directly in the center ofthe state. Services are offered from several locations, including the main office in the city ofBend and satellite offices in the cities of Redmond and La Pine. In addition. an MeAT responds to individuals who are experiencing a mental health crisis in the community and in hospital emergency rooms. The MCAT currently responds to locations throughout both Deschutes and Crook Counties, although the proposed project supports Crook County in developing and operating a separate team that can respond more quickly to residents in that geographic area. d. What is the address for the Appllcant'. primary office? DCBH's primary administrative and clinical offices are located in the Deschutes County Health Services Building at 2577 NE Courtney Drive, Bend, Oregon. The building is centrally located for the majority ofDeschutes County's residents and is accessible by public transportation. It is also conveniently situated near st. Charles Medical Center and other local medical and behavioral health service providers. e. Current experience as an OHA contractor: Does Applieant currently have a contract with the OHA to provide these services? If so, please provide that information in addition to the other infonnatioD required in this section. Page2of20 I DCBH has a long history ofworking cooperatively with the Oregon Health Authority to bring treatment services to Deschutes County and to improve the quality of care for its residents. From July 1, 2011 through June 30,2013, the relationship was ratified through Agreement #134309 and subsequent amendments. In July 2013, this document was replaced with Agreement #141408 which establishes funding levels and provides guidelines for DCHS to provide or coordinate provision of behavioral health and addictions prevention and treatment services during the 2013-15 biennium. A separate agreement, #142290, provides for tort liability coverage for the County, its officers, and employees in the delivery of services to individuals under the jurisdiction ofthe Psychiatric Security Review Board (pSRB). As a result of these and other contractual arrangements with the federal government, State of Oregon, Oregon Health Authority, and Addictions and Mental Health Division, DCBH has extensive experience in meeting administrative and regulatory mandates for mental health and I:addictions treatment services as well as rules set forth by the Oregon Health PJan and Medicaid IProgram. The Division's stafTis skilled and knowledgeable in administering state and federal funds and contracts and in complying with the associated reporting, fiscal management, and administrative rules and regulations. f. Provide an organization chart. A chart illustrating DCBS's organizational structure is attached to this proposal.: g. It will be important for Applicuts to develop meaningful relationships with socia) and support services in the services area. Describe how the Applicant has estabUshed and will maintain relationships with social and support services in the service area where appUcable. Deschutes County places a high value on collaboration and community involvement. As a result, DCHS coordinates closely with a variety of community organizations to Jink individuals with other key services in the community as needed. DCBH maintains this network through regular communication, shared health care reform planning efforts, collaborative projects, reciprocal referral systems, and contracted services. As further detailed in the response to question #1 of the narrative section, examples ofjust a few ofthe many social and support services which are offered through strong relationships already in place include primary health care; housing; employment; community .outreach, emergency rent, utility, and food assistance; cuJtura11y specific and linguistic assistance; and veterans' outreach and referrals. h. Provide project demographic information regarding ethnic, cultural, or Unguistic populations and the population(s) of focus for the proposed project. The proposed Crisis Services Program Expansion and Improvement project is intended to serve all Deschutes and Crook County residents in need of emergency intervention, without regard to age, ethnicity, cuJtural, linguistic, or economic status. In its most recent certified estimate, the Portland State University Population Research Center indicates that Deschutes County's CUITent resident population is 160,140. Although Page30f20 approximately 67% ofthe population lives within the cities ofBend, La Pine, Redmond, and Sisters, the rest are widely dispersed throughout small communities and rural environments. The 2010 U.S. Census states that nearly 95% ofDeschutes County's population is Caucasian. Although the HispanicILatino population makes up only 7.7%, this group is currently growing at a much faster pace than any other. Other ethnic groups .tallied by the U.S. Census are represented in smaller numbers in Deschutes County with Black, American Indian and Alaska Native, Native Hawaiian and Pacific Islander, and Asian persons representing fewer than 3%.* The portion ofDeschutes County residents who speak a language other than English in the home is 6.6%. Ofthese, most are Spanish-speaking. Over 15% ofthe total population is over the age of65 and 22.8% is under age 17. Overall, an estimated 8 of 100 Deschutes County residents live at or below the poverty level. . Crook County's cwrent resident population is estimated to be 20,650. Crook County is unique in Oregon in that only one incorporated population center, the city ofPrineville, is included within its boundaries. Approximately 44% ofthe County's population lives within Prineville, with the remaining 56% mostly living in farming and ranching communities or in more remote locations. The 2010 Census recorded over 95% ofCrook County's residents as Caucasian. The HispanicJLatino population comprises the next largest demographic group with a total of7.3% represented in the total.* Nearly 22% ofthe total population is over the age of65 and 21.2% is 17 years or younger. Approximately 16 of 100 persons live at or below the poverty level. • Totals exceed 100% as statistics include persons reporting two or more races. i. AppHeants mast describe their demonstrated experience and capacity for outreach to, and engagiag of, community members and health care providers In improvIDg the health of the eommunity and addressing regional, ealtura1, socioeconomic and racial disparities in health care that exist among the Applicant'. clients and In the AppUcant's community. DCHS is as concerned about the weUness ofthe community as it is with individuals. The Department has adopted Oregon's Triple Aim goals ofbetter health, better care, and less cost as the foundation ofits mission and operating plans. Additionally, it directs substantial energy to identifying and addressing populations suffering from a health disparity due to social, economic, geographic, or human conditions, and in working with a wide variety ofpartners to continually assess and improve healthcare systems through coalitions, collaborative projects, and coordinated plann.it1g. To further its progress in these matters, DCHS has been at the leading edge ofloca1 health transfonnation efforts occuning throughout Oregon. In 2011, the County was deeply involved in passing Senate Bill 204, which authorized the Central Oregon Health Council (COHC) as the region's public/private partnership for health care innovation. As a result, Crook:, Deschutes, and Jefferson Counties were among the first in the state with a certified regional COO. Under the governance ofCOHC, PacificSource Community Solutions, Inc., began acting in this capacity as . ofAugust 2012. PacificSource is now actively pursuing system-wide changes in the health care delivery sYstem to empower citizens to reach their fullest health potential. By employing a community process that involves a wide range ofhealth care stakeholders, PacificSouree is Page 4 of20 ! I· I . I I I leading the way in public policy, industry and patient culture, provider and health plan accountability, and efforts to ensure consistency, fairness, and better outcomes. Formed by a tn-county intergovemmental agreement and working alongside PacificSource, WESCO is also actively working to ensure that appropriate and needed services, including behavioral health and public health, are available to all residents ofCentral Oregon. In addition to other responsibilities, WEBCO serves as a convener of community organizations and health care providers to plan and implement programs to achieve this goal. DCHS, its neighboring county health care organizations, PacificSource, WEBCO, and a long list ofcommunity partners are CU1TeIltly collaborating in several initiatives designed to improve the health ofthe community and eliminate health disparities, such as: • Conducting a community health assessment to map the regional system ofcare and identify geographic, cultural, socioeconomic, and racial inequalities and gaps in services. • Adopting an annual community health improvement plan to address gaps and inequalites. • Taking steps to assure that communications, ou~member engagement, and services are tailored to cultural, health literacy, and linguistic needs. • Supporting processes to ensure that the culturally-diverse needs ofmember agencies are Iileet. J. Describe Applicant's practices and outcomes In hiring staff from a culturally-speelfle, ethilically.specific or Unguistically-speclfic baekgroud or experience and 1mb with the community. As previously described, Deschutes County's population is primarily Caucasian, but with a rapidly-growing HispanicILatino component and a measurable number ofpeople who speak Spanish only. As a result, DCHS consistently takes steps to recruit and hire staffwith background and experience that facilitates outreach to the Latino community and connects members of this demographic group with treatment and recovery services. In general, Deschutes County advertises all open positions on its website; in the local newspaper, the Oregonian, and Craig's List website; and in a variety of public venues, including some targeted toward Hispani<1Latino populations. In addition, DCHS indicates a preference for bi lingual candidates on its application fonns. As a result ofthese efforts, approximately 5.6% of the workforce includes persons ofHispanicILatino descent and 8.2% ofDCHS's staffmembers are bi-lingual. It. Describe Applicant's practices to effectively engage cultural, ethnic, or linpistic populations in health or behavioral health services. DCHS is committed to providing services that are respectful and sensitive to age, gender and sexual orientation, economic status. racia1lethnic background, cultural identity, and other factors. Consequently, the Department has taken several steps to ensure that all of Deschutes County residents have equal access to services and that these services are designed in a way that prevents cultural or linguistic barriers. As the predominant need is with the Hispanic/Latino population, PageSoflO r f, I..i' I I DCHS has taken both simple and comprehensive measures to engage these individuals and to provide services that are both readily accessible and culturally appropriate: • Signage and Forms: All signage, brochures, intake information, and other printed materials used in DCHS are available in both English and Spanish. i . • Linguistic Assistance: DCHS maintains a pool of qualified on-call interpreters and translators. Interpreters!trlators can be present at consultations, treatment sessions, and other appointments as needed and ensure that all communications are accurately conveyed and understood by both staff and individuals receiving services. A phone interpreter service is used when an on-site interpreter is not available. • Training: Deschutes County offers a full course of beginning and advanced Spanish language classes to employees as part of its annual training catalogue. DCHS also maintains a Diversity Group that works to better educate staff regarding cultural issues. The group has worked in conjunction with the DCHS Training Committee to provide opportunities for staff to learn. about various cultural issues in the community. • Assessment and Treatment: Within DeBH, conducting an evaluation of cultural factors that may impact an individual's treatment plan is considered to be standard clinical practice. Established intake and assessment forms and procedures act as a guide to clinicians and therapists in identifying these issues and ensuring that treatment proceeds accordingly_ ·Promm Description With this application, DCBH is proposing to improve and expand its existing mobile crisis capabilities and to increase access to supporting substance abuse and addictions treatment services within Central Oregon. Deschutes County has operated a Mobile Crisis Assessment Team (MCAT) since 2007. Currently, the MCAT consists ofa three-person team of Qualified Mental Health Professionals (QMHP) who respond 24n throughout Deschutes and Crook counties. The MCAT provides services anywhere in the community that is deemed most effective and efficient for safely resolving a crisis. It works closely with law enforcement, hospital staff, community service providers, local and regional crisis lin~ and family members to perfonn crisis mental health and initial substance abuse assessments, risk assessments, brief crisis intervention, and referrals for follow up services. The proposed Central Oregon Crisis Services Program Expansion and Improvement project consists of three components designed to address issues that are currently impacting the MCAT's ability to most effectively respond to individuals in crisis: 1. Coverage Area: The existing MeAT serves both Deschutes and Crook Counties. The combined population of this region is approximately 180,000 and these residents arc scattered throughout 6,000 square miles of territory. At a minimum, the response time from the city ofBend in Deschutes County, where the MeAT is based, to the city of Prlneville in Crook County is one hour. Delays can be even longer when travel to more isolated parts of the counties is required and in inclement weather which is frequent dming the winter Page 6 oflO I. II, I months. This proposal seeks to add a second MCAT based in Crook County to ensure more rapid response to outlying areas. 2. Service Linkages: The MCAT's potential is challenged by a lack of adequate service linkage for individuals who are assessed to need ongoing services after the initial contact. This proposal seeks to add a Qualified Mental Health Associate (QMHA) to the existing MCAT within Deschutes County. This individual will work closely with MCAT staff and provide same or next day outreach and follow-up to individuals who have received crisis evaluations and/or hospital discharges to facilitate on·going services and supports. 3. Substance Abuse SURPort: A lack of capacity at the local detoxification center to manage higher need dual-diagnosis referrals presents a third barrier to the crisis service system. The I region uses a central detox facility in the city ofRedmond that is operated by BestCare. This proposal seeks to add a Recovery Coach and medical transport to the detox program to both I I increase access to services and optimize use of the detox facility's limited resources. Authorization to Apply Authorized Signature: I Print Name: Scott Johnson 'Title: Deschutes County Health Services Department Director Date: November 18. 2013 ,Noll-Discrlmina~on By signing below, Applicant certifies that all eligible individuals to be considered for residency and services shall be considered without regard to race, color, sex or sexual orientatio~ religio~ creed, national origin, age (except under 18 years), familial status, marital status, source of income, or disability in addition to the mental or emotional disorder that qualifies that person for the program. (OAR 309..035-0360). Authorized Signature:: Print Name: Scott Johnson Title: Deschutes County Health Seryices1leparlment Director Date: • Noveniq~ 13~ 2013 ~'.. June3Q 2014 $124,290, .' , $319103',' . Page 7 oflO I jNarrative Questions 1. Descripdon of Crisis Services ! Deschutes County h~provided mobile crisis services in Deschutes and Crook Counties since 2007. The Mobile Community Assessment Team (MCAT) is integrated with first responder systems such as law enforcement and medical providers along with after-care community service providers. MCAT services are available to all citizens regardless of age, ethnic/cultural background, gender or sexual orientation, religious affiliation, or financial resources. The MCAT is embedded within the Community Assessment Team ofthe Deschutes County Behavioral Health Division (DCBH) which operates under the authority of the Deschutes County Health Services Department (DCHS). The MCAT consists of three qualified mental health professionals who are certified civil conunitIilent investigators designated by the Deschutes Health Services Department (DCHS) Director to respond in both Crook and Deschutes County. The MCAT provides crisis services 24 hours a day, seven days a week, and is accessed through a single telephone line that is answered at all hours. The phone number is distributed to and used by all ofDCHS's community partners, including operators ofcrisis lines for consruner and family access. MCAT members provide crisis services anywhere in the community that is deemed most effective and efficient for safely resolving a crisis situation. The MCAT works closely with law enforcement, hospital staft: community providers, local and regional crisis lines, and family members to provide crisis mental health and initial substance abuse assessments, risk . assessments, brief crisis intervention, and referrals for follow up services . . As patt of the DCBH's Community Assessment Team, the MCAT collaborates with civil commitment investigators who work with the local hospital to evaluate psychiatric holds placed on individuals. As a result, Team members may provide testimony in civil commitment hearings upon request. In addition, the MCAT participates in DCHS Multi-Disciplinary Treabnent Team meetings, Crisis Intervention Training for Law Enforcement, local National Alliance on Mental Health (NAMI) presentations, and other community-based programs. The primary focus ofall of these groups is to provide effective intervention for those who are most vulnerable to self·injury, present a risk to the community, and/or utilize the highest percentage of acute care resources. The Community Assessment Team is also active in educating other agencies and community members about crisis response and support. The Team was an initial partner and maintains ongoing involvement in the development ofthe Crisis Intervention Taskforce (CIT) and Crisis Intervention Training for Law Enforcement program. The taskforce membership includes representation from the community, parole and probation services, hospital emergency room, acute care hospital, mental health court:, district attorney's office, public defender's office. and each of the 10ca1law enforcement agencies located in Deschutes County. To date, the crr has presented three full 40-hour training sessions modeled after the Memphis CIT training model to Page 8 oflO ! I ! II more than 80 law enforcement and 911 Dispatchers. The Community Assessment Team and I other Deschutes County mental health providers serve as speakers and trainers in these sessions. I Community Linkages Members ofthe MCAT are able to draw on a wide array ofpartnerships to assist individuals in crisis. depending on their level ofneed, risk, and access to naturally occurring resources. Examples ofjust some ofthe partners who collaborate with DCBH and the MCAT to serve individuals in crisis include: • .Law-Enforcement andlusticeServices: Deschutes and Crook Counties' Sheriff's Offices I provide emergency response and detention when indicated, but also work with the MCAT to I Ievaluate and refer individuals to environments better suited to addressing a mental health crisis. Both local District Attorneys and Public Defenders coordinate with civil commitment proceedings and provide referrals to the Deschutes County Mental Health Comt when appropriate. The Parole and Probation Departments work with DCBH to link offenders with Ii . treatment services. • Emergency.Response and Intervention: Sl Charles Medical Center provides emergency room treatment, psychiatric holds and evaluation, civil commitment investigations, and access to acute care through the Sage View Psychiatric Center. • Addictions Treatment: LCSNW, BestCare, Serenity Lane, Trillium Family Services, and Pfeiffer and Associates provide both intensive residential and out-patient addictions and substance abuse treatment services. • Primary Health Care: Many organizations within Deschutes County provide health services I to individuals who are receiving DCBH services. including St. Charles Medical Center, Bend Memorial Clinic, Mosaic Medical Center, the La Pine Community Clinic, Volunteers in I- Medicine, and the Deschutes County Public Health Division ofDCHS. Mosaic Medical has I been offering primary health care one day each week: on~site at the DCBH Annex location for nearly two years. In July 2014, Mosaic plans to expand this service to five days each week:. • Housing: DCBH works closely with the Bethlehem ~the region's largest emergency homeless shelter, to provide temporary housing for individuals with a serious mental illness. HousingWorks, the local Housing Authority, helps find housing and obtain rental assistance for low-income individuals who are in treatment and/or worldng toward recovery. • EmplQ)'lllent: The State of Oregon Office ofVocational Rehabilitation offers a local referral resource in collaboration with DCBH's Supported Employment program to help individuals who need assistance to obtain and maintain employment. • Other Social and Smmort Systems: Neighborhnpact, the local community action agency network, delivers emergency rent, utility and food assistance to those in need. The Latino Community Association offers referrals, translation and intetpretation, and assistance in navigating DCBH services for the local Hispanir/Latino population. Central Oregon Vetera.n's Outreach works in partnership with DCBH to ensure that veterans with mental illness receive a range of supportive services in the community. Challenges Page 9 of10 Deschutes County's CIT applied for and was awarded a federal Sequential Intercept Model grant in which more than 30 representatives from behavioral health organizations (including DCBH), law enforcement, and the criminal justice system met and mapped out the 8 points ofinterface, attay of services offered, and gaps in service delivery. The goal ofthis project was to better understand both the strengths and weaknesses ofthe existing response system. This process provided significant insight into how the MCAT currently operates and what can be done to better assist residents within its service area. Delivering mobile crisis services presents a wide array of challenges, particularly within a service area which spans approximately 6,000 square miles. One of the factors identified as needing improvement is response time to outlying areas. The MCAT must be able to respond with face-to-face evaluations. However, due to the geographical distance between Deschutes and Crook Counties, response times are not ideal. Travel between the two countieS takes approximately 4S minutes and the average length oftime involved with a crisis assessment is 3.S to 4.0 hours. As the MCAT is based in Deschutes County, it does not possess an intimate knowledge of Crook County's resources or the acCess to records that a more locally-based unit would have. A constant concern ofDCBH, local law enforcement officials, the criminal justice system, and family members is to see the individual in crisis stabilize only to reject referred services upon release. Research is very clear that linkage ofindividuals to necessary and appropriate services following a crisis is essential to reducing further episodes and increasing positive outcomes. Additionally, connecting with services increases the individual's ability to live in a safe environment, obtain needed medical care, meet basic needs, stabilize at a higher level of . adaptation, avoid recidivism, and begin progress toward recovery. The ability to link individuals with other recovery services following an initial MCAT assessment or discharge from the local acute care facility is currently limited. Consequently, individuals fall into a circular pattern of not engaging in services, resuming negative living and relationship patterns, and deteriorating .into mental illness and crisis. Individuals encountered by the MCAT are frequently experiencing the effects ofbotb mental illness and addiction. While the MeAT provides crisis mental health and initial substance abuse assessments, access to detoxification services is currently inadequate. Inefficiency in utilization ofdetox facility beds and a lack ofsecure transportation creates a chronic barrier to creating real improvements in recovery outcomes. The proposed Central Oregon Crisis Services Program Expansion and Improvement project is designed to help overcome these obstacles and to ensure that all individuals in crisis receive the response and care needed to both stabilize and restore their lives. 2•. Eligibility Although the proposed Central Oregon Crisis Services Program Expansion and Improvement Project will serve residents living in both Deschutes and Crook County, DCHS is acting as applicant to the OHA Crisis Services Funding grant opportunity and, in the event that funds are awarded, will execute contracts~ administer funds, and oversee the project. Page 10 of 20 DCHS provides both behavioral health and public health services to the local community as illustrated in the attached organizational chart. Major divisions within DCHS include Behavioral Health, Developmental Disabilities, the Early Learning Council, Public Health, and Support Services which is comprised of staff dedicated to financial management, performance . management, and operational management The Department maintains a total of218.60 FTE and is currently operating with a $32,759,984 fiscal year budget. Established in 1962 to serve residents of Central Oregon, DCBH is the designated Community Mental Health Program for Deschutes County. The Division has held state licenses for mental health and alcohol and drug treatment services for over 30 years. DCBH functions within the organizational structure of Deschutes County, a political subdivision of the State of Oregon, and under the direction ofDCHS. DCBH employs 145.35 FI'E and, in tiscal year 2013-14, will operate with a total budget of$22,758,349. Approximately 37% of this amount represents state government payments. Federal grants and contracts, fees for service, and County general funds make up much of the balance. l I:DCBH consists ofthree primary program areas: Adult Treatment, Child and Family, and Crisis Services, which includes the MCAT. DCBH helps County residents facing serious mental health and addiction issues. Priority populations ofDCBH inc1ude Oregon Health Plan members, uninsured County residents, and people in crisis who are often in unstable situations or are a danger to themse1ves or others. DeBR also coordinates services for County residents in care at the State Hospital or served through other agencies, facilities, or treatment homes. These services alleviate community problems, assist people in need, promote individual health and recovery, and prevent more costly care and interventions. DCBR is expected to assist more than 4,500 individuals in FY 2013-14. 3. Development Plan Much of the proposed Central Oregon Crisis Services Program Expansion and Improvement project will build on the framework ofDCBH's existing MCAT. This function is incorporated into a larger Community Assessment Team which operates under a single supervisor within the Adult Treatment Program ofDCBH. Therefore, the supervisory, management, and support structures for the enhancement oftbe Deschutes County crisis services program ~already in . place and the project can be implemented immediately after funds are secured. Additionally, the project will benefit from the foundation of strong partnerships already in place with the local hospital, acute care facility, addictions treatment providers, law enforcement agencies, and the community justice system, allowing for full functionality without delay. LCSNW and BestCare Treatment Services will,be responsible fur some aspects ofthe proposed project as well which will be defined through individual service agreements with Deschutes County. LCSNW currently employs a small staff of QMHPs trained in crisis services who will form the basis fur expanded MCAT services. LCSNW recently added to this foundation with a dedicated crisis staff member who brings significant experience in constructing crisis policies and developing relationships with hospitals, law enforcement agencies, recovery centers, regional crisis response organizations, and other conm'lunity partners. As part of its development Page 11 of20 j. I I I plan, LCSNW will use these resources and consult with DCBH to model a program that closely follows the guidelines and structure ofDeschutes County's MCAT. i BestCare is also well-positioned to begin immediate implementation at such time as grant funds are awarded. BestCare has operated a robust Recovery Mentor program for the past seven years. This existing program will provide the organizational capacity to quickly expand services, while still maintaining a high level ofmodel fidelity through training and supervision. Resources In addition to grant funds, DCHS, LCSNW, and BestCare will dedicate significant in-kind resources in support ofthe proposed project In-kind contributionS are described in further detail within the budget narrative section ofthis proposal, but primarily include supervisory and management staff to provide oversight ofthe project and support staff to assist with project administration. During the planning process for the Central Oregon Crisis Services EXpansion 'and hnprovement project, DCHS, LCSNW, and BestCare Treatment Services committed to supplying such resources. However, these commitments will be formally agreed upon and . documented in individual service contracts between Deschutes County and LCSNW mid . Deschutes County and BestCare. The cost of in-kind support will be borne by each respective agencies' budget. In Crook and Deschutes Counties, behavioral health budgets receive a significant percentage ofrevenue from fees for service and general funds which are unrestricted and can be used for this purpose. As a private... non-profit organization, BestCare Treatment Services revenue is primarily derived from fees for service and government contracts. To ensure an ongoing commitment, the agencies will include this funding, specifically allocated to crisis services, in their annual adopted budgets for as many years as grant funding is available to support the proposed project. Atillptations As the proposed project builds on the infrastructure ofthe existing crisis response system which already serves Deschutes and Crook Counties' rural, urban, regional, racial/ethnic, and culturally diverse populations, few, ifany, additional adaptations will be required. The MCAT currently responds to emergencies throughout.all geographical areas ofthe region, within cities, small communities, and more isolated areas. Cultural competence is built into the program through coordination with the Latino Community Association, bi-lingual forms and documents, tnmslation and interpretation services, specialized staiftraining, and culturally-specific assessment and treatment protocols. These measures will be expected of any new staffing or program elements that are added as a result ofthis proposal. Tlmelines Deschutes and Crook Counties are fully committed and prepared to initiate the proposed project at such time as grant funds are awarded. In planning the elements of the project, the partners have already coordinated with LCSNW, Crook County's mental health service provider, and with BestCare Treatment Services, operator ofthe local detoxification facility. Existing staff Page 12 of20 members assigned to the MCAT are experienced in providing crisis response and will serve DB a resource in planning and implementation. They will be immediately available to begin refining program policies, procedures, and protocols as needed to correspond with the expanded and enhanced services. As much as possible, these tasks, as well as recruiting and hiring new staff; developing and executing contracts and agreements; providing training; and securing supplies and equipment will take place imInediately after a notice of grant award is issued. The table shown below further outlines the activities and timelines associated with the program: ".1,. .....Ae ·Accept and appropriate grant award and'eliiil' futo or amend' Dee 2013" ; existin contract with the Ore n Health Authori . •Fjpalize newstaft'. . .sition~descri:QD.s."" . . .. .:.:-:' ... Refiileprogr8ril policies~'procedures, and protocols, ifneeded, to DeC2013-Feb 2014 accommodate new elements. · Enttririto·agreem.mts With LCSNW and BestCareTreatment Services to. documen~.p~ 'eel roles and.. .. naibilities, Recruit and hire new s~ft Ian-Feb 2014 ; Provide Deschutes CountY Staff to cOliSUlfWitli crook County in Jan-Mar 2014 .develoin n~MCAT. .". .' Identify training requirements and provide training to new staff as Jan 20l4-Ongoing needed, including, but not limited to crisis services, voluntary and involuntary commitment, civil commitment investigation, ;; community based services and resources, treatment engagement, · motivational iptqvicwi t~ , and.IIIP"M_....., ~~l$!.._..._, , Fonnalize links with other community services, such as }lealth caret Jan 2014-Ongoing ·housin.:ob skills and food . . rt. :,.8 ' ',and ~lt1~~"staff. .... ...... . , : Monitor revenue and expenditures and progress toward program .. • R status to fun . source 'odicaU as uired. . Ion ~~e(nt . .. ··.sUstainIbiU 1ftIl.,~."C··~·:".1an~luue,2.0JS·..... .....C' ·e .... 00 to fudiVidUa1s:mcnsis irfDesehuteSQij4 crook Counties. · Monitor individuals' engagement with services and progress toward Ongoing .:~y .. 4. Management Plan The Central Oregon Crisis Services Program Expansion and Improvement project will be administered by Deschutes County. Funds designated for LCSNW and BestCare's elements of the project will be distributed to these agencies via subcontract. By contract, LCSNW and BestCare will have full authority over personnel within their agencies that are associated with the project and supported by grant funds. However, staffhired by Deschutes County and the remainder ofthe management plan will be the responsibility ofDCHS. Planning, implementation, oversight, supervision, monitoring, record-keeping, and reporting of all project activities will be assigned to the Adult Treatment Program, under the directio~ ofthe Behavioral Health Deputy Director, with the expectation that LCSNW and BestCaTe will be responsible for their respective project elements, including implementation, data trackin~ and reporting. Page 13 of10 I Additionally, the proposed project will receive administrative support ftom Deschutes County's general management, records-management, legal, human resources, and information technology staff. Both DCHS and DCBH have a long history ofworking cooperatively with the State of Oregon, Addictions and Mental Health Division ofthe Oregon Health Authority, the Oregon State Hospital, and the federal government to bring health care and behavioral health services to Deschutes County and to improve the quality oflife for its residents. As a result, Department staff members have extensive experience meeting administrative and regulatory mandates for health, behavioral health, and addictions treatment services as well as rules set forth by the Oregon Health Plan and Medicaid Program. DCHS's staffis skilled and knowledgeable in securing federal, state, and local funds and in complying with the associated reporting, fiscal management, and administrative rules and regulations. Fiscal MllIUlgement As with all other programs within DCHS, fiscal management and support will be perfonned by the Support Services unit which includes staff dedicated to financial management, operations management, and perfonnance management Support Services will work closely with the Adult Treatment Program to cany out the following activities: • Accept and appropriate the grant award. • Develop and submit the annual budget. for adoption by the County's Budget Committee. • Create a program within the accounting system to monitor grant funds and other resources. • Establish fiscal controls as needed to create safeguards and maintain project fidelity. • Process payroll associated with project staft: • Process and distribute contractual payments to LCSNW and BestCare. • Monitor project revenue and expenses for accuracy and completeness. • Produce periodic financial reports for use in tracking and reporting. .. Document financial activity and prepare reports as required by funding agency and others. All financial transactions related to the Crisis Services Program Expansion and Improvement project will be recorded within the HTE accounting system used County-wide. This will ensure a second layer ofoversight by the County's Finance Department which is responsible for managing and monitoring all ofDeschutes County's revenue and expenditures. In addition, all invoices and checks that draw on grant funds will be signed by the Behavioral Health Deputy Director or Health Services Director and approved by the County Administrator before payment is made to eliminate any possibility ofmismanagement or abuse. StIlJJing and Supervisiolt To meet the goals and objectives of the proposed project, DCBH will hire a 1.0 full-time equivalent (FI'E) Qualified Mental Health Associate (QMHA) to conduct outreach, provide case management, and offer supportive services and links to community-based services at the direction ofthe MeAT's Qualified Mental Health Professional (QMHP). This position will work closely with existing MeAT members and will report directly to the Community Page 14 of 20 l I Assessment Team Supervisor under the direction ofthe Adult Behavioral Health Program Manager. The Supervisor will guide project activities, monitor implementation, assess staff performance, review work products and timesheets, prepare and conduct staff evaluations, and take corrective action, ifneeded. Deschutes County's Personnel Department will provide assistance with staffing and supervision as well, particularly with recmiting and hiring, administering salary and benefit packages, and managing labor relations. · Contrad MlllUlgatent In the event that grant funds are awarded, OHA and Deschutes County will either enter into a new contract or amend agreement #141408 which establishes funding levels and outlines services to be provided during the 2013·1 S biennium. Additionally, two ofthe three project elements, the second MCAT and enhanced detox capabilities, will be implemented through subcontra~with LCSNW and BestCare. Responsibility for managing these contracts will be the responsibility of DCBH and the Adult Treatment Program. The Behavioral Health Deputy Director and the Adult Behavioral Health Program Manager will develop the contracts in cooperation with the other parties, but will be assisted in processing, executing, recording, and monitoring them by DCHS's Contract Specialist. The Contract Specialist works within the centralized Support Services unit of DCHS and has extensive background and experience in the appropriate fann, signatory authority, approval process, and legal requirements associated with these tasks. Data Collectlon and Reporting Effects of the proposed Central Oregon Crisis Services Expansion and Improvement project win be thoroughly measured, assessed, and reported, not only to comply with grant requirements, but also to determine its success, make continual improvements, and secure ongoing resources and support. MCAT staff in both Crook and Deschutes Counties will be expected to collect and evaluate data related to the number of: • Mobile crisis contacts. • Hospitalizations ofindividuals using mobile crisis services. • Contacts involving law enforcement. All data related to an individual's personal experience with the MCAT and crisis support system will be protected to ensure privacy and compliance with Health Insurance Portability and Accountability Act (HIPPA) mandates. Iffeasible, both Crook and Deschutes Counties will individually enter their respective data into State's Measures and Outcomes Tracking system . (MOTS) as required for analysis and assessment. If only a single agency can be granted access to MOTS, Crook County will provide its data to DCBH for entry into the system. Each quarter, or as requested by OHA, MCAT staff will prepare and submit reports describing the project's progress and status. Page 15 of20 ! . I' 5. Service Planning The overall goals ofthe proposed Central Oregon Crisis Service Expansion and Improvement project are to: • Deliver crisis response and trealm.ent services in the most effective, efficient, and economical way possible. • Decrease admissions to the Psychiatric Emergency Unit at st. Charles Medical Center. • Decrease re-admissions and recidivism among individuals in or recovering from a crisis situation. Within Central Oregon, an MCAT is already in place and delivering crisis response services to 1.residents of both Crook and Deschutes County. However, as indicated in the response to question #1 of this narrative (Description of Crisis Services), the existing MCAT is facing challenges and barriers to delivering these services in a way that achieves the goals listed above. The proposed service plan adds tb:ree programmatic elements to address these issues as described below: . Issue: Response Time and Coordination ofServices .PI'OgrtUII Element: Add a second MCAT to be based in and operated by Crook County in coordination with Deschutes County. Crook County cummtly contracts with LCSNW to serve as the local CHMP. LCSNW currently employs a small staff ofQMHPs trained in crisis services and available during regular business hours. However. it relies on Deschutes County's MCAT to respond after hours and on weekends, when much of the activity occurs. This creates several difficulties, such as a duplication ofeffort and resources; confusion among first-responders as to who to contact; inability to efficiently integrate individuals into the community mental health system; lack of consistency in service delivery; lack of clarity in clinical roles and duties; and unacceptable response times ofup to one hour. The proposed project seeks to resolve these issues by adding a second MCA T based in the city of Prineville, operated by LCSNW, and operational 24 hours a day, seven days a week. To ·accomplish this, LCSNW will expand upon its current resources and capabilities with assistance from the Deschutes County MCAT. LCSNW will collaborate with Deschutes County to develop its.MCAT and will closely follow DCBH's model for a successful program., including stnicture, staffing, policies, procedures, protocols, and guidelines for operation. After formation, the two MCATs will continue to cooperate on a regional basis, sharing infonnation, training opportunities, strategic planning, and resources to ensure that all of Central Oregon's crisis response needs are met. The new Crook County MCAT will consist of an existing Community Outreach Program Director with crisis experience who will oversee expansion ofthe current crisis services program; two new QMHPs trained in crisis response; and clerical staff dedicated from LCSNW's current support team. The Director and the two QMHPs will share the '}An commitment of community crisis response. In addition, quality management and strategic planning staff, Page 16 of20 supervisory counsel, community steering committee members, county counsel, and the Director ofOperations will contribute knowledge, expertise, and assistance to the new MCAT. All crisis response and coordination of service delivery in Crook County will be performed by the new: MCAT, ensuring a seamless continuum ofcare. The MCAT will link individuals with services provided by Mosaic Medical, the Family Care Clinic at Pioneer Memorial Hospital, outpatient treatment programs, and other suitable community-based and regional behavioral health and substance abuse treatment providers. Outreach will be conducted through efforts to strengthen relationships with current community partners and develop new affiliations with others. One method of accomplishing this will be to offer training in specialized crisis response and treatment services to local law enforcement and public safety officials, Pioneer Memorial Hospital stafl: recovery cent~regional crisis agencies, and supportive service providers. Issue: Case Management and Supportive Services Program Element: Provide a QMHA to provide support to individuals in crisis, coordinate post crisis and recovery service delivery, and conduct outreach in Deschutes County. Following immediate stabilization, individuals in crisis need a wide variety ofbehavioral health and addiction treatment, social supports, and conununity-based services to make progress toward recovery. However, without assistance, many will reject or drop out of programs designed for this purpose and find themselves in a recuning cycle ofrelapse, crisis, and recidivism. The ability to link individuals with other recovery services f01lowing an initial MeAT assessment or discharge from the local acute care facility is cmrently limited. To address this issue, the proposed project will augment the Deschutes County's immediate crisis response capabilities with a dedicated QMHA charged with providing after-care, case management, referrals, and follow-up contacts with individuals recovering from crisis. The QMHA will offer case management and supportive services in conjunction with the Deschutes County MeAT and in support ofthe goal to decrease further hospitalization and/or involvement with law enforcement. Examples of some of the responsibilities that will be assigned to the new QMHA include, but are not limited to. coordinating transportation; assisting with scheduling and attendance at after-care appointments; conducting outreach for check-in and support; and providing assistance with access to insurance and health care benefits. The position will also conduct telephone and personal outreach to the local hospitals and emergency rooms, community-based organizations, and other service providers. In 2012, the MCAT made over 1,100 face-to-face contacts and over 1,500 phone contacts. While the QMHA will not add to those numbers, the position will improve the care each individual receives by ensuring a successful connection with after-care services. The QMHA will be a full-time staffmember with typical office hours and ,8 Monday through Friday work schedule, but will also be required to work during evenings or weekends when needed. The new QMHA and the entire Deschutes County MeAT will be supervised by the DCBH Community Assessment Supervisor under the direction of the Adult Treatment Program. Additional leadership will be provided by the Adult 'Treatment Program Manager and Behavioral Health Deputy Director. Issue: Detoxification Services .and Dual-Diagnosis Treatment Capacity Page 17 of20 I,. i ., 1 I PrograM EleMent: I) Appoint a Recovery Mentor to ensure the best and highest utiHzation of limited detoxification facility resources; and 2) provide secure transportation from emergency care to the detox facility. Frequently, the MCAT responds to individuals in crisis who are affected by both mental illness and addiction. This population requires specific interventions to stabilize, including detoxification and in-patient care. BestCare operates the local detox center and conducts assessments within 24 hours ofadmittance; schedules Registered Nurses to attend patients, dispense medications, consult with physicians, and provide 2417 on-call care; maintains 24-hour I· a day Certified Nursing Assistants; and provides Recovery Coaches to help engage patients with their recovery program. I I However, limited capacity and inadequate access between the area's mental health crisis services at hospital emergency rooms and detox facilities present a chronic barrier to positive treatment outcomes. Much of this inefficiency is due to a poor utilization of beds in the detox facility, insufficient staff, and a lack: oftransportation options. The proposed project seeks to fill these gaps by initiating new procedUres to assess bed availability, expanding the Recovery Coach program, and procuring a consistent source of secure transport services. Concurrent with the Central Oregon Crisis Services Expansion and Improvement project, BestCare will begin providing electronic updates regarding bed availability. At the beginning of every 12-hour shift, all admitting clinics and MCATs will receive an email from BestCare detailing the status of each of the six beds in the detox center, including the referring clinic, referring staff, date of admission, and expected date of discharge. This will allow the referring staff to know bed availability and progress ofindividuals they have referred to the detox program without violation ofclient confidentiality. BestCare will also hire an additional .50 FTE Recovery Coach specifically dedicated to serving individuals admitted from crisis situations. The Recovery Coach will become part of Best Care's active Recovery Mentor program which has been operating for the past seven years and will be supervised by BestCare's existing management staff. Responsibilities ofthe Recovery Coach will include helping individuals create and follow a change management plan; engage in treatment; build community support for recovery; and address issues related to relationships, work, education, and life goals. This Recovery Coach will coordinate with the Deschutes County MCAT's QMHA to ensure that each referred individual is linked with appropriate services, is engaged in treatment, is adequately supervised, and experiences a positive outcome, Finally, BestCare has committed to developing a consistent source of secure transport to ~erve Central Oregon residents in crisis on any day and at all hours. The organization will recruit for and contract with a qualified transportation service provider that is experienced in carrying individuals with mental health illness who may also be inebriated and acting aggressively or irrationally. The need for secure transport throughout Central Oregon in association with crisis response and service delivery is expected to be five trips per month. . 6. Budget Page 18 ofl0 The proposed project budget is organized to correspond with the three program elements described above. While Deschutes County wiUact as fiscal agent of grant funds received, support for the Crook County and BestCare elements will be distributed in accordance with separate service contracts between Deschutes County and the individual agencies. Deschutes County's budgeted expenses include salary and benefits for a 1.0 FfE QMHA and adjunct costs associated with the position, including computer equipment and internal service charges for personnel, legal, information technology, finance, and building services. The QMHA will worle: closely with existing MCAT members to conduct outreach, coordinate service linkages, and provide case management to individuals in crisis. As these duties will require a significant amount oftravel in the community, the budget also includes the pro-rated cost of using a County vehicle. DCHS will contribute in-kind support in the form ofthe supervisory, fiscal oversight, quality improvement, clerical assistance, and management staffrequired to implement and operate the proposed project. The program elements assigned to Crook County will be the responsibility of LCSNW, the I·County's designated Community Mental Health Program agency. LCSNW will use grant funds for the wages and benefits of2.0 PTE QMHP positions to enhance its existing crisis service capabilities and create a second MCAT to directly serve Crook County residents and a .10 FfE Program Director to conduct project oversight. The QMHPs will help develop the MCAT's policies, procedures, protocols, and i.nfi:'astructu.r:e and will be responsible for 2417 crisis response services as part of the team. Additional grant-ftmded expenses related to the new staffinclude travel, office supplies, and computer and telephone equipment Additional in-kind resources that will be contributed by LCSNW will include supeIVisory, management, and clerical support as well as time associated with quality management and strategic planning staff, supervisory counsel, a community steering committee,and County Counsel. The third project element will be implemented by BestCare. BestCare will use grant funds to support a .50 FfE Recovery Coach to help individuals engage in trea1ment and to purchase secure transport to safely convey individuals in crisis to the detoxification center. In-kind support will include staff time to develop an automated system to track bed utilization and detox services corresponding to individuals referred from crisis situations as a result ofboth mental illness and addiction. . The total request for the six-month period of year one and the 12-month period of year two is $379,103. The table shown below further details each year ofthe proposed. use ofthe Oregon Health Authority's crisis services grant funds: R.eeipient Agency DesChUtes County ;:·LCSNW·· ,'" ~.' -" ' Budget Item 1.0 FTE QMHA Salary and Benefit~~... ,_,_,,",._" .Computer EquipI:nent' Intein8l Service Charges" 1/1/14 6130/14...........,.,.. 7/1114 6130/14 $72,1l6 ... -.. il)50 .' ... . '.$~" 5.00 :.,pj""",.. . ,~, $4,~~~ $8,995 . Page 19 of20 $4,138 . $8,215".10 PTE Program DireCtorSwary .. BestCare treatiiierif Ser:vi¥.e8 ! . . :~d BenefiJ~. Travel ,.. Telwhone Service Internal Service Charges .50 FTifltecovery COaCh Salary and Benefits . Contractual Secure Transport ..services. . ... , .. ... $1,500 -$150 $.600_ $6,645 $13,290 $21,060 . $2,550 $5,100 ,_ .... Total Grant-Funded . Projed Costs $124,290 . $254,813 :$379,lO~,c,.__..,,__._ ........".. ,.......... ' "'-. .... ,... ' lIncludes Health insurance. FICA, long-term disability, and life insurance 2 Includes annual cost of a county vehicle fur service provision and travel to semi~annuaI PATH meetings and !l"Plired trainings 3 Includeslaptoplwork station to allow for use duriDg outreach 4Includes county administrative costs including persoDDCJ,Iegal, building services, finance and IT. SAccounts for a Feb I, 2014 start date Existing Crisis Services Budget As the current operator of 2417 MCAT services in the geographic area ofboth Crook and Deschutes Counties, DCBH's existing budget most closely reflects the :regional commitment to emergency crisis response. The 2013-14 fiscal year adopted budget for crisis services is $1,031,048. The budget includes 7.0 FfE ofcrisis program and supervisory stat'(, including MCAT members and daytime personnel who act as hospital liaisons and perfonn civil commitment investigations. Additional staff expenses in the budget include portions ofother DCBH personnel allocated to the crisis cost center and necessary to support the program. Expenses for these positions are allocated across all costs centers in the DCBH based on clinical PTE and include positions such as the DCBH Deputy Director, quality management, fiscal, and support staff. The budget also includes the followin~ • Indirect charges for County-wide administration, finance, legal counsel, personnel, building services, and information technology services. • Flexible funding for items such as transportation, medication, and lodging, etc. • Staff training and travel. • Civil commitment expenses, including an examiner, witness fees, secure transport, etc. • Psychiatric medication management. • Office equipment and supplies. The budget is funded through a variety of resources, but primarily by State support, Oregon Health Plan reimbursements, the County general fund and :reserve funds. Page20of20