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HomeMy WebLinkAboutDoc 503 - PacificSource Agrmt - Health SvcsJI' Deschutes County Board of Commissioners 1300 NWWall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org AGENDA REQUEST & STAFF REPORT For Board Business Meeting of October 20,2014 DATE: October 14, 2014 FROM: Nancy Mooney, Contract Specialist Phone: 322-7516 Health Services, Behavioral Health Division TITLE OF AGENDA ITEM: Consideration of Board Signature of Document #2014-503, Agreement between PacificSource Community Solutions, Inc. (PSCS) and Deschutes County Health Services (DCHS). PUBLIC HEARING ON THIS DATE? No BACKGROUND AND POLICY IMPLlCA*nONS: Deschutes County Health Services will support the Assertive Community Treatment (ACT) project in Deschutes County to acquire Fidelity level infrastructure. PSCS delivers healthcare solutions to businesses and individuals throughout the Northwest and is an independent, wholly-owned subsidiary of PacificSource Health Plans a non-profit community health plan. PSCS has been providing Medicaid plans to Oregonians since 1995 and currently offers Oregon Health Plans (OHP) coverage to individuals who need help through the PacificSource Coordinated Care Organization (CCO). I 1 The ACT Team provides intensive treatment, case management and outreach services to those individuals with a serious mental illness who are under civil commitment or most at risk of state hospital admission. This team also provides oversight to mental health residential programs including adult foster homes, residential treatment homes and the secure residential treatment facility. FISCAL IMPLICATIONS: PSCS will distribute a payment of $394,331.13 to allow for project development costs. The remaining 10% of the grant award may be made in four (4) equal quarterly payments of $10,953.64, following receipt and approval of Deschutes County's quarterly report. RECOMMENDA1-ION & ACTION REQUESTED: Behavioral Health requests approval. ATTENDANCE: Nancy Tyler, Adult Treatment Supervisor DISTRIBUTION OF DOCUMENTS: Executed copies to: Nancy Mooney, Contract SpeCialist, Health Services DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This form is required to be submitted with ALL contracts and other agreements. regardless of whether the document is to be on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board agenda. the Agenda Request Form is also required. If this form is not included with the document, the document witt 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: I October 2, 20141 Department: I Health Services, Behaivioral Health Contractor/Supplier/Consultant Name: I PacificSource Community Solutions, Inc.1 Contractor Contact: I Tammie Metzler I Contractor Phone #: I 541-330-2471 Type of Document: Letter of Agreement (LOA) Goods and/or Services: Deschutes County Health Services will support the Assertive Community Treatment (ACT) project in Deschutes County to acquire Fidelity level infrastructure. Background &History: PSCS delivers healthcare solutions to businesses and individuals throughout the Northwest and is an independent, wholly-owned subsidiary of PacificSource Health Plans a non-profit community health plan. PSCS has been providing Medicaid plans to Oregonians since 1995 and currently offers Oregon Health Plans (OHP) coverage to individuals who need help through the PacificSource Coordinated Care Organization (CCO). The ACT Team provides intensive treatment, case management and outreach services to those individuals with a serious mental illness who are under civil commitment or most at risk of state hospital admission. This team also provides oversight to mental health residential programs including adult foster homes, residential treatment homes and the secure residential treatment facility. PSCS will distribute a payment of $394,331.13 to allow for project development costs. The remaining 10% of the grant award may be made in four (4) equal quarterly payments of $10,953.64, following receipt and approval of Deschutes County's quarterly report. Starting Date: I March 1, 20141 Ending Date: I June 30, 20151 Annual Value or Total Payment: I Maximum compensation is $438,145.70. ~ Insurance Certificate Receivei (checi box) Insurance Expiration Date: N/A 10/2/2014 Check all that apply: ~ RFP, Solicitation or Bid Process o Informal quotes «$150K)o Exempt from RFP, Solicitation or Bid Process (specify -see DCC §2.37) Funding Source: (Included in current budget? ~ Yes 0 No If No, has budget amendment been submitted? 0 Yes 0 No Is this a Grant Agreement providing revenue to the County? 0 Yes ~ No Special conditions attached to this grant: Deadlines for reporting to the grantor: IL-----l If a new FTE will be hired with grant funds, confirm that Personnel has been notified that it is a grant-funded position so that this will be noted in the offer letter: 0 Yes 0 No Contact information for the person responsible for grant compliance: Name: D Phone#:D Departmental Contact and Title: I Nancy Mooney, Contract Specialist Phone #: I 541-322-7516 I Deputy Director Approval: Distribution of Document: Department Director Approval: ~..L£b.~::":=:::;~---=------ I Date rn original to Nancy Mooney. Official Review: County Signature Required (check one)l~occ D Department Director (if <$25K) D Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ) Legal Review ~011 Date 11J-11..-{~ Document Number =20=-1.:-4:...,.-=-50;:;;..;3=--______ 10/2/2014 REVIEWED f(QlfY\; LEGAL COUNSEl Letter of Agreement Assertive Community Treatment Deschutes County Health Services Effective: March 1, 2014 -June 30, 2015 This Letter of Agreement ("Agreement") is made between, PacificSource Community Solutions, Inc., an Oregon Corporation ("Health Plan") and Deschutes County, a political subdivision of the State of Oregon, acting by and through Deschutes County Health Services Department, "(Provider"), collectively referred to as "parties", is effective March 1, 2014 and shall expire on June 30, 2015, unless terminated in accordance with subsection Paragraph B ''Termination''. PacificSource Community Solutions is contracted with the State of Oregon, acting by and through the Oregon Health Authority ("OHA"), Division of Medical Assistance Programs CDMAP"), to implement and administer services under the Oregon Health Plan ; Services are provided to Deschutes County residents who meet the criteria for ACT services . NOW, THEREFORE, in consideration of the mutual covenants and agreements, and subject to the conditions and limitations set forth in this Agreement , and for the mutual reliance of the parties in this Agreement , the parties hereby agree as follows: I. RESPONSIBILITIES OF PROVIDER Provider shall use these Agreement funds solely to support the Assertive Community Treatment (ACT) project in Deschutes County ("Provider's Service Area" or "Service Area") to acquire Fidelity level infrastructure. Provider's Agreement is designed to improve the community's capacity to provide ACT treatment services to Fidelity for those suffering from serious and persistent mental illness. Definition of Fidelity For the purposes of interpreting this Agreement, "Fidelity" means the extent to which a program adheres to the evidence based practice model. Fidelity to the ACT model means that an organization participates in measuring whether ACT is being implemented to Fidelity, and will require, at a minimum , meeting requirements outlined in OAR 410-172-0500 through 410-172­ 0510. Fidelity to the ACT model is measured using the Dartmouth ACT Fidelity Scale and other tools that are part of the ACT Evidence-Based Practice Kit. Program Description Provider shall perform the ACT program activities . Changes to program implementation are subject to OHA review and approval. The Provider will develop ACT program(s) in a manner that is consistent with Fidelity standards established in OAR 410-172-0500 through 410-172­ 0510 and that meets the needs of its Service Area. The Program Description is as follows : Assertive Cornmunity Treatment (ACT): a . Provider will enhance existing ACT-related services to develop a Fidelity ACT program as defined by OAR 410-172-0500 through 410-172-0510 within Deschutes County. DC -201 b. Provider will develop the ACT program to include dedicated capacity to serve Members involved with the criminal justice system. c. Provider's ACT program will be fully operational by June 30, 2015. d. Provider shall participate in technical assistance, and actively collaborate with the Oregon Center of Excellence for Assertive Community Treatment, and Options for Southern Oregon to develop the qualified Fidelity ACT program and support services and monitor Fidelity utilizing the Dartmouth ACT Fidelity Scale. 11-RESPONSIBILITIES OF HEALTH PLAN. Health Plan shall perform the following duties for the ACT program: Disbursement and Reporting Activities. The total not to exceed amount for this Agreement is $438,145.70. Following Agreement execution and receipt and approval of Provider's invoice, Health Plan will make an initial disbursement of 90% of the total award in the amount of $394,331.13 to allow for project development costs. The remaining 10% of the grant award may be made in four (4) equal quarterly payments of $10,953.64 beginning July 1, 2014 following receipt and approval of Provider's quarterly invoice and quarterly report as required under this Agreement. Each disbursement by Health Plan is contingent on the Provider being in compliance with the terms of this Agreement, including without limitation that all representations and warranties of Provider, are true on the date of disbursement. Provider understands and agrees that Health Plan's disbursement of funds under this Agreement is contingent on Health Plan receiving appropriations, limitations, allotments or other expenditure authority sufficient to allow Health Plan in the exercise of its reasonable administrative discretion, to disburse the funds. Nothing in this Agreement is to be construed as permitting any violation of Articles XI, section 7, of the Oregon Constitution or any other law regulating liabilities or monetary obligations of the State of Oregon. In the case that it becomes necessary to execute an amendment to this Agreement adopting supplemental proposals, budgets, timelines or objectives for measuring satisfaction of Program objectives, Health Plan will prepare and submit an amendment for Provider's signature. Any revisions or amendments to this Agreement must be made in writing and signed by both parties. Reporting Requirements. Provider will submit encounter data for ACT services through OHA's Medicaid Management Information System (MMIS) and Measures and Outcomes Tracking System (MOTS). All Members receiving ACT Services must be enrolled within two (2) business days of admission and disenrolled within one (1) business day of discharge and that Member's record maintained in MOTS as specified in OHA's MOTS manual and as it may be revised from time to time. Schedule of ACT Activities Reporting. Provider will submit written quarterly reports in a format acceptable to Health Plan on the status of Provider's ACT program development and progress toward Fidelity for the current reporting period and data projections for the next quarter, to include: a. Status of ACT service team development; b. Program Fidelity Scores; and c. Number of Members receiving ACT services. Recovery of Grant Funds. Any Agreement funds disbursed to Provider that are expended in violation or contravention of one or more of the provisions of this Agreement ("Misexpended Funds") or that remain unexpended on the earlier of termination or expiration of this Agreement ("Unexpended Funds") must be returned to the Health Plan. Provider shall return all Misexpended Funds to Health Plan promptly after Health Plan's written demand and no later than fifteen (15) days after receiving Health Plan's written demand. Provider shall return all Unexpended Funds to Health Plan within ten (10) days after the termination or expiration of this Agreement, whichever occurs earlier. III. GENERAL PROVISIONS A. Safeguarding of Information 1. Provider shall maintain the confidentiality of client records as required by applicable state and federal law, including without limitation, ORS 179.495 to 179.507, 45 CFR Part 205, 42 CFR Part 2, any administrative rule adopted by OHA implementing the foregoing laws, and any written policies made available to Provider by OHA Provider shall create and maintain written policies and procedures related to the disclosure of client information, and shall make such policies and procedures available to OHA for review and inspection as reasonably requested by OHA 2. Protected Health Information ("PHI"). No party or its agents will disclose any PHI except where required by law or as provided in this Agreement. Under any circumstance, any such disclosure must comply with all applicable federal and state laws and regulations, including, but not limited to, Health Insurance Portability and Accountability Act (HIPAA). 3. Provider will ensure that technical and organizational measures are adopted (a) to protect Provider data against accidental, unauthorized or unlawful destruction, loss, damage, alteration, disclosure, access and processing and (b) as required by any applicable data protection law. 4. Provider will inform Provider in writing within twenty-four (24) hours of any accidental or unlawful destruction or accidental loss or damage, alteration unauthorized disclosure or access to Customer data. B. Termination 1. Termination with or without Cause. This Agreement may be terminated by any Party, for any reason, upon ninety (90) days written notice to the other Parties. 2. Immediate Termination. This Agreement shall terminate immediately in the event any of the following occur: (1) a breach of any of the terms of this Agreement by a Party; (2) an order from a court of competent jurisdiction declaring this Agreement nUll, void, contrary to law, or otherwise terminated; or (3) an order from a state or federal agency with jurisdiction over the subject matter of this Agreement declares that this Agreement is nUll, void, contrary to law, or otherwise terminated. C. Indemnification. Within the limits of their respective policies of general liability and other appropriate insurance coverage (with minimum coverage limits as required by ORS 30.260 to ORS 30.300,) each Party agrees to indemnify and hold harmless the other from all fines, claims, demands, suits, actions, or costs, including legal fees of any kind or nature arising by reason of that Party's acts or omissions in the course of its performance of its obligations under this Agreement. This provision will be construed to include any and all costs associated with investigating, responding to, giving notice, or defending against a breach of security, or suspected breach of security, that results in the unauthorized disclosure of Protected Health Information. Insurance and indemnity requirements may be met via Provider's self-insurance program. D. Good Standing. Each Party represents and warrants to the others that it is duly and appropriately licensed, authorized and/or qualified to do business, and is in good standing in every jurisdiction in which a license, authorization, or qualification is required for the transaction of the business in which it is engaged. E. Compliance with Laws. Each Party represents and warrants that it will perform each of its obligations under this Agreement in compliance with all applicable federal, state and local laws, including, but not limited to, HIPAA. MISCELLANEOUS A. Entire Agreement. This Agreement, and the exhibits attached hereto, represents the entire understanding between the Parties with respect to its subject matter. B. Amendment. This Agreement, may only be amended in writing and signed by the Parties. The Parties agree to take any actions required to amend this Agreement, and/or its exhibits, from time to time as may be necessary to ensure compliance with all applicable federal and state laws and regulations. C. Relationship. Each Party will perform its obligations pursuant to this Agreement as an independent contractor. Nothing contained in this Agreement is intended to give rise to any agency, subcontractor, partnership, or joint venture relationship between the Parties or to impose upon the Parties any of the duties or responsibilities of such a relationship. D. Third Party Beneficiaries. This Agreement does not confer any legal rights on any third party, nor is it the intention of any Party hereto to create or confer any rights. E. Successors and Assigns. This Agreement is binding upon and will inure to the benefit of the Parties and their successors and assigns. This Agreement may not be assigned, delegated, or otherwise transferred by a Party, under any circumstances, without the prior written consent of the other Party. F. Governing Law. The validity, construction, and interpretation of this Agreement, including the rights and duties of the Parties hereto, shall be governed by the laws of the State of Oregon. G. Severability. Each provision of this Agreement shall be interpreted in such a manner as to be effective and valid under applicable law, however, if any provision is deemed to be invalid or unenforceable for any reason, then the Agreement shall be ineffective as to that provision only, and the remainder shall continue in full force and effect. H. Notices. All notices and other communications sent pursuant to this Agreement must be in writing and will be deemed to have been given on the date delivered personally, sent by facsimile, mailed by certified mail, or overnight delivery to the other Parties: I I To PacificSource Community Solutions, Inc.: To Deschutes County: Peter McGarry, Vice President Jane Smilie, Department Director PacificSource Community Solutions, Inc. Deschutes County Health Services PO Box 7469 2577 NE Courtney Dr. Bend, OR 97701 Bend, Oregon 97701 Phone No. 541-322-7500 I. Interpretation. This Agreement shall be interpreted, to the maximum extent possible, to comply with applicable federal and state laws and regulations, including, but not limited to, HIPAA. Any and all references to "the Agreement" shall be construed to include the exhibits attached hereto, including any terms and conditions included therein. J. Waiver. Any provision of this Agreement may be waived by the Party entitled to the benefit of such provision, provided that such waiver shall be in writing. Waiver of any breach or provision will not be construed as a waiver of any successive breach or provision. K. Covenant of Further Assurances. Each Party covenants and agrees that it will execute and deliver any further legal instruments subsequent to the execution of this Agreement, and without any additional consideration, as may be necessary to effectuate the state purposes herein IN WITNESS WHEREOF, the Parties have executed this Agreement by and through their duly authorized representatives. PACIFICSOURCE COMMUNITY SOLUTIONS, INC. DESCHUTES COUNTY HEAL TH SERVICES Peter McGarrv By: TAMMY BANEY, Chair ANTHONY DEBONE, Vice Chair ALAN UNGER, Commissioner Title: Vice President -Provider Network Title: Board of Deschutes County Commissioners Date: Date: Address: PO Box 7469 Address: 2577 NE Courtney Drive Bend, OR 97701 Title: Bend, OR 97701 Exhibit 1 CONFIDENTIALITY AGREEMENT WHEREAS, in connection with the performance of the ACT Services, PacificSource Community Solutions, Inc., and Deschutes County may receive from each other or otherwise have access to certain information that is required to be kept confidential in accordance with state and federal law, including, without limitation, the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, as may be amended from time to time (collectively, "HIPAA") and the federal Health Information Technology for Economic and Clinical Health Act (the "HITECH Act"); Therefore, in consideration of the foregoing premises and the mutual covenants and conditions set forth below and in that Letter of Agreement executed between PacificSource Community Solutions, Inc., and Deschutes County, and intending to be legally bound hereby, PacificSource Community Solutions Inc., and Deschutes County agree as follows. 1. Introduction The Parties hereto agree that the effective date of this Confidentiality Agreement (the "Agreement") shall be retroactive to March 1, 2014 (Effective Date) by and between PacificSource Community Solutions Inc., an Oregon Corporation, ("PSCS") and Deschutes County, a political subdivision of the State of Oregon, acting by and through Deschutes County Health Services, Behavioral Health Division ("County"), collectively referred to herein as "Party" or "Parties". 2. Definitions 2.1 "Disclosure" means the release, transfer, provision of access to, or divulging in any other manner, of PHI, outside either 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 "EPHf' 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); removable/transportable digital memory media (such as magnetic tape or disk, removable drive, optical disk, or digital memory card); the internet; the extra net; 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 either Party from or on behalf of either Party, or is created by either Party, or is made accessible to either Party by either 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 those actions provided to acquire Fidelity level infrastructure to support the Assertive Community Treatment (ACT) project in Deschutes County. 2.6 "Use" (whether capitalized or not and including the other forms of the word) means, with respect to PHI, the sharing, employment, application, utilization, transmission, examination, retention, or analysis of such information to, from or within either Parties' organization. 3. AGREEMENT. Each Party agrees that it shall: 3.1 not use PHI except as necessary to provide the Services. 3.2 not disclose PHI to any third party without the other Party's prior written consent, except as required by law; 3.3 not use or disclose PHI except as permitted 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 the other Party any use or disclosure of PHI not permitted by this Agreement of which it 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 Party's compliance with HIPAA. 3.9 ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Party agree to the same restrictions, conditions, and requirements that apply to the Party with respect to security and privacy of such information. 3.10 make PHI available to the other Party as necessary to satisfy the other Party'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. 3.11 make any amendment(s) to PHI in a designated record set as directed or agreed to by the other Party pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy the other Party's obligations under 45 CFR 164.526. 3.12 to the extent the a Party is to carry out one or more 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). 3.13 If a Party (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 a Party's books and records relating to the use and disclosure of PHI, the Party, to the extent it is not legally prohibited from so doing, shall promptly notify the other Party and cooperate with the other Party in connection with any reasonable and appropriate action the Parties deem necessary with respect to such PHI. 3.14 If any part of a Party's performance of business functions involves creating, receiving, storing, maintaining, or transmitting EPHI: 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 either Party, in accordance with the requirements of 45 CFR Part 160 and Part 164, Subparts A and C; and B. report to the other Party any security incident relating to the EPHI that either Party maintains. 4. HIPAA Data Breach Notification and Mitigation 4.1 Parties agree 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. Parties will, following the discovery of a HIPAA Breach, notify the other Party immediately and in no event later than seven (7) business days after Party discovers such HIPAA Breach, unless the Party 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 the other Party, the discovery of a HIPAA Breach shall occur as of the first day on which such HIPAA Breach is known to a Party or, by exercising reasonable diligence, would have been known to the Party. Parties 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 Party. No later than seven (7) business days following a HIPAA Breach, Party shall provide the other Party with sufficient information to permit the other Party 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) a Party, the Party will provide the other Party 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 Party 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 the Party may conduct further investigation concerning the HIPAA Breach. Following a HIPAA Breach, ----------------- the Party will have a continuing duty to inform the other Party of new information learned by Party 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, Parties agree 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, a Party 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. Each Party shall indemnify, defend and hold the other Party harmless from and against any and all actual losses, liabilities, damages, costs and expenses (collectively, "Information Disclosure Claims") arising directly from (i) the Party's use or disclosure of Individually Identifiable Information (including PHI) in violation of the terms of this Agreement or applicable law, and (ii) the Party's breach of any HIPAA Breach of unsecured PHI and/or any State Breach of Individually Identifiable Information. 5. Other Provisions 5.1 A breach under this Agreement shall be deemed to be a material default in the Parties' Letter of Agreement. 5.2 Both Parties authorize termination of this Agreement by the other Party if a Party determines the other Party has violated a material term of this Agreement. 5.3 To the extent there are any inconsistencies between this Agreement and the terms of any terms of any other agreement, either written or oral, between the Parties, the terms of this Agreement shall prevail. PSCS: Deschutes County Health Services: BY: Signature Name: peter McGarry Title: Vice President -Provider Network Title: Director