HomeMy WebLinkAboutDoc 309 - Telecare Services Agrmt\
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 June 27, 2012
QAIg: June 14, 2012
FROM: Lori Hill, Adult Treatment Supervisor Phone: 322-7535
Health Services, Behavioral Health Division
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document #2012-309, Agreement between Telecare Mental
Health Services of Oregon, Inc. and Deschutes County Health Services (DCHS).
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
Telecare Mental Health Services of Oregon, Inc. (Contractor) provides 24-hour secure residential
treatment facilities for individuals with mental or emotional disorders who have been hospitalized
and need services to avoid further hospitalization because they are a danger to themselves or
others. Telecare shall provide services for up to sixteen (16) residents that have been jointly
approved by County and Telecare. The purpose of secured residential treatment services is to
stabilize resident's psychiatric symptoms, improve independent living skills, and then discharge the
resident into an appropriate and safe level of community services of less intensity as clinically
appropriate.
Telecare will invoice Division of Medical Assistance Programs (DMAP) in accordance with
procedures and forms prescribed by the Oregon Health Authority (OHA). County agrees to pay
Telecare funds that are received by County through OHA by amendment to the contract between
Deschutes County and OHA, contract #134309. Funding for operation and facilities will be in
accordance with a budget submitted by Telecare to OHA and County and approved by both OHA
and County.
FISCAL IMPLICATIONS:
Maximum compensation is $2,520,000.
RECOMMENDATION & ACTION REQUESTED:
Behavioral Health requests approval.
ATTENDANCE: Lori Hill, Adult Treatment Supervisor
DISTRIBUTION OF DOCUMENTS:
Executed copies to: Nancy Mooney, Contract Specialist, Health Services
J
DESCHUTES CQUNTY 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
j the Board Secretary.)
I Please complete aI/ sections above the Official Review line.
I Date: I May 30, 2012 I
Department: I Health Services, Behavioral Health I
1 Contractor/Supplier/Consultant Name: I TeJecare Mental Health Services of Oregon, Inc.1I
Contractor Contact: I Gemma Lim I Contractor Phone #: I 510-337-7950
I
I
~ ~ Type of Document: Personal Services Contract
Goods and/or Services: Telecare Mental Health Services of Oregon, Inc. provides 24-hour
secure residential treatment facilities for individuals with mental or emotional disorders who
have been hospitalized and need services to avoid further hospitalization because they are a
danger to themselves or others.I Background & History: Telecare shall provide 24-hour Secure Residential Treatment Facility
services for up to sixteen residents that have been jOintly approved by County and Telecare.
I
1 The purpose of Secured Residential Treatment Services is to stabilize resident's psychiatric
symptoms, improve independent living skills, and then discharge the resident into an
appropriate and safe level of community services of less intenSity as clinically appropriate.
l Telecare will invoice Division of Medical Assistance Programs (DMAP) in accordance with
procedures and forms prescribed by the Oregon Health Authority {OHA}. County agrees to pay
Telecare funds that are received by County through OHA by amendment to the contract
between Deschutes County and OHA, contract #134309. Funding for operation and facilities
will be in accordance with a budget submitted by T elecare to OHA and County and approved by
both OHA and County.
Agreement Starting Date: I July 1, 2012 I Ending Date: I June 30, 2013
Annual Value or Total Payment: I Maximum compensation is $2,520.@]
f2J Insurance Certificate Received (check box)
Insurance Expiration Date: I July 1, 2012 I
Check all that apply:
D RFP. Solicitation or Bid Process
D Informal quotes «$150K)
f2J Exempt from RFP, Solicitation or Bid Process (specify -see OCC §2.37)
Funding Source: (Induded 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: I'-_-'
Deadlines for reporting to the grantor: CJ
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: Cl
Phone#:D
Departmental Contact and Title: I Nancy Mooney, Contract Specialist
Phone #: [541-322-7516 I
Department Director Approval: ~.~I»'uhv
Ignatu Date
Distribution of Document: Return both onginals to Nancy Mooney, Behavioral Health
Department.
Official Review:
County Signature Required (check one): 5!t BOCC 0 Department Director (if <$25K)
o Administrator (if >$25~U~<$150K; if >$150K, BOCC Order No. )
Legal Review cJ8tt-L (J2u;.f} Date r; I ~ -f '2.
I
Document Number =20;...1=2:...;:-3;;.;:0=9_______
513012012
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LEGAL COUNSEL
Fo r Re cordin g Stam p Only
DESCHUTES COUNTY SERVICES AGREEMENT
AGREEMENT NO. 2012-309
This Agreement (the "Agreement') is made and entered into by and between Deschutes County , a political
subdivision of the State of Oregon , hereinafter referred to as "County ," and Telecare Mental Health Services of
Oregon, Inc., 1080 Marina Village Pkwy , Suite 100, Alameda, CA 94501 , hereinafter referred to as "Contractor."
WHEREAS, County owns property to be licensed as a secure residential treatment facility that has been
approved by State of Oregon (hereinafter referred to as "Facility") for Individuals enrolled in behavioral health
programs; and
WHEREAS , County and Contractor agree that a secure residential treatment facility is a preferred
behavioral health care model in Central Oregon to provide residential behavioral health services ;
WHEREAS, County has signed a lease with Contractor for the property at 20370 Poe Sholes Road in
Bend to be operated as the Facility and Contractor is capable of operating and managing the Facility; and
WHEREAS , County is authorized pursuant to ORS 430.670 to obtain, by contract, the services necessary
to operate a community behavioral health program ; and
WHEREAS, Contractor has available staff for the performance of the services described in this
Agreement ; and
WHEREAS, Contractor has obtained and shall continue to qualify for approval from the State of Oregon,
Oregon Health Authority ("OHA") for purposes of providing services under this Agreement ; now , therefore,
IT IS HEREBY AGREED by and between the parties above mentioned, for and in consideration of the
mutual promises hereinafter stated as follows :
1. Effective Date . The effective date of this Agreement shall be July 1, 2012. Unless extended or terminated
earlier in accordance with its terms , this Agreement shall terminate when County accepts Contractor's
completed performance or on June 30 , 2013 , whichever date occurs last. Agreement termination shall not
extinguish or prejudice County's right to enforce this Agreement with respect to any default by Contractor
that has not been cured .
2 . Contractor's Services. Contractor shall provide all services as outlined in Exhibit 1 of this Agreement.
Contractor shall provide 24-hour Secure Residential Treatment Facility (SRTF) services for up to sixteen
(16) residents that have been jointly approved by County and Contractor . Contractor shall provide SRTF
services described in the attached Service Description, titled "Residential Treatment Services", Service 10
code MHS 28 and "Secure Residential Treatment Facility", Services 10 Code MHS 28A, Exhibit 1A and in
accordance with OAR 309-035-0100 through 309-035-0190, in the Facility. Contractor shall also provide
out-patient mental health services to SRTF residents in accordance with OAR 309 -16-0600 through 309
016-0685 "Medicaid Payment for Rehabilitative Mental Health Services and OAR 309-032-1500 through
309-032-1565 "Integrated Services and Supports Rule". Contractor shall screen and assess Individuals for
tobacco use , and offer tobacco cessation resources to Individuals choosing to quit.
3. Regulations and Duties . Contactor shall comply with all applicable provisions of the Contract between
County and the State of Oregon , including applicable Service Descriptions attached thereto , in place at the
time this Agreement is executed and effective July 1, 2011, (Contract #134309, the "Contrad') between
the Oregon Health Authority ("OHA") and Deschutes County , as the same may be amended, replaced
and/or renewed from time to time. Contractor agrees to comply with the rules and regulations of County,
PAGE 1 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
DC -20
applicable provisions in the Contract between County and the OHA, incorporated herein by reference, as
of the effective date of such regulations, applicable provisions of the Administrative Rules and Procedures
of the OHA, applicable Federal regulations and all provisions
of Federal and State statutes, rules and regulations relating to Contractor's performance of services under
this Agreement. Any act or duty of County, imposed upon County by OHA, which, by the nature of this
Agreement, County determines to be within the scope of this Agreement and is to be performed by
Contractor, Contractor shall perform on behalf of County. No federal funds may be used to provide
services in violation of 42 USC 14402.
4. Reporting.
A. Contractor shall document the expenditure of all funds paid to Contractor under this Agreement.
Unless applicable federal law requires Contractor to utilize a different accounting system, Contractor
shall create and maintain all expenditure records in accordance with generally accepted accounting
principles and in sufficient detail to permit County and the Oregon Health Authority to verify how the
funds paid to Contractor under this Agreement were expended.
B. Contractor agrees to prepare and furnish such reports and data as may be required by County and the
Oregon Health Authority, including but not limited to Individual records which contain Individual
identification, problem assessment, Individual Service and Support Plan (including any training and/or
care plan), appropriate medical information, and Individual Service Notes, including a service
termination summary and current assessment or evaluation instrument as designated by the Oregon
Health Authority in the administrative rules. Contractor shall retain Individual records in accordance
with OAR 166-150-0005 through 166-150-0215 (State Archivist). Unless OAR 166-150-0005 through
116-150-0215 requires a longer retention period, Individual records must be retained for a minimum of
ten (10) years from termination or expiration of this Agreement. It is understood that due to the limited
nature of Contractor's services under this Agreement, not all of these documents will have been
prepared by Contractor and therefore need not be furnished. Oregon Health Authority Client Process
Monitoring System (CPMS) data, Community Mental Health Provider Report, and Termination Service
Recording Form shall, if necessary, be completed in accordance with Oregon Health Authority
requirements and submitted to Oregon Health Authority through County . Contractor agrees to, and
does hereby grant County and the Oregon Health Authority the right to reproduce , use and disclose
for County or Oregon Health Authority purposes, all or any part of the reports, data, and technical
information furnished to County under this Agreement. Contractor shall make available to County,
Oregon Health Authority and any Individual of Contractor as defined in Exhibit 1, of this Agreement,
any and all written materials in alternate formats in compliance with Oregon Health Authority's policies
or administrative rules. For purposes of the foregoing, "written materials" includes, without limitation,
all work product and contracts related to this Agreement.
C . Contractor shall prepare and furnish the following information to Oregon Health Authority when a
Service is delivered:
1) Individual, Service and financial information as specified in the Service Description.
2) All additional information and reports that Oregon Health Authority or County reasonably
requests .
D. Contractor shall submit reports as requested by County. All notices, bills and payments shall be
made in writing and may be given by personal delivery or by mail. Notices, bills, and payments sent
by mail should be addressed as follows:
Contractor: Telecare Mental Health Service of Oregon, Inc.
1080 Marina Village Pkwy, Suite 100
Alameda, CA 94501 Phone: (510) 337-7950
Attn: Marshall Langfeld
County: Deschutes County Health Services
2577 NE Courtney Dr.
Bend, OR 97701 Phone: (541) 322-7535
Attn: Lori Hill
PAGE 2 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
5. Access to Records. Contractor shall maintain fiscal records and all other records pertinent to this
Agreement.
A. All fiscal records shall be maintained pursuant to generally accepted accounting standards, and
other records shall be maintained to the extent necessary to clearly reflect actions taken .
1) Contractor shall retain and keep accessible all books, documents, papers and records that are
directly related to this Agreement, the funds paid to Contractor hereunder or to any services
delivered hereunder, for a minimum of seven (7) years, or such longer period as may be
required .
2) If an audit, litigation or other action involving this Agreement is started before the end of the
seven-year (7) period, the records shall be retained until all issues arising out of the action are
resolved.
B. County, the Oregon Health Authority, the Secretary of State's Office of the State of Oregon, the
Federal Government, and their duly authorized representatives shall have the right to direct access
to all of Contractor's books, documents, papers and records related to this Agreement, the funds
paid to Contractor hereunder, or any services delivered hereunder for the purpose of conducting
audits and examinations, making copies, excerpts and transcripts . In addition, Contractor shall
permit authorized representatives of County and the Oregon Health Authority to perform site
reviews of all services delivered by Contractor hereunder.
1) These records also include licensed software and any records in electronic form, including but
not limited to computer hard drives, tape backups and other such storage devices. County shall
reimburse Contractor for Contractor's cost of preparing copies.
2) At Contractor's expense, the County, the Secretary of State's Office of the State of Oregon, the
Federal Government, and their duly authorized representatives , shall have license to enter upon
Contractor's premises to access and inspect the books, documents, papers , computer software,
electronic files and any other records of the Contractor which are directly pertinent to this
Agreement.
3) If Contractor's dwelling is Contractor's place of business, Contractor may, at Contractor's
expense, make the above records available at a location acceptable to the County.
6. Confidentiality. Contractor shall maintain confidentiality of information obtained pursuant to this
Agreement as follows:
a . Contractor shall not use, release or disclose any information Contractor shall not use, release or
disclose any information concerning any employee , Individual, applicant or person doing business
with the County for any purpose not directly connected with the administration of County's or the
Contractor's responsibilities under this Agreement except upon written consent of the County, and if
applicable, the employee, Individual , applicant or person.
b. The Contractor shall ensure that its agents, employees, officers and subcontractors with access to
County and Contractor records understand and comply with this confidentiality provision.
c. Contractor shall treat all information as to personal facts and circumstances obtained on Medicaid
eligible individuals as privileged communication, shall hold such information confidential, and shall
not disclose such information without the written consent of the individual, his or her attorney, the
responsible parent of a minor child , or the child's guardian, except as required by other terms of this
Agreement.
d. Nothing prohibits the disclosure of information in summaries, statistical information, or other form
that does not identify particular individuals.
e . Personally identifiable health information about applicants and Medicaid recipients will be subject to
the transaction, security and privacy provisions of the Health Insurance Portability and
Accountability Act ("HIPAA").
f. Contractor shall cooperate with County in the adoption of policies and procedures for maintaining
the privacy and security of records and for conducting transactions pursuant to HIPAA
requirements .
PAGE 3 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
g. This Agreement may be amended in writing in the future to incorporate additional requirements
related to compliance with HIPAA.
h. If Contractor receives or transmits protected health information, Contractor shall enter into a
Business Associate Agreement with County, which, if attached hereto, shall become a part of this
Agreement.
i. Individually Identifiable Health Information about specific individuals is confidential. Individually
Identifiable Health Information relating to specific individuals may be exchanged between County
and OHA for purposes directly related to the provision of Services to Individuals which are funded in
whole or in part under this Agreement. Contractor shall maintain the confidentiality of Individual
records as required by applicable state and federal law, including without limitation, ORS 179-495 to
179.507, 45 CFR Part 205, 42 CFR Part 2, any administrative rule adopted by the Oregon Health
Authority, implementing the foregoing laws, and any written policies made available to Contractor by
County or by the Oregon Health Authority. Contractor shall create and maintain written policies and
procedures related to the disclosure of Individual information and shall make such policies and
procedures available to County and the Oregon Health Authority for review and inspection as
reasonably requested by County or the Oregon Health Authority.
7. County Monitoring and Site Visits. Contractor agrees that services provided under this Agreement by
Contractor, Facilities used in conjunction with such services, Individual records, Contractor's policies,
procedures, performance data, financial records, and other similar documents and records of Contractor,
that pertain, or may pertain, to services under this Agreement, shall be open for inspection by County, or
its agents, at any reasonable time during business hours. Contractor agrees to retain such records and
documents for a period of ten (10) years, or such longer period as may be prescribed for such records
and documents by the State of Oregon Archivist or until the conclusion of any dispute or proceeding
related to the services under this Agreement or involving the records of Contractor, whichever is longer.
Contractor shall permit County and OHA to make site visits upon reasonable notice to monitor the delivery
of services under this Agreement.
8. Payment of Agreement. Subject to availability of funds, Contractor will receive payment for providing the
services described in Paragraph 2.
A. Contractor shall bill DMAP in accordance with procedures and forms prescribed by OHA for all Part
B funds (as defined in Exhibit 1) that are approved by OHA as part of Contractor's budget.
Contractor agrees that payment for these services shall be DMAP's responsibility and not County's
responsibility. Contractor shall not invoice or expect payment from County for services billed to
DIVIAP under this subsection.
i) All Extended Care Services reimbursable service billings shall be in accordance with OHA
Medicaid General Provider Rules 410-120-0000 through 410-120-1940 and MHS Mental Health
and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health
Services Rule as listed in OAR 309-016-0600 through 309-016-0685.
ii) Contractor shall bill all Personal Care Services in accordance with forms and procedures
prescribed by OHA.
iii) Contractor agrees to complete, monitor and obtain all prior authorizations as needed for
Extended Care Service and Personal Care Service billing submissions.
B. County agrees to pay to Contractor, all "Part An funds received by County which are allocated by
OHA for services (described in Exhibit 1) provided by Contractor or are expenditures approved by
OHA in Contractor budget.
i) Contractor agrees to invoice County on a monthly basis for all Part A funds that are approved
by the OHA as part of Contractor's budget and paid to the County by amendment to the
contract. County agrees to make approved payments to Contractor within thirty (30) days of
receipt of invoice.
ii) Contractor agrees to complete and submit all documentation of expenditures for Part A funds as
required by OHA and County and to comply with all requirements of the Service Description in
which funding is allocated.
PAGE 4 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-30~
C . Funding for operation of the facilities will be in accordance with a budget submitted by Contractor to
OHA and County and approved by OHA and County in negotiation with Contractor thirty days (30)
prior to the anniversary of this Agreement.
D . Any extension of services for the period after June 30, 2013 will be by separate Agreement.
9 . Payments in Future Years beyond June 30 , 2013. l\Jot later than April 2013, Contractor and County shall
meet to review this Agreement and negotiate the program and reporting requirements, protocols and
payment to be paid by County and OHA to Contractor beginning after July 1, 2013 . The parties may at
that time also negotiate payment methods and amounts for one or more years after 2013 .
10. Recovery of Funds . Expenditures of Contractor may be charged to this Agreement only if they: (1) are in
payment for services performed under this Agreement; (2) conform to applicable State and Federal
regulations and statutes; (3) are in payment of an obligation incurred during the period of this Agreement;
and (4) when added to other compensation pursuant to this Agreement 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 Agreement, or if federal authorities demand the repayment of federal funds
received under this Agreement, County may recover all federal funds paid under this Agreement, unless a
smaller amount is disallowed or demanded . If OHA disallows or requests repayment for any funds paid
under this Agreement due to Contractors ' acts or omissions, Contractor shall make payment to the County
of the amount disallowed or requested .
In the event that the OHA determines that County is responsible for the repayment of any funds owed to
the OHA by Contractor, Contractor agrees to make such payment within ten (10) days of notification by
County or the OHA of said determination by the OHA.
11. Retention of Revenue and Earned Interest. Fees and third -party reimbursements, including all amounts
paid pursuant to Title XIX of the Social Security Act by the OHA, for services rendered by Contractor, and
interest earned on such funds in the possession of Contractor, shall be retained by Contractor provided
that such amounts are received on account a behavioral health service described in Exhibit 1 of this
Agreement and complies with the standards of the OHA.
12 . Withholding of Payments. Notwithstanding any other payment provIsion of this Agreement, should
Contractor fail to submit required reports required by Section 4(A) and Exhibits 1, 2 and 3 when due , or fail
to perform or document the performance of contracted services, County shall immediately withhold
payments under this Agreement until the required reports have been submitted by the Contractor.
13. Termination. All or part of this Agreement may be terminated by mutual consent of both parties, or by
either party at any time for convenience upon ninety (90) days notice in writing to the other party.
The County may also terminate all or part of this Agreement for any of the causes specified below:
A. With thirty (30) days written notice , if funding to the County from Federal, State, or other sources is not
obtained or is not continued at levels sufficient to allow for purchase of the indicated quantity of
services. The County will give more notice whenever possible .
B . With sixty (60) days written notice, if Federal or State regulations are modified or changed in such a
way that services are no longer allowable for purchase under this Agreement.
C . Upon notice of denial , revocation , or non-renewal of any letter of approval, license , or certificate
required by law or regulation to be held by the Contractor to provide a service element under this
Agreement.
D. With thirty (30) days written notice, if Contractor fails to provide services, or fails to meet any
performance standard as specified by the County in this Agreement (or subsequent modifications to
this Agreement) within the time specified herein, or any extensions thereof.
PAGE 5 OF 11 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2012-309
E . Upon written or oral notice, if County has evidence that the Contractor has endangered or is
endangering the health and safety of Individuals, residents, staff, or the public.
F. Failure of the Contractor to comply with the provisions of this Agreement or any applicable Federal ,
State and local laws and rules which may be cause for termination of this Agreement. The
circumstances under which this Agreement may be terminated by either party under this paragraph
may involve major or minor violations . Major violations include, but are not limited to :
1. Acts or omissions that jeopardize the health, safety, or security of Individuals.
2 . M isuse of funds.
3. Intentional falsification of records .
In the case a failure to perform jeopardizes the safety and security of any residents of the facil ities
covered under this Agreement , the Contractor, the County and the OHA shall jointly conduct an
investigation to determine whether an emergency exists and what corrective action will be
necessary. Such investigation shall be completed in accordance with OHA procedures and the
Agreement.
The Contractor may also terminate all or part of this Agreement for the cause specified below:
1) With (30) days written notice , if the "Part A U funding is not paid to Contractor as outlined in 7(B).
14 . Encumbrance or Expenditure After Notice of Termination. Contractor shall not make expend itures , enter
into contracts, or encumber funds in its possession that belong to the County , after notice of termination or
termination as set out above , without prior written approval from County .
15. Independent Contractor. Contractor is engaged hereby as an independent contractor, as defined in ORS
670 .600 and will be so deemed for purposes of the following:
A. Contractor will be solely responsible for payment of any Federal or State taxes required as a result of
this Agreement.
B. Contractor shall be solely responsible for and shall have control over the means, methods,
techniques, sequences and procedures of performing the work, and shall be solely responsible for
the errors and omissions of its employees, subcontractors and agents. For goods and services to be
provided under this Agreement, Contractor agrees to:
1) perform the work in a good, workmanlike, and timely manner;
2) comply with all applicable legal requirements;
3) take all precautions necessary to protect the safety of all persons at or near facilities , including
employees and patients of Contractor and County;
4) take full responsibility for wages and entitlements of Contractor's employees assigned to or
furnishing services at facilities.
C . It is agreed by and between the parties that Contractor is not carrying out a function on behalf of the
County , OHA or State of Oregon , and County, OHA and State of Oregon do not have the right of
direction or control of the manner in which Contractor delivers services under this Agreement or
exercise any control over the activities of the Contractor. Contractor is not an officer , employee or
agent of County as those terms are used in ORS 30.265.
D. County is not , by virtue of this Agreement, a partner or joint venturer with Contractor in connection with
activities carried on under this Agreement, and shall have no obligation with respect to Contractor's
debts or any other liabilities of each and every nature .
E . The Contractor is an independent contractor for purposes of the Oregon Workers' Compensation law
(ORS Chapter 656) and is solely liable for any Workers' Compensation coverage under this
Agreement.
16. Contractor and Subcontractors . Contractor agrees to make all provisions of this Agreement with the
County applicable to any subcontractor performing work under this Agreement. Contactors who perform
the work without the assistance of labor or any employee, as determined under ORS Chapter 656 and
rules adopted pursuant thereto , need not obtain Workers Compensation coverage.
PAGE 6 OF 11 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2012-309
17. Constraints.
A. The Provisions of ORS 279B.220, 279B.230, and 279B.235, are by this reference incorporated and
made a part of this Agreement:
1) Contractor shall pay employees for overtime work performed under this Agreement in accordance
and otherwise comply with applicable provisions of ORS 653.010 to 653.261 and the Fair Labor
Standards Act of 1938 ("FLSA") (29 U .S.C 201 et. seq .).
B. This Agreement is expressly subject to the debt limitation of Oregon counties set forth in Article XI,
Section 10, of the Oregon Constitution, and is contingent upon funds being appropriated therefore.
Any provisions herein, which would conflict with law, are deemed inoperative to that extent.
C. Contractor agrees that no person shall, on the grounds of race, color, creed, national origin, sex,
marital status, or age, suffer discrimination in the performance of this Agreement when employed by
Contractor. Unless exempted under the rules, regulations and relevant orders of the Secretary of
Labor, 41 CFR, Chapter 60, Contractor agrees to comply with (i) all provisions of Executive Order No.
11246, as amended by Executive Order No . 11375 of the President of the United States dated
September 24, 1965 as supplemented in Department of Labor regulations (41 CFR Part 60), (ii) Titles
VI and VII of the Civil Rights Act of 1964 as amended, (iii) Sections 503 and 504 of the Rehabilitation
Act of 1973 as amended and 45 CFR 84.4, which states, "No qualified person shall, on the basis of
handicap, be excluded from partiCipation in, be denied benefits of, or otherwise be subjected to
discrimination under any program or activity which receives or benefits from Federal financial
assistance" (iv) the Age Discrimination in Employment Act of 1974, as amended, and the Age
Discrimination Act of 1975, as amended (v) the Vietnam Era Veterans' Readjustment Assistance
Act of 1975, (vi) all applicable rules regulations and order of the Secretary of Labor concerning
equal opportunity in employment and the provisions of ORS Chapters 659 and 659A (vii) Title II of
the Americans with Disabilities Act of 1990 as amended (42 USC 12131 et. Seq.), ORS 30.670 to
30.685, and all regulations and administrative rules established pursuant to those laws in the
construction, remodeling, maintenance and operation of any structures and facilities, and in the
conduct of all programs, services and training associated with services delivered under the Agreement
(viii) all regulations and administrative rules established pursuant to the foregoing laws, (ix) all other
applicable requirements of federal civil rights and rehabilitation statutes, rules and regulations, and
(x) all federal laws governing operation of Community Mental Health Programs, including without
limitation, all federal laws requiring reporting of Individual abuse. These laws, regulations and
executive orders are incorporated by reference herein to the extent that they are applicable to the
Agreement and required by law to be so incorporated. No federal funds may be used to provide
Work in violation of 42 USC 14402.
D. If the limitation amount specified in this Agreement for Title XIX Clinic Services exceeds $100,000,
Contractor shall provide the State of Oregon with written assurance that Contractor will comply with all
applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 USC
1857 (h), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water
Act) including but not limited to Section 508 of the Clean Water Act (33 USC 1368) Executive Order
11738 and Environmental Protection Agency regulations (40 CFR Part 15) which prohibit the use
under non-exempt Federal contracts, grants or loans of facilities included on the EPA List of Violating
Facilities. Violations shall be reported to the OHA, HHS and the appropriate Regional Office of the
Environmental Protection Agency.
E. Contractor shall comply with Federal rules and statutes pertaining to the Addictions and Mental Health
(AMH) and Social Security (formerly Title XX) Block Grant(s); including the Public Health Services Act,
especially sections 1914 (b)(1-5), 1915 (c)(12), 1916 (b)(2) and Public Law 97-35 .
F. The individual signing on behalf of Contractor hereby certifies and swears under penalty of perjury that
she/he is authorized to act on behalf of Contractor .
G. The provisions of Deschutes County Code, Section 2.37.150 are incorporated herein by reference.
PAGE 7 OF 11 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2012-309
18. Partnership. County is not, by virtue of this Agreement, a partner or joint venturer with Contractor in
connection with activities carried out under this Agreement, and shall have no obligation with respect to
Contractor's debts or any other liabilities of each and every nature. Unless Contractor is a State of
Oregon governmental agency, Contractor agrees that it is an independent contractor and not an agent
of the State of Oregon, the Oregon Health Authority or County .
19. Hold Harmless.
a. To the fullest extent authorized by law Contractor shall defend (in the case of the state of
Oregon and the Oregon Health Authority, subject to ORS Chapter 180), save, hold harmless
and indemnify the County, the State of Oregon and the Oregon Health Authority their officers,
employees and agents from and against all claims, suits, actions, losses, damages, liabilities
costs and expenses of any nature resulting from or arising out of, or relating to the activities of
Contractor or its officers, employees, contractors, or agents under this Agreement, including
without limitation any claims that the work, the work product or any other tangible or intangible
items delivered to County by Contractor that may be the subject of protection under any state or
federal intellectual property law or doctrine, or the County's use thereof, infringes any patent,
copyright, trade secret, trademark, trade dress, mask work utility design or other proprietary
right of any third party.
b. Contractor shall have control of the defense and settlement of any claim that is subject to
subparagraph a of this paragraph; however neither Contractor nor any attorney engaged by
Contractor shall defend the claim in the name of Deschutes County or any department or
agency thereof, nor purport to act as legal representative of the County or any of its
departments or agencies without first receiving from the County's legal counsel, in a form and
manner determined appropriate by the County's legal counsel , authority to act as legal counsel
for the County, nor shall Contractor settle any claim on behalf of the Count without the approval
cif the County's legal counsel.
c. To the extent permitted by Article XI, Section 10, of the Oregon Constitution and the Oregon
Tort Claims Act, ORS 30.260 through 30.300, County shall defend, save, hold harmless and
indemnify Contractor and its officers, employees and agents from and against all claims, suits,
actions, losses, damages, liabilities costs and expenses of any nature resulting from or arising
out of , or relating to the activities of County or its officers, employees, contractors, or agents
under this Agreement.
20 . Insurance . Prior to the effective date of this Agreement, Contractor shall obtain , at Contractor's expense,
and maintain in effect all insurance requirements as specified in Exhibit 2.
21. Settlement of Disputes . Differences between a Contractor and County, or between contractors , will be
resolved when possible at appropriate management levels, followed by consultation between boards, if
necessary .
22. Financial Audit. Contractor shall provide a copy of its financial review or financial audit conducted by a
certified public accountant within ninety (90) days following the end of each fiscal year .
23 . Assignment. Contractor shall not assign this Agreement without the prior written consent of County.
24 . Renewal. This Agreement may be renewed, subject to the following conditions : (1) renewal will be based
on the County Annual Implementation Plan approved by the OHA , and (2) renewal is subject to the
availability of funding.
25 . Compliance with provisions, requirements of funding source and Federal and State laws, statutes , rules,
regulations, executive orders and policies. Debt Limitation . This Agreement is expressly subject to the
debt limitation of Oregon counties set forth in Article XI , Section 10, of the Oregon Constitution, and is
contingent upon funds being appropriated therefore.
A Any provisions herein, which would conflict with law, are deemed inoperative to that extent.
PAGE 8 OF 11 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2012-309
B. Contractor shall comply with all federal, state and local laws, regulations , executive orders and
ordinances applicable to the Agreement.
C. Without limiting the generality of the foregoing, Contractor expressly agrees to comply with the
following laws, regulations and executive orders to the extent they are applicable to the Agreement:
1) Titles VI and VII of the Civil Rights Act of 1964, as amended;
2) Sections 503 and 504 of the Rehabilitation Act of 1973, as amended ;
3) the Americans with Disabilities Act of 1990 , as amended and ORS 659A.112 through 659A.139;
4) Executive Order 11246 , as amended;
5) the Health Insurance Portability and Accountability Act of 1996;
6) the Age Discrimination in Employment Act of 1967 , as amended, and the Age Discrimination
Act of 1975, as amended ;
7) the Vietnam Era Veterans ' Readjustment Assistance Act of 1974, as amended ;
8) ORS Chapter 659A , as amended ;
9) all regulations and administrative rules established pursuant to the foregoing laws; and
10) all other applicable requirements of federal and state civil rights and rehabilitation statutes, rules
and regulations .
11) all federal law governing operation of Community Mental Health Programs, including without
limitation, all federal laws requiring reporting of Individual abuse . These laws, regulations and
executive orders are incorporated by reference herein to the extent that they are applicable to
the Agreement and required by law to be so incorporated. No federal funds may be used to
provide services in violation of 42 USC 14402.
12) Contractor shall comply with Executive Order 11246, entitled "Equal Employment Opportunity ,"
as amended by Executive Order 11375, and as supplemented in Department of Labor
regulations (41 CFR Part 60).
13) If Contract maximum compensation , including amendments, exceeds $100 ,000 then Contractor
shall comply with all applicable standards, orders, or requirements issued under Section 306 of
the Clean Air Act (42 U.S.C . 1857 (h)), the Federal Water Pollution Control Act as amended
(commonly known as the Clean Water Act) (33 U.s.C . 1251 to 1387), specifically including , but
not limited to Section 508 (33 U.s.C . 1368 ). Executive Order 11738, and Environmenta l
Protection Agency regulations (2 CFR Part 1532), which prohibit the use under non-exempt
Federal contracts , grants or loans of facilities included on the EPA List of Violating Facilities .
Violations shall be reported to the Oregon Health Authority, Human Services (HHS) and the
appropriate Regional Office of the Environmental Protection Agency .
14) Contractor shall comply with applicable mandatory standards and policies relating to energy
efficiency that are contained in the Oregon energy conservation plan issued in compliance with
the Energy Policy and Conservation Act (Pub . L. 94-163).
15) Contractor shall not knowingly and willfully make or cause to be made any false statement or
representation of a material fact in connection with the furnishing of items or Services for which
payments may be made by OHA.
16) Contractor may not use the funds paid under this Agreement for the following services:
a) To provide inpatient hospital services;
b) To make cash payments to intended recipients of health services;
c) To purchase or improve land, to purchase, construct or permanently improve (other than
minor remodeling) any building or other facility or to purchase major medical equipment ;
d) To satisfy any requirement for expenditure of non-federal funds as a condition for receipt of
federal funds (whether the federal funds are received under this Agreement or otherwise);
e) With respect to Substance Abuse Prevention and Treatment Block Grant moneys only, to
purchase services from any person or entity other than a public or non -profit entity ; or
f) To carry out any program prohibited by section 245(b) of the Health Onmibus Programs
Extension Act of 1988 (codified at 42 USC 300ee(E).
17) Contractor may expend funds paid to Contractor under this Agreement only in accordance with
federal OMB Circular A-87 as that circular is applicable to allowable costs .
18) To the extent Contractor provides any service whose costs are paid in whole or in part by
Medicaid, Contractor shall comply with the federal and state Medicaid statutes and regulations
applicable to the service, including but not limited to:
PAGE 9 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
1. Keep such records as may be necessary to disclose the extent of services furnished to
Individuals and, upon request , furnish such records or other information to the OHA, the
Medicaid fraud section of the Oregon Department of Justice and the Secretary of Health and
Human Services ;
2. Comply with all appl icable disclosure requirements set forth in 42 CFR Part 455 , Subpart B;
3. Comply with any applicable advance directive requirements specified in 42 CFR Sect ion
431 .107(b)(4); and
4. Comply with the certification requirements of 42 CFR Sections 455 .18 and 455.19.
19) Contractor shall comply with the Pro-Children Act of 1995 (codified at 20 USC Section 6081 et.
seq .).
26 . Additional Federal Law Compliance Requirements.
A. Contractor shall comply with all applicable federal, state and local laws, administrative rules,
ordinances and regulations.
B. Prohibitions Against Lobbying .
1. Contractor, or any person, firm or corporation acting on behalf of Contractor, certifies that no funds
paid under this Agreement will be used to influence or attempt to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or any 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.
27 . Reductions in Agreement Funding.
A. Any funds spent by Contractor for purposes not authorized by this Agreement shall either be paid
directly by the Contractor to the County or, if not so paid, at the discretion of County, shall be applied
to future payments from County to the Contractor. Payments by County in excess of authorized
amounts that have not been repaid by the Contractor within thirty (30) days after the Agreement's
expiration or after notification by the County, whichever date is earlier, shall be deducted from future
payments from County to the Contractor or may justify termination of the Agreement.
B. In the event that a statutorily required operating license or letter of approval is not extended or is
suspended , County's obligation to provide reimbursement for services or program expenses
hereunder will cease on the date of termination of this Agreement (whether in whole or in part) or the
date of expiration or suspension of the license or letter of approval, whichever date is earlier.
28 . Attorney Fees . In the event an action , suit or proceeding , including appeal there from, is brought for
breach of any of the terms of this Agreement, or for any controversy arising out of this Agreement, each
party shall be responsible for its own attorney's fees , expenses, costs and disbursements for said action,
suit, proceeding or appeal.
29 . Entire Agreement. This Agreement constitutes the entire Agreement between the parties on the subject
matter hereof. There are no understandings, Contracts , or representations, oral or written, not specified
herein regarding this Agreement.
30. Survival. The provisions of paragraphs 3 to 12, 17 to 20 , 22 to 27 , shall survive the termination or
expiration of this Agreement.
PAGE 10 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
L , VP and CFO
j\
DATED this __ day of _______. 2012
COUNTY: Deschutes County Health Services
BOARD OF COUNTY COMMISSIONERS
OF DESCHUTES COUNTY, OREGON
ANTHONY DEBONE, Chair
ALAN UNGER, Vice Chair
ATTEST :
Recording Secretary TAMMY BANEY, Commissioner
CONTRACTOR: T elecare Corporation
~r·
PAGE 11 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
EXHIBIT 1
DESCHUTES COUNTY SERVICES AGREEMENT
STATEMENT OF WORK, COMPENSATION
PAYMENT TERMS AND SCHEDULE
Definitions:
Adult Mental Health Initiative (AMHI): AMHI is a system reform project initiated by the
Oregon Health Authority. The purpose of the initiative is to improve the system of
community-based long term care and residential services for people who have been in the
Oregon State Hospital. The proposal is to shift resources and authority from the State of
Oregon to Mental Health Organizations and counties for the referral and management of
individuals placed in state hospital and residential facilities. This would only include people
involved in or at risk of the civil commitment process.
Division of Medical Assistance Programs (DMAP): An office of the Oregon Health
Authority responsible for coordinating Medical Assistance Programs, including the OHP
Medicaid Demonstration and the Children's Health Insurance Program (CHIP). DMAP
writes and administers the state Medicaid rules for medical services, contracts with
providers, maintains records of Individual eligibility and processes and pays DMAP
providers.
Extended Care Services: Non-OHP Medicaid rehabilitative services that are reimbursed
on a fee for service basis. These services are billed with the use of specially designated
Non-Oregon Health Plan (OHP) Medicaid Extended Care Services billing codes. Use of
these codes requires prior authorization by the County and Central Oregon Health Board.
Psychiatric Security Review Board (PSRB): The Psychiatric Security Review Board has
jurisdiction over persons in Oregon found to be "guilty except for insanity" of a crime. The
board's jurisdiction is equal to the maximum sentence provided by statute for the crime for
which the person was found "guilty except for insanity." The board's primary purpose is to
protect the public through the on-going review of the progress of those placed under its
jurisdiction and a determination of their appropriate placement. The board has the authority
to: commit a person to a state hospital designated by the Oregon Health Authority ;
conditionally release a person from a state hospital to a community-based program with
close monitoring and supervision; discharge a person from its jurisdiction; and, when
appropriate, revoke the conditional release of a person under its jurisdiction and order the
person's return to a state hospital pending a full hearing before the board.
Part A Funds: These funds are dispersed directly to Deschutes County by State of Oregon
through Intergovernmental Agreement for Financing of Community Mental Health Services.
Part B Funds: These funds are awarded to Deschutes County by State of Oregon through
Intergovernmental Agreement for Financing of Community Mental Health Services as a
limitation amount only. Funds are not dispersed directly to Deschutes County. The OHA's
Division of Medical Assistance Programs (DMAP) disburses the award up to the limitation
amount directly to the service provider on a fee-for-service basis.
Personal Care Services: Services delivered in Residential Treatment Homes or Facility
that include but are not limited to the following: crisis stabilization, money and household
management, supervision of daily living activities, provision of care for safety and well-
PAGE 1 OF 4 -EXHIBIT 1 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
being, administration and supervision of medication, provision and arrangement of routine
transportation , behavior management, management of diet and physical health problems .
Residential Treatment Services: For the purposes of this Agreement, Residential
Treatment Services are behavioral health services delivered on a 24-hour basis to
individuals eighteen (18) years of age or older with mental or emotional disorders who have
been hospitalized, who are at immediate risk of hospitalization, who need continuing
services to avoid hospitalization or who are a danger to themselves or others or who
otherwise require continuing care to remain in the community . Residential Treatment
Services includes services delivered to individuals who the County, in conjunction with the
OHA has determined are unable to live independently without supervised intervention ,
training or support and are eligible for MHS 28 Services funded through this Agreement.
Services will also be subject to the Specialized Service Requirement of MHS 28A that
services be delivered in a Secure Residential Treatment Facility.
1. Contractor shall perform the following work:
Service 1: Secure Residential Treatment Facility (SRTF):
The purpose of SRTF services is to stabilize resident's psychiatric symptoms , improve independent living
skills, and then discharge the resident into an appropriate and safe level of community services of less
intensity as clinically appropriate.
A. Contractor shall provide 24 -hour SRTF services to up to sixteen (16) residents . Contractor shall provide
SRTF services described in the attached Service Description titled "Residential Treatment Services ,
Service 10 code MHS 28 , and "Secure Residential Treatment Facility", Services 10 Code MHS 28A ,
Exhibit 1A and in accordance with OAR 309-035-0100 through 309-035-0190 , in the Facility .
1. Services shall also include:
a. Non-Residential Adult Mental Health Services , Service 10 Code MHS 20 , Exhibit 1 B;
b. Non-Residential Adult Mental Health Services (Designated), Service 10 Code MHS 201 ,
Exhibit 1-0;
c . Medicaid reimbursable service billings in accordance with the OHA Medicaid General
Provider Rules 410-120-0000 through and 410-120-1940; OHA Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health
Services Rule as listed in OAR 309-016-0600 through 309-016-0650 ; and Integrated
Services and Supports Rule 309-032-1500 through 309-032-1565 .
2 . Contractor must enroll all Individuals served in Oregon State's Client Process Monitoring System
(CPMS) database within 24 hours of admission and disenroll within 24 hours of discharge .
3. Residential Screening Process : The Contractor must jointly participate with the County in a
screening process for all potential admissions to a SRTF facility. Contractor understands that the
County must also approve any Individual admitted to the facility .
4. For residents under the jurisdiction of the Psychiatric Security Review Board : Contractor shall follow
all services and requirements as outlined in the resident's Conditional Release Order . Contractor
shall inform the County immediately via phone of a resident's failure to follow any Conditional
Release requirement, of any significant change in the resident's status or symptoms , or of any
situation in the opinion of the Contractor which impacts the resident's ability to maintain community
placement within the Facility in accordance with Conditional Release orders .
B. The Contractor must ensure the following at the Facility where SRTF services are provided :
1. Currently have in place and maintain throughout the life of this Agreement , licensing as a
Secure Residential T reatment Facility as defined in OAR 309-035-0100 through 309-035-0190 .
2 . Contractor must obtain and maintain any other licenses and/or certifications as necessary or
required by law or administrative rule for a provider of SRTF services and as an operator of the
facility. This will include Contractor maintaining approval from County and OHA under OAR 309
012-0130 through 309-012-220, "Certificates of Approval for Mental Health Services ".
3. Contractor agrees to provide only those outpatient behavioral health services that are required
for Contractor's role as a residential treatment provider. Contractor agrees to not utilize this
certification to establish or provide any other outpatient services within Deschutes County
unless expressly approved by County under separate agreement.
C . Contractor shall provide SRTF services to Individuals who meet the following criteria :
PAGE 2 OF 4 -EXHIBIT 1 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
2. Be 18 years or older; and
3. Be referred through AMHI process OR through Psychiatric Security Review Board; and
4 . Be approved by County in collaboration with Contractor, the program treating referral hospital,
responsible Community Mental Health Program (CMHP) and/or the Mental Health Organization
(if enrolled) responsible for the Individual.; and
5. Have an Axis I Diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders
and
6. Be currently approved for payment through AMHI or PSRB.
2. County Services. County shall provide Contractor, at County's expense, with material and services
described as follows:
1. County will maintain primary responsibility for screening and approval of admissions to the
residential treatment Facility and will provide Residential Specialist staff and/or PSRB
Coordinator to participate in this process. Screenings will be conducted in coordination with
Contractor's SRTF staff, however, any resident accepted for admission to the facility must also
be approved by the County for placement. Residential Specialist staff and PSRB Coordinator
staff will also provide regular outreach and coordination with Contractor's SRTF staff.
2 . County will maintain primary responsibility for PSRB monitoring and reporting in accordance
with OAR 309-032-1540 (4).
3. County agrees to provide a letter of support to Contractor as part of certification application
outlined in 1 (B)(2) for Contractor to operate as an Outpatient Mental Health Provider within
Deschutes County and to provide the required monitoring and oversight in coordination with
Addictions and Mental Health Division.
3. Consideration. Subject to availability of funds, Contractor will receive payment for providing the services
described in Exhibit 1, Paragraph 1.
A Contractor shall bill DMAP in accordance with procedures and forms prescribed by OHA for all services
funded under Part B dollars. Contractor agrees that payment for these services shall be DMAP's
responsibility and not County's responsibility. Contractor shall not invoice or expect payment from
County for services billed to DMAP under this subsection.
i) All Extended Care Services reimbursable service billings shall be in accordance with the OHA
Medicaid General Provider Rules 410-120-0000 through and 410-120-1940 and MHS Mental Health
and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0600 through 309-016-0685.
ii) Contractor shall bill all Personal Care Services in accordance with forms and procedures prescribed
byOHA
iii) Contractor agrees to complete, monitor and obtain all prior authorizations as needed for Extended
Care Service and Personal Care Service billing submissions.
B. County agrees to pay to Contractor, all "Part A" funds received by County which are allocated by OHA
for services provided by Contractor as described in this Exhibit.
i) Contractor agrees to invoice County on a monthly basis for Part A payments that are approved by
the OHA as part of Contractor's budget and paid to the County by amendment to State Contract
#134309. County agrees to make approved payments to Contractor within 30 days of receipt of
invoice and receipt of funds from the OHA
ii) Contractor agrees to complete and submit all documentation of expenditures for all Part A funds as
required by OHA and the County and to comply with all requirements of the Service Description in
which funding is allocated.
C. Funding for operation of the Facility will be in accordance with a budget submitted by Contractor to OHA
and County and approved by OHA and County.
D. Contractor shall be entitled to reimbursement for travel expenses 0 YES [g] NO [Check one]
4. The maximum compensation.
a. The maximum, not to exceed consideration under this Agreement, which includes any allowable
expenses, shall be $2,520,000 . Contractor shall receive up to the total maximum amount for any
allowable expenses allocated by OHA for Contractor services to the County under State Contract
#134309. All funds allocated to County as "Part B" payments will be paid directly to the Contractor by
DMAP on the County's behalf. All funds allocated to County for services provided by the Contractor as
PAGE 3 OF 4 -EXHIBIT 1 -PERSONAL SERVICES CONTRACT No. 2012-309
"Part A" payments, will be paid to the Contractor directly by the County. All funds will be paid in
accordance with a budget that is approved by OHA.
b. All funds awarded to Contractor under this Agreement are subject to OHA monitoring and adjustment.
All adjustments in funds awarded will be made by amendment to the State Contract #134309. OHA will
monitor and adjust funds awarded throughout the term of this Agreement at OHA discretion.
c. Contractor may also receive funding for Start-up Special Projects as outlined in Service 10 Code MHS
37, Exhibit 1-C. Contractor is responsible for expenditure of MHS 37 funds in accordance with budget
approved by the OHA and for completion and submission of all required documentation of fund
expenditures to County and OHA.
d. Recovery of Overpayment: All payments made to Contractor under this Agreement are subject to
recovery by OHA and/or the County in accordance with OAR 410-120-1397 Recovery of Overpayments
to Providers --Recoupments and Refunds and Service Element Descriptions for MHS 28, MHS 28A,
MHS 20, MHS 201 and MHS 37 funds:
i. If a federal audit of the work rendered by Contractor under this Agreement results in a
refund to or disallowance by the federal government of funds paid to Contractor under this
Agreement, OHA and/or County may recover from Contractor the amount of the refund or
disallowance and any applicable OHA matching funds.
ii . If Contractor expends funds paid to Contractor under this Agreement for purposes not
authorized by this Agreement, OHA and/or County may recover the amount of the
unauthorized expenditure from Contractor.
iii. If billings under this Agreement result in payments to Contractor to which Contractor is not
entitled , OHA and/or County, after giving written notification to Contractor, may withhold
from payments due to Contractor such amounts, over such periods of time as are
necessary to recover the amount of overpayment.
5. Schedule of Performance or Delivery.
a. County's obligation to pay depends upon Contractor's delivery or performance in accordance with the
schedule listed in Exhibit 1, Paragraph 1.
b. County will only pay for completed work that conforms to the terms of the Agreement.
6. Renewal. This Agreement may be renewed as outlined in Section 8 of this Agreement and subject to the
following conditions:
a. Renewal will be based on the County Annual Implementation Plan approved by the OHA.
b . Renewal is subject to the availability of funding.
7. Modification of Exhibit 1-A through 1-0, State Requirements for Behavioral Health Subcontract
In the event the State of Oregon modifies the terms of SE 28, 20, 37 or 201, it is understood and agreed
that this Agreement will also be deemed revised accordingly without further action of the parties .
Authority to change this Exhibit to comply fully with Deschutes County's State Contract #134309 shall
rest with the Director of Telecare Corporation and the Deschutes County Health Services Director. Both
parties must agree for the Exhibit to be modified .
PAGE 4 OF 4 -EXHIBIT 1 -PERSONAL SERVICES CONTRACT No. 2012-309
EXHIBIT 1-A
Service Name: RESIDENTIAL TREATMENT SERVICES
Service ID Code: MHS 28
I. Service Description
Residential Treatment Services (MHS 28) are:
A. Services delivered on a 24-hour basis to individuals 18 years of age or older with mental or emotional
disorders who have been hospitalized or are at immediate risk of hospitalization, who need continuing
services to avoid hospitalization or who are a danger to themselves or others or who otherwise require
continuing care to remain in the community; and
B. Services delivered to individuals who the County, in conjunction with the Oregon Health Authority (OHA)
determines are unable to live independently without supervised intervention, training or support are
eligible for MHS 28 Services funded through this Agreement.
The specific MHS 28 Services delivered to an individual are determined based upon an individualized
assessment of treatment needs and development of plan of care that are intended to promote the well being,
health and recovery of the individual through the availability of a wide-range of residential service options.
MHS 28 Services delivered in Residential Treatment Facilities (as defined in OAR 309-035-0100 through 309
035-0190) (RTF) or Residential Treatment Homes (as defined in OAR 309-035-0250 through 309-035-0460)
(RTH), or another licensed setting approved by OHA include, but are not limited to, the following:
A. Crisis stabilization services, such as accessing psychiatric, medical, or qualified professional
intervention to protect the health and safety of the individual and others;
B. Timely, appropriate access to crisis intervention to prevent or reduce acute, emotional distress, which
might necessitate psychiatric hospitalization;
C. Management of personal money and expenses;
D . Supervision of daily living activities and life skills such as training with nutritional wellness, personal
hygiene, clothing care and grooming, communication with social skills, health care, household
management and using community resources;
E. Provision of care including assumption of a responsibility for the safety and well-being of the individual;
F. Administration and supervision of prescribed and non-prescribed medication;
G. Provision or arrangement of routine and emergency transportation;
H. Management of aggressive or self-destructive behavior;
I. Management of a diet, prescribed by a physician, requiring extra effort or expense in preparation of
food; and
J. Management of physical or health problems, including, but not limited to, seizures or incontinency .
Financial assistance is dependent upon an individual meeting defined criteria, established by the Oregon Health
Authority (OHA) and posted on the OHA, Addictions and Mental Health (AMH) website . OHA and its designees
have the authority to review Clinical records and have direct contact with individuals. The County and any
providers must notify individuals in writing within five state business days of a determination on admission, as
defined by OHA policy, posted on the OHA AMH website.
PAGE 1 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT CONTRACT No. 2012-309
II. Performance Requirements
A provider of MHS 28 services shall give first priority in admission to referrals from individuals transitioning from
the State Hospitals, and referrals of individuals on the State Hospital wait list. A Provider of MHS 28 Services
funded through this Agreement must deliver the Services in a facility licensed as a Residential Treatment
Facility or Secured Residential Treatment Facility under OAR 309-035-0100 through 309-035-0190 or as a
Residential Treatment Home under OAR 309-035-0250 through 309-035-0460, as such rules may be revised
from time to time.
III. Special Reporting Requirements
County must complete and deliver to OHA the form as prescribed by OHA for any individual receiving MHS 28
Services funded through this Agreement when the individual is transferred to another residence or facility
operated by the Provider, the individual is transferred to another Provider of MHS 28 Services, MHS 28 Services
to the individual end or the payment rate for the individual changes. An individual's payment rate may only be
changed after consultation with and approval by OHA and only if the MHS 28 Services for that individual are
funded from the Residential Limitation (as defined below).
If County has authorized or anticipates authorizing delivery of MHS 28 Services to an individual and wishes to
reserve NlHS 28 service capacity for that individual for a short period of time when the individual is not actually
receiving the services, County must submit a written Reserved Service Capacity Payment (RSCP) Request and
Contract Amendment Request to OHA under OAR 309-011-0105 through 309-011-0115 . If OHA approves the
RSCP and Contract Amendment Request, OHA and County shall execute an amendment to the State Contract
#134309 to reduce Residential Limitation, Part B, and add funds necessary to make the approved payments to
reserve the service capacity to the Part A Award . OHA shall have no obligation to make the payments unless
and until the State Contract #134309 has been so amended. All individuals receiving MHS 28 Services with
funds provided under this Agreement must be enrolled in the Client Process Monitoring System (CPMS)
database within 24 hours of admission and disenrolled within 24 hours of discharge, and the individual'S CPMS
record for MHS 28 Services must be maintained, as specified in OHA's CPMS manual located at:
http://www.oregon.gov/OHAImentalhealth/publications/cpmsmanual_mh .pdf?ga=t, and as it may be revised
from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 28 Services in two different ways. Certain funds (the "Part A Award")
are calculated, disbursed and settled as set forth in Section IV (A) below. The Part A Award is set forth in the
State Contract #134309 on MHS 28 lines that contain an "A" in column one. Other funds (the "Residential
Limitation") are not calculated, disbursed or settled under this Agreement. These funds are set forth in the State
Contract #134309 on MHS 28 lines that contain a "B" in column one and are paid as described in Section IV (B)
below.
Part B Limitation : The provider of the service needs to be enrolled as a Medicaid Provider and follow the
procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA
calculates the rates and the claims are processed through OHA' Medicaid Management Information System
(MMIS). OHA calculates the Part B limitation and OHA' Division of Medical Assistance Programs (DMAP)
disburses the payment directly to service providers on a fee-for-service basis . OHA sets procedures and rates
for the Limitation. Rates are available on the OHA website located at
http://egov.oregon.gov/O HAimentalhealth/publications/codebooks/m hO 1 09rates. pdf.
OHA will provide notice to County in timely manner if there is a change in rates. All Medicaid reimbursable
service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services
Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309
016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on
the OHA website located at http://www.oregon.gov/OHAImentalhealth/publications/codebooks/manual.pdf.
A The Part A Award will be calculated, disbursed and settled as follows:
1. Calculation of Financial Assistance . OHA will provide financial assistance for MHS 28 Services
identified in a particular line of the State Contract #134309 with an "A" in column one from funds
identified on that line in an amount equal to the rate set forth in the special condition identified in
PAGE 2 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
that line of the State Contract #134309, multiplied by the number of units of MHS 28 Services
delivered under that line of the State Contract # 134309 during the period specified in that line ,
subject to the following:
i. Total OHA payment for MHS 28 Services delivered under a particular line in the State Contract
#134309 containing an "A" in column one shall not exceed the total funds awarded for MHS 28
Services as specified in that line of the State Contract #134309;
ii. OHA is not obligated to provide financial assistance for any MHS 28 Services that are not
properly reported in CPMS by the date 60 days after the earlier of termination or expiration of
this Agreement, termination of OHA' obligation to provide financial assistance for MHS 28
Services, or termination of County 's obligation to include the Program Area, in wh ich rvlHS 28
Services fall , in its Community Mental Health Program (CMHP); and
iii. OHA will reduce the financial assistance for MHS 28 Services delivered under a particular line
of the State Contract #134309 containing an "A" in column one by the amount received by a
Provider of MHS 28 services , as payment of a portion of the cost of the services from an
individual receiving such services .
2 . Disbursement of Financial Assistance. Unless a different disbursement method is specified in that
line of the State Contract #134309, OHA will disburse funds awarded for MHS 28 Services identified
in a particular line of the State Contract #134309 with an "A" in column one , to County in
substantially equal monthly allotments during the period specified in that line of the State Contract
#134309, subject to the following :
i. OHA may, after 30 days (unless parties agreed otherwise) written notice to County, reduce the
monthly allotments based on under used allotments identified in CPMS or through other reports
requ ired or permitted by this Service Description or applicable Special Terms and Conditions.
ii . OHA may, upon written request of County, adjust monthly allotments.
iii . Upon amendment to the State Contract #134309, OHA shall adjust monthly allotments as
necessary, to reflect changes in the funds awarded for MHS 28 Services on that line of the
State Contract #134309 .
3. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have
occurred during the term of this Agreement between actual OHA disbursements of funds awarded
for MHS 28 Services under a particular line of the State Contract #134309 containing an "A" in
column one and amounts due for such services provided by County based on the rate set forth in
the special condition identified in that line of the State Contract #134309 . For purposes of this
section , amounts due to County is determined by the actual amount of services delivered under that
line of the State Contract #134309 during the period specified in that line of the State Contract
#134309, as properly reported in CPMS or through other method required or permitted by this
Service Description or an applicable Specialized Service Requirement. The settlement process will
not apply to funds awarded for an approved Reserved Service Capacity Payment.
B. Residential Limitation . The Residential Limitation, Part B is disbursed by OHA directly to service
providers based on monthly rates authorized by County after consultation with OHA, subject to the
following :
1. All payment rates authorized by County under this Section IV (B) for delivery of MHS 28 Services
must meet the following requirements :
i. The rates must be reasonable under the facts and circumstances in existence at the time each
rate is set, including but not limited to the state of the market for MHS 28 Serv ices in the
geographic area in which the services will be delivered and the needs of the particular individual
receiving services.
2. County shall not authorize, in aggregate under this Section IV (B), financial assistance for MHS 28
Services in excess of the Residential Limitation . Total aggregate financial assistance means the
PAGE 3 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT CONTRACT No. 2012-309
total of all financial assistance authorized before reducing payments to account for client resources
received by the provider from an client, or another on behalf of the client, in support of client care
and services provided;
3. The monthly rate will be prorated for any month in which the individual is not served for a portion of
the month;
4. Financial assistance will be reduced (offset) by the amount of client resources received by the
provider from the client or client's health insurance in support of client care and services provided;
5. The Residential Limitation is included in this Agreement. If OHA anticipates that payments for MHS
28 Services authorized by County under this Section IV (B) will exceed the amount of the
Residential Limitation, OHA may unilaterally reduce the award of funds, as set forth in the State
Contract #134309, for any other IVlHS Service or Services to the extent of the State of Oregon's
general fund portion of the anticipated Residential Limitation shortfall. OHA and County shall
execute an appropriate amendment to the State Contract #134309 to reflect the reduction of the
Part A Award and the increase in the Residential Limitation; and
6. OHA is not obligated to provide financial assistance for any MHS 28 Services that are not properly
reported through CPMS by the date 60 days after the earlier of termination or expiration of this
Agreement, termination of OHA' obligation to provide financial assistance for MHS 28 Services or
termination of County's obligation to include the Program Area, in which MHS 28 Services fall, in its
CMHP.
PAGE 4 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
EXHIBIT 1-B
Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR ADULTS (GENERAL)
Service 10 Code: MHS 20
I. Service Description
Non-Residential Mental Health Services For Adults (General) (MHS 20) are mental health services delivered to
persons diagnosed with serious mental health illness, or other mental or emotional disturbance posing a danger
to the health and safety of themselves or others. Non-Residential Mental Health Services for Adults (General)
shall include one or more of the following :
A. Case management services;
B. Vocational and social services;
C. Rehabilitation;
D. Support to obtain and maintain housing;
E. Medication and medication monitoring;
F. Emotional support;
G. Individual, family and group counseling and therapy;
H. Sex offender treatment; and
I. Interpreter services
II. Performance Requirements
Providers of MHS 20 shall provide coordination of care services for county of responsibility residents in
residential treatment programs , which include extended care managed services, regardless of the location. The
coordination of care shall include participation in the residential provider's treatment planning process and in
planning for the individual's transition to outpatient services.
Providers of MHS 20 Services funded through this Agreement must:
A. Comply with OAR 309-032-1500 through 309-032-1565 , as such rules may be revised from time to time;
B. Maintain a Certificate of Approval, for the delivery of clinical services, in accordance with OAR 309-012
0130 through OAR 309-012-0220, as such rules may be revised from time to time; and
C. Investigate and report allegations of abuse regarding served individuals and provide protective services
to those individuals to prevent further abuse. The investigation, reporting and protective services must
be completed in compliance with ORS 430.735 through 430 .765 and OAR 407-045-0000 through 407
045-0980 , as such statutes and rules may be revised from time to time .
III. Special Reporting Requirements
Providers of MHS 20 Services funded through this Agreement must:
A. Submit information and data on abuse reports, investigations and protective services involving
individuals to whom the Provider provides MHS 20 Services , as such information and data is reasonably
requested by the Oregon Health Authority (OHA) in order to fully understand allegations and reports of
abuse, the resulting investigations and protective services and any corrective actions.
B. All individuals receiving MHS 20 Services with funds provided under this Agreement must be enrolled in
the Client Process Monitoring System (CPMS), and the individual's CPMS record for MHS 20 Services
must be maintained, as specified in OHA's CPMS manual located at:
http://www.oregon.gov/OHAfmentalhealth/publications/cpmsmanual_mh .pdf?ga=t, and as it may be
revised from time to time .
PAGE 1 OF 3 -EXHIBIT 1-B -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
IV. Financial Assistance Calculation, Disbursement & Settlement Procedures
OHA provides financial assistance for MHS 20 Services in two different ways , through Part A and Part B
("Limitation ") Awards. The Award is set in the State Contract #134309 on MHS 20 lines in column one (1) that
contain an "A" for Part A or "B " for Part B Award . The Part B award is not calculated, disbursed or settled under
this Agreement, but is included for budgetary purposes. The provider of the service needs to be enrolled as a
Medicaid Provider and follow the procedures for billing the OHA for Medicaid mental health services outlined in
the Chemical Dependency Medicaid Provider Manual. OHA calculates the rates and the claims are processed
through the OHA's Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and
OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on a
fee-for-service basis . Rates are available on the OHA website located at
http://egov.oregon.gov/OHNmentalh ealth/pu blications/codebooks/m h01 09rates . pdf.
OHA will provide notice to Contractor in timely manner if there is a change in rates. All Medicaid reimbursable
service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services
Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309
016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on
the OHA website located at http://www .oregon.gov/OHNmentalhealth/publications/codebooks/manuaLpdf.
The Part A Award financial assistance will be calculated, disbursed and settled as follows :
A Calculation of Financ ial Assistance : The Part A Award for MHS 20 Services is intended to be general
financial assistance to County for MHS 20 Services . Accordingly, OHA will not track delivery of MHS 20
Services or service capacity on a per unit bas is so long as County offers and delivers MHS 20 Services
as part of its CMHP.
1. Total OHA financial assistance for MHS 20 Services under a particular line of the State Contract
#134309 shall not exceed the total funds awarded for MHS 20 Services as specified on that line .
2 . OHA is not obligated to prov ide financial assistance for any MHS 20 Services delivered to
individuals that are not properly reported in CPMS (or through other methods permitted or required
by this Service Description or an applicable Specialized Service Requirement) by the date sixty (60)
days after the earlier of termination of this Agreement, termination of OHA's obligation to provide
financial assistance for MHS 20 Services , or termination of County's obligation to include the
Program Area , in which MHS 20 Services fall , in its CMHP .
B. Disbursement of financial assistance : Unless a different disbursement method is specified in that line of
the State Contract #134309 , OHA will disburse the Part A Award for MHS 20 Services identified in a
particular line of the State Contract #134309 to County in substantially equal monthly allotments during
the period specified in that line of the State Contract #134309, subject to the following :
1. OHA may, upon written request of County, adjust monthly allotments .
2 . Upon amendment to the State Contract #134309 , OHA shall adjust monthly allotments as
necessary , to reflect changes in the funds awarded for MHS 20 Services on that line of the State
Contract #134309.
3. OHA may reduce the monthly allocation when the county is identified by the Addictions and Mental
Health Division (AMH) as the County of Responsibility of a patient at the State Hospital and the
patient exceeds the length of stay authorized by OHA by more than 30 days. The reduction of the
month ly allocation will be based on the follow ing table:
PAGE 2 OF 3 -EXHIBIT 1-B -DES CHUTES COUNTY SERVICES AGREEMENT No. 2012-309
Days Beyond Authorization Percentage of State Hospital Cost of
Care
0-30 0%
31 -60 25%
61 -90 50%
91 -120 75%
121 and over 100%
State Hospital Cost of Care will be the cost of care identified in the current Institutional Cost of Care
Rates Report published by the OHA Institutional Revenue Section C. Agreement Settlement:
Agreement Settlement will be used to confirm the offer and delivery of MHS 20 Services by County as
part of its CMHP, based on data properly reported in CPMS or through other reports required or
permitted by this Service Description or an applicable Specialized Service Requirement.
PAGE 3 OF 3 -EXHIBIT 1-B -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
EXHIBIT 1-C
Service Name : MHS SPECIAL PROJECTS
Service I D Code : MHS 37
I. Service Description
MHS Special Projects (MHS 37) are mental health services within the scope of ORS 430.630 delivered on a
demonstration or emergency basis for a specified period of time . Each project is described in a separate exhibit
to this MHS 37 Service Description. When the State Contract #134309 contains a line awarding funds for MHS
37 Services , that line will contain a special condition specifying the exhibit to this MHS 37 Service description
that describes the project for which the funds are awarded.
The specific MHS 37 Services to be provided under this Agreement are described in exhibits , if any, to this MHS
37 Service Description, which exhibits are incorporated herein by this reference.
II. Performance Requirements
Providers of MHS 37 Services funded through this Agreement with Medicaid dollars must comply with OAR 309
016-0000 through 309-016-0755 . See exhibits, if any, to this MHS 37 Service Description .
III. Special Reporting Requirements
See exhibits, if any, to this MHS 37 Service Description.
IV. Payment Procedures
See exhibits, if any, to this MHS 37 Service Description .
Even if the State Contract #134309 awards funds for NlHS 37 Services , the Oregon Health Authority (OHA) shall
have no obligation to provide financial assistance for any MHS 37 Services under this Agreement (even if funds
therefore are disbursed to County) unless a special project description is attached to this Service Description as
an exhibit.
PAGE 1 OF 1 -EXHIBIT 1-C -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
EXHIBIT 1-0
Service Name : NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR ADULTS (DESIGNATED)
Service 10 Code: MHS 201
I. Service Description
Non-Residential Mental Health Services For Adults (Designated) (MHS 201) are mental health services
delivered to individuals specified in the State Contract #134309 who have a serious mental illness , or other
mental or emotional disturbance posing a danger to the health and safety of themselves or others .
Non-Residential Mental Health Services For Adults (Designated) include :
A. Case management services;
B. Vocational and social services ;
C. Rehabilitation;
D. Support to obtain and maintain housing;
E. Medication and medication monitoring ;
F. Emotional support;
G . Individual, family and group counseling and therapy ;
H . Sex offender treatment; and
I. Interpreter services .
II. Performance Requirements
Providers of MHS 201 Services shall provide coordination of care services for county of responsibility residents
in residential treatment programs, which include extended care managed services , regardless of the location .
The coordination of care shall include participation in the residential provider's treatment planning process and
in planning for the individual's transition to outpatient services. Services funded through this Agreement for any
resident will be time limited and subject to review and revision by OHA.
Providers of MHS 201 Services funded through this Agreement must:
A. Comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time;
B . Maintain a Certificate of Approval, for the delivery of clinical services, in accordance with OAR 309-012
0130 through OAR 309-012-0220 , as such rules may be revised from time to time; and
C . Investigate and report allegations of abuse regarding served individuals and provide protective services
to those individuals to prevent further abuse. The investigation , reporting and protective services must
be completed in compliance with ORS 430.731 through 430 .768 and OAR 407-045-0000 through 407
045-0980, as such statutes and rules may be revised from time to time.
III. Special Reporting Requirements
A. County shall provide the Oregon Health Authority (OHA) with a summary report of MHS 201 Services
delivered with funds provided under this Agreement within 45 days after the end of the 12-month period
ending June 30 , during the term of this Agreement, and after the termination of this Agreement.
Submit reports to:
Oregon Health Authority
Add ictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N .E. E86
Salem, OR 97301-1118
PAGE 1 OF 3 -EXHIBIT 1-0 -DESCHUTES COUNTY SERVICES AGREEMENT No . 2012-309
Reports must be prepared using forms and procedures prescribed by OHA.
B. Submit information and data on abuse reports, investigations and protective services involving
individuals to whom the Provider provides MHS 201 Services, as such information and data is
reasonably requested by OHA in order to fully understand allegations and reports of abuse, the resulting
investigations and protective services and any corrective actions .
C . All individuals receiving MHS 201 Services with funds provided under this Agreement must be enrolled
in the Client Process Monitoring System (CPMS), and the individual 's CPMS record for MHS 201
Services must be maintained, as specified in OHA' CPMS manual located at:
http ://www .oregon.gov/OHNmentalhealth/publications/cpmsmanual_mh .pdf?ga=t, and as it may be
revised from time to time .
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 201 Services in two different ways, through Part A and Part B
("Limitation") Awards . The Award is set in the State Contract #134309 on MHS 201 lines in column one that
contain an "A" for Part A or "B" for Part B Award .
Part B Limitat ion -The provider of the service needs to be enrolled as a Medica id Provider and follow the
procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA
calculates the rates and the claims are processed through OHA 's Medicaid Management Information System
(MMIS). OHA calculates the Part B limitation and OHA's Division of Medical Assistance Programs (DMAP)
disburses the payment directly to service providers on a fee-for-service basis .
Rates are available on the OHA website located at
http://egov. oregon . gov IOHNmentalhealth/p u blications/codebooks/m hO 1 09rates. pdf.
OHA will provide notice to Contractor in timely manner if there is a change in rates. All Medicaid reimbursable
service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services
Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0000 through 309
016-0450 the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the
OHA website located at
http://www.oregon .gov/OHNmentalhealth/publications/codebooks/manual.pdf.
The Part A Award financial assistance will be calculated , disbursed and settled as follows:
A. Calculation of Financial Assistance : OHA will pay for MHS 201 Services identified in a particular line of
the State Contract #134309 with an "A" in Column one, multiplied by the number of units of MHS 201
Services delivered under that line of the State Contract #134309 during the period specified in that line,
subject to the following :
1. Total OHA financial ass istance for N1HS 201 Services under a particular line of the State Contract
#134309 shall not exceed the total funds awarded for MHS 201 Services as specified on that line .
2. OHA is not obligated to provide financ ial assistance for any MHS 201 Services delivered to
individuals who are not properly reported in CPMS (or through other method permitted or required
by this Service Description or an applicab le Specialized Service Requirement) by the date s ixty (60)
days after the earlier of termination of this Agreement , termination of OHA's obligation to provide
financial assistance for MHS 201 Services , or termination of County's obligation to include the
Program Area, in which N1HS 201 Services fall, in its CMHP .
3. OHA will reduce the financial assistance for MHS 201 Services delivered under a particular line of
the State Contract #134309 containing and "An in Column one by the amount received by a Provider
of MHS 201 Services, as payment of a portion of the cost of the services from an individual
receiving such services .
B. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line of
the State Contract #134309 , OHA will disburse the Part A Award for MHS 201 Serv ices identified in a
PAGE 2 OF 3 -EXHIBIT 1-0 -BEHAV IORAL HEALTH SERVICES CONTRACT No. 2012-309
particular line of the State Contract #134309 to County in substantially equal monthly allotments during
the period specified in that line of the State Contract #134309, subject to the following:
1. OHA may, upon written request of County, adjust monthly allotments;
2. Upon amendment to the State Contract #134309, OHA shall adjust monthly allotments as
necessary, to reflect changes in the funds awarded for MHS 201 Services on that line of the State
Contract #134309.
3. OHA may after 30 days (unless parties agreed otherwise) written notice to County, reduce the
monthly allotments based on under used allotments identified through CPMS or through other
method permitted or required by this Service Description or an applicable Specialized Service
Requirement;
C. Agreement Settlement: Agreement Settlement will be used to confirm the delivery of MHS 201 Services
to the individuals specified in the State Contract #134309 by County as part of its CMHP, based on data
properly reported in CPMS or through other reports required or permitted by this Service Description or
an applicable Specialized Service Requirement.
PAGE 3 OF 3-EXHIBIT 1-0 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2012-309
EXHIBIT 2
DESCHUTES COUNTY SERVICES AGREEMENT
Agreement No. 2012-309
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 Agreement. Policies written on a
"claims made" basis must be approved and authorized by Deschutes County.
Contractor Name: Telecare Mental Health Services of Oregon, Inc.
Workers Compensation insurance in compliance with ORS 656 .017, requIring Contractor and all subcontractors to
provide workers' compensation coverage for all subject workers, or provide certification of exempt status under ORS
656.126(2). Employer's Liability Insurance with coverage limits of not less than $500,000 must be included.
Professional Liability insurance with an occurrence combined single limit of not less than :
Per Occurrence limit Annual Aggregate limit
o $500,000 0 $500,000
IZI $1,000 ,000 0 $1 ,000,000
o $2,000,000 IZI $3,000,000
Professional Liability insurance covers damages caused by error, omission, or negligent acts related to professional
services provided under this Agreement. The policy must provide extended reporting period coverage, sometimes referred
to as "tail coverage" for claims made within two years after this Agreement is completed. Contractor shall maintain either
"tail" coverage or continuous "claims made" liability coverage , provided the effective date of the continuous "claims made"
coverage is on or before the effective date of the Agreement , for a minimum of 24 months following the later of: (a) the
Contractor's completion and County's acceptance of all Services required under the Agreement or, (b) the expiration of all
warranty periods provided under the Agreement. Notwithstanding the foregOing 24-month period described above, then the
Contractor may request and OHA may grant approval of the maximum "tail" coverage period reasonably available in the
marketplace . If OHA approval is granted , the Contractor shall maintain "tail" coverage for the maximum time period that the
"tail" coverage is reasonably available in the marketplace .
IZI Reguired bJ' County o Not required by County (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
o Oregon Tort Claims Act limits 0 Oregon Tort Claims Act limits
IZI $1,000,000 0 $2,000 ,000
o $2,000,000 IZI $3,000 ,000
Commercial General Liability insurance includes coverage for personal injury, bodily injury , advertising injury, property
damage, premises, operations, products, completed operations and contractual damages. This insurance shall include
personal injury liability, products and completed operations and shall be written on an occurrence form basis . The Oregon
Legislature has adopted legislation which establishes tort claims limits for actions against local public bodies, including
their officers, agents and employees. The tort claims act limits are automatically adjusted on July 1 every year
By separate endorsement, the policy shall name Deschutes County, the State of Oregon, the Oregon Health
Authority, their officers, agents, employees and volunteers as an additional insured . The additional insured
endorsement shall not include declarations that reduce any per occurrence or aggregate insurance limit. The contractor
shall provide additional coverage based on any outstanding claim(s) made against policy limits to ensure that minimum
insurance limits required by the County are maintained. Construction contracts may include aggregate limits that apply on
a "per location" or "per project" basis .
PAGE 1 OF 2 -EXHIBIT 2 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
Automobile Liability insurance with a combined single limit of not less than:
Per Occurrence
D $500,000
x $1,000,000
D $2,000,000
Automobile Liability insurance covering all owned, non-owned and hired vehicles, includes coverage for
bodily injury and property damage resulting from operation of a motor vehicle. Commercial Automobile
Liability Insurance shall provide coverage for any motor vehicle (symbol 1 on some insurance certificates)
driven by or on behalf of Contractor during the course of providing services under this Agreement.
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 .
x Required by County 0 Not required by County (one box must be checked)
Additional Requirements. Contractor shall pay all deductibles and self-insured retentions. A cross-liability
clause or separation of insured's condition must be included in all commercial general liability policies required by
this Agreement. Contractor's coverage will be primary in the event of loss .
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with
the signed Agreement. The Contractor or its insurer shall provide at least thirty (30) days written notice to County
before cancellation, termination , material change, potential exhaustion of aggregate limits, non-renewal or
reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the
self-insured retention level. For commercial general and automobile liability coverage, the Certificate shall also
provide, by policy endorsement, that Deschutes County, the State of Oregon, their agents, officers,
employees and volunteers are additional insureds with respect to Contractor's services provided under this
Agreement. The endorsement must be in a format acceptable to Deschutes County. If requested, complete copies
of insurance policies shall be provided to the County.
Risk Management review Date
PAGE 2 OF 2 -EXHIBIT 2 -DESCHUTES COUNTY SERVICES AGREEMENT NO. 2012-309
EXHIBIT 3
DESCHUTES COUNTY SERVICES AGREEMENT
Agreement No. 2012-309
Disclosure of Protected Health Information
1. Purpose. The purpose of this exhibit is to set forth the terms and conditions of disclosure of "protected
health information" (as defined in Section 2.1 of this exhibit) between Contractor and COUNTY. It is the
intent of COUNTY and Contractor that this exhibit will meet the requirements of 45 CFR § 164 .504(e) of
the privacy regulations and 45 CFR § 164 .314(a) of the security regulations promulgated by the U.S.
OHA of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996
(HIPAA) (collectively the "HIPAA Regulations").
2. Use And Disclosure Of PHI.
2.1 Definitions. For purposes of this exhibit, the term "protected health information" (PHI) means
Individually Identifiable Health Information transmitted or maintained in any form or medium.
"Individually Identifiable Health Information" is information, including demographic information, that:
(a) relates to (i) the past, present or future physical or mental health or condition of an individual
person, (ii) the provision of health care to an individual person, or (iii) the past, present or future
payment for the provision of health care to an individual person; and (b) identifies that person (or
with respect to which there is a reasonable basis to believe the information can be used to identify
the person). Terms used by but not otherwise defined in this exhibit shall have the same meaning
as those in 45 CFR Parts 160, 162, and 164 . .
2.2 Security and Confidentiality. If Contractor discloses any PHI to COUNTY , or if COUNTY creates
or receives any PHI on behalf of Contractor, COUNTY will maintain the security and confidentiality
of such PHI in County's possession as is required by the HIPAA Regulations. Contractor shall
maintain the security and confidentiality of any PHI received by Contractor.
2.3 Use and Disclosure. Neither Contractor nor COUNTY not use or disclose PHI except as permitted
by this exhibit or other parts of this agreement, or as required by law.
2.4 Disclosure Procedure. Unless such disclosure is required by law, neither COUNTY nor Contractor
may disclose PHI unless: (a) the disclosing party first obtains reasonable assurances from the
person to whom the PHI is disclosed that the PHI will be held confidentially and used or further
disclosed only as required by law or for the purpose for which it was disclosed to the person, and (b)
the person notifies the disclosing party of any instances of which the person is aware of breaches of
confidentiality of the PHI.
3. Other Obligations.
3.1 Safeguards. COUNTY and Contractor will use appropriate safeguards to prevent use or disclosure
of PHI otherwise than as permitted by this exhibit.
3.2 Reports. COUNTY will report to Contractor any use or disclosure of PHI by COUNTY or its
Workforce not provided for by this exhibit of which COUNTY becomes aware. Contractor will report
to COUNTY any use or disclosure of PHI by Contractor or its officers, employees or agents not
provided for by this exhibit of which Contractor becomes aware .
Agents. COUNTY will ensure that any agents, including subcontractors, to whom COUNTY provides PHI
received from Contractor (or created or received by COUNTY on behalf of Contractor) agree to the same
restrictions and conditions that apply to COUNTY with respect to such PHI. Contractor will ensure that
any agents , including subcontractors, to whom Contractor provides PHI received from COUNTY (or
created or received by Contractor on behalf of COUNTY) agree to the same restrictions and conditions
that apply to Contractor with respect to such PHI.
PAGE 1 OF 2 -EXHIBIT 3 -DESCHUTES COUNTY SERVICES AGREEMENT No . 2012-309
3.3 Availability. COUNTY and Contractor shall make PHI in either's possession available to the
individual who is the subject of the PHI as required by the HIPAA Regulations.
3.4 Amendment. COUNTY and Contractor shall make available PHI in its or their possession for
amendment of the PHI by the person identified in the PHI and incorporate any such amendments in
accordance with the HIPAA Regulations.
3.5 Access. If COUNTY has PHI in a designated record set, COUNTY will provide Contractor, upon
Contractor's reasonable request, access for inspection of County's books, records, policies,
practices and procedures concerning the use and disclosure of PHI for purposes of assisting
Contractor with its obligations for record keeping and compliance with complaint investigations and
compliance reviews as required by the HIPAA Regulations. If Contractor has PHI in a designated
record set, Contractor will provide COUNTY, upon COUNTY'S reasonable request, access for
inspection of Contractor's books, records, policies, practices and procedures concerning the use
and disclosure of PHI for purposes of assisting COUNTY with its obligations for record keeping and
compliance with complaint investigations and compliance reviews as required by the HIPAA
Regulations.
4. Accounting Of Disclosures. Although COUNTY and Contractor do not anticipate making disclosures
other than for the purposes of this agreement, COUNTY and Contractor will maintain records of all
disclosures of PHI made otherwise than for the purposes of this agreement, including the date of the
disclosure, the name and address (if known) of the recipient of the PHI, a brief description of the PHI
disclosed, and the purpose of the disclosure as necessary to permit Contractor and COUNTY to respond
to a request by an individual for an accounting of disclosures in accordance with 45 CFR § 164.528.
Each party will make such record available to the other party upon request.
5. Disclosure To U.S. Department Of Health And Human Services. Each party will make its internal
practices, books, and records relating to the use and disclosure of PHI received from the other party (or
created or received by one party on behalf of the other party) available to the Secretary of the United
States Department of Health and Human Services, for purposes of determining County's and Contractor's
compliance with the HIPAA Regulations.
6. Procedure Upon Termination. Upon termination of this agreement, COUNTY and Contractor will, if
feasible, return or destroy all PHI that the party maintains in any form, and will retain no copies of such
PHI or , if the parties agree that return or destruction is not feasible, each party will continue to extend the
protections of this exhibit to such PHI, and limit further use of the PHI to those purposes that make the
return or destruction of the PHI infeasible.
7. No Third Party Beneficiaries. There are no third party beneficiaries to the agreement or this exhibit.
PAGE 2 OF 2 -EXHIBIT 3 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
Exhibit 4
DESCHUTES COUNTY SERVICES AGREEMENT
Agreement No. 2012-309
Compliance with provisions, requirements of funding source and
Federal and State laws, statutes, rules, regulations, executive orders and policies.
Conflicts of Interest
Contractor certifies under penalty of perjury that the following statements are true to the best of
Contractor's knowledge:
1. If Contractor is currently performing work for the County, State of Oregon or federal government, Contractor
by signature to this Agreement declares certifies that; Contractor's Work to be performed under this
Agreement create no potential or actual conflict of interest as defined by ORS 244 and no rules or
regulations of Contractor's employee agency (County State or Federal) would prohibit Contractor's Work
under this Agreement. Contractor is not an "officer," "employee," or "agent" of the County, as those terms
are used in ORS 30.265.
2. Miscellaneous Federal Provisions. Contractor shall comply with all federal laws, regulations, and
executive orders applicable to the Contractor or to the delivery of Services. Without limiting the generality of
the foregoing, Contractor agrees to comply with the following laws, regulations and executive orders to the
extent they are applicable to the Agreement:
a. Titles 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;
c. the Americans with Disabilities Act of 1990, as amended;
d. Executive Order 11246, as amended,
e. the Health Insurance Portability and Accountability Act of 1996;
f. the Age of Discrimination in Employment Act of 1967, as amended, and the Age of 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, ruls and regulations;
j. all federal law governing operation of Community Mental Health Programs, including without
limitation, all federal laws requiring reporting of Individual abuse. These laws, regulations and executive
orders are incorporated by reference herein to the extent that they are applicable to the Agreement and
required by law to be so incorporated. No federal funds may be used to provide services in violation of
42 USC 14402.
3 Equal Employment Opportunity. Contractor shall com ploy 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).
4. Clean Air, Clean Water, EPA Regulations. If Agreement maximum compensation, including amendments,
exceeds $100,000 then Contractor shall comply with all applicable standards, orders, or requirements
issued under Section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), the Federal Water Pollution Control Act
as amended (commonly known as the Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but
not limited to Section 508 (33 U.S.C. 1368). Executive Order 11738, and Environmental Protection Agency
regulations (2 CFR Part 1532), which prohibit the use under non-exempt Federal contracts, grants or loans
of facilities included on the EPA List of Violating Facilities. Violations shall be repoted to Oregon Health
Authority, the State of Oregon Health and Human Services (HHS) and the appropriate Regional Office of the
Environmental Protection Agency.
5. 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 (Pub. L. 94-163).
PAGE 1 OF 2 -EXHIBIT 4 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
6. 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 USC 6901 et. seq.). Section 6002 of that Act (codified at 42 USC 6962) requires that preference
be given in procurement programs to the purchase of specific products containing recycled materials identified
in guidelines developed by the Environmental Protection Agency. Current guidelines are set forth in 40 CFR
Part 247 .
7. Audits.
a. Contractor shall comply, if applicable, with the applicable audit requirements and responsibilities set
forth in the Office of Management and Budget Circular A-133 entitled "Audits of States, Local
Governments and Non-Profit Organizations."
b. Contractor shall also be required to comply with applicable Code of Federal Regulations (CFR)
sections and OMB Circulars governing expenditure of federal funds . State, local and Indian Tribal
Governments and governmental hospitals must follow OMB A-1 02. Non-profits, hospitals, colleges and
universities must follow 2 CFR Part 215. Sub-recipients shall be required to monitor any organization to
which funds are passed for compliance with CFR and OMB requirements.
8. No federally appropriated funds have been paid or shall be paid, by or on behalf of Contractor, to any
person for influencing or attempting to influence an officer or employee of any agency, a member of
Congress , an officer or employee of Congress, or an employee of a member of Congress in connection 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.
a . If any funds other than federally appropriated funds have been paid or shall be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of Congress, an
officer or employee of Congress, or an employee of a member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, Contractor agrees to complete and submit
Standard Form-LLL "Disclosure Form to Report Lobbying ," in accordance with its instructions.
1) Standard Form-LLL and instructions are located in 45 CFR Part 93 Appendix B.
2) If instructions require filing the form with the applicable federal entity, Contractor shall then as a
material condition of this Agreement also file a copy of the Standard Form-LLL with the Oregon
Health Authority.
3) This filing shall occur at the same time as the filing in accordance with the instructions .
b. Contractor understands this certification is a material representation of fact upon which the County and
the Oregon Health Authority has relied in entering into this Agreement. Contractor further understands
that submission of this certification is a prerequisite , imposed by 31 USC 1352 for entering into this
Agreement.
c. 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.
d. Contractor shall include the language of this certification in the award documents for all sub-awards at
all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative
agreements) and that all sub-recipients shall certify and disclose accordingly.
e. Contractor is solely responsible for all liability arising from a failure by Contractor to comply with the
terms of this certification.
f. Contractor promises to indemnify County for any damages suffered by County as a result of
Contractor's failure to comply with the terms of this certification.
9. Contractor understands that, if this Agreement involves federally appropriated funds, this certification is a
material representation of facts upon which reliance was placed when this Agreement was made or entered
into, submission of this certification is a prerequisite for make or entering into this Agreement imposed by
Section 1352, Title 311, U.S. Code and that 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 failure
cd:l4lAt,ec}y( Date ~1111"
PAGE 2 OF 2 -EXHIBIT 4 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
Exhibit 5
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2012~309
CONFIDENTIALITY AGREEMENT
County will make available and/or transfer to Contractor certain Information, in conjunction with goods or
services that are being provided by Contractor to County that is confidential and must be afforded special
treatment and protection.
Contractor will have access to and/or receive from County certain Information that can be used or disclosed only
in accordance with this Agreement and the HHS Privacy Regulations.
To the extent required by 42 U.S.C. 1171 et seq. enacted by the Health Insurance Portability and Accountability
Act of 1996 and regulations promulgated thereunder, Contractor assures County that Contractor will
appropriately safeguard protected health information made available to or obtained by Contractor.
Contractor further agrees to comply with applicable laws relating to protected health information and with
respect to any task or other activity Contractor performs on behalf of County, to the extent County would be 1 required to comply with such requirements.
I
I
For purposes of this Agreement, the following terms shall apply:
-4 A. Contractor shall be considered a Contractor;
B. County shall be considered a COVERED ENTITY;
C. HHS Privacy Regulations shall mean the Code of Federal Regulations (C.F.R.) at Title 45, Sections
160 and 164;
D. Individual shall mean the person who is the subject of the Information, and has the same meaning
as the term 'individual' is defined by 45 C.F.R. 164.501; and
E. Secretary shall mean the Secretary of the Department of Health and Human Services (HHS) and
any other officer or employee of HHS to'whom the authority involved has been delegated;
F. Information shall mean any health information provided and/or made available by County to
Contractor, and has the same meaning as the term 'health information' as defined by 45 C.F.R.
160.102.
Contractor agrees it shall:
1. Not use or further disclose such information other than as permitted or required by this Agreement.
Contractor shall not, except as necessary for the proper management, administration and performance
of its duties under this Agreement, use, reproduce, disclose, or provide to third parties, any confidential
document or information relating to the County, its members or to Individuals seeking services from
County or its members without the prior written consent or authorization of the County or of the
Individual. If Contractor uses such information for the purposes set forth above, it will only do so if the
disclosure is required by law or Contractor obtains reasonable assurances from the person to whom the
information is disclosed that it will be held confidentially and used or further disclosed only as required
by law or for the purpose for which Contractor disclosed it to the person. Contractor shall ensure that its
personnel, employees, affiliates and agents maintain the confidentiality of patient health information and
business information of County.
PAGE 1 OF 2 -EXHIBIT 5 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
2 . Not use or further disclose the information in a manner that would violate the requirements of applicable
law, if done by County;
3. Use appropriate safeguards to prevent use or disclosure of such information other than as provided for
by this Agreement;
4 . Report to County any use or disclosure of such information not provided for by this Agreement of which
Contractor becomes aware;
5. Ensure that any subcontractors or agents to whom Contractor provides protected health information
received from County agree to the same restrictions and conditions that apply to Contractor with respect
to such information;
6. Make available protected health information in accordance with applicable law, i.e., the Code of Federal
Regulations (C .F.R.) at Title 45 , Sections 160 and 164;
7. Maintain standard records, pursuant to this Agreement , and to provide such records and other
necessary information to the County as may be requested in writing and as permitted by law.
Contractor agrees that all records kept in connection with this agreement are subject to review and audit
by the County upon reasonable notice of a minimum of 14 work days from the date of written request by
the County .
8. Make Contractor's internal practices, books, and records relating to the use and disclosure of
protected health information received from County available to the Secretary of the United
States Health & Human Services for purposes of determining County's compliance with
applicable law (in all events, Contractor shall immediately notify County upon receipt by
Contractor of any such request, and shall provide County with copies of any such materials);
9. Upon termination of this Agreement, Contractor shall promptly return all protected health
information received from County. If the return of protected health information is not feasible,
Contractor shall continue the protections required under this contract to the protected health
information consistent with the requirements of this Attachment and the HIPAA privacy
standards.
Date: fa l"l \I 2Sv f'1 CFO
Contractor:
Signature: v-J.'f-H~i,.l......f"'----I---Al'rH'T---Title
PAGE 2 OF 2 -EXH I BIT 5 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2012-309
Exhibit 6
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2012-309
REQUIRED PROVIDER CONTRACT PROVISIONS
Oregon Health Authority Exhibit H of 2011-2013 Intergovernmental Agreement #134309
1. Expenditure of Funds. Contractor may expend the funds paid to Contractor under this Contract solely
on the delivery of services as described in Exhibit 1 of this Contract ("Services"), subject to the following
limitations (in addition to any other restrictions or limitations imposed by this Contract):
a. Contractor may not expend on the delivery of Services any funds paid to Contractor under this
Contract in excess of the amount reasonable and necessary to provide quality delivery of Services.
b. If this Contract requires Contractor to deliver more than one service, Contractor may not expend
funds paid to Contractor under this Contract for a particular service on the delivery of any other
service.
c. If this Contract requires Contractor to deliver alcohol, drug abuse and addiction services, Contractor
may not use the funds paid to Contractor under this Contract for such services:
(1) To provide inpatient hospital services;
(2) To make cash payments to intended recipients of health services;
(3) To purchase or improve land, to purchase, construct or permanently improve (other than minor
remodeling) any building or other facility or to purchase major medical equipment;
(4) To satisfy any requirement for expenditure of non-federal funds as a condition for receipt of
federal funds (whether the federal funds are received under this Contract or otherwise);
(5) With respect to federal Substance Abuse Prevention and Treatment Block Grant moneys only, to
purchase services from any person or entity other than a public or non-profit entity; or
(6) To carry out any program prohibited by section 245(b) of the Health Omnibus Programs
Extension Act of 1988 (codified at 42 USC 300ee(5).
d. Contractor may expend funds paid to Contractor under this Contact only in accordance with federal
OMB Circular A-87 as that circular is applicable on allowable costs.
2. Records Maintenance, Access and Confidentiality.
a. Access to Records and Facilities. County, the Oregon Health Authority, the Secretary of State's
Office of the State of Oregon, the Federal Government, and their duly authorized representatives
shall have access to the books, documents, papers and records of Contractor that are directly
related to this Contract, the funds paid to Contractor hereunder, or any services delivered hereunder
for the purpose of making audits, examinations, excerpts, copies and transcriptions. In addition,
Contractor shall permit authorized representatives of County and the Oregon Health Authority to
perform site reviews of all services delivered by Contractor hereunder.
b. Retention of Records. Contractor shall retain and keep accessible all books, documents, papers,
and records, that are directly related to this Contract, the funds paid to Contractor hereunder or to
any services delivered hereunder, for a minimum of six (6) years, or such longer period as may be
required by other provisions of this Contract or applicable law, following the termination or expiration
of this Contract. If there are unresolved audit or other questions at the end of the Six-year period,
Contractor shall retain the records until the questions are resolved.
c. Expenditure Records. Contractor shall document the expenditure of all funds paid to Contractor
under this Contract. Unless applicable federal law requires Contractor to utilize a different
Accounting system, Contractor shall create and maintain all expenditure records in accordance with
generally accepted accounting principles and in sufficient detail to permit County and the Oregon
Health Authority to verify how the funds paid to Contractor under this Contract were expended.
PAGE 1 OF 4 -EXHIBIT 6 TO PERSONAL SERVICES CONTRACT No. 2012-309
d. Individual Records. Unless otherwise specified in this Contract, Contractor shall create and
maintain an Individual record for each Individual who receives services under this Contract. The
Individual record must contain:
(1) Individual identification;
(2) Problem assessment;
(3) Services and supports, training and/or care plan;
(4) Medical information when appropriate; and
(5) Service notes including service conclusion summary and current assessment or evaluation
instrument as designated by the Oregon Health Authority in administrative rules. Contractor
shall retain Individual records in accordance with OAR 166-150-0005 through 166-150-0215
(State Archivist). Unless OAR 166-150-0005 through 116-150-0215 requires a longer retention
period, Individual records must be retained for a minimum of ten (10) years from termination or
expiration of this Contract.
e. Safeguarding of Individual Information. Contractor shall maintain the confidentiality of Individual
records as required by applicable state and federal law, including without limitation, ORS 179.495 to
179.507,45 CFR Part 205,42 CFR Part 2, any administrative rule adopted by the Oregon Health
Authority, implementing the foregoing laws, and any written policies made available to Contractor by
County or by the Oregon Health Authority. Contractor shall create and maintain written policies and
procedures related to the disclosure of Individual information, and shall make such policies and
procedures available to County and the Oregon Health Authority for review and inspection as
reasonably requested by County or the Oregon Health Authority.
f. CPMS Enrollment (If Applicable to Contract). As specified in the Oregon Health Authority's Client
Process Monitoring System ("CPMS") manual (for Alcohol, Drug Abuse and Addiction Services or
Mental Health Services, as appropriate), Contractor shall enroll in CPMS, each Individual receiving a
service under this Contract and maintain that Individual's CPMS record as specified in the CPMS
manual available at http://www.oregon.gov/OHAlmentalhealth/publications/main.shtml
3. Alternative Formats of Written Materials. In connection with the delivery of Services, Contractor shall:
a. Make available to an Individual, without charge to the Individual, upon the Individual's, the County's
or the Oregon Health Authority's request, any and all written materials in alternate, jf appropriate,
formats as required by the Oregon Health Authority's administrative rules or by the Oregon Health
Authority's written policies made available to Contractor.
b. Make available to an Individual, without charge to the Individual, upon the Individual's, County's or
the Oregon Health Authority's request, any and all written materials in the prevalent non-English
languages in the area served by Contractor.
c. Make available to a Individual, without charge to the Individual, upon the Individual's, County's or
the Oregon Health Authority's request, oral interpretation services in all non-English languages in
the area served by Contractor.
d. Make available to a Individual with hearing impairments, without charge to the Individual, upon the
Individual's, County's or the Oregon Health Authority's request, sign language interpretation
services and telephone communications access services. For purposes of the foregoing, "written
materials" includes, without limitation, all written materials created or delivered in connection with
the services and all subcontractor contracts related to this Contract.
4. Reporting Requirements. Contractor shall prepare and furnish the following information to County and
the Oregon Health Authority when a service is delivered under this Contract:
a. Individual, service and financial information as specified in the applicable service description
attached hereto and incorporated herein by this reference.
PAGE 2 OF 4 -ExHIBIT 6 TO PERSONAL SERVICES CONTRACT No. 2012-309
b. All additional information and reports that County or the Oregon Health Authority reasonably
requests.
5. Compliance with law. Contractor shall comply with all state and local laws, regulations, executive
orders and ordinances applicable to the Contract or to the delivery of services hereunder. Without
limiting the generality of the foregoing, Contractor expressly agrees to comply with the following laws,
regulations and executive orders to the extent they are applicable to the Contract:
(a) all applicable requirements of state civil rights and rehabilitation statutes, rules and regulations;
(b) all state laws governing operation of community mental health programs, including without
limitation, all administrative rules adopted by the Oregon Health Authority related to community
mental health programs;
(c) all state laws requiring reporting of Individual abuse; (d) ORS 659A.400 to 659A.409, ORS
659A.145 and all regulations and administrative rules established pursuant to those laws in the
construction, remodeling, maintenance and operation of any structures and facilities, and in the
conduct of all programs, services and training associated with the delivery of services under this
Contract. These laws, regulations and executive orders are incorporated by reference herein to the
extent that they are applicable to the Contract and required by law to be so incorporated. All
employers, including Contractor, that employ subject workers who provide services in the State of
Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation coverage,
unless such employers are exempt under ORS 656.126. In addition, Contractor shall comply, as if it
were County thereunder, with the federal requirements set forth in Exhibit G to the certain 2011
2013 Intergovernmental Agreement for the Financing of Community Addictions and Mental Health
Services between County and the Oregon Health Authority dated as of July 1, 2011, which Exhibit is
incorporated herein by this reference. For purposes of this Contract, all references in this Contract
to federal and state laws are references to federal and state laws as they may be amended from
time to time.
6. Unless Contractor is a State of Oregon governmental agency, Contractor agrees that it is an
independent contractor and not an agent of the State of Oregon, the Oregon Health Authority or County
7. To the extent permitted by applicable law, Contractor shall defend (in the case of the state of Oregon
and the Oregon Health Authority, subject to ORS Chapter 180), save and hold harmless the State of
Oregon, the Oregon Health Authority, County, and their officers, employees, and agents from and
against all claims, suits, actions; losses, damages, liabilities, costs and expenses of any nature
whatsoever resulting from, arising out of or relating to the operations of the Contractor, including but not
limited to the activities of Contractor or its officers, employees, subcontractors or agents under this
Contract.
8. Contractor understands that Contractor may be prosecuted under applicable federal and state criminal
and civil laws for submitting false claims, concealing material facts, misrepresentation, falsifying data
system input, other acts of misrepresentation, or conspiracy to engage therein.
9. Contractor shall only conduct transactions that are authorized by the County for transactions with the
Oregon Health Authority that involve County funds directly related to this Contract.
10. Contractor(s} that are not units of local government as defined in ORS 190.003 shall obtain, at
Contractor's expense, and maintain in effect with respect to all occurrences taking place during the term
of the Contract, insurance requirements as specified in Exhibit I of the certain 2011-2013
Intergovernmental Agreement for the Financing of Community Addictions and Mental Health Services
between County and the Oregon Health Authority dated as of July 1, 2011, which Exhibit is incorporated
herein by this reference.
11 Contractor(s} that are not units of local government as defined in ORS 190.003, shall indemnify, defend,
save and hold harmless the State of Oregon and its officers, employees and agents ("Indemnitee") from
and against any and all claims, actions, liabilities, damages, losses, or expenses (including attorneys'
fees) arising from a tort (as now or hereafter defined in ORS 30.260) caused, or alleged to be caused, in
PAGE 3 OF 4 -EXHIBIT 6 TO PERSONAL SERVICES CONTRACT No. 2012-309
whole or in part, by the negligent or willful acts or omissions of Provider or any of the officers, agents,
employees or subcontractors of the contractor( "Claims"). It is the specific intention of the parties that
the Indemnitee shall, in all instances, except for Claims arising solely from the negligent or willful acts or
omissions of the Indemnitee, be indemnified by the Contractor from and against any and all Claims.
12. Contractor shall include sections 1 through 10, in substantially the form set forth above, in all permitted
Contractor contracts under this Contract.
SVP /CkDDate: ~ h If'lSignatur
Contractor:
PAGE 4 OF 4 -EXHIBIT 6 TO PERSONAL SERVICES CONTRACT No. 2012-309
I DATE (MM/OD/YYVY)ACORD· CERTIf-.~ATE OF LIABILITY INSUhi"'\NCE 06/2912011~
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
MARSH RISK &INSURANCE SERVICES
345 CALIFORNIA STREET, SUITE 1300
CAliFORNIA LICENSE NO 0437153
SAN FRANCISCO. CA 94104
Attn: SanFrancisco_Certs@marsh,com/f: 212·948-0398
CONTACT
NAME: r -.
INSURER(S) AFFORDING COVERAGE
I r;O~.NO):
__I-=~AIC.~
072624-CAS-Pl-l,.,2 GLALP WC OR INSURER A : Nautilus Insurance Company 17370
INSURED
TElECARE MENTAl HEALTH SERVICES
OF OREGON, INC,
1080 MARINA VILlAGE PARKWAY, SUITE 100
AlAMEDA, CA 94501
INSURER B : Zurich American Insurance Company
~~URER C : American Zurich Insurance Companyre'
INSURERD:
16535
---40'142 -~
~SURER~_ -~---~-~.~~~--~~. .--~.~.
INSURER F:
COVERAGES CERTIFICATE NUMBER-SEA·002094218-05 REVISION NUMBER-2
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
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 CU\.IMS.
~ ADDL SUBR I !tOLICYEF~1 ~v EX~) ~~~~
TYPE OF INSURANCE IINsR WVI} POLICY NUMBER MMlDDlYYVV MlDOlYVVV LIMITS
A GENERAlliABIUTY X GFP1000063P3 07/0112011 07101/2012 EACH OCCURRENCE $ 1,000,000
~ -1:l~~~'::.!U_HEN I ED 100,000I~MMERCIAL GENERAL LIABILITY PREMI~!;~ (Ea .occurrence) $
CLAIMS-MADE ~OCCUR MED EXP (Anyone person) $ _ _ -::~
X i SIR: $100,000 ~'"'"""'"'WO" , 1,000,000tJ --------------
GENERAL AGGREGATE $ 3,000,000 --~--------.-------
rxi'L AGGR~~E LIMIT APnS PER: PRODUCTS -COM PlOP AG.§... _~_____ 1,000,000
X POLICY ~f;'RT LOC I $
B AUTOMOBILE L1ABILfTV X BAP378473307 0710112011 07101/2012 COMBINED SINGLE LIMIT 1,000,000 r-;.(Eli~O!L.,. ----------.----
X ANY AUTO
I I
BODILY INJURY (Per person) $
r-ALLOWNED ~"""oe,, BODIL Y INJUR Y(Per accidenl~ $ ~AUTOS AUTOS
NON-OWNED I rp~9~~c~Je~I?AMAGEI S
IX
HIRED AUTOS AUTOS ,
Comp $250 X CoII:$500 I $I
UMBRELLA LlAB
r-1°CCUR i EACH ()rrll"''''~Nr''' $ r--
EXCESSLIAB CLAIMS·MADE ''''''''''''1ATE $
OED I I RETENTION $ 1$
C WORKERS COMPENSATION WC829852009 07/01/2011 07/0112012 X IT~g$'T:ug;:, I IOJ~'AND EMPLOYERS' LIABILITY YIN ---------~,"--=
ANY PROPRIETOAIPARTNERlEXECUTIVE 0 NIA I E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? 1,000,000, (Mandatory in NH) E.L DISEASE· EA EMPLOYEE $ --,~If yes, OOscribe under EL DISEASE POLICY LIMIT $ 1,000,000DESCRIPTION OF OPERATIONS below
A PROFESSIONAL LIABILITY PFP1 000081 P3 107101/2011 0710112012 AGGREGATE 3,000,000
CLAIMS MADE; SIR $100,000 ,AGGREGATE 3,000,000
J
DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (AI tach ACORD 101, Additional Remarks Schedule, if more space is required)
DESCHUTES COUNTY, iTS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS ARE ADDITIONAL INSUREDS UNDER THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES SOLELY AS
RESPECTS WORK PERFORMED BY OR FOR THE NAMED INSURED IN CONNECTION WITH THE CONTRACT AGREEMENT.
CERTIFICATE HOLDER CANCELLAliON
OESCHUTES COUNTY HEALTH SERVICES
2577 NE COURTNEY DRIVE
BEND, OR 97702
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
t
AUTHORIZED REPRESENTATIVE
of Marsh Risk & Insurance Services
Ellen Redell Brown "t~
(§) 1988-2010 ACORD CORPORATION. All fights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
PRODUCER
MARSH RISK &INSURANCE SERVICES
345 CALIFORNIA STREET, SUITE 1300
CAlIFORNIA LICENSE NO. 0437153
SAN FRANCISCO, CA 94104
Attn: SaIlFrancisco.Certs@marsh,comlf: 212·948-0398 T
072624-CAS-PL-11·12 GLALPL WC OR INSURERS AFFORDING COVERAGE i NAIC#
INSURED INSURERG:
TELECARE MENTAL HEALTH SERVICES
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INSURERH:OF OREGON, INC. .---.-------------.--..--,-,,----"--t--~,--------,,----I1000 MARINA VILLAGE PARKWAY, SUITE 100 INSURER I:
AlAMEDA, CA 94501
INSURERJ:
TEXT
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Other
Limils
EACH OCCURRENCE: 1,000,000
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CERTIFICATE HOLDER
DESCHUTES COUNTY HEALTH SERVICES
2577 NE COURTNEY ORIVE
BEND, OR 97702
AUTHORIZED REPRESENTATIVE
of Marsh Risk & Insurance Services
Ellen Redell Brown
:,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -AUTOMATIC STATUS WHEN
REQUIRED' IN AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
HEAlTHCARE GENERAL L1ABIUTY COVERAGE FORM
A. Section 11-Who Is An Insured Is amended to Include as an ~ddltionaJ insured any person or organization
. for whom you are performing operations when you and such person or organization have agreed in writing in
a contract or agreement that such person or organization be added as an additional Insured on yourpolicy.·1 Such parson or organization is an additional insured only with respect to lIablUly fOr "bodily injurY', 'property
.damage~ or "personal and advertising injury" caused in Whole or in part, by:
I. 1. 'rour 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.
A person's or organ izaUon's status as an addiUonal insured under this ~endorsement ends when your
operations for that additional insured are completed.
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NOTHlNG CONTAINED HEREIN SHALL VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS,
PROVISIONS, REPRESENTATIONS, CONOmONS OR AGREEMENTS OF THE POLICY OTHER THAN AS
STATED ABOVE. .
SSM-0081(1J01) Includes copyrighted malerial of Insurance Set1Iices Office, Inc. wilh its PBfje1ol1
permission..1