HomeMy WebLinkAboutDoc 008 - Amend DHS Behav Health AgrmtDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of January 5, 2011
DATE: December 29, 2010
FROM: Lori Hill, Adult Treatment Program Manager, Deschutes County Health Services,
541-322-7535.
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document #2011-008, Amendment #47 to the 2009-2011 State
Intergovernmental Agreement for the financing of mental health, developmental disability and
addiction services, State Agreement #127295.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
The 2009-2011 Intergovernmental Agreement for the financing of mental health, developmental
disability and addiction services sets forth the dollar amounts and guidelines for Deschutes County
Health Services (DCHS) to provide or coordinate provision of mental health and developmental
disability treatment services to individuals, as well as alcohol, other drug and problem gambling
prevention and treatment services for the 2009-2011 biennium.
Amendment #127295-47 modifies funding for the following service elements:
1) Service element #20 — Non -Residential Adult Mental Health Services - $5,047; funds are
removed for rehabilitative services for one client at Edgecliff Residential Treatment Home.
2) Service element #24 — Regional Acute Psychiatric Inpatient Services - $529,250; funds are
awarded for two beds.
3) Service element #28 — $0; Limitation is decreased and funds are awarded for service
payment for one client at Edgecliff Residential Treatment Home.
4) Service element #201 — Non -Residential Adult Mental Health Services - $7,069; funds are
awarded for rehabilitative services, room & board for one client at Edgecliff Residential
Treatment Home.
FISCAL IMPLICATIONS:
Maximum Compensation is $532,272.
RECOMMENDATION & ACTION REQUESTED:
Behavioral Health recommends approval.
ATTENDANCE: Nancy England, Contract Specialist
DISTRIBUTION OF DOCUMENTS:
Fax the documents to April D. Barret at (503) 378-4324, and fully executed copy to Nancy England,
Contract Specialist, Behavioral Health Department.
April Barrett ,
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document wIl 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 Comrnissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
Please complete alt sections above the Offclal Review line.
December 17, 2010
Department:
Health Services, Behavioral Health
Contractor/Supplier/Consultant Name:
Contractor Contact:
Type of Document: Amendment
Oregon Department of Human Services
Contractor Phone #:
503-945-5821
Goods and/or Services: Deschutes County Health Services (DCHS) provides or
coordinates the provision of mental health and developmental disability treatment
services to individuals; services may include alcohol and drug treatment, problem
gambling prevention treatment services, transportation services, housing services and
the provision of peer resources.
Background & History: The intergovemmental agreement between the Department of
Human Services and DCHS provides the financing for mental health, developmental
disability and addiction services and sets forth the guidelines for DCHS to provide or
coordinate provision of mental health and developmental disability services to
individuals.
Amendment #47 to the agreement modifies funding for the following service elements:
1) Service element #20 — Non -Residential Adult Mental Health Services - $5,047,
funds are removed for rehabilitative services for one client at Edgediff
Residential Treatment Home.
2) Service element #24 — Regional Acute Psychiatric Inpatient Services - $529,250,
funds are awarded for two beds.
3) Service element #28 — $0, Limitation is decreased and funds are awarded for
service payment for one client a Edgecliff Residential Treatment Home.
4) Service element #201 — Non -Residential Adult Mental Health Services - $7,069,
funds are awarded for rehabilitative services, room & board for one client at
Edgecliff Residential Treatment Home.
Agreement Starting Date:
July 01, 2010
Annual Value or Total Payment:
Ending Date:
June 30, 2011
Maximum Compensation is $531,272
® Insurance Certificate Received (check box)
Insurance Expiration Date:
County is Contractor
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? ® Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes 0 No
Is this a Grant Agreement providing revenue to the County? ❑ Yes ® No
Special conditions attached to this grant:
Deadlines for reporting to the grantor:
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant -funded position so that this will be noted in the offer letter: ❑ Yes ❑ No
Contact information for the person responsible for grant compliance: Name:
Phone #:
Departmental Contact and Title:
Phone #:
541-322-7516
Nancy England, Contract Specialist
Department Director Approval:Oi iwr- C1I
Signature
2-2-7-o 1p
Date
Distribution of Document: Fax to April D. Barrett at (503) 373-7365, fully executed
copy to Nancy England, Behavioral Health Department, (541) 322-7565.
Official Review:
County Signature Required (check one): BOCC 0 Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review
Date
Document Number: 2010-735
-?3—/o
12/17/2010
Oregon
Theodore R. Kulongoski, Governor
DATE: December 9, 2010
TO: Scott Johnson, Director
Deschutes County
Department of Human Services
Administrative Services
Office of Contracts & Procurement
250 Winter Street NE, 3rd Floor
Salem, OR 97301-1080
(DHS
RE: Amendment #47 to the
2009-2011 Intergovernmental Agreement for the Financing
of Mental Health, Developmental Disability, and Addiction
Services Agreement #127295
Enclosed is an amendment to the Agreement.
NOTE: Payment for amendments returned to DHS by the 3rd
Friday of every month are more likely to be in the following month's
allotment or electronic fund transfer.
The instructions for processing this amendment are as follows:
• Open and print the electronic file containing the amendment for signature by
the appropriate authorized County Official(s).
• Obtain the authorized signature(s) on the Amendment and if the amendment
is more than 10 pages the "Fax Back Statement.
• Fax the entire amendment to DHS at 503-373-7365. If amendment is more
than 10 pages fax only the signature page of the amendment and the
completed, signed "Fax Back Statement" to DHS at the number above.
Following receipt by DHS of your signed amendment, DHS will route its copy of
amendment to the official(s) who is/are authorized to execute the amendment.
Once the amendment is signed DHS will scan the Amendment and transmit to the
appropriate County official.
If you have questions regarding this financial assistance award, please contact
Sheryl Derting, Mental Health & Addiction Services, at (503) 945-6263 or April
D. Barrett at (503) 945-5821.
Sincerely,
April D. Barrett, OPBC
Contracts Specialist
Enclosure
"Assisting People to Become Independent, Healthy and Safe"
An Equal Opportunity Employer
Oregon
Theodore R. Kulongoski, Govemor
FAX BACK STATEMENT
Department of Human Services
Administrative Services Division
Office of Contracts & Procurement
250 Winter Street NE, 3rd Floor
Salem, OR 97301
)(DHS
Please complete the following statement and return it along with the completed
signature page. If any changes are made to the Amendment, please return the
Amendment in its entirety. Thank you.
I
(Name) (Title)
received a copy of Amendment #47 to Agreement #127295, between
the State of Oregon, acting by and through the Department of Human Services and
Deschutes County, from Tami Goertzen on December 9, 2010.
On , I signed the printed form of the Amendment without change
(Date)
from the electronically transmitted document.
A copy of the signature page pertaining to the above listed Amendment containing
my signature is included with this facsimile transmission.
(Signature) (Date)
After all parties have signed, you will receive a copy of the Amendment for your
records. If you have any questions, please call April D. Barrett at (503) 945-5821.
Attachment(s)
"Assisting People to Become Independent, Healthy and Safe"
An Equal Opportunity Employer
Oregon
-1.85_9 Theodore R. Kulongoski, Governor
Department of Human Services
Administrative Services
Office of Contracts & Procurement
250 Winter Street NE, 3rd Floor
Salem, OR 97301
(503) 945-5818
Fax: (503) 378-4324
)(DHS
In compliance with the Americans with Disabilities Act, this
document is available in alternate formats such as Braille,
large print, audiotape, oral presentation and electronic format.
To request an alternate format, please send an e-mail to
DHS.Forms@state.or.us or contact the Office of Document
Management at (503) 378-3523, and TTY at 503-378-3523.
FORTY-SEVENTH AMENDMENT TO
DEPARTMENT OF HUMAN SERVICES
2009-2011 INTERGOVERNMENTAL AGREEMENT FOR THE
FINANCING OF MENTAL HEALTH, DEVELOPMENTAL DISABILITY
AND ADDICTION SERVICES AGREEMENT #127295
This Forty -Seventh Amendment to Department of Human Services 2009-
2011 Intergovernmental Agreement for the Financing of Mental Health,
Developmental Disability and Addiction Services dated as of July 1, 2009 (as
amended, the "Agreement"), is entered into, as of the date of the last signature
hereto, by and between the State of Oregon acting by and through its Department
of Human Services ("Department" or "DHS") and Deschutes County ("County").
RECITALS
WHEREAS, the Department and County wish to modify the Financial Assistance
Award set forth in Exhibit C-1 of the Agreement.
NOW, THEREFORE, in consideration of the premises, covenants and agreements
contained herein and other good and valuable consideration the receipt and
sufficiency of which is hereby acknowledged, the parties hereto agree as follows:
AGREEMENT
1. The financial and service information in the Financial Assistance Award are
hereby amended as described in Exhibit 1 attached hereto and incorporated
herein by this reference. Exhibit 1 must be read in conjunction with the
portion of Exhibit C-1 of the Agreement that describes the effect of an
amendment of the financial and service information.
"Assisting People to Become Independent, Healthy and
An Equal Opportunity Employer
DC -2011
008
2. Capitalized words and phrases used but not defined herein shall have the
meanings ascribed thereto in the Agreement.
3. County represents and warrants to Department that the representations and
warranties of County set forth in section 2 of Exhibit E of the Agreement are
true and correct on the date hereof with the same effect as if made on the
date hereof.
4. Except as amended hereby, all terms and conditions of the Agreement
remain in full force and effect.
5. This Amendment may be executed in any number of counterparts, all of
which when taken together shall constitute one agreement binding on all
parties, notwithstanding that all parties are not signatories to the same
counterpart. Each copy of this Amendment so executed shall constitute an
original.
IN WITNESS WHEREOF, the parties hereto have executed this amendment as of
the dates set forth below their respective signatures.
STATE OF OREGON ACTING BY AND THROUGH
ITS DEPARTMENT OF HUMAN SERVICES
By: Date:
Name: Stella Transue
Title: Administrator, DHS Office of Contracts & Procurement
Deschutes County
By: Date:
Name: Title:
Document date: 12/9/2010 Amendment #47 Page 2
Reference #042
Exhibit 1 to the 47th Amendment to
Department of Human Services
2009-2011 Intergovernmental Agreement for the
Financing of Mental Health, Developmental Disability
and Addiction Services Agreement #127295
Document date: 12/9/2010
Reference 1/042
Amendment #47 Page 3
DEPARTMENT OF HUMAN SERVICES
Financial Assistance Award Amendment (FAAA)
2009-2011
CONTRACTOR: DESCHUTES COUNTY Contract#: 127295
DATE: 12/08/2010 Reference#: 042
MENTAL HEALTH SERVICES
SECTION: 1
SERVICE REQUIREMENTS MEET EXHIBIT B AND, IF INDICATED, EXHIBIT B-2
Start/End CPMS
Part Dates Name
Approved
Service Funds
SE# 20 NON-RESIDENTIAL ADULT MH SERV
B 10/2010- 1/2011 N/A
SUBTOTAL SE# 20
- $5,047
Approved Serv. Unit EXHIB B2 Spec
Start-up Units Type Codes Cond#
$0 -8. SLT N/A
- $5,047 $O
SE# 24 REGIONAL ACUTE PSYCH INPATIENT
A 7/2010- 6/2011 N/A $529,250 $O 730. CSD N/A
SUBTOTAL SE# 24 $529,250 $0
SE# 28 RESIDENTIAL TREATMENT SERVICES
A 10/2010- 1/2011 ONZEDR-860130
B 10/2010- 1/2011 N/A
SUBTOTAL SE# 28
$9,000 $0 4. SLT N/A M0518 1
- $9,000 $0 -4. SLT N/A
$0 $0
SE# 201 NON -RES DESIGNATED SVCS MHS
A 10/2010- 1/2011 ONZEDR-860130 $7,069 $0 0. NA N/A
SUBTOTAL SE# 201 $7,069 $0
TOTAL SECTION 1 $531,272 $0
TOTAL AUTHORIZED FOR MENTAL HEALTH SERVICES $531,272
TOTAL AUTHORIZED FOR THIS FAAA: $531,272
DEPARTMENT OF HUMAN SERVICES
Financial Assistance Award Amendment (FAAA)
CONTRACTOR: DESCHUTES COUNTY Contract#: 127295
DATE: 12/08/2010
REASON FOR FAAA (for information only):
REF#: 042
Non -Residential Adult Mental Health (General) (MHS 20) funds are removed
for rehabilitative services for one client at Edgecliff RTH, LOI
#09-11-2643.
Regional Acute Psychiatric Inpatient Services (MHS 24) funds are awarded
for two beds, LOI #09-11-2664.
Residential Treatment Services (MHS 28) limitation is decreased and funds
are awarded for service payment for one client at Edgecliff RTH, LOI
#09-11-2643.
Non -Residential Adult Mental Health Services (Designated) (MHS 201) funds
are awarded for rehabilitative services, room & board and PIF for one
client at Edgecliff RTH, LOI #09-11-2643.
The following special condition(s) apply to funds as indicated by the
special condition number in column 9. Each special condition set forth
below may be qualified by a full description in the Financial Assistance
Award.
M0518 1 MHS 28 Rate: For services delivered to individuals during a
particular month, Department will provide financial assistance at
the rate of $3,000 per month per individual.
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W N N d' O d' at d' N N al O\ lO
al al al ON L} O1 m m N N al O\ 00
lO al O\ m CO N N 0 0 0 CO H
H1 l0 l0 H H CO OD 0 0 to ,n N
co m m d' d' H H N N d W 00
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0
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0
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W N N d' O d' d' d' N N O\ O\ 11
O\ O\ al ON t/} 01 m m N N 01 al CO
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co m m d' d' H H N N d• d' CO
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TOTAL SE#
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TOTAL SE#
SUPPORTED EMPLOYMENT SERVCS
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O H ri O1 O1
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CSS -HOMELESS
m
W
0
NON -RES DESIGNATED SVCS
0
N
TOTAL SE# 201
$9,692,903
N
N
0
$9,160,954
0
0 0
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"REVISED TOTAL" column
The amounts in the