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HomeMy WebLinkAboutDoc 693 - Telecare MH AgrmtREVIE LEGAL COUNSEL For Recording Stamp Only DESCHUTES COUNTY SERVICES CONTRACT CONTRACT NO. 2010-693 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 behavioral health clients; 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, Department of Human Services ("Department") 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 December 1, 2010 or the date, on which each party has signed the Contract or upon arrival of County client(s), whichever is later. 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, 2011, whichever date occurs last. Contract 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 ID code MHS 28 and "Secure Residential Treatment Facility", Services ID 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 309-16-0000 through 309- 016-0450 "Medicaid Payment for Rehabilitative Mental Health Services and OAR 309-032-1500 through 309-032-1565 "Integrated Services and Supports Rule". 3. Regulations and Duties. Contactor shall comply with all applicable provisions of the County Financial Assistance Contract, including applicable Service Descriptions attached thereto, in place at the time this Agreement is executed and effective July 1, 2009, (Contract #127295, the "Contract") between the Oregon State Department of Human Services ("Department") and Deschutes County, as the same may be amended, replaced and/or renewed from time to time. Contractor agrees to comply with the rules and regulations of County, applicable provisions in the Contract between County and the Department, PAGE 1 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 DU 0TO "6 93 incorporated herein by reference, as of the effective date of such regulations, applicable provisions of the Administrative Rules and Procedures of the Department, 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 Department, 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 agrees to prepare and furnish reports and data as may be required by the Department, through the contract, including but not limited, to financial reports documenting all expenditures of funds under this Agreement in accordance with generally accepted accounting rules and procedures, client records which contain client identification, problem assessment, treatment (including any training and/or care plan), appropriate medical information, and progress notes, including a service termination summary and current assessment or evaluation instrument as designated in the administrative rules. Department Client Process Monitoring System (CPMS) data shall be completed in accordance with Department requirements and submitted to Department. Contractor agrees to, and does hereby grant County and Department the right to reproduce, use and disclose for County or Department purposes, all or any part of the reports, data, and technical information furnished to County under this Agreement. Contractor shall make available to County, Department and any client of Contractor any and all written materials in alternate formats in compliance with Department's policies or administrative rules. For purposes of the foregoing, "written materials" includes, without limitation, all work product and contracts related to this Agreement. B. Access to Records and Facilities. Department, 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 Agreement, the financial assistance provided hereunder, or any Service for the purpose of making audits, examinations, excerpts, copies and transcriptions. Contractor shall permit, authorized representatives of Department to perform site review of Facility and all services delivered by Contractor. C. Reporting Requirements. Contractor shall prepare and furnish the following information to Department when a Service is delivered: 1. Client, Service and financial information as specified in the Service Description and other Exhibits. 2. All additional information and reports that Department or County reasonably requests that are applicable to the services provided to covered patients. 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 97702 Attn: Lori Hill Phone: (541) 322-7535 5. Confidentiality. Contractor shall maintain confidentiality of information obtained pursuant to this Agreement as follows: a. Contractor shall not use, release or disclose any information concerning any employee, client, 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, client, applicant or person. PAGE 1 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 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. 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 (Exhibit 4), shall become a part of this Agreement. 6. County Monitoring and Site Visits. Contractor agrees that services provided under this Agreement by Contractor, the Facility used in conjunction with such services, client 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 seven (7) 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 Department to make site visits upon reasonable notice to monitor the delivery of services under this Agreement. 7. Payment of Agreement. Subject to availability of funds, Contractor will receive payment for providing the services described in Paragraph 2. A. Contractor shall bill Division of Medical Assistance Programs (DMAP) in accordance with procedures and forms prescribed by Department for all Part B funds (as defined in Exhibit 1) that are approved by Department 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 neither invoice nor expect payment from County for services billed to DMAP under this subsection. i) All Non -OHP Medicaid Extended Care Services reimbursable service billings shall be in accordance with Department Medicaid General Provider Rules 410-120-1280 and 410-120- 1300-1380 and MHS Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-000 through 309-016-0450. ii) Contractor shall bill all Personal Care Services in accordance with forms and procedures prescribed by Department. 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 Department for services (described in Exhibit 1) provided by Contractor under this Agreement or are expenditures approved by Department in Contractor budget. i) Contractor agrees to invoice County on a monthly basis for all Part A funds that are approved by the Department as part of Contractor's budget and paid to the County by amendment to the Agreement. County agrees to make approved payments to Contractor within 30 days of receipt of invoice. PAGE 3 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 ii) Contractor agrees to complete and submit all documentation of expenditures for Part A funds as required by Department and 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 Department and County and approved by Department and County in negotiation with Contractor prior to opening of the Facility. D. Any extension of services for the period after June 30, 2011 will be by separate amendment to this Agreement. 8. Payments in Future Years beyond June 30, 2011. Not later than April 2011, 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 Department to Contractor beginning after July 1, 2011. The parties may at that time also negotiate payment methods and amounts for one or more years after fiscal year 2010-11. 9. 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 Department 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 Department determines that County is responsible for the repayment of any funds owed to the Department by Contractor, Contractor agrees to make such payment within ten (10) days of notification by County or the Department of said determination by the Department. 10. 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 Department, 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 Department. 11. 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. 12. 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 three (3) months 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. PAGE 4 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 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. E. Upon written or oral notice, if County has evidence that the Contractor has endangered or is endangering the health and safety of clients, 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 clients. 2. Misuse of funds. 3. Intentional falsification of records. In the case a failure to perform jeopardizes the safety and security of any residents of the Facility covered under this Agreement, Contractor, County and Department 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 Department procedures and the Agreement. The Contractor may also terminate all or part of this Agreement for the cause specified below: A. With thirty (30) days written notice, if the "Part A" funding is not paid to Contractor as outlined in 7(B). 13. Encumbrance or Expenditure After Notice of Termination. Contractor shall not make expenditures, enter into contracts, or encumber funds in its possession that belong to County, after notice of termination or termination as set out above, without prior written approval from County. 14. 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: a. perform the work in a good, workmanlike, and timely manner; b. comply with all applicable legal requirements; c. take all precautions necessary to protect the safety of all persons at or near Facility, including employees and patients of Contractor and County; d. take full responsibility for wages and entitlements of Contractor's employees assigned to or furnishing services at Facility. C. It is agreed by and between the parties that Contractor is not carrying out a function on behalf of County, Department or State of Oregon, and County, Department 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 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. PAGE 5 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 E. 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. 15. 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. 16. Constraints. A. The Provisions of ORS 2796.220, 2796.230, and 2796.235, 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.0 201 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 Facility, 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 Client abuse. These laws, regulations and executive orders are incorporated by reference herein to the extent that they are applicable to the Agreement and required by law to be so incorporated. No federal funds may be used to provide 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 Department, HHS and the appropriate Regional Office of the Environmental Protection Agency. PAGE 6 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 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. 17. Hold Harmless. To the fullest extent authorized by law Contractor shall indemnify, save and hold harmless and defend the State of Oregon, Department, County, and their departments officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses, of any nature whatsoever, resulting from, arising out of or relating to the operations of Contractor, including, but not limited to the activities of Contractor, its officers, employees, subcontractors and agents under this Agreement. To the extent permitted by Article XI, Section 10, of the Oregon Constitution and within the applicable limits of the Oregon Tort Claims Act, ORS 30.260 through 30.300, County shall defend, save, hold harmless and indemnify Contractor and its officers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities costs and expenses of any nature resulting from or arising out of, or relating to the activities of County or its officers, employees, contractors, or agents under this 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 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 Department, and (2) renewal is subject to the availability of funding. 25. Additional Federal Law Compliance Requirements. A. Contractor shall comply with all applicable federal, state and local laws, administrative rules, ordinances and regulations. B. Contractor shall not knowingly and willfully make or cause to be made any false statement or representation of a material fact in connection with the furnishing of items or Services for which payments may be made by Department. C. 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: 1. Keep such records as may be necessary to disclose the extent of services furnished to clients and, upon request, furnish such records or other information to the Department, the Medicaid fraud section of the Oregon Department of Justice and the Secretary of Health and Human Services; 2. Comply with all applicable disclosure requirements set forth in 42 CFR Part 455, Subpart B; 3. Comply with any applicable advance directive requirements specified in 42 CFR Section 431.107(b)(4); and PAGEirOF9 — BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 4. Comply with the certification requirements of 42 CFR Sections 455.18 and 455.19. D. 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. 26. Reductions in Contract 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. 27. 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 attorneys fees, expenses, costs and disbursements for said action, suit, proceeding or appeal. 28. 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. 29. Survival. The provisions of paragraphs 3 to 11, 16 to 19, 22 to 26 29, shall survive the termination or expiration of this Agreement. PAGE 8 OF 9 — BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 COUNTY: CONTRACTOR: DATED this t Day of 2011. BOARD OF COUNTY COMMISSIONERS OF DESC PE' ES COUNTY, OREGON TAMM : AN 417, , Chair ANTHONY DEBONE, Commissioner (fir --- ALAN UNGER, Commissioner ATTEST: EST: ' fD Recording Secretary Telec -,+ orporation PAGE 9 OF 9 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 EXHIBIT 1 DESCHUTES COUNTY SERVICES CONTRACT STATEMENT OF WORK, COMPENSATION PAYMENT TERMS AND SCHEDULE Definitions: Adult Mental Health Initiative (AMHI): AMHI is a system reform project initiated by the State of Oregon Department of Human Services. 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 Department of Human Services 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 client 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 Accountable Behavioral Health Alliance (ABHA). 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 Department of Human Services; 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 Department'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- being, administration and supervision of medication, provision and arrangement of routine transportation, behavior management, management of diet and physical health problems. PAGE 1 OF 4 — EXHIBIT 1 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 Residential Treatment Services: For the purposes of this Contract, 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 Department 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 ID code MHS 28, and "Secure Residential Treatment Facility", Services ID 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 ID Code MHS 20 , Exhibit 1B; b. Non -Residential Adult Mental Health Services (Designated), Service ID Code MHS 201, Exhibit 1-D; c. Medicaid reimbursable service billings in accordance with the DHS Medicaid General Provider Rules 410-120-1280 and 410-120-1360-1380; DHS Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-000 through 309-016-0450; and Integrated Services and Supports Rule 309-032-1500 through 309-032-1565. 2. Contractor must enroll all Clients served in Oregon State's Client Process Monitoring System (CPMS) database within 24 hours of admission and disenrolled 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 client 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 Contract, licensing as a Secure Residential Treatment 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 Department 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. PAGE 2 OF 4 — EXHIBIT 1 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 C. Contractor shall provide SRTF services to Clients who meet the following criteria: 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 Client.; 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 Department 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 Department Medicaid General Provider Rules 410-120-1280 and 410-120-1360-1380 and MHS Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-000 through 309-016-0230. ii) Contractor shall bill all Personal Care Services in accordance with forms and procedures prescribed by DHS. 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 Department 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 Department as part of Contractor's budget and paid to the County by amendment to State Contract #127295 . County agrees to make approved payments to Contractor within 30 days of receipt of invoice. ii) Contractor agrees to complete and submit all documentation of expenditures for all Part A funds as required by DHS 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 Department and County and approved by Department and County. d. Contractor shall be entitled to reimbursement for expenses as set forth in Exhibit 5 0 YES ® NO [Check one] 4. The maximum compensation. a. The maximum, not to exceed consideration under this contract, which includes any allowable expenses, shall be $1,250,000. Contractor shall receive up to the total maximum amount for any allowable expenses allocated by DHS for Contractor services to the County under 2009-11 Intergovernmental Agreement. 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. 2010-693 "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 Department. b. All funds awarded to Contractor under this contract are subject to Department monitoring and adjustment. All adjustments in funds awarded will be made by amendment to the County 2009-11 IGA. Department will monitor and adjust funds awarded throughout the term of this contract at Department discretion. c. Contractor may also receive funding for Start-up Special Projects as outlined in Service ID Code MHS - 37, Exhibit 1-C. Contractor is responsible for expenditure of MHS 37 funds in accordance with budget approved by the Department and for completion and submission of all required documentation of fund expenditures to County and Department. d. Recovery of Overpayment: All payments made to Contractor under this contract are subject to recovery by Department 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 Contract results in a refund to or disallowance by the federal government of funds paid to Contractor under this Contract, DHS and/or County may recover from Contractor the amount of the refund or disallowance and any applicable Department matching funds. ii. If Contractor expends funds paid to Contractor under this Contract for purposes not authorized by this Contract, Department and/or County may recover the amount of the unauthorized expenditure from Contractor. iii. If billings under this contract result in payments to Contractor to which Contractor is not entitled, DHS 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 Contract. 6. Renewal. This Contract may be renewed as outlined in Section 8 of this contract and subject to the following conditions: a. Renewal will be based on the County Annual Implementation Plan approved by the Department. b. Renewal is subject to the availability of funding. 7. Modification of Exhibit 1-A through 1-D, State Requirements for Behavioral Health Subcontract In the event the State of Oregon modifies the terms of SE 28, 28A, 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 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. 2010-693 EXHIBIT 1-A SERVICE ID CODE MHS 28 and MHS 28A 1V113 Go)GVV7-GV11 Page 1 of 5 Service Name: RESIDENTIAL TREATMENT -SERVICES Service ID Code: MHS 28 I. Service Description Residential Treatment Services (MIS 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. B. Services delivered to individuals who the County, in conjunction with the Department determines are unable to live independently without supervised intervention, training or support arc eligible for MI -IS 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. MI -IS 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") 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. MI -IS 28 GT0323-09 t. PAGE 1 OF 5 — EXHIBIT 1-A - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 Approved 5/29/2009 MHS 28/2009-2011 Page 2 of 5 G. Provision or arrangement of routine and/or 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. J. Management of physical or health problems, including seizures or incontinency. II. Performance Requirements A provider of MHS 28 services shall give first priority in admission to referrals from the State Hospitals, followed by referrals from the Addictions and Mental Health Division's. Transitions Management and Utilization Review Unit (TMURU) and referrals of individuals on the State Hospital wait list. The TMURU or its designee shall provide direction to the provider regarding the prioritization of individuals for admission. 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 Department the "Personal Care Data Form For Residential Facilities" for any individual receiving MI -IS 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. County may only change an individual's payment rate after consultation with Department 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 with funds from the Residential Limitation (as defined below) and wishes to reserve MHS 28 service capacity for that individual for a short period of time when the individual is not actually receiving the services, County and the provider or anticipated provider of the services must submit a written residential Vacancy Exception Request to Department. If Department approves the Request, Department and County shall execute an amendment to the Financial Assistance Award 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. Department shall have no obligation to make the payments to reserve the service capacity unless and until the Financial Assistance Award has been so amended. PAGE 2 OF 5 — EXHIBIT 1-A - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 MHS 28/2009-2011 Page 3 of 5 All individuals receiving MHS 28 Services with funds provided under this Agreement must be enrolled in CPMS, and the individual's CPMS record for MHS 28 Services must be maintained, as specified in Department's CPMS manual. IV. Financial Assistance Calculation and Disbursement Procedures Department 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 Financial Assistance Award 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 Financial Assistance Award on MHS 28 lines that contain a "B" in column one and are paid as described in Section IV(B) below. A. The Part A Award will be calculated, disbursed and settled as follows: 1. Calculation of Financial Assistance. Department will provide financial assistance for MHS 28 Services identified in a particular line of the Financial Assistance Award 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 that line of the Financial Assistance Award, multiplied by the number of units of MHS 28 Services delivered under that line of the Financial Assistance Award during the period specified in that line, subject to the following: a. Total Department payment for MHS 28 Services delivered under a particular line in the Financial Assistance Award containing an "A" in column one shall not exceed the total funds awarded for MHS 28 Services as specified in that line of the Financial Assistance Award. b. Department is not obligated to provide financial assistance for any MHS 28 Services that are not properly reported in Client Process Monitoring System (CPMS) by the date 60 days after the earlier of termination of this Agreement, termination of Department's 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 Community Mental Health Program (CMIIP). c. Department will reduce the financial assistance for MHS 28 Services delivered under a particular line of the Financial Assistance Award containing an "A" in column one by the amount received, as payment of a portion of the cost of the services, by a Provider of MHS 28 Services from an individual receiving such services with funds awarded in that line of the Financial Assistance Award. PAGE 3 OF 5 - EXHIBIT 1-A - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 MHS 28/2009-2011 Page 4 of 5 2. Disbursement of Financial Assistance. Department will disburse funds awarded for MHS 28 Services identified in a particular line of the Financial Assistance Award with an "A" in column one, to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: a. Department may, after 30 days (unless parties agreed otherwise) written notice to County, reduce the monthly allotments based on under used allotments identified CPMS or through other reports required or permitted by this Service Description or applicable Special Terms and Conditions.. b. Department may, upon written request of County, adjust monthly allotments. c. Upon amendment to the Financial Assistance Award, Department shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 28 Services on that line of the Financial Assistance Award. 3. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual Department disbursements of fluids awarded for MHS 28 Services under a particular line of the Financial Assistance Award containing an "A" in column one and amounts due for such services based on the rate set forth in the special condition identified in that line of the Financial Assistance Award and the actual amount of services delivered under that line of the Financial Assistance Award during the period specified in that line of the Financial Assistance Award, 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 Vacancy Exception Request. B. Residential Limitation. The Residential Limitation is disbursed by Department directly to service providers based on monthly rates authorized by County after consultation with Department, subject to the following: 1. All payment rates authorized by County under this Section IV (B) for delivery of MT -IS 28 Services must meet the following requirements: a. 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 Services in the geographic area in which the services will be delivered and the needs of the particular individual receiving services; A ,, Cnonnno PAGE 4 OF 5 — EXHIBIT 1-A - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 11/11 :10 4Ol4VV7-'4V L 1 Page 5 of 5 b. County may (i) set different rates for delivery of MIIS 28 Services to different individuals and (ii) revise existing rates to reflect cost of living adjustments or other scheduled increases in payment for MHS•28 Services to the extent approved or authorized by the Oregon Legislative Assembly or the Legislative Emergency Board. c. County must document its methodology for determining a particular rate and furnish such documentation to Department. County shall retain such documentation in accordance with section 10 of Exhibit E of this Agreement. 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 total of all financial assistance authorized before reducing payments to account for client resources received for a provider 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 in support of client care and services provided. 5. The Residential Limitation is included in this Agreement for budgetary purposes. If Department anticipates that payments for MHS 28 Services authorized by County under this Section IV (B) will exceed the amount of the Residential Limitation, Department may unilaterally reduce the award of funds, as set forth in the Financial Assistance award, for any other MHS Service or Services to the extent of the general fund portion of the anticipated Residential Limitation shortfall and County shall execute and deliver to Department an appropriate amendment to the Financial Assistance Award to reflect the reduction of the Part A Award and the increase in the Residential Limitation. 6. Department 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 of this Agreement, termination of Department's 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 5 OF 5 - EXHIBIT 1-A - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 MHS 28A/2009-2011 Page 1 of 2 Service Name: Service Element I.D. Code: Specialized Service: EXHIBIT 1-B SERVICE ID CODE MHS 28 Residential Treatment Services MHS 28 SECURE RESIDENTIAL TREATMENT FACILITY Exhibit B Code: 28A I. Service Description and II. Performance Requirements (exceeding Exhibit B) Funds awarded for MHS 28 Services that are identified in the Financial Assistance Award as subject to this Specialized Service Requirement may only be expended on MHS 28 Services that are delivered in Secure Residential Treatment Facilities (as defined in OAR 309-035-0100 through 309-035-0190, as such rules may be revised from time to time) to individuals discharged from state psychiatric hospitals or local acute psychiatric programs who have a history of behaviors that are harmful to themselves or others. MI -IS 28 Services delivered with funds provided under this Agreement and subject to this Specialized Service Requirement include the following, in addition to the services otherwise described in the MHS 28 Service Description: rehabilitative services such as mental health assessment, diagnosis, and treatment plan development; monitoring and management of psychotropic medications; development of behavioral programs; establishment of a therapeutic milieu; group and individual skills training; consultation to other Agencies/Providers serving individuals receiving MHS 28 Services. Providers of MHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must comply with OAR 309-035-0100 through 309-035-0190, as such rules may be revised from time to time. Providers of MHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must deliver the Services in a facility that is residential in nature and as homelike as possible but whose buildings and grounds are locked to prevent free egress by individuals receiving services at the facility, in compliance with Building Code and Uniform Fire Code provisions. Providers of MHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must deliver the services in a facility staffed with a combination of on-site Qualified Mental Health Professionals (as defined in OAR 309-035-0100 through 309-035-0190), Qualified Mental Health Associates (as defined in OAR 309-035-0100 through 309-035-0190) and other staff sufficient to meet the security, behavioral, recreational, and mental health needs of residents, as identified in their service plans, on a 24-hour basis. MHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement may only be delivered to individuals approved by Department's Addictions and Mental Health Division (AMH) Transitions Management and Utilization Review Unit (TMURU). MHS 28A GT0323-09 Approved 5/29/2009 PAGE 1 OF 2 — EXHIBIT 1-B - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 • MHS 28A/2009-2011 Page 2 of 2 III. Reporting Requirements (exceeding Exhibit B) Providers of MHS 28 Services delivered with funds provided under this Agreement that are subject to this Specialized Service Requirement must provide data related to the assessment of outcomes of such services, as such data may be reasonably requested by Department's AMH. IV. Financial Assistance Calculation and Disbursement Procedures (exceeding Exhibit B) None MHS 28A GT0323-09 Approved 5/29/2009 PAGE 2 OF 2— EXHIBIT 1-B - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 EXHIBIT 1-C SERVICE ID CODE MHS 20 MHS 20/2009-2011 Page 1 of 3 Service Name: NON-RESIDENTIAL ADULT MENTAL HEALTH SERVICES (GENERAL) Service ID Code: MHS 20 I. Service Description Non -Residential Adult Mental Health Services (General) (MHS 20) are mental health services delivered to persons diagnosed with serious mental illness, or other mental or emotional disturbance posing a danger to the health and safety of themselves or others. These services 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 monitoring F. Emotional support G. Individual, family and group counseling and therapy 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 projects, 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 309-032-0525 through 309-032-0605, as such rules may be revised from time to time. B. Maintain a Certificate of Approval in accordance with OAR 309-012-0130 through OAR 309-012-0220, as such rules may be revised from time to time. 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 410-009-0050 through 410-009-0160, as such statutes and rules may be revised or amended from time to time. NHS 20 GT0323-09 Approved 5/29/2009 PAGE 1 OF 3 — EXHIBIT 1-C - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 MHS 20/2009-2011 Page 2 of 3 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 MES 20 Services, as such information and data is reasonably requested by Department in order to fully understand allegations and reports of abuse, the resulting investigations and protective services and any corrective actions. B. Client Process Monitoring System (CPMS) Enrollment. All individuals receiving MHS 20 Services with funds provided under this Agreement must be enrolled in CPMS, and the individual's CPMS record for MHS 20 Services must be maintained, as specified in Department's CPMS manual. N. Financial Assistance Calculation, Disbursement & Settlement Procedures Department 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 Financial Assistance Award 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. Department's Division of Medical Assistance Programs ("DMAP") calculates and disburses the award up to the Limitation directly to service providers on a fee-for-service basis. DMAP sets procedures and rates for the Limitation. All Medicaid reimbursable service billings shall be in accordance with the DHS 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. If Department anticipates or determines that billings to DMAP for MHS 20 Services delivered in County (or in the region served by the Community Mental health Program (CIvMHP) operated by or contractually affiliated with County, whichever area is larger) will exceed the amount of the Limitation, Department may unilaterally reduce the amount of the Part A Award to the extent of the general fund portion of the anticipated Limitation shortfall and County shall execute and deliver to Department an amendment to the Financial Assistance Award to reflect the reduction in the Part A Award and the increase in the Limitation. The Part A Award financial assistance will be calculated, disbursed and settled as follows: A. Calculation of Financial Assistance: The Part A Award for MHS 20 Services is intended to be general financial assistance to County for MHS 20 Services. Accordingly, Department will not track delivery of MHS 20 Services or service capacity on a per unit basis so long as County offers and delivers MHS 20 Services as part of its CMHP. Total Department financial assistance for MHS 20 Services under a particular line of the Financial Assistance Award shall not exceed the total funds awarded for MHS 20 Services as specified on that line. MHS 20 GT0323-09 Approved 5/29/2009 PAGE 2 OF 3 - EXHIBIT 1-C - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 MHS 20/2009-2011 Page 3 of 3 B. Disbursement of financial assistance: Department will disburse the Part A Award for MHS 20 Services identified in a particular line of the Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: 1. Department may, upon written request of County, adjust monthly allotments. 2. Upon amendment to the Financial Assistance Award, Department shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 20 Services on that line of the Financial Assistance Award. 3. The Department may reduce the monthly allocation when the county is identified by the Addictions and Mental Health Division (AMI -I) as the County of Responsibility of a patient at the State Hospital and the patient exceeds the length of stay authorized by the Department by more than 30 days. The reduction of the monthly allocation will be based on the following table: 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% The percentage of the Cost of Care will be reduced by an additional 50% if the County's patient ADP (Average Daily Population) or identified DHS approved multi -county region's ADP is at or below the ADP Targets established by AMI -1. State Hospital Cost of Care will be the cost of care identified in the current Institutional Cost of Care Rates Report published by the DHS 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. MHS 20 GT0323-09 Approved 5/29/2009 PAGE 3 OF 3 — EXHIBIT 1-C - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 EXHIBIT 1-D SERVICE ID CODE MHS 37 MHS 37 Start-up/2009-2011 Page 1 of 2 Exhibit MHS 37 -Start -Up Start-up Special Projects I. Service Description The funds awarded for this special project must be used for start-up activities described in a Special Condition. For purposes of this special project description, start-up activities are activities necessary to prepare for new or revised implementation of Mental Health Services. Notwithstanding the description of the start-up activities in a Special Condition, funds awarded for this special project may not be used for real property improvements of $5,000 and above. H. Performance Requirements The funds awarded for this special project may be expended only in accordance with Exhibit I, which is incorporated herein by this reference. III. Special Reporting Requirements County must prepare and submit reports to Department on the expenditure of the funds awarded for this special project. The reports must be prepared in accordance with forms prescribed by Department and procedures described in Exhibit I. IV. Financial Assistance Calculation and Disbursement Procedures A. Calculation of Financial Assistance: Department will provide financial assistance, from funds awarded for this special project in a particular line of the Financial Assistance Award, in an amount equal to the actual allowable expenditures (as described in Exhibit 1) incurred by a Provider in implementing the special project described herein, subject to the requirements of Exhibit I and subject to the following additional restrictions: 1. Total Department financial assistance for implementation of the special project described herein under a particular line of the Financial Assistance Award shall not exceed the total funds awarded for the special project described herein as specified in that line of the Financial Assistance Award; and 2. Department is not obligated to reimburse any special project expenditures that are not properly reported to Department using forms prescribed by Department and procedures contained in Exhibit # within ninety (90) days after the earlier of: a. termination of this Agreement, b. termination of Department's obligation to provide financial assistance for MHS 37 Services, or MES 37 Start-up GT0323-09 Approved 6/4/2009 PAGE 1 OF 2 — EXHIBIT 1-D - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 MHS 37 Start-up/2009-2011 Page 2 of 2 c. termination of County's obligation to include the Program Area, in which MHS 37 Services fall, in its Community Mental Health Program (CMHP). B. Disbursement of Financial Assistance: Department will disburse the fundsawarded for this special project in a particular line of the Financial Assistance Award after Department's receipt of Comity's properly completed "Request for Payment of Start - Up Funds", as described in and in accordance with Exhibit I. C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the team of this Agreement between actual Department disbursements of funds awarded for this special project under a particular line of the Financial Assistance Award and amounts due for implementation of the special project based on actual allowable expenditures incurred in implementing the special project under that line of the Financial Assistance Award during the period specified on that line, as such expenses are properly reported using forms prescribed by Department and procedures outlined in Exhibit I. 3vfHS 37 Start-up GT0323-09 Approved 6/4/2009 PAGE 2 OF 2 — EXHIBIT 1-D - BEHAVIORAL HEALTH SERVICES CONTRACT NO. 2010-693 EXHIBIT 1-E SERVICE ID CODE MHS 201 MHS 201/2009-2011 Page 1 of 3 Service Name: NON-RESIDENTIAL ADULT MENTAL HEALTH SERVICES (DESIGNATED) Service ID Code: MHS 201 I. Service Description Non -Residential Adult Mental Health Services (Designated) (MHS 201) are mental health services delivered to individuals specified in the Financial Assistance Award who have a chronic mental illness, or other mental or emotional disturbance posing a danger to the health and safety of themselves or others. A. The purpose of MHS 201 Services is to provide mental health services in community settings that reduce or ameliorate the disabling effects of mental illness. B. Non -Residential Adult Mental Health Services (Designated) include: 1. Case management services 2. Vocational and social services 3. Rehabilitation 4. Support to obtain and maintain housing 5. Medication and medication monitoring 6. Emotional support 7. Individual, family and group counseling and therapy II. Performance Requirements Providers of MHS 201 funded through this Agreement must: A. provide coordination of care services for county of responsibility residents in residential treatment programs, which include Extended Care Managed projects, 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. B. maintain a Certificate of Approval in accordance with OAR 309-012-0130 through OAR 309-012-0220, as such rules may be revised from time to time. C. comply with OAR 309-032-0525 through 309-032-0605, as such rules may be revised from time to time. D. maintain a Certificate of Approval in accordance with OAR 309-012-0130 through OAR 309-012-0220, as such rules may be revised from time to time. MHS 201 GT0323-09 Approved 5/29/2009 PAGE 1 OF 3 — EXHIBIT 1-E - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 MHS 201/2009-2011 Page 2 of 3 E. 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 410-009-0050 through 410-009-0160, as such statutes and rules may be revised or amended from time to time. III. Special Reporting Requirements A. County shall provide Department 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. Reports must be prepared using forms and procedures designated by Department. B. All individuals receiving MHS 201 Services with funds provided under this Agreement must be enrolled in Client Process Monitoring System (CPMS), and the individual's CPMS record for MHS 201 Services must be maintained, as specified in Department's CPMS manual. W. Financial Assistance Calculation and Disbursement Procedures Department 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 Financial Assistance Award on MHS 201 lines in column one (1) that contain an "A" for Part A or "B" for Part B Award. The Part A Award is set forth in the Financial Assistance Award on MHS 201 lines that contain an "A" in column one. Other funds (the "Limitation") are not calculated, disbursed or settled under this Agreement. Financial assistance up to the Limitation is calculated by Department's Division of Medical Assistance Programs ("DMAP") and disbursed directly to service providers on a fee for service basis by DMAP in accordance with DMAP procedures and at DMAP rates. The Limitation is set forth in the Financial Assistance Award on MHS 201 lines that contain a "B" in column one. The Limitation is included in this Agreement for budgetary purposes. If Department anticipates that billings to DMAP for MHS 201 Services delivered in County (or in the region served by the Community Mental Health Program (CMHP) operated by or contractually affiliated with County, whichever area is larger) will exceed the amount of the Limitation, Department may unilaterally reduce the amount of the Part A Award to the extent of the general fund portion•of the anticipated Limitation shortfall and County shall execute and deliver to Department an appropriate amendment to the Financial Assistance Award to reflect the reduction in the Part A Award and the increase in the Limitation. MHS 201 GT0323-09 Approved 5/29/2009 PAGE 2 OF 3 - EXHIBIT 1-E - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 MHS 201/2009-2011 Page 3 of 3 The Part A Award financial assistance will be calculated, disbursed and settled as follows: A. Calculation of Financial Assistance: The Part A Award for MHS 201 Services is intended to be financial assistance to County for MHS 201 Services. Total Department financial assistance for MHS 201 Services under a particular line of the Financial Assistance Award shall not exceed the total funds awarded for MHS 201' Services as specified on that line. 1. Department is not obligated to provide financial assistance for any MHS 201 Services delivered to individuals who are not properly reported through CPMS (or through other method permitted or required by this Service Description or an applicable Specialized Service Requirement) by the date 60 days after the earlier of termination of this Agreement, termination of Department's obligation to provide financial assistance for MHS 201 Services, or termination of County's obligation to include the Program Area, in which MHS 201 Services fall, in its CMHP. B. Disbursement of Financial Assistance: Department will disburse the Part A Award for MHS 201 Services identified in a particular line of the Financial Assistance Award to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: 1. Department 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. 2. Department may, upon written request of County, adjust monthly allotments. 3 Upon amendment to the Financial Assistance Award, Department shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 201 Services on that line of the Financial Assistance Award. C. Agreement Settlement: Agreement Settlement will be used to confirm the delivery of MHS 201 Services, to the individuals specified in the Financial Assistance Award, by County as part of its CMHP, based on data properly reported in CPMS or through other method permitted or required by this Service Description or an applicable Specialized Service Requirement. MHS 201 GT0323-09 Approved 5/29/2009 PAGE 3 OF 3 - EXHIBIT 1-E - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 EXHIBIT 2 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010 - INSURANCE REQUIREMENTS Contractor shall at all times maintain in force at Contractor's expense, each insurance noted below. Insurance coverage must apply on a primary or non-contributory basis. All insurance policies except Professional Liability shall be written on an occurrence basis and be in effect for the term of this contract. Other than Professional Liability insurance, authorization from Deschutes County is required for any policy written on a "claims made" basis. Contractor Name: Telecare Corporation Workers Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage in accordance with ORS Chapter 656 for all subject workers. Contractor and all subcontractors of Contractor with one or more employees must have this insurance unless exempt under ORS 656.027 (See Exhibit 2). Employer's Liability Insurance with coverage limits of not less than $500,000 must be included. THIS COVERAGE IS REQUIRED. Attach Certificate of Insurance for Contractor. If Contractor does not have coverage and claims to be exempt, attach Exhibit 4 in lieu of Certificate. Professional Liability insurance with an occurrence combined single limit of not less than: Per Occurrence limit $ 500,000 x $1,000,000 $2,000,000 Professional Liability insurance covers damages caused by error, omission, or negligent acts related to professional services provided under this Contract. This policy must provide extended reporting period coverage, sometimes referred to as "tail coverage" for claims made within two years after this contract is completed. Annual Aggregate limit $ 500,000 $1,000,000 x $2,000,000 RI Required by County ❑ Not required by County (one box must be checked) Commercial General Liability insurance with a combined single limit of not less than: Per Occurrence limit $ 500,000 x $1,000,000 Annual Aggregate limit $ 500,000 $1,000,000 _$2,000,000 x $2,000,000 Commercial General Liability insurance includes coverage for personal injury, bodily injury, advertising injury, property damage, premises, operations, products, completed operations and contractual damages. By separate endorsement, the policy shall name Deschutes County, its officers, agents, employees and volunteers as an additional insured. The additional insured endorsement shall not include exclusions that reduce any required per occurrence or aggregate insurance limits. Construction contracts may include aggregate limits that apply on a "per location" or "per project" basis. PAGE 1 OF 2 — EXHIBIT 2 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 El Required by County ❑ Not required by County ❑ Policy endorsed with additional insured language (One box must be checked) (This box must be checked) Automobile Liability insurance with a combined single limit of not less than: Per Occurrence $ 500,000 $1,000,000 $2,000,000 Automobile Liability insurance covers bodily injury and property damage resulting from operation of a motor vehicle. Commercial Automobile Liability Insurance shall provide coverage for any motor vehicle (symbol 1 on some insurance certificates) driven by or on behalf of Contractor during the course of providing services under this contract. Commercial Automobile Liability is required for contractors that own business vehicles registered to the business. Examples include: plumbers, electricians or construction contractors. Examples of acceptable personal automobile policies include contractors who are sole proprietors that do not own vehicles registered to the business. ❑ Required by County I1 Not required by County (one box must be checked) Additional Requirements. An insurance company admitted to do business in Oregon and rated B+ or better by Best's Insurance Rating must provide insurance policies. Contractor shall pay all deductibles and retentions. A cross -liability clause or separation of insured's condition must be included in all commercial general liability policies required by this Contract. Contractor's coverage will be primary in the event of loss. Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contracts. The Certificate shall provide that there shall be no cancellation, termination, material change, or reduction of limits of the insurance coverage without at least 30 days written notice from the Contractor's insurer to the County. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. For commercial general liability the Certificate shall also provide, by policy endorsement, that Deschutes County, its agents, officers, employees and volunteers are additional insureds with respect to Contractor's services provided under this Contract. The additional insured endorsement must not include exclusions that erode any limits of required coverage. 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 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 Exhibit 3 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. Department 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. 3.3 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 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 3.4 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. 3.5 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. 3.6 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 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 Exhibit 4 BUSINESS ASSOCIATE AGREEMENT County will make available and/or transfer to Contractor certain Information, in conjunction with goods or services that are being provided by Contractor to County, that is confidential and must be afforded special treatment and protection. Contractor will have access to and/or receive from County certain Information that can be used or disclosed only in accordance with this Agreement and the HHS Privacy Regulations. To the extent required by 42 U.S.C. 1171 et seq. enacted by the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, Contractor assures County that Contractor will appropriately safeguard protected health information made available to or obtained by Contractor. Contractor further agrees to comply with applicable laws relating to protected health information and with respect to any task or other activity Contractor performs on behalf of County, to the extent County would be required to comply with such requirements. For purposes of this Agreement, the following terms shall apply: A. Contractor shall be considered a BUSINESS ASSOCIATE; 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 clients of County or its members without the prior written consent or authorization of the County or of the client. 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 4 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 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 pri :cy standards. Date: 1114111 Signature: Contractor: Telecare Menta i / rirces of o"07 Title V?eco PAGE 2 OF 2 — EXHIBIT 4 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 Exhibit 5 EXPENSE REIMBURSEMENT 1. Travel and Other Expenses. (When travel and other expenses are reimbursed.) a. It is the policy of the County that all travel shall be allowed only when the travel is essential to the normal discharge of the County responsibilities. 1) All travel shall be conducted in the most efficient and cost effective manner resulting in the best value to the County. 2) Travel expenses shall be reimbursed for official County business only. 3) County shall not reimburse Contractor for any item that is not otherwise available for reimbursement to an employee of Deschutes County per Deschutes County Finance Policy F-1, "REIMBURSEMENT FOR MISCELLANEOUS EXPENSES AND EXPENSES INCURRED WHILE TRAVELING ON COUNTY BUSINESS," dated 11/8/06. 4) County may approve a form other than the County Employee Reimbursement Form for Contractor to submit an itemized description of travel expenses for payment. 5) Personal expenses shall not be authorized at any time. 6) All expenses are included in the total maximum contract amount. b. Travel expenses shall be reimbursed only in accordance with rates approved by the County and only when the reimbursement of expenses is specifically provided for in Exhibit 1, paragraph 3 of this contract. c. The current approved rates for reimbursement of travel expenses are set forth in the above described policy. d. County shall not reimburse for any expenses related to alcohol consumption or entertainment. e. Except where noted, detailed receipts for all expenses shall be provided. f. Charge slips for gross amounts are not acceptable. g. County shall not reimburse Contractor for any item that is not otherwise available for reimbursement to an employee of Deschutes County. 2. Approved reimbursements: a. Mileage. Contractor shall be entitled to mileage for travel in a private automobile while Contractor is acting within the course and scope of Contractor's duties under this Contract and driving over the most direct and usually traveled route to and from Bend, Oregon. 1) Reimbursement for mileage shall be equal to but not exceed those set by the United States General Services Administration ("GSA") and are subject to change accordingly. 2) To qualify for mileage reimbursement, Contractor shall hold a valid, current driver's license for the class of vehicle to be driven and carry personal automobile liability insurance in amounts not less than those required by this Contract. 3) No mileage reimbursement shall be paid for the use of motorcycles or mopeds. b. Meals. 1) Any reimbursement for meals shall be for actual cost of meals incurred by Contractor while acting within the course and scope of Contractor's duties under this Contract. 2) For purposes of calculating individual meals where the Contractor is entitled only to a partial day reimbursement, the following maximum allocation of the meal expenses applies: a) Breakfast, $10; b) Lunch, $15; c) Dinner, $31. 3) Except in the event of necessary overnight travel as provided below, partial day meal expenses shall be reimbursed as follows and only while Contractor is acting within the course and scope of Contractor's duties under this Contract: a) Breakfast expenses are reimbursable if Contractor is required to travel more than two (2) hours: before the start Contractor's regular workday (i.e. 8:00 a.m.)., b) Lunch expenses are reimbursable only if Contractor is required to travel overnight and begins the journey before 11:00 am or ends the journey after 11:00 a.m. PAGE 1 OF 2 — EXHIBIT 5 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 c) Dinner expenses are reimbursable only if Contractor is required to travel more than two (2) hours after Contractor's regular workday (i.e. 5:00 p.m.). 4) Breakfast and dinner expenses are reimbursable during Contractor's necessary overnight travel while acting within the course and scope of Contractor's duties under this Contract and shall not exceed those set by the GSA. and are subject to change accordingly. c. Lodging. 1) County shall reimburse Contractor for Contractor's actual cost of lodging necessary to provide service to the County and shall not exceed the maximum lodge set by the GSA for Bend, Oregon. 2) Reimbursement rates for lodging are not considered "per diem" and receipts are required for reimbursement. d County shall not reimburse Contractor in excess of the lowest fair for any airline ticket or vehicle rental charges. 3. Exceptions. Contractor shall obtain separate written approval of the County Administrator for any exceptions to the expense items listed above prior to incurring any expense for which reimbursement shall be sought. PAGE 2 OF 2 — EXHIBIT 5 - BEHAVIORAL HEALTH SERVICES CONTRACT No. 2010-693 AR DJ PRODUCER MARSH RISK 8 INSURANCE SERVICES 345 CALIFORNIA STREET, SUITE 1300 CALIFORNIA LICENSE NO. 0437153 SAN FRANCISCO, CA 94104 Attn: SanFrancisco.Certs@marsh.com / f: 212-948-0398 072624 -CAS --10-11 GLALP WC OR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 07/07/2010 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED TELECARE MENTAL HEALTH SERVICES OF OREGON, INC. 1080 MARINA VILLAGE PARKWAY, SUITE 100 ALAMEDA, CA 94501 INSURER A: Nautilus Insurance Company 17370 INSURER B: Zurich American Insurance Company 16535 INSURER c: American Zurich Insurance Company 40142 INSURER D: INSURER E: COVERAGES 2 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO INSR� TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE MMI DATEIDD/YYYY) POLICY EXPIRATION DATE(MMIDD/YYYYI LIMITS A x GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GFP1000063P2 S.I.R. $100,000 07/01/2010 07/01/2011 EACH OCCURRENCE $ 1,000.000 DAMAGE TO RENTED PREM SES Ea occurrence) $ 1 00,000 CLAIMS MADE X OCCUR MED EXP (Arty one person) $ 5,000 GENERAL PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 AGGREGATE O IT APPLIES PER POLICY T PRODUCTS - COMP/OP AGO $ 1 1)00,000 B X AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAP378473306 07/01/2010 07/01/201 1 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE $ $ $ % C WORKERS EMPLOYERS ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory SPECIAL COMPENSATION AND LIABILITY Y / N WC829852008 07/01/2010 07/01/2011 X I INC STARTS I 1OTH- TARY I TC FR E.L. EACH ACCIDENT $ 1,000,000 EXCLUDED? N 1 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 in NH) If yes, describe under PROVISIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 A OTHER PROFESSIONAL LIABILITY CLAIMS MADE PFP1000081P2 S.I.R. $100,000 07/01/2010 07/01/2011 AGGREGATE 3,000,000 EACH OCCURRENCE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 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 SEA -001594626-03 CANCELLATION DESCHUTES COUNTY HEALTH SERVICES 2577 NE COURTNEY DRIVE BEND, OR 97702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. VittIZEDREPRJSENTAnce of Marslhl Rrs & SENTATce Services Ellen Redell Brown &CORD 25 (2009/01) © 1998-2009 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Acord 25 (2009/01) 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 LIABILITY COVERAGE FORM A. Section tt-- Who Is An Insured Is amended to Include as an additional 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 your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", °property damage" or "personal and advertising injury" caused in whole or In part, by: 1. Your acts or omissions; or 2 Tile acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. NOTHING CONTAINED HEREIN SHALL VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, PROVISIONS., REPRESENTATIONS, CONDITIONS OR AGREEMENTS OF THE POLICY OTHER THAN AS STATED ABOVE. SSM -0081(7107) Includes copyrighted mated of Insurance Services Office, inc. will its Page 1 of 1 permission. DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be retumed to the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form electronically to the Board Secretary.) Date: Please complete all sections above the Official Review line. December 14, 2010 Department: Health Services, Behavioral Health Contractor/Supplier/Consultant Name: Contractor Contact: Gemma Lim Telecare Mental Health Services of Oregon, Inc. Contractor Phone #: Type of Document: Personal Services Contract 510-337-7950 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. 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 Contractor. 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 Tess intensity as clinically appropriate. Contractor shall bill Division of Medical Assistance Programs (DMAP) in accordance with procedures and forms prescribed by Department of Human Services (DHS). County agrees to pay Contractor funds that are received by County through DHS by amendment to DHS Contract. Funding for operation and facilities will be in accordance with a budget submitted by Contractor to DHS and County and approved by both DHS and County. Agreement Starting Date: December 1, 2010 Annual Value or Total Payment: Ending Date: June 30, 2011 Maximum compensation is $1,250,000 ® Insurance Certificate Received (check box) Insurance Expiration Date: July 1, 2011 Check all that apply: ❑ RFP, Solicitation or Bid Process 0 Informal quotes (<$150K) ® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37) 17/1 d/711111 Funding Source: (Included in current budget? ® Yes 0 No If No, has budget amendment been submitted? 0 Yes 0 No Is this a Grant Agreement providing revenue to the County? 0 Yes ® No Special conditions attached to this grant: Deadlines for reporting to the grantor. If a new FTE will be hired with grant funds, confirm that Personnel has been notified that it is a grant -funded position so that this will be noted in the offer letter. 0 Yes 0 No Contact information for the person responsible for grant compliance: Name: Phone #: Departmental Contact and Title: Phone #: 541-322-7516 Department Director Approval: Nancy England, Contract Specialist la1i5jlo Date Distribution of Document: Retum both originals to Nancy England, Behavioral Health Department. Official Review: County Signature Required (check one): 0 BOCC 0 Department Director (if <$25K) 0 Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ) Legal Review Document Nurnber 20693 Date it ) (_� 1 I