HomeMy WebLinkAboutDoc 329 - IGA - DHS - Mental Health SvcsDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of June 29, 2011
DATE: June 22, 2011
FROM: Nancy England, Contract Specialist, Deschutes County Health Services, 322-7516
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document #2011-329, Intergovernmental Financial Agreement
Award #134309 between Deschutes County Health Services, Behavioral Health Division and the
Oregon Health Authority for the financing of Community Addictions and Mental Health Services for
year 2011-2013.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
The Oregon Health Authority (OHA) was created by the 2009 Oregon legislature to bring most health-
related programs in the state into a single agency to maximize its purchasing power, the attached
Intergovernmental Agreement (#134309) outlines the services and financing for fiscal year 2011-2013.
OHA is at the forefront of lowering and containing costs, improving quality and increasing access to
health care in order to improve the lifelong health of Oregonians. In the public sector, OHA will
consolidate most of the state's health care programs, including Addictions & Mental Health
Services (AMH), Public Health, the Oregon Health Plan (OHP), HealthyKids Connect, employee
benefits and public-private partnerships. This will give the state greater purchasing and market
power to begin tackling issues with costs, quality, lack of preventive care and health care access.
In both the public and the private sector, OHA will be working to fundamentally improve how health
care is delivered and paid for, but because poor health is only partially due to lack of medical care,
OHA will also be working to reduce health disparities and to broaden the state's public health
focus. Ultimately, OHA is charged with delivering a plan to the Legislature to ensure that all
Oregonians have access to affordable health care.
The 2011-2013 biennium Intergovernmental Agreement for the Financing of Community
Addictions and Mental Health Services sets the dollar amounts and guidelines for
Deschutes County Health Services to provide or coordinate provision of behavioral health
as well as alcohol, other drug and problem gambling prevention and treatment services for
the next two years. The Intergovernmental Agreement (IGA) does not contain funding for
Mental Health Services (MHS) financials. It is the intent of the State to send an
amendment containing the MHS financial information as soon as possible.
FISCAL IMPLICATIONS:
Funding reimbursement for Alcohol & Drug service elements FY 11-13 is $785,601
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of Document #2011-329, Intergovernmental Financial Agreement Award
#134309 between Deschutes County Health Services, Behavioral Health and the Oregon Health
Authority is requested.
ATTENDANCE: Scott Johnson, Director
DISTRIBUTION OF DOCUMENTS:
E -Mail (tami.i.goertzenastate.or.us) Tami Goertzen, signed Page 2 of the agreement, a
completed page 10 of Exhibit F, and the completed, signed Document Return Statement.
Also, please e-mail the Board Resolution and insurance documentation. Original documents
to Nancy England at Health Services.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. lithe document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
Please complete all sections above the Official Review line.
June 17, 2011
Department:
Health Services, Behavioral Health
Contractor/Supplier/Consultant Name:
Contractor Contact:
April Barrett
Oregon Health Authority
Contractor Phone #:
Type of Document: Intergovernmental Agreement
503-945-5821
Goods and/or Services: The Oregon Health Authority (OHA) was created by the 2009
Oregon legislature to bring most health-related programs in the state into a single agency
to maximize its purchasing power; the attached Intergovernmental Agreement (#134309)
outlines the services and financing for fiscal year 2011-2013.
Background & History: OHA is at the forefront of lowering and containing costs, improving
quality and increasing access to health care in order to improve the lifelong health of
Oregonians. In the public sector, OHA will consolidate most of the state's health care programs,
including Public Health, the Oregon Health Plan (OHP), HealthyKids Connect, employee
benefits and public-private partnerships. This will give the state greater purchasing and market
power to begin tackling issues with costs, quality, lack of preventive care and health care
access. In both the public and the private sector, OHA will be working to fundamentally improve
how health care is delivered and paid for, but because poor health is only partially due to lack of
medical care, OHA will also be working to reduce health disparities and to broaden the state's
public health focus. Ultimately, OHA is charged with delivering a plan to the Legislature to
ensure that all Oregonians have access to affordable health care.
The 2011-2013 biennium Intergovernmental Agreement for the Financing of
Community Addictions and Mental Health Services sets for the dollar amounts and
guidelines for Deschutes County Health Services to provide or coordinate provision of
behavioral health and developmental disability treatment services to individuals, as well
as alcohol, other drug and problem gambling prevention and treatment services for the
coming two years.
The Intergovernmental Agreement (IGA) does not contain funding for Mental Health
Services (MHS) Financials. It is the intent of the State to send an amendment
containing the MHS financial information as soon as possible.
Agreement Starting Date:
July 01, 2011
Annual Value or Total Payment:
Ending Date:
June 30, 2013
Biennial revenue is approximately, $785,601.
® Insurance Certificate Received (check box)
Insurance Expiration Date:
N/A County is Contractor
6/17/2011
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (4150K)
® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? ® Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes ❑ 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
Jvne-17,11
Date
Distribution of Document: E -Mail (tami.i.goertzen(a.state.or.us) Tami Goertzen,
signed Page 2 of the agreement, a completed page 10 of Exhibit F, and the completed,
signed Document Return Statement. Also, please e-mail the Board Resolution and
insurance documentation. Original documents to Nancy England at Health Services.
Official Review:
County Signature Required (check one): 0 BOCC 0 Department Director (if <$25K)
0 Administrator (if >$25K but 4150K; if >$150K, BOCC Order No. )
Legal Review Date
Document Number: 2011-329
6/17/2011
)tDHS
Oregon Department
of Human Services
ADMINISTRATIVE SERVICES DIVISION
Office of Contracts and Procurement
Heeg°61thy
John A Kitzhaber, MD, Govemor
250 Winter St NE, Room 306
Salem, OR 97301
Voice: (503) 945-5818
FAX: (503) 378-4324
DOCUMENT RETURN STATEMENT
Re: Amendment #00 to Agreement #134309 hereinafter referred to as "Document."
Please complete the following statement and return it along with the completed signature page and the
Contractor Data and Certification page and/or Contractor Tax Identification Information form (if
applicable).
Important: If you have any questions or find errors in the above referenced Document, please contact
the contract specialist, April D. Barrett at (503) 945-5821.
I
Scott Johnson , Director
(Name)
(Title)
received a copy of the above referenced Document, between the State of Oregon, acting by and through
its Oregon Health Authority, and Deschutes County, by e-mail from Tami Goertzen on June 4, 2011.
On June 17. 2011 _, I signed the electronically transmitted Document without
(Date)
change. I am returning the completed signature page and Contractor Data and Certification page and/or
Contractor Tax Identification Information form (if applicable) with this Document Return Statement.
‘Junei 17 it
(Date)
REVitWv ED
'N SEL
In compliance with the Americans with Disabilities Act, this document is
available in alternate formats such as Braille, large print, audio
recordings, Web -based communications and other electronic formats. To
request an alternate format, please send an e-mail to dhsalt(astate.or.us or
call 503-378-3486 (voice) or 503-378-3523 (TTY) to arrange for the
alternative format.
AGREEMENT # 134309
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
This 2011-2013 Intergovernmental Agreement for the Financing of Community Addictions
and Mental Health Services (the "Agreement") is between the State of Oregon acting by and
through its Oregon Health Authority ("OHA") and Deschutes County, a political subdivision of
the State of Oregon ("County").
RECITALS
WHEREAS, ORS 430.610(4) and 430.640(1) authorize OHA to assist Oregon counties
and groups of Oregon counties in the establishment and financing of community addictions and
mental health programs operated or contracted for by one or more counties;
WHEREAS, County has established and proposes, during the term of this Agreement, to
operate or contract for the operation of community addictions and mental health programs in
accordance with the policies, procedures and administrative rules of OHA;
WHEREAS, County has requested financial assistance from OHA to operate or contract
for the operation of its community addictions and mental health programs;
WHEREAS, in connection with County's request for financial assistance and in
connection with similar requests from other counties, OHA and representatives of various
counties requesting financial assistance, including the Association of Oregon Counties, have
attempted to conduct agreement negotiations in accordance with the Principles and Assumptions
set forth in a Memorandum of Understanding that was signed by both parties;
WHEREAS, OHA is willing, upon the terms of and conditions of this Agreement, to
provide financial assistance to County to operate or contract for the operation of its community
addictions and mental health programs;
WHEREAS, various statutes authorize OHA and County to collaborate and cooperate in
providing for basic community addictions and mental health programs and incentives for
134309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/2011 1131'220
DC 2O11:32r,
community-based care in a manner that ensures appropriate and adequate statewide service
delivery capacity, subject to availability of funds; and
WHEREAS, within existing resources awarded under this agreement, each
CMHP/LMHA shall develop a plan to improve the integration of mental health, chemical
dependency and physical/dental health care services with each Oregon Health Plan PHP (Prepaid
Health Plan) serving individuals in the county. The plan shall be submitted as part of the
Biennial Implementation Plan, required by ORS 430.630(1 1)(b), and be limited to providing a
brief description of the approach, the basic goals and expected outcomes.
NOW, THEREFORE, in consideration of the foregoing premises and other good and
valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties
hereto agree as follows:
AGREEMENT
1. Effective Date and Duration. This Agreement shall become effective on July 1, 2011.
Unless terminated earlier in accordance with its terms, this Agreement shall expire on June
30, 2013.
2. Agreement Documents, Order of Precedence. This Agreement consists of the following
documents:
This Agreement without Exhibits
Exhibit A Definitions
Exhibit B-1 Service Descriptions
Exhibit B-2 Specialized Service Requirements
Exhibit C Financial Assistance Award
Exhibit D Special Terms and Conditions
Exhibit E General Terms and Conditions
Exhibit F Standard Terms and Conditions
Exhibit G Required Federal Terms and Conditions
Exhibit H Required Provider Contract Provisions
Exhibit I Provider Insurance Requirements
Exhibit J Startup Procedures
Exhibit K Catalogue of Federal Domestic Assistance (CFDA) Number Listing
In the event of a conflict between two or more of the documents comprising this
Agreement, the language in the document with the highest precedence shall control. The
precedence of each of the documents comprising this Agreement is as follows, listed from
highest precedence to lowest precedence: (a) this Agreement without Exhibits, (b) Exhibit
G, (c) Exhibit A (d) Exhibit D, (e) Exhibit E (f) Exhibit B-1, (g) Exhibit B-2, (h) Exhibit F,
(i) Exhibit H, , (j) Exhibit I, (k) Exhibit J, (1) Exhibit K. and (m) Exhibit C.
134309 Deschutes Count
OHA II-13GT0217-II
Approved 5/9/2011 2 of 220
EACH PARTY, BY EXECUTION OF THIS AGREEMENT, HEREBY
ACKNOWLEDGES THAT IT HAS READ THIS AGREEMENT, UNDERSTANDS IT,
AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS.
Deschutes County
By:
Tammy Baney, Chair
Deschutes County Board of
Commissioners
Authorized Signature Date
State of Oregon acting by and through its Oregon Health Authority
By:
Authorized Signature Title Date
Approved for Legal Sufficiency:
Approved via email by Steven Marlowe 5/9/2011
Assistant Attorney General Date
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OHA 11-13 GT0217-11
Approved 5/9/2011 3 of 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT A
DEFINITIONS
As used in this Agreement, the following words and phrases shall have the indicated meanings.
Certain additional words and phrases are defined in the Service Descriptions, Specialized Service
Requirements and special conditions in the Financial Assistance Award. When a word or phrase
is defined in a particular Service Description, Specialized Service Requirement or special
condition in the Financial Assistance Award, the word or phrase shall not necessarily have the
ascribed meaning in any part of the Agreement other than the particular Service Description,
Specialized Service Requirement or special condition in which it is defined.
1. "Addiction Services" means all Services whose service code begins with the letters
2. "Agreement Settlement" means OHA's reconciliation, after termination or expiration of
this Agreement, of amounts OHA actually disbursed to County under this Agreement from
the Financial Assistance Award with amounts that OHA is obligated to pay to County
under this Agreement from the Financial Assistance Award, as determined in accordance
with the financial assistance calculation methodologies set forth in the Service
Descriptions. OHA reconciles disbursements and payments on an individual Service basis
as set forth in the Service Descriptions, and in accordance with Exhibit E, Section 1,
Disbursement and Recovery of financial assistance.
3. "Allowable Costs" means the costs described in OMB Circular A-87 except to the extent
such costs are limited or excluded by other provisions of this Agreement, whether in the
applicable Service Descriptions, Specialized Service Requirements, special conditions
identified in the Financial Assistance Award (FAA), or otherwise.
4. "Amending Line" has the meaning set forth in Exhibit C.
5. "Authorizing Resolution" has the meaning set forth in section 4 of Exhibit E.
6. "Claim" has the meaning set forth in section 1 of Exhibit F.
7. "Client" means, with respect to a particular Service, any individual who is receiving that
Service, in whole or in part, with funds provided under this Agreement.
8. "Client Process Monitoring System" or "CPMS" means OHA's information system that
tracks and documents Service delivery or any successor system designated by OHA.
9. "Community Mental Health Program" or "CMHP" means a centrally organized and
coordinated program of services for persons with mental and emotional disorders and
addiction dependencies operated by, or contractually affiliated with a LMHA and operated
in a specific geographic area of the State of Oregon.
10. "Corresponding Line" has the meaning set forth in Exhibit C.
11. "County" has the meaning set forth in the first paragraph of this Agreement.
134309 Deschutes County
OHA 11-13 GT0217-H
Approved 5/9/2011 4 of 220
12. "County Financial Assistance Administrator" has the meaning set forth in section 4 of
Exhibit E.
13. "DHS" means the Department of Human Services of the State of Oregon.
14. "Drug Court" or "Drug Treatment Court" means any court given the responsibility
pursuant to ORS 3.450 to handle cases involving substance -abusing offenders through
comprehensive supervision, drug testing, treatment services and immediate sanctions and
incentives.
15. "Federal Funds" means all funds paid to County under this Agreement that OHA receives
from an agency, instrumentality or program of the federal government of the United States.
16. "Financial Assistance Award" or "FAA" means the description of financial assistance
set forth in Exhibit C attached hereto and incorporated herein by this reference, as such
Financial Assistance Award may be amended from time to time Disbursement of funds
identified in the FAA is made by OHA using procedures and systems described in the
Exhibit B-1 Service Description for each respective Service.
17. "Grant Appeals Board" has the meaning set forth in section 1 of Exhibit E.
18. "Local Mental Health Authority" or "LMHA" means the county court or board of
commissioners of one or more counties who choose to operate a CMHP.
19. "Medicaid" means Federal Funds received by OHA under Title XIX of the Social Security
Act and Children's Health Insurance Funds administered jointly with Title XIX funds as
part of state medical assistance programs by OHA.
20. "Mental Health Services" means all Services whose service code begins with the letters
"MHS."
21. "Misexpenditure" means money, other than an Overexpenditure, disbursed to County by
OHA under this Agreement and expended by County that:
(a) Is identified by the federal government as expended contrary to applicable statutes,
rules, OMB Circulars or any other authority that governs the permissible expenditure
of such money, for which the federal government has requested reimbursement by the
State of Oregon and whether in the form of a federal determination of improper use
of federal funds, a federal notice of disallowance, or otherwise; or
(b) Is identified by the State of Oregon or OHA as expended in a manner other than that
permitted by this Agreement, including without limitation, any money expended by
County, contrary to applicable statutes, rules, OMB Circulars or any other authority
that governs the permissible expenditure of such money; or
(c) Is identified by the State of Oregon or OHA as expended on the delivery of a Service
that did not meet the standards and requirements of this Agreement with respect to
that Service.
22. "Overexpenditure" means money disbursed by OHA under this Agreement and expended
by County that is identified by the State of Oregon or OHA, through Agreement Settlement
or any other disbursement/payment reconciliation permitted or required by this Agreement,
as in excess of the amount County is entitled to as determined in accordance with the
134309 Deschutes County
OI -IA I I -13 GT0217- I I
Approved 5/9/2011 5 of 220
financial assistance calculation methodologies set forth in the applicable Service
Descriptions or Exhibit D.
23. "Program Area" means any one of the following: Mental Health Services or Addiction
Services.
24. "Provider" has the meaning set forth in section 6 of Exhibit E. As used in a Service
Description and elsewhere in this Agreement where the context requires, Provider also
includes County if County provides the Service directly.
25. "Provider Contract" has the meaning set forth in section 6 of Exhibit E.
26. "Seniors and People with Disabilities" or "SPD" means DHS's section responsible for
management, financing and regulation of Developmental Disability Services.
27. "Service" means any one of the following services or group of related services as
described in Exhibit B-1, whose costs are covered in whole or in part with financial
assistance pursuant to Exhibit C of this Agreement. Only Services whose costs are covered
in whole or in part with financial assistance pursuant to Exhibit C, as amended from time to
time, are subject to this Agreement.
Service Name
Service Code
Local Administration — Mental Health Services
MHS 01
Local Administration — Addictions Services
A&D 03
A&D Special Projects
A&D 60
Adult Alcohol and Drug Residential Treatment
A&D 61
Housing Services for Dependent Children Whose Parents are in
Alcohol and Drug Residential Treatment
A&D 62
Peer Delivered Services
A&D 63
Continuum of Care Services
A&D 66
Alcohol and Drug Residential Capacity Services
A&D 67
Prevention Services
A&D 70
Youth Alcohol and Drug Residential Treatment Services
A&D 71
Drug Treatment Court Services
A&D 72
Integrated Co -Occurring Disorders (COD) Treatment Services
A&D 73
Problem Gambling Prevention Services
A&D 80
Problem Gambling Treatment Services
A&D 81
Problem Gambling Special Projects
A&D 82
Non -Residential Mental Health Services For Adults — General
MHS 20
Child and Adolescent Mental Health Services
MHS 22
Regional Acute Psychiatric Inpatient Services
MHS 24
Community Crisis Services for Adults and Children
MHS 25
Non -Residential Youth and Young Adults Mental Health Services In
Transition (Designated)
MHS 26
Residential Mental Health Treatment Services for Youth and Young
Adults In Transition
MHS 27
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OI -IA I I-13GT0217-11
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Service Name
Service Code
Residential Treatment Services
MHS 28
Community Treatment and Supervision Services for Individuals Under
the Jurisdiction of the Adult and Juvenile Panels of the Psychiatric
Security Review Boards
MHS 30
Enhanced Care/Enhanced Care Outreach Services
MHS 31
Adult Foster Care Services
MHS 34
Older/Disabled Adult Mental Health Services
MHS 35
Pre -Admission Screening and Resident Review Services
MHS 36
MHS Special Projects
MHS 37
Evidence -Based Supported Employment Services
MHS 38
Projects For Assistance In Transition From Homelessness (PATH)
Services
MHS 39
Non -Residential Mental Health Services For Adults (Designated)
MHS 201
28. "Service Description" means the description of a Service set forth in Exhibit B-1.
29. "Specialized Service Requirement" means any one of the following specialized service
requirements as described in Exhibit B-2 whose costs are covered in whole or in part with
Financial Assistance pursuant to Exhibit C of this Agreement. Only Services whose costs
are covered in whole or in part with financial assistance pursuant to Exhibit C, as amended
from time to time, are subject to this Agreement.
Specialized Service Requirement Name
Specialized Service Requirement Code
Intensive Treatment and Recovery Services
A&D 61A
Intensive Treatment and Recovery Services
A&D 66A
Treatment Foster Care Services
MHS 22A
Early Psychosis Project (EPP)
MHS 26A
Secure Residential Treatment Facility
MHS 28A
Relative Foster Care
MHS 34A
Gero-Specialist
MHS 35A
SPD Residential
MHS 35B
30. "Underexpenditure" means money disbursed by OHA under this Agreement that remains
unexpended at Agreement termination or expiration, other than money County is permitted
to retain and expend in the future under section 4.b of Exhibit E.
134309 Deschutes County
OHA 11-13 GT0217-I1
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2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL
HEALTHSERVICES
EXHIBIT B-1
SERVICE DESCRIPTIONS
Not all Services described in Exhibit B-1 may be covered in whole or in part with financial
assistance pursuant to Exhibit C of this Agreement. Only Services whose costs are covered in
whole or in part with financial assistance pursuant to Exhibit C, as amended from time to time,
are subject to this Agreement.
134309 Deschutes Count
OHA 11-13 GT0217-I1
Approved 5/9/2011 8 of 220
Service Name: Local Administration — Mental Health Services
Service ID Code: MHS 01
I. Service Description
Mental Health Local Administration (MHS 01) is the central management of a
Community Mental Health Program for which financial assistance is included in the
Financial Assistance Award of this Agreement. MHS 01 includes planning and resource
development, coordination of Community Mental Health Program services with state
hospital services, negotiation and monitoring of contracts and subcontracts, and
documentation of service delivery in compliance with state and federal requirements.
II. Performance Requirements
In providing MHS 01 Mental Health Services, County must comply with OAR 309-014-
0000 through 309-014-0040, as such rules may be revised from time to time.
II1. Special Reporting Requirements
No special reporting requirements.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The financial assistance awarded for MHS
01 is intended to be general financial assistance to County for local administration
of a CMHP. Accordingly, OHA will not track delivery of MHS 01 Services or
service capacity on a per unit basis so long as County utilizes the funds awarded
for MHS 01 on administration of its CMHP. Total OHA financial assistance for
MHS 01 Services under a particular line of the Financial Assistance Award shall
not exceed the total funds awarded for MHS 01 as specified on that line.
B. Disbursement of Funds: Unless a different disbursement method is specified in
the Financial Assistance Award, OHA will disburse the financial assistance
awarded for MHS 01 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. Upon amendment
to the Financial Assistance Award, OHA shall adjust monthly allotments as
necessary, to reflect changes in funds awarded for MHS 01 Services on that line
of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm County's
administration of its CNIHP and reconcile any discrepancies that may have occurred
during the term of this Agreement between actual OHA disbursements of financial
assistance awarded for MHS 01 Services under a particular line of the Financial
Assistance Award and amounts due for such services based on the delivery of
Mental Health or Addiction Services and the financial assistance awarded for those
services under a particular line of the Financial Assistance Award.
134309 Deschutes County
OHA 11-13 GT0217-I 1
Approved 5/9/2011 9 (4'220
Service Name: Local Administration — Addictions Services
Service ID Code: A&D 03
I. Service Description
Local Administration (A&D 03) is the central management of a Community Mental
Health Program for which financial assistance is included in the Financial Assistance
Award of this Agreement. A&D 03 includes planning and resource development,
coordination of Community Mental Health Program service delivery for alcohol abuse,
drug abuse and problem gambling, negotiation and monitoring of contracts and
subcontracts, and documentation of service delivery in compliance with state and federal
requirements.
II. Performance Requirements
In providing A&D 03 Services for Addiction Services, County must comply with OAR
309-014-0000 through 309-014-0040, as such rules may be revised from time to time.
III. Special Reporting Requirements
No special reporting requirements.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance: The financial assistance awarded for A&D
03 is intended to be general financial assistance to County for local administration
of a CMHP for Addiction services. Accordingly, OHA will not track delivery of
A&D 03 Services or service capacity on a per unit basis so long as County utilizes
the funds awarded for A&D 03 on administration of its CMHP. Total OHA
financial assistance for A&D 03 Services under a particular line of the Financial
Assistance Award shall not exceed the total funds awarded for A&D 03 as
specified on that line.
B. Disbursement of Funds. Unless a different disbursement method is specified in
the Financial Assistance Award, OHA will disburse the financial assistance
awarded for A&D 03 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. Upon amendment
to the Financial Assistance Award, OHA shall adjust monthly allotments as
necessary, to reflect changes in funds awarded for A&D 03 Services on that line
of the Financial Assistance Award.
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OHA 11-13 GT0217-1 I
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C. Agreement Settlement: Agreement Settlement will be used to confirm County's
administration of its CMHP and reconcile any discrepancies that may have occurred
during the term of this Agreement between actual OHA disbursements of financial
assistance awarded for A&D 03 Services under a particular line of the Financial
Assistance Award and amounts due for such services based on the delivery of
Addiction Services and the financial assistance awarded for those services under a
particular line of the Financial Assistance Award.
134309 Deschutes County Approved 5/9/2011 11 of220
OHA 11-13 GT0217-11
Service Name: A&D SPECIAL PROJECTS
Service ID Code: A&D 60
I. Service Description
A&D Special Projects (A&D 60) are alcohol and drug abuse services within the scope of
ORS 430.630 delivered on a demonstration or emergency basis for a specified period of
time. Each project is described in a separate exhibit to this A&D 60 Service Description.
When the Financial Assistance Award contains a line awarding funds for A&D 60
Services, that line will contain a special condition specifying the exhibit to this A&D 60
Service Description that describes the project for which the funds are awarded.
The specific A&D 60 Services for which financial assistance is provided under this
Agreement are described in exhibits, if any, to this A&D 60 Service Description, which
exhibits are incorporated herein by this reference.
II. Performance Standards
See exhibits, if any, to this A&D 60 Service Description.
III. Special Reporting Requirements
See exhibits, if any, to this A&D 60 Service Description.
IV. Payment Procedures
See exhibits, if any. to this A&D 60 Service Description.
Even if the Financial Assistance Award awards funds for A&D 60 Services, OHA shall
have no obligation to provide financial assistance under this Agreement for any A&D 60
Services (even if funds therefore are disbursed to County) unless a corresponding special
project description is attached to this Service Description as an exhibit.
Even if the Financial Assistance Award awards funds for A&D 60 Services, OHA shall
have no obligation to disburse any funds under this Agreement for A&D 60 Services unless
a corresponding special project description is attached to this Service Description as an
exhibit.
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Exhibit A&D 60 -Startup
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 alcohol and drug
abuse services.
I. Performance Requirements
The funds awarded for this special project may be expended only in accordance with
Exhibit J, Startup Procedures, which is incorporated herein by this reference..
II. Special Reporting Requirements
County shall prepare and submit expenditure reports to OHA on the expenditure of the
funds awarded for this special project. Reports shall be sent to:
Oregon Health Authority
Addictions and Mental Health Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
III. Financial Assistance Calculation and Disbursement Procedures
A. Financial Assistance Calculation: OHA will provide financial assistance for this
special project, from funds identified in a particular line of the Financial
Assistance Award, in an amount equal to the actual allowable expenditures (as
described in Exhibit J, Startup Procedures) incurred in implementing the special
project during the period specified in that line, subject to the requirements of
Exhibit J, Startup Procedures and subject to the following additional restrictions:
1. Total 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 in that
line of the Financial Assistance Award; and
2. OHA is not obligated to provide financial assistance for any special project
expenditures that are not properly reported to OHA using forms and
procedures described in Exhibit J, Startup Procedures by the date 60 days after
the earlier of termination of this Agreement, termination of OHA's obligation
to provide financial assistance for A&D 60 services, or termination of
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County's obligation to include the Program Area, in which A&D 60 Services
fall, in its CMHP.
B. Disbursement: OHA will disburse the funds awarded for this special project in a
particular line of the Financial Assistance Award after OHA's receipt of County's
properly completed "Request for Payment of Start -Up Funds", as described in and
in accordance with Exhibit J. Startup Procedures.
C. Agreement Settlement: Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for these special projects under a particular line
of the Financial Assistance Award and amounts due for implementation of the
special projects based on actual allowable expenditures incurred in implementing
the special project under that line of the Financial Assistance Award, as such
expenses are properly reported using forms and procedures described in Exhibit J,
Startup Procedures.
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EXHIBIT A&D 60 -Strategic Prevention Framework (SPF)
I. Service Description
The Strategic Prevention Framework State Incentive Grant (SPF SIG) program will
provide an effective, comprehensive prevention framework with a common set of goals
to be adopted and integrated at the local level to:
• Prevent the onset and reduce the progression of substance abuse, including childhood
and underage drinking;
• Reduce substance abuse -related problems; and
• Build prevention capacity and infrastructure at the local level.
SPF SIG -funded programs shall utilize the Department of Health and Human Service's
Substance Abuse Mental Health Service Administration's (SAMHSA's) SPF SIG
(available at http://prevention.samhsa.gov/evidencebased/evidencebased.pdf) as the
model on which to develop long-range strategic plans and annual action plans. In sum,
the SPF SIG is a five-step evidence -based process for community planning and decision-
making.
The five-step model includes, but is not limited to:
1. Assessment: Mobilize key stakeholders to collect the needed data to understand
substance abuse consequences, consumption patterns, and contributing factors to
those patterns of the specific drug use issues identified.
2. Capacity: Mobilize/build capacity with a local coalition to change the conditions
and address the specific drug use issues identified.
3. Planning: Produce strategic goals, objectives, and performance targets as well as
preliminary action plans including a logic model.
4. Implementation: Implement the plan with multiple policies, practices, strategies,
or interventions based on characteristics, culture, and context of the target
population.
5. Evaluation: Measure impact of SPF and monitor, sustain, improve, or replace
implemented practices, policies or programs based on evaluation findings.
SPF SIG services will be implemented through one or more of the SAMHSA Center for
Substance Abuse Prevention's (CSAP) six strategies. The six strategies with examples of
services are:
1. Information Dissemination- media campaigns, speaking engagements;
2. Prevention Education — school curricula and parenting education and skill
building;
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3. Alcohol, Tobacco & Other Drug (ATOD) free alternatives, youth leadership and
community service projects;
4. Problem Identification and Referral — student assistance programs
5. Community Based Processes- interagency collaboration, coalition building, and
networking;
6. Environmental/Social Policy- school policies and community laws concerning
alcohol. tobacco and other drugs.
II. Performance Requirements
County, in providing A&D 60 Services, must comply with OAR 415-056-0000 through
415-056-0025, and must have a current Letter of Approval issued by OHA.
County must implement its SPF SIG Services funded through this Agreement in
accordance with the SPF SIG framework, described in section 1, culminating with a
Strategic Plan, (Plan), which is subject to OHA approval, within the first six months of
funded services. OHA Financial Assistance to the County in the subsequent biennium,
for SPF SIG Services, will in part depend upon the County achievement of the outcomes
set forth in the Plan. In the event of a conflict or inconsistency between the provisions of
the Plan and the provisions of this Service Description, the provisions of this Service
Description shall control.
County's performance shall include the following:
Assessment:
• Additional needs assessment data collection: measuring the intervening variables for
problem behavior through completion of a logic model. Data is expected to be as
localized as possible.
• Complete other assessment tools as directed to include Tri -Ethnic Community
Readiness Assessment and cross -site evaluation instruments (e.g. GLI, CLI and PLI).
Capacity:
• One FTE for Project Director.
• Coalition: County must either have in place or form a coalition with required sectors,
as defined by the SPF Advisory Council. The coalition must demonstrate the
following: mission statement, bylaws (including cultural competency
statement/policy), officers, records of meeting notes/minutes, meeting schedule,
coalition/board development/training plan, etc.
Planning:
• A comprehensive Plan will be completed for priorities identified by OHA. The Plan
will address all five steps of the SPF SIG process with inclusion of sustainability and
cultural competency. Logic models addressing root causes or intervening variables
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from sub -recipient location will be included to ensure that counties will be able to
guarantee the right fit of the practices, policies or programs selected for
implementation to make countywide changes in the priority area.
• Detailed timelines, goals and objectives, and challenges/barriers will also be
addressed in the Plan.
Implementation:
• The Plan will be reviewed by OHA's Evidence -Based Practices Committee to ensure
that the appropriate strategies, policies, and practices are implemented to address the
priority area. All chosen strategies, policies, and practices must meet the 75%
threshold of being evidence based. The Plan must also be approved by the SPF
Advisory Council.
• Training will be provided by OHA to ensure that the County has the capacity to
deliver and replicate the programs, policies, and practices in order to reach the desired
change.
Evaluation:
• County will complete evaluation tools and any other evaluation requirements as
instructed by OHA's evaluation team.
• Data entry and reports will be monitored and tracked.
• County will make best efforts to have a written commitment from all of the County's
schools to implement the Student Wellness Survey.
County must participate in site visits, any state trainings or required meetings. County
shall comply with OHA's written materials provided at OHA's training sessions.
III. Special Reporting Requirements
Ongoing monitoring and evaluation are essential to determine if the outcomes desired are
achieved and to assess program effectiveness and service delivery quality. All tools and
evaluation measures will be provided by OHA's prevention unit.
• County must provide federally required performance data including the Community
Level Instrument (CLI) and the Program Level Instrument (PLI) upon request by
OHA, with quarterly reports being completed for and returned to OHA.
• County will complete the needs assessment workbook, evaluation workbook and any
other tool deemed reasonably necessary by OHA.
• County must provide a one-year budget narrative (budget detail and justification) to
OHA's prevention unit.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance. The funds awarded for SPF are intended to
be general financial assistance to County for this SPF project. Accordingly, OHA
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will not track delivery of SPF services on a per unit basis so long as County
delivers SPF Services as part of its CMHP. Total OHA financial assistance for
SPF Services under a particular line of the Financial Assistance Award shall not
exceed the total funds awarded for SPF Services as specified on that line.
B. Disbursement: OHA will disburse the funds awarded for SPF Services identified
in a particular line of the Financial Assistance Award to County as set forth in the
Special Condition on that line:
1. OHA may, upon written request of County, adjust allotments.
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
allotments as necessary, to reflect changes in the funds awarded for SPF
Services on that line of the Financial Assistance Award.
3. OHA may, after notice to County, suspend allotments pending receipt of
complete and accurate CLI and PLI data and required reports described in
Section III above.
C. Agreement Settlement. Agreement Settlement will be used to verify the inclusion
of SPF Services as part of County's CMHP, based on data properly reported to
OHA through reports required or permitted by this Service Description or an
applicable Specialized Service Requirement.
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OHA 11-13 GT0217-11
Service Name: ADULT ALCOHOL AND DRUG RESIDENTIAL TREATMENT
SERVICES
Service ID Code: A&D 61
I. Service Description
Adult Alcohol and Drug Residential Treatment Services (A&D 61) are services delivered
to individuals 18 years of age or older who are unable to live independently in the
community, cannot maintain even a short period of abstinence and are in need of 24-hour
supervision, treatment and care. The purpose of A&D 61 Services is to support, stabilize
and rehabilitate individuals and to permit them to return to independent community
living. A&D 61 Services provide a structured environment for an individual on a 24-hour
basis consistent with Level III of the chemical dependency placement, continued stay and
discharge criteria set forth in OAR 309-032-1500 through 309-032-1565, as such rules
may be revised from time to time, as appropriate to the individual's needs and include
structured counseling, educational services, recreation services, self help group
participation services, and planning for self-directed recovery management to support the
gains made during treatment. In addition, providers must have written admission polices
and procedures in place for individuals who appropriately use prescribed medications to
treat addiction. Written polices and procedures must include referrals to alternate
treatment resources for those not admitted to the program. A&D 61 Services address the
needs of diverse population groups within the community, with special emphasis on
ethnic minorities.
II. Performance Requirements
Providers of A&D 61 Services funded through this Agreement must comply with OAR
309-032-1500 through 309-032-1565, as such rules may be revised from time to time.
Providers of A&D 61 Services funded through this Agreement must also have a current
license issued by the OHA in accordance with OAR 415-012-0000 through 415-012-
0090.
Subject to the preference for pregnant women and intravenous drug users described in
Exhibit G, Required Federal Terms and Conditions, County and Providers of A&D 61
Services funded through this Agreement must give priority access to such Services first to
individuals referred from the Oregon Health Authority and to individuals who are
covered by Medicaid and then to individuals referred by Drug Treatment Courts from
within the region as such region is designated by the OHA after consultation with County
and relevant Providers. A&D 61 Services funded through this Agreement may be
delivered to individuals referred from any county within the region and no priority or
preference shall be given to individuals referred from any particular county with the
region based on the referring county. Except as provided in IV.C, Agreement Settlement
of this service description, at least 60% of the A&D 61 Services funded through this
Agreement must be delivered to individuals receiving Medicaid. The remaining A&D 61
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Services funded through this Agreement may be delivered to individuals who need State
support to finance their treatment, and who may or may not be eligible for Medicaid.
Providers of A&D 61 Services funded through this Agreement must participate in client
outcome studies conducted by OHA.
III. Special Reporting Requirements
All individuals receiving A&D 61 Services with funds provided under this Agreement
must be enrolled in CPMS, and the individual's CPMS record for A&D 61 Services must
be maintained, as specified in OHA's CPMS manual located at
http://www.oregon ;ov/OHA/mentalhealth/publications/cpms-manual/ad2009cpms-
manual.pdf?ga=t
IV. Financial Assistance Calculation and Disbursement Procedures
The procedures for calculating and disbursing financial assistance from A&D61 funds
included in the Financial Assistance Award are set forth below.
Funds Described in the Financial Assistance Award
A. Calculation of Financial Assistance. OHA will provide financial assistance for
A&D61 Services identified in a particular line of the Financial Assistance Award
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 ofA&D61 Services delivered under that line of
the Financial Assistance Award during the period specified in that line, subject to
the following:
1. Total OHA financial assistance for A&D61 Services delivered under a
particular line in the Financial Assistance Award shall not exceed the total
funds awarded for A&D61 Services as specified in that line in the
Financial Assistance Award; and
2. OHA is not obligated to provide financial assistance for any A&D61
Services for 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 OHA's
obligation to provide financial assistance for A&D61 Services, or
termination of County's obligation to include the Program Area, in which
A&D61 Services fall, in its CMHP.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
financial assistance awarded for A&D 61 Services 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:
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1 OHA may, after 30 days (unless parties agree otherwise) written notice to
County, reduce the monthly allotments based on under -used allotments
identified through CPMS or through other reports required or permitted by
this Service Description or an applicable Specialized Service Requirement
or Special Terms and Conditions;
2. OHA may, upon written request of County, adjust monthly allotments; and
3. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded
for A&D 61 Services on that line of the Financial Assistance Award.
C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for A&D61 Services under a particular line of the
Financial Assistance Award and amounts due for such services provided based on
the rate set forth in the special condition identified in that line of the Financial
Assistance Award. For purposes of this section, "amounts due" is determined by
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 permitted or required by
this Service Description or an applicable Specialized Service Requirement.
The Medicaid eligibility percentage requirement will be settled on an average
statewide basis. If the statewide percentage of recipients of AD 61 services who
are eligible for Medicaid falls below 60%, settlement will be made with those
Counties who fall below the minimum percentage. Settlement will be based on
the percentage County falls below the statewide percentage requirement and to the
extent necessary that when combined with other Counties who fall below the
statewide percentage enable the state to meet its statewide percentage minimum.
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Service Name:
HOUSING SERVICES FOR DEPENDENT CHILDREN WHOSE
PARENTS ARE IN ALCOHOL AND DRUG RESIDENTIAL
TREATMENT
Service ID Code: A&D 62
I. Service Description
Housing Services for Dependent Children Whose Parents are in Alcohol and Drug
Residential Treatment (A&D 62) are housing services (room and board) delivered to
individuals who are dependent children age 18 and younger so the child(ren) may reside
with their custodial parent in the same adult alcohol and drug residential treatment
facility.
II. Performance Requirements
Providers ofA&D 62 services funded through this Agreement must comply with OAR
309-032-1500 through 309-032-1565, as such rules may be revised from time to time.
Providers ofA&D 62 services funded through this Agreement must also have a current
license issued by the OHA in accordance with OAR 415-012-0000 through 415-012-
0090, as such rules may be revised from time to time, and participate in outcome studies
conducted by the OHA.
III. Special Reporting Requirements
All individuals receiving A&D 62 Services with funds provided under this Agreement
must be enrolled in CPMS, and the individual's CPMS record for A&D 62 Services must
be maintained, as specified in OHA's CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/pub l ications/cpms-manual/ad2009cpms-
manual.pdf?ga=t.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance. The funds awarded for A&D 62 services are
intended to be general financial assistance to the County for A&D 62 services
with funds provided under this Agreement. Accordingly, the OHA will not track
delivery ofA&D 62 services on a per unit basis, so long as the County offers and
delivers A&D 62 services as part of its CMHP. Total OHA payment for all A&D
62 services delivered under a particular line of the Financial Assistance Award
shall not exceed the total funds awarded for A&D 62 services as specified in that
line of the Financial Assistance Award.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
financial assistance awarded for A&D 62 Services 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:
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1. OHA may, upon written request of County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
A&D 62 Services on that line of the Financial Assistance Award.
C. Agreement Settlement. Agreement Settlement will be used to confirm the offer
and delivery of A&D 62 services by County as part of its CMHP based on the
delivery of A&D 62 services as properly reported in CPMS or through other
reports required or permitted by this Service Description or an applicable
Specialized Service Requirement.
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Service Name: Peer Delivered Services
Service ID Code: A&D 63
I. Service Description
For the purpose of A&D 63, Recovery Center, Facilitating Center, Peer Delivered
Services, and Peer Support Specialist have the following meanings.
Recovery Centers are comprised of and led by people in recovery from Substance Use
Disorders, as defined in OAR 309-032-1505(128). The centers maintain a structured
daily schedule of activities where Peer Delivered Services may be delivered . These
centers serve as recovery resources for the local community.
Facilitating Centers serve as "mentor sites" training and providing ongoing technical
assistance for the Recovery Centers. Facilitating Centers provide structure and support
for developing and sustaining Recovery Centers. People in recovery will be involved in
every aspect of program design and implementation. Facilitating Centers must use
curricula approved by the Addictions and Mental Health Division for training purposes.
Peer Delivered Services include an array of services designed to meet the needs of
participants as they progress through various stages in their recovery from Substance Use
Disorders, including: emotional, informational, instrumental, and family supports. Peer
Delivered Services are further defined in OAR 309-032-1500 through 309-032-1565,
particularly OAR 309-032-1505(88).
Peer Delivered Services include, but are not limited to:
1. Assertive outreach to identify and engage those in need of recovery.
2. Minimizing harm to self, family, and community in the transitions through
identification, engagement, destabilization of addiction, and recovery initiation.
3. Recovery capital/need assessment for individuals, families, communities.
4. Recovery education and coaching for individual/family (normative recovery
information, encouragement, support, and companionship; enhancement of recovery
self-management skills), often delivered in the environment of the individual/family.
5. Community -level recovery education.
6. Recovery resource identification, mapping, and development, including volunteer
recruitment.
7. Recovery resource mobilization (activating a state of readiness to respond to the
needs of an individual/family at a particular point in time).
8. Community -level recovery resource development.
9. Assertive linkage to communities of recovery (support groups and support
institutions).
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OHA 1113 GT0217-I 1
10. Liaison (bridging, brokering/negotiating, partnering) between individual, family,
organization, and community.
1 1 . Recovery -focused skill training aimed at full community participation in education,
employment, housing, leisure, worship and pro -recovery family and social
relationships.
12. Companionship and modeling of recovery lifestyle, including participation in leisure
activities that would be judged a breach of ethics for addiction counselors, e.g. eating
together at a restaurant, attending or participating in a sporting event, attending a
social event such as a concert or recovery celebration event.
13. Problem -solving to eliminate obstacles to recovery, e.g. linkage to resources for
child-care, transportation, community re-entry from jail/prison.
14. Recovery check-ups (sustained monitoring, support/companionship, and recovery
promotion).
15. Recovery advocacy for individual/family needs (empower individuals and family
members to assert their rights and needs).
16. Recovery leadership development.
17. Conducting a regular self -inventory of personal and organizational performance via
reflection, dialogue with service constituents, and analysis of recovery -focused
service benchmark data.
18. Emotional support. Emotional support refers to demonstrations of empathy, caring,
and concern that enhance self-esteem and confidence. Peer mentoring, peer coaching,
and peer -led support groups are examples of peer-to-peer recovery services that
provide emotional support.
19. Informational support. informational support refers to sharing knowledge,
information and skills. Peer -led life skills training, job skills training, educational
assistance, and health and wellness information are examples of peer-to-peer recovery
support services.
20. Instrumental support. Instrumental support services include modeling and peer -
assisted daily -life tasks that people with serious addiction histories in early recovery
are often incapable of doing on their own having never attained these skills. Examples
include navigating transportation to support groups, accessing quality child care,
completing job applications, locating safe alcohol and drug free housing, obtaining
vocational, educational, and self-sufficiency supports, and navigating social service
programs. Affiliation support helps people in recovery establish positive connections
with others in recovery. This support helps people in early recovery establish a
positive peer culture that prevents re -affiliation with negative peer cultures such as
former associates who are not in recovery and people who are actively engaged in
criminal behavior.
21. Family support. Family support includes educational, informational and affiliation
services for family members with relatives (as identified by the family) who are in
recovery from substance use disorders. These services are designed to help families
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develop and maintain positive relationships, improve family functioning, increase
understanding of recovery processes and build connections among family members
for mutual support.
Peer Support Specialists are individuals defined in OAR 309-032-1505(89) which may
be revised from time to time. Peer Support Specialists are compensated for delivering
Peer Delivered Services. Peer Support Specialists must provide documentation of
completion of an AMH/DHS approved core curricula including ethics training.
Target Population:
Individuals with Substance Use Disorders, as defined in 309-032-1505(128), and who are
seeking long-term recovery are included in the target population (Target Population).
II. Performance Requirements and Quality Measures
County shall use the funds awarded under this Agreement to provide Peer Delivered
Services in a manner that benefits the Target Population. The Peer Delivered Services
shall be delivered at Recovery Centers or in communities by Peer Support Specialists.
To the satisfaction of the OI --IA, County must insure that Peer Delivered Services:
1. Are clearly defined in ways that differentiate them from professional treatment
services and from sponsorship in 12 -Step or other mutual -aid groups.
2. Are authentically peer based (participatory, peer led and peer driven) in design
and operation.
3. Are authentically peer engaging and retaining a pool of peer leaders who reflect
the diversity of the community and of people seeking recovery support.
4. Have an intentional focus on leadership development.
5. Operate within an ethical framework that reflects peer and recovery values.
6. Incorporate principles of self-care, which are modeled by staff and peer leaders,
and have a well considered process for handling relapses.
7. Are non -stigmatizing strengths -based.
8. Honors the cultural practices of all participants and incorporate cultural strengths
into the recovery process.
9. Connect peers with other community resources irrespective of types of services
offered.
10. Have well established mutually supportive relationships with key stakeholders.
11. Have a plan to sustain itself.
12. Have well documented governance, fiscal, and risk management practices to
support its efforts.
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13. Are based on identified community and individual strengths and needs including
cultural and population characteristics.
14. Are culturally responsive, and geographically accessible.
15. Are delivered by Peer Support Specialists who maintain policies and procedures
that facilitate and document accessibility to a full range of services.
The quality of the Peer Delivered Services supported with funds provided under this
Agreement will be measured in accordance with the criteria set forth herein. These
criteria are applied on a county -wide basis each calendar quarter (or portion thereof)
during the period for which the funds are awarded for Peer Delivered Services under this
Agreement. Providers employing Peer Support Specialists must develop and implement
quality assurance/quality improvement processes to improve, progressively as measured
by the criteria set forth herein, the quality of Peer Delivered Services supported by funds
under this Agreement. AMH may recommend additional actions to improve quality.
III. Special Reporting Requirements
Within 30 days of the County providing A&D 63 services, County will provide an entry
baseline assessment report in a form satisfactory to OHA.
Within 30 days after the end of each quarter in the 2011-2013 biennium, County shall
submit to OHA, AMH a report that includes:
1. The amount of funds spent as of the end of the reporting period;
2. Number of people served by Peer Support Specialist(s) categorized by age, gender
and ethnicity;
3. Breakdown of service received;
4. Number of people who acquired safe, permanent, alcohol and drug free place to live
in the community during service participation;
5. Number of people who gained employment or engaged in productive educational or
vocational activities during service participation;
6. Number of people who remained crime -free during service participation; and,
7. Number of people served who are being retained from the previous quarter.
AMH will provide templates for reporting purposes.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance: The funds awarded for A&D 63 are intended
to be general financial assistance to the County for A&D 63. Accordingly, OHA
will not track delivery of A&D 63 services or service capacity on a per unit basis
except as necessary to verify the performance requirements set forth above have
been meet. Total OHA financial assistance for all A&D 63 services delivered
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under a particular line of the Financial Assistance Award shall not exceed the
total funds awarded for A&D 63 as specified in that line of the Financial
Assistance Award.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
funds awarded for A&D 63 services on a particular line of the Financial
Assistance Award to County in substantially equal monthly allotments during the
period specified in the Financial Assistance Award, subject to the following:
1. OHA may, upon written request of County, adjust monthly allotments.
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary to reflect changes in the funds awarded
for A&D 63 services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer
and delivery of these services described herein and satisfaction of the minimum
performance requirements, based on data properly reported through reports
required or permitted by this service description.
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Service Name: CONTINUUM OF CARE SERVICES
Service ID Code: A&D 66
I. Service Description
Continuum of Care Services (A&D 66) are services delivered to youth and adults with
substance use disorders. The purpose of A&D 66 Services is to build upon resilience,
assisting individuals to make healthier lifestyle choices and to promote recovery from
substance use disorders. A&D 66 Services consist of case management, clinical care and
continuing care delivered when therapeutically necessary and consistent with the
developmental and clinical needs of the individual. Continuum of Care Services (A&D
66) must be provided in a manner that is informed by generally accepted research that has
been applied to the populations served through this Agreement. For purposes of A&D
66, case management, clinical care and continuing care have the following meanings:
Case Management services are flexible, community-based, recovery and client -oriented
services that enhance the scope of the addiction treatment and recovery continuum by
providing the individual with a single point of contact for multiple health and social
service systems and assisting the individual in advocating for his or her needs. Case
management services assist the individual with needs that generally are thought to be
outside the realm of substance use disorder treatment. Case management services also
assist individuals transitioning from community settings to residential care and from
residential care back to community settings.
Clinical Care services are assessment, counseling and treatment services, meeting the
Standards for Outpatient and Residential Alcohol and Drug Treatment Programs (set
forth in OAR 309-032-1500 through 309-032-1565, as such rules may be amended from
time to time). The services may also include medically prescribed pharmacological
agents approved by the U.S. Food and Drug Administration for the treatment of
substance use disorders, i.e., methadone, buprenorphine, acamprosate and naltrexone.
Continuing Care services are services provided to individuals in treatment to sustain
their commitment to recovery and consist of ongoing intermittent contact by the
individual with a treatment Provider including, but not limited to, telephone outreach,
participation in individual or group counseling, self help groups and programs, and
transitional housing.
A&D 66 Services are provided at one of the following levels of care as therapeutically
necessary and consistent with the clinical need of the individual:
Level I (Outpatient) Non-residential treatment services provided to the individual in
regularly scheduled face-to-face therapeutic sessions. This level of service consists of 1-
6 hours per week of face-to-face therapeutic sessions for adolescents and 1-9 hours per
week for adults. Such services may include individual, group and family counseling, as
well as long-term support for recovery management including relapse prevention.
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OHA I1-13 GT0217-I1
Level II (Intensive Outpatient) This level of service affords the individual the
opportunity to remain in his or her existing environment (social, familial, vocational),
while still benefiting from a therapeutic, structured program. It is a non-residential
service consisting of at least nine hours of face-to-face contact per week for adults and at
least six hours of face-to-face contact per week for adolescents who meet the
administrative rule placement requirements (OAR 309-032-1525(3)(d)(F))for this level of
care. Level II Providers may provide evening services, day treatment services, or partial
hospitalization. Such Services may include individual, group and family counseling, as
well as medically -prescribed pharmacological agents.
Level III Non-medical Detoxification This level of service provides twenty-four hour
observation, monitoring and treatment for individuals who are suffering from alcohol or
other drug intoxication or withdrawal.
Subject to the preference for pregnant women and intravenous drug users described in
Exhibit G, Required Federal Terms and Conditions, County must give preference in
A&D 66 service delivery to persons referred by OHA and persons referred by Drug
Treatment Courts within County's service area.
II. Performance Standards and Quality Measures
Providers of A&D 66 Services funded through this Contract must also have a current
license issued by the OHA in accordance with OAR 415-012-0000 through 415-012-
0090. Providers of A&D 66 Continuing Care Level I and II Services funded through this
Agreement must comply with OAR 309-032-1500 through 309-032-1565 and OAR 415-
020-0000 through 415-020-0090, as such rules may be revised from time to time.
Providers of A&D 66 Continuing Care Level III Services funded through this Agreement
must comply with OAR 415-050-0000 through 415-050-0095, as such rules may be
revised from time to time.
With respect to each individual that Provider serves with funds provided under this
Agreement, Provider shall deliver all A&D 66 Services therapeutically necessary for an
eligible individual from the date Provider begins serving the individual through the date
set forth in the Financial Assistance Award.
A&D 66 Continuing Care Level I or Level II services provided to any individual enrolled
in the Oregon Health Plan for chemical dependency benefits are not eligible for payment
under this Agreement. Providers must refer such individuals to the identified health care
service delivery provider for A&D 66 Services.
The quality of the A&D 66 Services supported with funds provided under this Agreement
will be measured in accordance with the criteria set forth below. These criteria are
applied on a countywide basis each calendar quarter (or portion thereof) during the period
for which the funds are awarded for A&D 66 Services under this Agreement. County
must develop and implement quality assurance /quality improvement processes to
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improve, progressively as measured by the criteria set forth below, the quality of A&D 66
Services supported with funds provided under this Agreement. OHA may recommend
additional actions to improve quality.
Access: Access is measured by OHA as the percentage of County residents estimated by
OHA surveys to need treatment who are enrolled in A&D 66 Services.
Utilization: Utilization requirements for individuals receiving continuum of care services
(non detox) will be identified in a special condition subject to funds awarded in a
particular line in the Financial Assistance Award, Exhibit C. These funds are used to
increase capacity and cannot be used to supplant already existing resources.
Engagement: Engagement is measured by OHA as the percentage of individuals
receiving A&D 66 Services with funds provided through this Agreement who enter
treatment following positive assessment.
Retention: Retention is measured by OHA as the percentage of individuals receiving
A&D 66 Services with funds provided through this Agreement who are actively engaged
in treatment for 90 days or more.
Reduced Use: Reduced use is measured by OHA as the percentage of individuals
engaged in and receiving A&D 66 Services with funds provided through this Agreement
who reduce their use of alcohol or other drugs during treatment, as reported in CPMS
upon termination of treatment.
Completion: Completion is measured as the percentage of individuals engaged in and
receiving A&D 66 Services with funds provided through this Agreement who complete
two thirds of their treatment plan and are not abusing alcohol or other drugs at the time
services are terminated.
Providers of A&D 66 Services funded through this Agreement must participate in client
outcome studies conducted by OHA.
III. Special Reporting Requirements
All individuals receiving A&D 66 Services with funds provided under this Agreement
must be enrolled in CPMS, and the individual's CPMS record for A&D 66 Services must
be maintained, as specified in OHA's CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpms-manual/ad2009 pms-
manual.pdf'?ga=t
IV. Financial Assistance Calculation and Disbursement Procedures
The procedures for calculating and disbursing financial assistance from A&D 66 funds
included in the Financial Assistance Award are set forth below.
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A) Calculation of Financial Assistance. OHA will provide financial assistance or
A&D 66 Services identified in a particular line of the Financial Assistance Award
from funds identified on that line based on the number of individuals to be served
multiplied by the case rate per individual as specified in the special condition
identified in that line of the Financial Assistance Award subject to the following:
1) Total OHA financial assistance for A&D 66 Services delivered under a
particular line in the Financial Assistance Award shall not exceed the total
funds awarded for A&D 66 Services as specified in that line in the Financial
Assistance Award.
2) OHA is not obligated to provide financial assistance for any A&D 66 Services
for 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 OHA's obligation to provide
financial assistance for A&D 66 Services, or termination of County's
obligation to include the Program Area, in which A&D 66 Services fall, in its
CMHP.
B) Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
financial assistance awarded for A&D 66 Services 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) OHA may, after 30 days (unless parties agree otherwise) written notice to
County, reduce the monthly allotments based on under -used allotments
identified through CPMS or through other reports required or permitted by
this Service Description or an applicable Specialized Service Requirement or
Special Terms and Conditions.
2) OHA may, upon written request of County, adjust monthly allotments.
3) Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
A&D 66 Services on that line of the Financial Assistance Award.
C) Agreement Settlement. Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for A&D 66 Services under a particular line of
the Financial Assistance Award and amounts due for such services based on
biennial utilization requirements as specified in the special condition identified in
that line of the Financial Assistance Award and the actual amount of individuals
served under that line of the Financial Assistance Award during the effective
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period of this contract, as properly reported in CPMS or through other method
permitted or required by this Service Description or an applicable Specialized
Service Requirement.
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Service Name: ALCOHOL AND DRUG RESIDENTIAL CAPACITY SERVICES
Service ID Code: A&D 67
I. Service Description
Alcohol and Drug Residential Capacity Services (A&D 67) are 24-hour residential
services delivered to individuals who are enrolled in A&D 61 and A&D 71 services.
A&D 67 Services provide a structured environment for an individual on a 24-hour basis
consistent with Level III of the chemical dependency, continued stay and discharge
criteria set forth in OAR 309-032-1500 through 309-032-1565, as such rules may be
revised from time to time, are appropriate to the individual's needs and include housing
and food services.
II. Performance Requirements
Providers of A&D 67 Services funded through this Agreement must comply with OAR
309-032-1500 through 309-032-1500, as such rules may be revised from time to time.
Providers of A&D 67 Services funded through this Agreement must also have a current
license issued by OHA in accordance with OAR 415-012-0000 through 415-012-0090and
must participate in client outcome studies conducted by OHA.
III. Special Reporting Requirements
No special reporting requirements.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance. The funds awarded for A&D 67 services are
intended to be general financial assistance to the County for A&D 67 services for
individuals receiving A&D 6l and A&D 71 services with funds provided under
this Agreement. Accordingly, OHA will not track delivery of A&D 67 services
on a per unit basis, so long as the County offers and delivers A&D services as part
of its CMHP. Total OHA payment for all A&D 67 services delivered under a
particular line of the Financial Assistance Award shall not exceed the total funds
awarded for A&D 67 services as specified in that line of the Financial Assistance
Award.
B. Disbursement of Financial Assistance. Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
financial assistance awarded for A&D 67 Services in a particular line of the
Financial Assistance Award to County as set forth in the Special Condition on
that line, subject to the following:
1. OHA may, upon written request of County, adjust allotments; and
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2. Upon amendment to the Financial Assistance Award, OHA shall adjust
allotments as necessary, to reflect changes in the funds awarded for A&D 67
Services on that line of the Financial Assistance Award.
C. Agreement Settlement. Agreement Settlement will be used to confirm the offer
and delivery of A&D 67 services by County as part of its CMHP based on the
delivery of A&D61 and A&D71 services as properly reported in CPMS or
through other reports required or permitted by this Service Description, or an
applicable Specialized Service Requirement.
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OHA 11-13 GT0217-11
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Service Name: PREVENTION SERVICES
Service ID Code: A&D 70
I. Service Description
Prevention Services (A&D 70) are integrated strategies designed to prevent substance
abuse and associated effects, regardless of the age of participants. They are designed to
reduce risk factors and increase protective factors associated with substance abuse. A&D
70 Services fall within one of the four prevention categories of the Institute of Medicine
(IOM) Continuum of Care. The IOM prevention categories include Promotion,
Universal, Selective, and Indicated Prevention. Promotion and Universal prevention
addresses the entire population with messages and programs aimed at prevention or
delaying the use of alcohol, tobacco and other drugs. Selective prevention targets subsets
of the total population that are deemed to be at risk for substance abuse by virtue of the
membership in a particular population segment. Indicated prevention is designed to
prevent the onset of substance abuse in individuals who do not meet criteria for addiction
but who are showing elevated levels of risk and early danger signs.
A&D 70 Services are implemented through one or more of the Center for Substance
Abuse Prevention's (CSAP) six strategies. The six strategies with examples of services
are:
A. Information Dissemination - media campaigns;
B. Prevention Education - school curricula and parenting education and skill building;
C. Alcohol, Tobacco & Other Drugs (ATOD) Free Alternatives - youth leadership and
community service projects;
D. Community Based Processes - community coalitions (Communities That Care);
E. Environmental/Social Policy - school policies and community laws concerning
alcohol, tobacco and other drugs; and
F. Problem Identification and Referral - student assistance programs.
II. Performance Requirements
Agencies, as defined in OAR 415-056-0005, providing A&D 70 Services must comply
with OAR 415-056-0000 through 415-056-0025, and must have a current Letter of
Approval issued by OHA, Addictions and Mental Health Division (AMH).
County must implement its A&D 70 Services funded through this Agreement in
accordance with the Biennial Implementation Plan dated as of July 1, 2011, which is
incorporated herein by this reference (the "Plan"). OHA financial assistance to County in
the subsequent biennium, for A&D 70 Services, will in part depend upon County's
achievement of the outcomes set forth in the Plan. In the event of a conflict or
inconsistency between the provisions of the Plan and other provision of this Service
Description, the other provisions of this Services Description shall control.
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III. Special Reporting Requirements
A. Minimum Data Set for Prevention (MDS).
All A&D 70 Services financed in whole or in part with funds provided under this
Agreement must be reported electronically by County to OHA on a quarterly
basis. Electronic data submission into the MDS system is due by the 15th of the
month following the end of the quarter with respect to services provided in the
prior quarter.
B. County must submit a standardized written annual report to OHA's Addictions
and Mental Health Division describing the results of A&D 70 Services in
achieving the outcomes set forth in the Plan. The report shall document
prevention strategies as they relate to decreasing risk factors and increasing
protective factors as well as local efforts to implement evidence -based prevention
strategies. Annual reports are due within 45 days of the end of the state fiscal
year, and must be sent to:
Oregon Health Authority
Addictions and Mental Health Division
Attention: Prevention Services Specialist
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance. The funds awarded for A&D 70 Services are
intended to be general financial assistance to County for A&D 70 Services.
Accordingly, OHA will not track delivery of A&D 70 services on a per unit basis
so long as County delivers A&D 70 Services as part of its CMHP. Total OHA
financial assistance for A&D 70 Services under a particular line of the Financial
Assistance Award shall not exceed the total funds awarded for A&D 70 Services
as specified on that line.
B. Disbursement: OHA will disburse the funds awarded for A&D 70 Services
identified in a particular line of the Financial Assistance Award to County as set
forth in the Special Condition on that line:
1. OHA may, upon written request of County, adjust allotments;
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
allotments as necessary, to reflect changes in the funds awarded for A&D 70
Services on that line of the Financial Assistance Award; and
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3. OHA may, after notice to County, suspend allotments pending receipt of
complete and accurate Minimum Data Set Prevention data and required
reports described in Section 111 above.
C. Agreement Settlement. Agreement Settlement will be used to verify the inclusion
of A&D 70 Services as part of County's CMHP, based on data properly reported
to OHA through reports required or permitted by this Service Description or an
applicable Specialized Service Requirement.
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OHA 11 -136T0217 -1I
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Service Name: YOUTH ALCOHOL AND DRUG RESIDENTIAL TREATMENT
SERVICES
Service ID Code: A&D 71
I. Service Description
Youth Alcohol and Drug Residential Treatment Services (A&D 71) are services
delivered to individuals aged 12 through 17 who are unable to live independently in the
community, cannot maintain even a short period of abstinence and are in need of 24-hour
supervision, treatment and care. The purpose of A&D 71 services is to support, stabilize
and rehabilitate alcohol and drug dependent youths to permit them to return to
independent community living. A&D 71 services provide a structured environment for
an individual on a 24-hour basis, as appropriate to the individual's needs and include
structured counseling, educational services, recreation services, self help group
participation services and aftercare planning to support the gains made during treatment.
In addition, providers must have written admission polices and procedures in place for
individuals who appropriately use prescribed medications to treat addiction. Written
polices and procedures must include referrals to alternate treatment resources for those
not admitted to the program. A&D 71 services address the needs of diverse population
groups within the community.
II. Performance Requirements
Providers of A&D 71 services funded through this Agreement must comply with OAR
309-032-1500 through 309-032-1565, as such rules may be revised from time to time.
Providers of A&D 71 services funded through this Agreement must also have a current
license issued by OHA in accordance with OAR 415-012-0000 through 415-012-0090.
Subject to the preference for pregnant women and intravenous drug users described in
Exhibit G, Required Federal Terms and Conditions, County and Providers of A&D 71
services funded through this Agreement must give priority access to such services first to
individuals referred from OHA and persons referred by Drug Treatment Courts within
County's service area. A&D 71 services funded through this Agreement may be
delivered to individuals referred from any county within the State and no priority or
preference shall be given to individuals referred from any particular county.
All of the A&D 71 services funded through this Agreement must be delivered to
individuals who are Medicaid -eligible.
County must provide a program capable of delivering treatment services to people with
serious co-occurring mental health and substance use disorders. Delivery of such services
must include, but is not limited to the following tasks - all of which must be documented
in the clinical record:
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OHA 11-13 GT0217-11
A. Address co-occurring disorders in program policies and procedures, client
assessment, treatment and planning, program content, and transition/discharge
planning.
B. Address the interaction of the substance -related and mental health disorders in
assessing each adolescent's history of psychological trauma, readiness to change,
relapse risk and recovery environment.
C. Arrange for, as needed, pharmacological monitoring and psychological
assessment and consultation, either on site or though coordinated consultation off
site.
D. Involve the family or significant others of the client in the treatment process.
E. Obtain clinically appropriate family or significant other involvement and
participation in all phases of assessment, treatment planning, and treatment.
F. Use treatment methods appropriate for adolescents with significant emotional
disorders that are based on sound clinical theory and professional standards of
care.
G. Plan the transition from residential to community-based services and supports that
are most likely to lead to successful clinical outcomes for each adolescent. This
includes scheduling a face-to-face meeting between the client and the community-
based outpatient provider within seven days of discharge from the residential
program.
Providers ofA&D 71 services funded through this Agreement must participate in client
outcome studies conducted by OHA.
III. Special Reporting Requirements
All individuals receiving A&D 71 Services with funds provided under this Agreement
must be enrolled in CPMS, and the individual's CPMS record for A&D 71 Services must
be maintained, as specified in OHA's CPMS manual located at:
http://www.oregon.gov/OHA/mental health/publications/cpms-manual/ad2009cpms-
manual.pdf?ga=t
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance. OHA will provide financial assistance for
A&D 71 Services identified in a particular line of the Financial Assistance Award
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 A&D 71 Services delivered under that line of
the Financial Assistance Award during the period specified in that line, subject to
the following:
1. Total OHA financial assistance for A&D 71 Services delivered under a
particular line in the Financial Assistance Award shall not exceed the total
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OHA 11-13 GT0217-I 1
funds awarded for A&D 71 Services as specified in that line in the Financial
Assistance Award; and
2. OHA is not obligated to provide financial assistance for any A&D 71 Services
for 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 OHA's obligation to provide
financial assistance for A&D 71 Services, or termination of County's
obligation to include the Program Area, in which A&D 71 Services fall, in its
CMHP.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
funds awarded for A&D 71 Services 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. OHA may, after 30 days (unless parties agree otherwise) written notice to
County, reduce the monthly allotments based on under used allotments
identified through CPMS or through other reports required or permitted by
this Service Description or applicable Specialized Service Requirement;
2. OHA may, upon written request of County, adjust monthly allotments; and
3. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
A&D 71 Services on that line of the Financial Assistance Award.
C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for A&D 71 Services under a particular line of
the Financial Assistance Award and amounts due for such services provided by
County based on the rate set forth in the special condition identified in that line of
the Financial Assistance Award. For purposes of this section, "amounts due" to
County is determined by 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
reports required or permitted by this Service Description or an applicable
Specialized Service Requirement.
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Service Name: DRUG TREATMENT COURT SERVICES
Service ID Code: A&D 72
I. Service Description
Drug treatment court services (A&D 72) are services delivered to individuals who have
lost control of their use of alcohol or other drugs and who are participating in a drug
treatment court program. The purpose of A&D 72 Services is to assist individuals
recovering from alcohol abuse or drug dependency. Funds awarded for A&D 72 Services
that are identified in the Financial Assistance Award may only be expended on A&D 72
Services that are delivered to adolescents (ages 12 to 18) and adults (age 18 and over)
enrolled in drug treatment courts. Drug courts operate under the principles described
below:
A. Drug courts integrate alcohol and other drug treatment services with justice system
case processing;
B. Using a nonadversarial approach, prosecution and defense counsel promote public
safety while protecting participants' due process rights.
C. Eligible participants are identified early and promptly placed in the drug court
program;
D. Drug courts provide access to a continuum of alcohol, drug and other related
treatment and rehabilitation service;
E. Abstinence is monitored by frequent alcohol and other drug testing;
F. A coordinated strategy governs drug court responses to participants' compliance;
G. Ongoing judicial interaction with each drug court participant is essential;
H. Monitoring and evaluation measure the achievement of program goals and gauge
effectiveness;
1. Continuing interdisciplinary education promotes effective drug court planning,
implementation and operations; and
J. Forging partnerships among drug courts, public agencies, and community-based
organizations generates local support and enhances drug court program effectiveness.
Providers of A&D 72 funded through this contract must also have a current license issued
by OHA in accordance with OAR 415-012-0000 through 415-012-0090. The Provider
funded through this Agreement must comply with OAR 309-032-1500 through 309-032-
1565, as such rules may be revised from time to time.
With respect to each individual that the Provider serves with funds provided under this
Agreement, the Provider shall deliver all A&D 72 services therapeutically necessary for
an eligible individual from the date the Provider begins serving the individual through the
date set forth in the Financial Assistance Award.
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A&D 72 services provided to any individual enrolled in the Oregon Health Plan for
chemical dependency benefits are not eligible for payment under this contract. The
Provider must refer such individuals to their managed care plan for A&D 72 services.
A&D 72 Services delivered with funds provided under this agreement include the
following: clinical care, case management, continuing care, and participation in the drug
court team, which for the purposes of A&D 72, have the following meanings:
Clinical care services consist of screening, comprehensive assessment for substance use
diagnosis and level of care assignment, treatment for substance use disorders, meeting the
Standards for Outpatient Chemical Dependency Programs, set forth in OAR 415-050-
0000 through 415-050-0095 and 309-032-1500 through 309-032-1565, as such rules may
be amended from time to time.
Case management services are community-based and specific to the identified client
needs that support independence and recovery from substance use disorders. Case
management services provide the individual with a single point of contact for multiple
justice, health and social service systems. These services assist individuals transitioning
through the continuum of care, and assist the individual in advocating for his or her needs
to access necessary services and supports for substance use disorders.
Continuing care services are provided to individuals enrolled in drug treatment courts to
sustain their commitment to substance use recovery and consist of ongoing intermittent
contact by the individual with a treatment staff including, but not limited to telephone
outreach, home visits, participation in recovery self help groups and programs, and
transitional housing. Evidence -based practices identified for community-based services
for the criminal justice population shall guide the outreach activities.
Participation in the Drug Court Team: The provider shall participate in the drug court
process by serving on the drug court team that may include participation in regular client
case staffings. As a team member, the Provider will coordinate multiple aspects of a
client's life and bridge continuing care responsibilities between all partners involved in
the drug treatment court system.
Drug court treatment services (A&D 72) are delivered in outpatient and intensive
outpatient programs as described by the American Society of Addiction Medicine, Patient
Placement, Continued Stay and Discharge Criteria, Second Edition -Revised (ASAM
PPC -2R) as referenced in OAR 309-032-1505. A&D 72 services are provided at one of
the following levels of care as therapeutically necessary and consistent with the clinical
need of the individual:
Level I (Outpatient) Non-residential treatment services provided to the individual in
regularly scheduled face-to-face therapeutic sessions. This level of service consists of 1-
6 hours per week of face-to-face therapeutic sessions for adolescents and 1-9 hours per
week for adults. Such services may include individual, group and family counseling, as
well as long-term support for recovery management including relapse prevention.
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Level II (Intensive Outpatient) This level of service affords the individual the
opportunity to remain in his or her existing environment (social, familial, vocational),
while still benefiting from a therapeutic, structured program. It is a non-residential
service consisting of at least nine hours of face-to-face contact per week for adults and at
least six hours of face-to-face contact per week for adolescents who meet the
administrative rule placement requirements for this level of care. Level II Providers may
provide evening services, day treatment services, or partial hospitalization. Such
Services may include individual, group and family counseling, as well as medically -
prescribed pharmacological agents.
II. Performance Standards and Quality Measures
The quality of drug treatment court services supported with funds provided under this
Agreement will be measured in accordance with the criteria set forth below:
Engagement: Engagement is measured by OHA through the Client Process Monitoring
System (CPMS) as the number of people enrolled in treatment services referred from the
drug court system.
Retention: Retention is measured by OHA through the CPMS as the number of
individuals receiving drug treatment court services with funds provided through this
Agreement who are actively engaged in treatment for 90 days or more.
Improvements in Life Circumstances: Improvements in life circumstances is measured
by OHA through the CPMS as the number of enrolled participants in drug treatment
courts who obtain a GED or high school diploma, obtain or improve employment,
increase monthly income, and obtain drug-free and adequate housing.
Completion of Program Requirements: Completion of program requirements is
measured by the OHA through the CPMS by the number of enrolled participants in drug
treatment courts who complete treatment.
III. Special Reporting Requirements
Clients enrolled in drug treatment courts receiving substance use (chemical dependency
program) services will be enrolled in the Client Process Monitoring System (CPMS)
while receiving services using a dedicated provider number and referral code for
Criminal Justice System, Institutions and Agencies, Integrated Treatment Court as
specified in OHA's CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpms-manual/ad2009cpms-
manual.pdf?ga=t
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance: The funds awarded for this service element are
intended to be general financial assistance to the Provider for A&D 72.
Accordingly, ORA will not track delivery of these services or service capacity on a
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OHA 11-13 GT0217-I 1
per unit basis except as necessary to verify the performance requirements set forth
above have been met. Total OHA financial assistance for all A&D 72 services
delivered under a particular line of the Financial Assistance Award shall not exceed
the total funds awarded for A&D 72 as specified in that line of the Financial
Assistance Award.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
funds awarded for A&D 72 services on a particular line of the Financial Assistance
Award to Contractor in substantially equal monthly allotments during the period
specified in the Financial Assistance Award, subject to the following:
1. OHA may, after 30 days (unless parties agreed otherwise) written notice to
County, reduce the monthly allotments based on under used allotments
identified through the required quarterly reports
2. OHA may, upon written request of County, adjust monthly allotments.
3. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
A&D 72 services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and
delivery of these services, based on CPMS or through other reports required or
permitted by this Service Description.
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Service Name: INTEGRATED CO-OCCURRING DISORDERS (COD)
TREATMENT SERVICES
Service ID Code: A&D 73
I. Service Description
Integrated co-occurring disorders treatment services are delivered to people with serious
co-occurring mental health and substance use disorders (COD). Services include case
management, clinical care, continuing care and psychiatric stabilization with non-medical
detoxification funded by the Oregon Health Authority (OHA), Addictions and Mental
Health Division (AMH). COD services build on resilience and promote recovery in an
effort to provide clients the ability to attain the highest Ievel of functioning and to prevent
psychiatric hospitalization, substance use relapse, and criminal justice system
involvement. For the purposes ofA&D 73, case management, clinical care, continuing
care and psychiatric stabilization with non-medical detoxification have the following
meanings:
Case management services are community-based and specific to the identified client
needs. Case management services support recovery from substance use and mental health
disorders and provide the individual with a single point of contact for multiple health and
social service systems and assist the individual in advocating for his or her needs. These
services assist individuals transitioning through the continuum of care and in accessing
necessary services and recovery supports for both substance use and mental health
disorders.
Clinical care services consist of screening, comprehensive integrated assessments for
substance use and mental health diagnosis, treatment for both substance use and mental
health disorders concurrently, meeting the Standards for Outpatient Chemical
Dependency and Mental Health Treatment Programs, set forth in OAR 415-050-0000
through 415-050-0095 and 309-032-1500 to 309-032-1565, as such rules may be
amended from time to time.
Continuing care services are provided to individuals in treatment to sustain their
commitment to mental health and substance use recovery and consist of ongoing
intermittent contact by the individual with a treatment staff including, but not limited to
telephone outreach, home visits, participation in dual diagnosis recovery self help groups
and programs, and transitional housing.
Evidence Based practices identified for community-based services for this population
shall guide the outreach activities.
Psychiatric stabilization with non-medical detoxification
Psychiatric stabilization with non-medical detoxification services consist of medically
monitored inpatient stabilization and detoxification for people who meet medical criteria
for withdrawal that include 24 hour medical monitoring and clinically managed
residential detoxification called social detoxification. Services shall meet standards for
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O11A 11-13 GT0217-11
Approved 5/9/2011 46 of 220
ALCOHOL DETOXIFICATION CENTERS, set forth in OAR 415-050-0000 through
415-050-0095 as such rules may be amended from time to time. Services include a set of
interventions to manage acute detoxification and withdrawal symptoms and meet the
needs of individuals with co-occurring mental health and substance use disorders and
other physical health problems. Psychiatric services include mental health status exam,
psychiatric evaluation if indicated, psychotropic medication dispensing and medication
management.
Description of Program:
The Provider shall provide services that are based on identified client strengths and
needs, comprehensive, and geographically accessible. Services shall bridge continuing
care responsibilities between all levels of a collaborative and integrated system of care.
The Provider shall maintain policies and procedures which facilitate and document
accessibility to a full range of services. The Provider shall conduct integrated screenings
and comprehensive clinical assessments, and integrated treatment and discharge planning
for both mental health and substance abuse disorders.
Target Population:
Youth and adults with DSM -IV -TR Axis I mental health and substance use disorder
diagnosis.
Service Level Expectation:
The Provider will screen each client for the presence of substance use, problem gambling,
mental health conditions, and chronic medical conditions in compliance with OAR 309-
032-1525(3)(d)(B) to identify co-occurring symptoms and level of severity base on the
SAMHSA Quadrant Model and determine appropriate level of ASAM placement. When
the assessment process determines the presence of co-occurring substance use and mental
health disorders, all providers must document referral for further assessment, planning
and intervention from an appropriate professional, either with the same provider or with a
collaborative community provider in compliance with OAR 309-032-1525(3)(e).
Competency Checklist:
Staff competencies shall be evaluated in accordance with the AMH approved Co-
occurring Disorders Competency Checklist. Staff shall meet minimum basic competency
in accordance with the AMH COD Competency Checklist, which can be located at
http://www.oregon.gov/OHA/addiction/co-occurring/docs/checkI ist-basic.pdf?ga=t.
II. Performance Standards and QualityMeasures
Providers of A&D 73 funded through this contract must also have a current license for
both chemical dependency and mental health issued by OHA in accordance with OAR
415-012-0000 through 415-012-0090 and 309-012-0130 through 309-012-0220 as such
rules may be revised from time to time.
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With respect to each individual that the Provider serves with funds provided under this
Agreement, the Provider shall deliver all A&D 73 Services therapeutically necessary for
the individual from the date the Provider begins serving the individual through the date
set forth in the Financial Assistance Award.
A Provider may not use A&D 73 funds provided under this Agreement to deliver services
to any individual enrolled in the Oregon Health Plan for either mental health or chemical
dependency benefits. The Provider must refer such individuals to their managed care
plan.
The quality of the COD services supported with funds provided under this Agreement
will be measured in accordance with the criteria set forth below. These criteria are
applied on a countywide basis each calendar quarter (or portion thereof) during the period
for which the funds are awarded for COD services under this Agreement. The Provider
must develop and implement quality assurance/quality improvement processes to
improve, progressively as measured by the criteria set forth below, the quality of COD
services supported by funds under this Agreement. OHA may recommend additional
actions to improve quality.
Access: Access is measured by OHA as the percentage of County residents estimated by
OHA surveys to need COD treatment who are enrolled in COD services.
Engagement: Engagement is measured by OHA as the percentage of people receiving
COD services with funds provided through this Agreement who enter treatment
following comprehensive integrated mental health and substance use assessment.
Retention: Retention is measured by OHA as the percentage of individuals receiving
COD services with funds provided through this Agreement who are actively engaged in
treatment for 90 days or more.
Reduced Psychiatric Hospitalization: Psychiatric Hospitalization is measured by OHA
as the number of people enrolled in COD services funded by this Agreement who are
admitted for psychiatric hospitalization while enrolled in treatment.
Reduced Criminal Justice Involvement: Criminal Justice Involvement is measured by
OHA as the number of people enrolled in COD services funded by this Agreement who
are arrested while enrolled in treatment.
Research/Best Practice Expectation: The Provider will use evidence -based practices
for people with COD that include, but are not limited to, Motivational Enhancement or
Interviewing, Integrated Dual Disorder Treatment, Assertive Community Therapy,
Supported Employment, Supported Housing, Dual Diagnosis Treatment Groups,
Individual Substance Abuse Counseling, Seeking Safety, Dialectic Behavioral Therapy,
and Family Psychoeducation.
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III. Special Reporting Requirements
Clients enrolled in mental health and substance use (chemical dependency) COD
treatment services will be enrolled in the Client Process Monitoring System (CPMS)
using a dedicated provider number for either mental health or substance use (chemical
dependency) according to the provider's site specific primary service as specified in
OHA's CPMS manual located at
http://www.oregon.t;ov/OHA/mentalhealth/publ ications/cpms-manual/ad2009cpms-
manual_pdf?ga=t
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance: The funds awarded for this service element
are intended to be general financial assistance to the Provider for A&D 73.
Accordingly, OHA will not track delivery of these services or service capacity on
a per unit basis except as necessary to verify the performance requirements set
forth above have been meet. Total OHA financial assistance for all A&D 73
services delivered under a particular line of the Financial Assistance Award shall
not exceed the total funds awarded for A&D 73 as specified in that line of the
Financial Assistance Award.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
funds awarded for A&D 73 services on a particular line of the Financial
Assistance Award to Contractor in substantially equal monthly allotments during
the period specified in the Financial Assistance Award, subject to the following:
1. OHA may, upon written request of County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments s necessary, to reflect changes in the funds awarded for
A&D 73 services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer
and delivery of these services, based on CPMS or through other reports required
or permitted by this Service Description or an applicable Specialized Service
Requirement.
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/2011 49 of220
Service Name: PROBLEM GAMBLING PREVENTION SERVICES
Service ID Code: A&D 80
I. Service Description
Problem Gambling Prevention services (A&D 80) are designed to meet one or more of
the following objectives:
A. Outreach aimed at increasing public awareness of problem gambling (this is
differentiated from treatment specific outreach which is covered by A&D 81); and
B. Prevent problem gambling.
The anticipated goals and outcomes for County's Problem Gambling Prevention Services
will be described and included in County's Biennial Implementation Plan approved by
OHA. County's A&D 80 Services will be monitored and evaluated on the basis of their
effectiveness in achieving the goals and outcomes identified in the approved Biennial
Problem Gambling Prevention Implementation Plan. OHA financial assistance to County
in the subsequent biennium, for A&D 80 Services, will in part depend upon achievement
of the goals and outcomes identified in County's Problem Gambling Prevention
Implementation Plan for the previous biennium as approved by OHA.
II. Performance Requirements
A. County must designate a Certified Prevention Specialist, or person who is working on
obtaining that certification and will obtain such certification within 24 months of the
effective date of this Agreement. New hires without the CPS credential. must make
application within six (6) months of their hire date and achieve the Certified
Prevention Specialist credential within (24) months of their hire date.
The designated coordinator shall be responsible for preparing the problem gambling
prevention implementation plan, annual report and for overseeing and coordinating
problem gambling prevention activities, programs and services provided in the
County
County's designated Problem Gambling Prevention coordinator/contact person must
attend two Oregon Health Authority (OHA) sponsored problem gambling prevention
meetings per calendar year.
B. County must attend at least one meeting each of County's Local Alcohol and Drug
Planning Committee (LADPC) and Commission on Children and Families (CAF)
during the biennium and must present information on problem gambling prevention
and outreach issues, services and data to these partners. County shall also obtain
input on its Biennial Problem Gambling Prevention Implementation Plan during
County's comprehensive planning process. OHA may require additional County
agency review and approval, provided OHA gives notice in writing at least 45 days
before the plan is due.
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OHA 11-13 GT0217-11
III. Special Reporting Requirements
A. Providers of A&D 80 services funded under this Agreement must submit written
reports to OHA by August 30 of each year, describing the Provider's activities,
appraisal of activities, and expenses during the preceding fiscal year in providing
A&D 80 services. Reports shall be sent to:
Oregon Health Authority
Addictions and Mental Health Division
Attention: Problem Gambling Specialist
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
B. Final Biennial Expenditure Report: Providers of A&D 80 services funded under this
Agreement must submit to OHA a final report of actual revenues and expenditures of
A&D 80 funds disbursed under this Agreement. The report is due within 60 days
after termination of this Agreement or termination of OHA's obligation under this
Agreement to provide financial assistance to County for A&D 80 services, whichever
is earlier. Reports must be prepared using forms and procedures designated by OHA.
IV. Payment Procedures
A. Basis of payment: OHA payment for A&D 80 services identified in a particular line
of the Financial Assistance Award is based on anticipated reimbursement for actual
allowable expenditures incurred by a Provider in delivering A&D 80 services under
that line of the Financial Assistance Award during period specified in that line,
subject to the following:
1. Allowable expenditures are limited to the standard and customary rates for the
following:
a. Personnel expenses (salaries, wages, payroll tax and fringe benefit costs) for
delivery of A&D 80 services;
b. Operating expenses, such as program materials, office rent/lease, office
utilities, telephone costs, office equipment rental and repair, office supplies,
and staff travel for delivery of services, participation in problem gambling -
prevention -related meetings, trainings and events. Operating expenses are
limited to the amount approved in the Biennial Problem Gambling
Prevention Implementation Plan budget;
c. Professional consultation needed to support or enhance OHA-funded
problem gambling prevention services; and
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OHA 11-13 GT0217-11
Approved 5/9/2011 51 o1220
d. Administrative expenses, capital outlay, or other expenses not listed in
sections IV(A)(1)(a), (b) and (c) above, only if approved in writing or e-
mail by OHA.
2. Total OHA payment for all A&D 80 services delivered under a particular line of
the Financial Assistance Award shall not exceed the total funds awarded for
A&D 80 as specified in that line of the Financial Assistance Award; and
3. OHA is not obligated to pay for any A&D 80 services that are not properly
reported to OHA as described in this Service Description.
B. Disbursement of funds: Unless a different disbursement method is specified in that
line of the Financial Assistance Award, OHA will disburse the funds awarded for
A&D 80 services 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. OHA, may, after 30 days (unless parties agree otherwise) written notice to
County, reduce the monthly allotments based on under used allotments identified
through reports required or permitted by this Service Description or an applicable
Specialized Service Requirement;
2. OHA may, Upon written request of County, adjust monthly allotments; and
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for A&D 80
services on that line of the Financial Assistance Award.
Agreement Settlement will be used to confirm the offer and delivery of A&D 80
services by County or Programs based on the approved Final Biennial Expenditure
Report
V. Exceptions and Waivers
County may request in advance in writing, and OHA in its sole discretion may approve, a
limited number of waivers and exceptions to the above.
134309 Deschutes County
OHA I I-13 GT0217-I
Approved 5/9/2011 52 01 220
Service Name: PROBLEM GAMBLING TREATMENT SERVICES
Service ID Code: A&D 81
I. Service Description
Problem Gambling Treatment Services (A&D 81) are as follows:
A. Outpatient problem gambling treatment services provide problem gambling
assessment, treatment and rehabilitation services delivered on an outpatient basis
or intensive outpatient basis to individuals with gambling related problems who
are not in need of 24-hour supervision for effective treatment. A&D 81 Services
must include regularly scheduled face-to-face or non -face-to-face therapeutic
sessions or services in response to crisis for the individual and may include
individual, group, couple, and family counseling.
B. Residential problem gambling treatment services provide problem gambling
assessment, treatment, rehabilitation and twenty-four hour observation monitoring
for pathological and problem gamblers consistent with Level 1I1 of ASAM PCC -
2R.
C. Treatment -specific outreach is targeted outreach for which the primary purpose is
to get pathological and problem gamblers and/or their family members into
treatment.
D. For purposes of this Agreement, an individual with a gambling related problem is
an individual with (a) a primary diagnosis of Pathological Gambling (DSM -IV
code 312.31), (b) a primary diagnosis of sub -clinical Pathological Gambling
(meets two to four DSM -IV diagnostic criteria for Pathological Gambling), or (c)
a primary diagnosis of Relational Problem Related to Pathological Gambling (a
variant of DSM -IV code V61.9).
E. Problem Gambling Treatment Services are to be made available to any Oregon
resident meeting criteria as described in Section I D above. Service to out of state
residents is permissible if the presenting gambling problem is reported as
primarily related to an Oregon lottery product.
II. Performance Standards
Providers of A&D 81 Services funded through this Agreement must maintain a License
as a Mental Health Service Agency or a Letter of Approval as an Alcohol and Drug
Treatment Agency for all levels of outpatient treatment in accordance with OAR 309-
032-1500 through 309-032-1565 Building Requirements, OAR 415-012-0000 through
415-012-0090 Standards for Approval/Licensure of Alcohol and Other Drug Programs
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OHA 11-13 GT0217-1 I
Approved 5/9/2011 53 of 220
and OAR 309-012-0130 through 309-012-0220 Certificates of Approval for Mental
Health Services; as such rules may be revised from time to time.
Providers of A&D 81 Services funded through this Agreement must comply with onsite
reviews, per OAR 415-012-0050 through 415-012-0090 Onsite Reviews.
Providers (and County, as applicable) of A&D 81 Services funded through this
Agreement must comply with the requirements set forth in Exhibits A&D 81-1 and A&D
81-2attached hereto and incorporated herein by this reference.
Providers of A&D 81 Services funded through this Agreement must meet the
performance standards below. These performance standards are imposed and assessed on
an individual Provider basis. If OHA determines that a Provider of A&D 81 Services
funded through this Agreement fails to comply with any of the specified performance
standards, the specific areas out of Agreement compliance would then be reviewed at the
next scheduled site review or a discretionary site review could be scheduled specifically
to review these areas.
Access: The amount of time between a problem gambling affected individual's request
for A&D 81 Services and the first offered service appointment must be five business days
or less for at least 90% of all individuals receiving A&D 81 Services funded through this
Agreement.
Retention: The percent of problem gambling affected individuals receiving A&D 81
Services funded through this Agreement who actively engage in the A&D 81 Services for
at least 10 clinical contact sessions must not be less than 40%.
Successful Completion: The percent of all individuals receiving A&D 81 Services
funded through this Agreement who successfully complete treatment must not be less
than 35%. A successful problem gambling treatment completion is defined as the
individual's: (a) achievement of at least 75% of short-term treatment goals, (b)
completion of a continued wellness plan (i.e., relapse prevention plan), and (c) lack of
engagement in problem gambling behaviors for at least 30 days prior to successful
completion of A&D 81 Services.
Client Satisfaction: The percent of problem gambling affected individuals receiving
A&D 81 Services funded through this Agreement who complete a problem gambling
client satisfaction survey would positively recommend the Provider to others must not be
less than 85%. Client satisfaction surveys must be collected by not less than 50% of total
enrol lments.
Long-term Outcome: At the six month follow up for individuals completing treatment, a
minimum of 50% must report abstinence or reduced gambling.
134309 Deschutes County Approved 5/9/2011 54 of 220
OHA 11-13 GT0217-I1
III. Special Reporting Requirements
Providers of A&D 81 Services funded through this Agreement must submit the following
information to OHA (or to OHA's designee), regarding individuals receiving A&D 81
Services. All providers must comply with the current GPMS User Manual located at
http://www.oregon.gov/OHA/addiction/gambling/2010/gpms-data-col lection.pdf
A. GPMS (Gambling Process Monitoring System) Intake Data: The GPMS record
abstracting form and the client self-report survey must be collected and submitted
within 14 days of the first face-to-face treatment contact with an individual.
B. Client Consent Form: A completed client informed consent form to participate in
evaluation follow-up efforts must be collected and submitted prior to service
conclusion. Client refusal to participate in the follow-up survey must be
documented in the client file.
C. Encounter Data: Encounter data for billing must be collected and submitted as
described in Exhibit A&D 81-2 attached hereto and incorporated herein by this
reference. Prior to submitting an encounter claim each claimed encounter must be
documented in the clinical record. Encounter claim documentation placed in the
clinical record must include the date of the encounter service, the type of service
delivered, the length of service, a clinical note describing data from the session,
the clinician's signature and date the note was completed.
D. GPMS Discharge Data: GPMS discharge data must be collected and submitted
within 90 days after the last date of service to an individual.
IV. Financial Assistance Calculation and Disbursement Procedures
Special Conditions Apply for Participating Rural Counties -See Exhibit-A&D 81-1,
Financial Assistance Calculation and Disbursement Procedures- Rural Counties
A. Financial Assistance Calculation. OHA provides financial assistance for A&D 81
Services identified in a particular line of the Financial Assistance Award at the
rate of $89.00 (for purposes of this Service Description, one hour is no less than
50 minutes of direct face-to-face service) for individual treatment sessions
(including individuals, couples and family sessions), $22.25 per hour for group
sessions and $89.00 per hour for problem gambling assessment sessions for
individuals, subject to the following:
1. OHA will not make multiple financial assistance payments for a single
clinical activity, except for group therapy. For example, OHA will not provide
financial assistance for an individual treatment session for both an individual
and his or her spouse when the treatment was delivered in a single marital
session.
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2. For purposes of this Service Description, "session" or "treatment session"
means A&D 81 Services delivered in individual, couple, family, or group
formats. Treatment sessions must be reported by type (e.g., individual, couple,
family or group) and length (time).
3. Services provided are limited to 12 months per individual client, inclusive of
continuing care. This service limitation will count 12 consecutive months
starting with the enrollment date. Clients must have been out of service for a
minimum of ninety days prior to any re -enrollment in the state system.
4. Providers may request a waiver of the above service limitation. The request
shall be in writing, email is acceptable. Request shall be sent to OHA at email
address provided. Waiver shall include clinical need for waiver and treatment
plan indicating the requested length of time to complete plan. Waivers will be
for fixed periods and must be received in the Problem Gambling Services
office 45 days prior to exceeding the twelve month service limitation period.
5. Providers of A&D 81 Services funded through this Agreement may not charge
individuals whose A&D 81 Services are funded through this Agreement any
co -pay or other fees for such Services.
6. Total OHA financial assistance for all A&D 81 Services delivered under a
particular line of the Financial Assistance Award shall not exceed the total
funds awarded for A&D 81 Services as specified in that line of the Financial
Assistance Award.
7. OHA is not obligated to provide financial assistance for any A&D 81 Services
that are not properly reported as described or referenced in this Service
Description by the date 60 days after the termination of this Agreement,
termination of OHA's obligation under this Agreement to provide financial
assistance to County for A&D 81 Services, or termination of County's
obligation under this Agreement, to include the Program Area, in which A&D
81 Services fall, in its CMHP.
8. If at any time during the term of this Agreement, the total A&D 81 Services
delivered under a particular line of the Financial Assistance Award entitles
County to less than 100% of the funds disbursed to County under that line
during that period, OHA may unilaterally reduce the amount of funds awarded
for A&D 81 Services in that line in proportion to the underutilization during
that period and may also unilaterally reduce the amount of funds awarded for
A&D 81 Services in that line in an amount equal to funds disbursed to County
under that line that were not utilized, and OHA shall execute an appropriate
amendment to the Financial Assistance Award to reflect that reduction.
9. Provider and/or County are expected to reconcile encounter data reports and
correct any errors within 30 days of receipt of encounter data report received
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OHA 1 I-13 GT0217-1 1
from OHA's management information system provider. Discrepencies must
include apparent cause and remedy. Adjustments will be carried forward to
the next month within the effective period of this Agreement.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
funds awarded for A&D 81 Services in a particular line of the Financial
Assistance Award to County in substantially equal monthly allotments during the
period specified in that line, subject to the following:
1. OHA may, after 30 days (unless parties agree otherwise) written notice to
County, reduce the monthly allotments based on actual delivery of services
identified through GPMS or through other reports required or permitted by
this Service Description or an applicable Specialized Service Requirement.
2. OHA may, upon written request of County, adjust monthly allotments.
3. Upon amendment to the Financial Assistance Award, OHA shall, adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
A&D 81 Services on that line of the Financial Assistance Award.
4. County may, with OHA approval, apply A&D 81 funds for services not
provided in the first fiscal year toward A&D 81 Services in the second fiscal
year.
C. Agreement Settlement: Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for A&D 81 Services under a particular line of
the Financial Assistance Award and amounts due for such services based on the
rates set forth above. For purposes of this section, "amounts due" to County is
determined by the actual amount of Services delivered under that line of the
Financial Assistance Award during the period specified on that line, as properly
reported as described or referenced in this Service Description or an applicable
Specialized Service Requirement. Any County funded under Exhibit A&D 81 -1 -
Rural Counties, as specified in the special condition on that line of the Financial
Assistance Award, are exempt from this agreement settlement as long as they
comply with performance standards specified under Exhibit A&D 81-1, III.
D. Provider Audits. Providers and sub -contracted Providers receiving A&D 81
payments from OHA are subject to audit for all payments applicable to A&D 81
services rendered. The audit ensures that proper payments were made for covered
services, to recover overpayments, and to discover possible instances of fraud and
abuse. This audit will verify that encounter data submissions are documented in
the client file as described in section Ill C above. OHA may apply the Division of
Medical Assistance Program (DMAP) Provider Audit rules and the Fraud and
Abuse rules to providers and provider sub -contractors of A&D 81 Services
funded through this Agreement in accordance with OAR 410-120-1505 through
410-120-1510 Provider Audits, as such rules may be revised from time to time.
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Approved 5/9/2011 57 of220
Exhibit A&D 81-1
Requirements for Rural Counties
Financial Assistance Calculation and Disbursement Procedures Rural Counties
OHA may apply the following conditions to Rural counties:
All Service Descriptions and Performance Standards and Special Reporting Requirements set
forth in A&D 81 shall apply unless hereto modified or waived.
The intention of these conditions is to provide an investment within Rural counties with the goal
being to use this investment to ensure viable Problem Gambling Services are available to all
Oregonians.
I. Financial Assistance Calculation and Disbursement Procedures
1. Financial Assistance Calculation. OHA will provide financial assistance for AD
81 Services utilizing a base rate method.
A. This Financial Assistance Award will be determined annually for Counties
designated as Rural Counties in the special condition on that line of the
Financial Assistance Award.
B. The County or Regional consortium must submit encounter data as if they
were being reimbursed via that method. At the end of each fiscal year, if the
encounter data is more than base payment, the County or Regional consortium
shall receive the amount shown from the Encounter Data that was in addition
to the Base Payments if funds are available.
II. Financial Assistance Calculation and Disbursement Procedures for Multi -County
Management agreements:
If services are sub -contracted, the sub -contracts must be approved in advance by OHA.
Sub -contract rates must be delineated and approved by OHA.
III. Performance Standards that apply under these Special Conditions:
A. A detailed plan demonstrating how the County intends to develop, grow, and
sustain viable problem gambling services must be submitted and approved by
OHA.
B. County must submit an annual progress report that documents maintenance of
effort and progress made in establishing viable problem gambling treatment
services. Annual reports are due to OHA by Sept. 1, 2011 and Sept 1, 2012.
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C. Viable problem gambling services shall be evaluated by OHA utilizing the
following example components:
1. Outreach: Documented efforts within the community designed to increase
awareness of problem gambling as a treatable public health issue including
problem identification, referral procedures, and program contact information
(including the state-wide Helpline).
2. Case Finding: Efforts with community to specifically increase appropriate
referrals to treatment services as defined under A&D 81 Service descriptions.
These would be long term inter -agency, intra -agency, and allied healthcare
relationships specifically developed and nourished for the purpose of
identifying problem gambling within existing populations through appropriate
screening and referral.
3. Problem gambling treatment interventions as defined under A&D 81 Service
descriptions.
4. Required reporting and reconciliation of A&D 81 service rates and client
eligibility/system evaluation data.
5. Quality control and improvement plan including incorporation of consumer
feedback.
Providers of services funded through this agreement must be able to demonstrate
to OHA satisfaction their ability to recognize and respond appropriately to the
unique needs of problem gamblers in their community by developing and
implementing Gambling Treatment Services that are delivered by qualified
counselors/therapists
134309 Deschutes County Approved 5/9/2011 59 of -220
OHA 11-13 GT0217-1 1
Exhibit A&D 81-2
Encounter Data Reporting Requirements
In order to efficiently implement the disbursement of financial assistance it is necessary for all
Providers of A&D 81 Services funded through this Agreement to submit individual -level service
delivery activity (encounter data) within 30 days following the end of each month to OHA or its
designee.
Data shall be electronically submitted utilizing the HIPAA approved "837' format. Files to be
transferred over non -secure web/internet facilities must be encrypted utilizing an encryption
format approved by the OHA. The subject line for each electronic transmission of data must
include the program name, the month covered by the submission (e.g. May 2010) and the words
"Gambling Encounter Data."
Agencies with secure web services may post the data to their server as long as access and timely
notification is provided to the OHA or its designee.
134309 Deschutes County
OHA 11-13 GT0217-I 1
Approved 5/9/2011 60 of 220
EXHIBIT A&D 81-3
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Service Criteria
Service provided by qualified counselor per OAR 309-032-1520
Service provided by qualified counselor per OAR 309-032-1520
MD or Psychiatric Mental Health Nurse Practitioner
QHHP who is licensed Psychologist or a Psychology Intern supervised by a
Licensed Psychologist
MD or Psychiatric Mental Health Nurse Practitioner
Services delivered by a licensed registered nurse or QMHP related to the
dispensing, administration and management of medications.
Services provided in a licensed mental health residential facility and intensively
staffed 24 -hours under a physician approved treatment plan for which treatment
includes an appropriate mix and intensity of assessment, medication
management, individual and group therapies and skills development to reduce or
liminate the acute symptoms of the disorder and restore the client's ability to
function in a home or the community to the best possible level.
Services provided in a licensed residential alcohol and drug treatment facility
designated as a residential gambling treatment program and intensively staffed
24-hour for which treatment includes an appropriate mix and intensity of
assessment, medication management, individual and group therapies and skills
development to reduce or eliminate the acute symptoms of the disorder and
restore the client's ability to function in a home or the community to the best
possible level.
Services provided for coordinating access to and provision of services from
multiple agencies, establishing service linkages, advocating for treatment needs,
Upper
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Description
Gambling Treatment counseling
and therapy, per 15 min
Gambling Treatment counseling,
group per 15 min
Psychiatric Diagnostic Interview
Psychological Testing with
interpretation and report, per hour
Medication Management
Comprehensive medication
services, per 15 min
Psychiatric health facility service,
per diem
Residential gambling treatment
service, per diem
arion County Bridgeway
Residential Program Only
Case management, per 15 min
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and providing assistance in obtaining entitlements based on mental or emotional
disability,
Screening to determine the appropriateness of consideration of an individual for
participation in A&D 81 services. This services deferens from a mental health
assessment in that the activity may be delivered over the telephone and requires
not only the evaluation of a client's treatment needs, but also an evaluation of
available treatment options.
Pressure relief counseling or other forms of counseling provided to individuals
nrolled in A&D 81 services or their family members for the purpose of
financial restitution of gambling debt.
Sign language/oral interpreter services necessary to ensure the provision of
services for individuals with hearing impairments or in the primary language of
non-English speaking individuals. Such interpreters shall be linguistically
appropriate and be capable of communicating in English and the primary
language of the individual and be able to translate clinical information
effectively.
Payment for interpreter services is only allowed when provided in conjunction
with another service such as assessment, individual/family therapy, or group
therapy, etc. whenever feasible, individuals should receive services from staff,
who are able to provide sign and/or oral interpretive services. In this case,
interpreter services cannot be billed in addition to the therapeutic service.
Services provided in a properly licensed 24-hour facility by non-medical
professionals within their scopes of licensure or certification. Services must be
reasonably expected to improve or maintain the condition and functional level
and prevent relapse or hospitalization. Services include assessment, supervision,
structure and support, and case coordination.
Services provided to clients who have completed problem gambling treatment
within the past 12 months and are to be utilized to facilitate continued recovery
or to avert a potential relapse. Services can be provided within an existing
therapy or psycho -educational group being provided to current clients or to a
group of previous clients meeting on a regular basis for aftercare.
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Behavioral Health Screening per
15 minutes
Financial counseling, per hour
Sign language/oral interpreter
service, per 15 min
Respite care services, not in the
home, per diem
Continuing Care Group Services,
per 15 min for gambler and/or
family member
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Limited to: 1. Service provider's travel to and from primary site providing AD81
services and ancillary AD81 service site; 2. Mileage charges by program or case
consultants; 3. Service provider's travel bringing clients to the treatment site. 4.
Service providers transportation costs to bring clients to and from the residential
treatment site. 5. Client transportation costs
`Treatment specific outreach with primary purpose of getting problem gamblers
and/or family members enrolled in services.
*** Providers must bill at rates, based upon the cost of services determined through a cost allocation, not in excess of their usual and
customary charge to the general public ** (OAR 309-016-0105 and OAR 309-016-0420)
Current US
GSA rate
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Approved 5/9/2011
EXHIBIT A&D 81-4
Oregon Problem Gambling Services
Outreach Procedure CodesAnnual
Client Finding Outreach is defined as Treatment Specific Outreach with the primary
purpose of getting problem gamblers and/or family members enrolled in services. This
type of outreach is geared specifically towards increasing the number of clients
receiving treatment; it is targeted; it generally involves repeated contacts and the
development of a relationship with the provider; the provider is generally another
professional and the goal is to increase the number of clients they assess and refer to
your program.
See Exhibit A&D 81-3.
Billing Code 50A Strategic outreach plan training and/or plan development.
Limited to maximum of 10% of A&D 81 allocations unless preauthorized by OHA Problem Gambling
Manager.
Billing Code 50B Time spent with allied agencies to develop and follow up on formal
referral agreements.
Limited to (8 Hours) per allied agency, unless preauthorized by OHA Problem Gambling Manager.
Billing Code 50C Time spent delivering presentations to professionals in
health/medicine/social services/legal/financial with the express intent to follow up with
individual contacts in order to establish relationship, develop screening and referral
agreements and protocols, etc.
Billing Code 50D Time spent delivering presentations to targeted high risk clients
groups, including but not limited to:
Incarcerated individuals
A/D clients (OP/Residential)
MH clients (OP/Residential)
CAF clients
These presentations shall be focused on signs and symptoms of disordered gambling,
treatment options and how to access treatment.
Billing Code 50E Treatment Ads (yellow pages, web -based ads, radio, tv, newspaper)
Limited to maximum of 20% of 81 allocations unless preauthorized by OHA Problem Gambling
Manager.
Billing Code 50F Exhibiting at a conference or meeting of professionals that we know
from experience are likely to have problem gamblers in their practices and are in a
position to potentially refer (ie, physicians, nurses, social services, corrections, legal,
financial). This is in contrast to a conference for service organizations (ie Kiwanis,
Elks), schools, PTAs and health fairs.
Limited to (4 hours) per exhibit, unless preauthorized by OHA Problem Gambling Manager.
134309 Deschutes County
OHA 1 I-13 GT0217-I1
Approved 5/9/201 1 64 of 220
Billing Code 50G Other as pre -authorized by OHA Problem Gambling Manager.
134309 Deschutes Count)
OHA 11-13 GT0217-I 1
Approved 5/9/2011 65 01 220
Service Name: PROBLEM GAMBLING TREATMENT ENHANCEMENTS PROJECTS
Service ID Code: A&D 82
I. Service Description
Problem Gambling Treatment Enhancements Projects (A&D 82) are problem gambling services
designed to supplement Problem Gambling Treatment & Prevention services (A&D 81 & A&D
80) and are delivered on a demonstration or emergency basis for a specified period of time.
Funds awarded for A&D 82 Services may be used to serve individuals with special needs. These
individuals include highly suicidal individuals, individuals with co-occurring severe psychiatric
conditions, individuals with severe housing problems, non-English speaking individuals,
individuals with treatment access obstacles, and repeat treatment failures. These funds may be
used for treatment enhancements designed to increase access, retention or volume of client
services.
II. Performance Requirements
A. County will submit a Problem Gambling Treatment Enhancements Plan to OHA in a
business plan format describing the County's Project. The plan shall include a detailed
implementation plan, specifically what Treatment Enhancement is being proposed and
what the anticipated outcome will be.
B. OHA has sole discretion to approve or disapprove County's plans depending on availability
of funds to support the projects.
III. Special Reporting Requirements
A. County must submit a written annual report to OHA in September of each fiscal year, in a
format prescribed by OHA, describing County's activities, accomplishments, and
expenses during the preceding fiscal year as detailed in the Problem Gambling Treatment
Enhancements Plan.
B. County must submit to OHA a Final Biennial Performance Report containing actual
outcomes of A&D 82 funds paid under this Agreement. The Final Biennial Performance
Report is due within 60 days after the expiration or termination of the Agreement,
whichever is earlier. The Final Biennial Performance Report must be prepared using forms
and procedures designated by OHA.
Reports shall be submitted to:
Oregon Health Authority
Addictions and Mental Health Division
Attention: Problem Gambling Manager
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
134309 Deschutes County
ODA 11-13 GT0217-I 1
Approved 5/9/2011 66 of 220
IV. Payment Procedures
A. Basis of payment: OHA payment ofA&D 82 Services identified in a particular line of the
Financial Assistance Award is based on actual allowable expenditures incurred by a
Provider in delivering A&D 82 Services under that line of the Financial Assistance Award
subject to the following:
1. Allowable expenditures are limited to the following:
i. Personnel expenses (salaries, wages, payroll tax and fringe benefit costs)
for delivery ofA&D 82 Services above and beyond the services normally
delivered as part of the Outpatient Treatment and Prevention Problem
Gambling (A&D 80 & 81).
ii. Operating expenses, such as office rent/lease, office utilities, telephone
costs, office equipment rental and repair, office supplies, printing,
publications, staff travel and staff training.
Administrative expenses, capital outlay, or other expenses not listed in
sections IV(A)(1)(a) to (c) above.
2. Total OHA payment for all A&D 82 Services delivered under a particular line of
the Financial Assistance Award shall not exceed the total funds awarded for A&D
82 as specified in that line of the Financial Assistance Award.
3. OHA is not obligated to pay for any A&D 82 Services that are not properly
reported to OHA as described in this Service Description by the date 60 days after
expiration or termination of this Agreement, whichever date is earlier.
B. Disbursement of funds: Unless a different disbursement method is specified in that line of
the Financial Assistance Award, OHA will disburse the funds awarded for A&D 82
Services in a particular line of the Financial Assistance Award to County in substantially
equal monthly Assistance Award, subject to the following:
1. OHA, may, after 30 days (unless parties agreed otherwise) written notice to County,
reduce the monthly allotments based on under used allotments identified through
reports required or permitted by this Service Description or applicable Specialized
Service Requirement.
2. OHA may, upon written request of County, adjust monthly allotments.
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary to reflect changes in the funds awarded for A&D 82
Services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and
delivery ofA&D 82 services by County based on the Final Biennial Performance Report
that includes a narrative report detailing completion or progress of the Problem Gambling
Treatment Enhancements Plan.
134309 Deschutes County
OHA 11-13 GT0217-I 1
Approved 5/9/2011 67 of 220
Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR ADULTS
(GENERAL)
Service ID Code: MHS 20
I. Service Description
Non -Residential Mental Health Services For Adults (General) (MHS 20) are mental health
services delivered to persons diagnosed with serious mental health illness, or other mental or
emotional disturbance posing a danger to the health and safety of themselves or others.
Non -Residential Mental Health Services for Adults (General) shall include one or more of the
following:
A. Case management services;
B. Vocational and social services;
C. Rehabilitation;
D. Support to obtain and maintain housing:
E. Medication and medication monitoring;
F. Emotional support;
G. Individual, family and group counseling and therapy;
H. Sex offender treatment; and
1. Interpreter services
II. Performance Requirements
Providers of MHS 20 shall provide coordination of care services for county of responsibility
residents in residential treatment programs, which include extended care managed services,
regardless of the location. The coordination of care shall include participation in the residential
provider's treatment planning process and in planning for the individual's transition to outpatient
services.
Providers of MHS 20 Services funded through this Agreement must:
A. Comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised
from time to time;
B. Maintain a Certificate of Approval, for the delivery of clinical services, in accordance
with OAR 309-012-0130 through OAR 309-012-0220, as such rules may be revised from
time to time; and
C. Investigate and report allegations of abuse regarding served individuals and provide
protective services to those individuals to prevent further abuse. The investigation,
reporting and protective services must be completed in compliance with ORS 430.735
134309 Deschutes County
OHA 11-13 GT0217-I 1
Approved 5/9/2011 68 of 220
through 430.765 and OAR 407-045-0000 through 407-045-0980, as such statutes and
rules may be revised from time to time.
III. Special Reporting Requirements
Providers of MHS 20 Services funded through this Agreement must:
A. Submit information and data on abuse reports, investigations and protective services
involving individuals to whom the Provider provides MHS 20 Services, as such
information and data is reasonably requested by the Oregon Health Authority (OHA) in
order to fully understand allegations and reports of abuse, the resulting investigations and
protective services and any corrective actions.
B. All individuals receiving MHS 20 Services with funds provided under this Agreement
must be enrolled in the Client Process Monitoring System (CPMS), and the individual's
CPMS record for MHS 20 Services must be maintained, as specified in OHA's CPMS
manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf7ga=t, and
as it may be revised from time to time.
IV. Financial Assistance Calculation, Disbursement & Settlement Procedures
OHA provides financial assistance for MHS 20 Services in two different ways, through Part A
and Part B ("Limitation") Awards. The Award is set in the 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. The provider of the service needs to be enrolled as a Medicaid Provider and
follow the procedures for billing the OHA for Medicaid mental health services outlined in the
Chemical Dependency Medicaid Provider Manual. OHA calculates the rates and the claims are
processed through the OHA's Medicaid Management Information System (MMIS). OHA
calculates the Part B limitation and OHA' Division of Medical Assistance Programs (DMAP)
disburses the payment directly to service providers on a fee-for-service basis. Rates are available
on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109rates.pdf. OHA will
provide notice to Contractor in timely manner if there is a change in rates. All Medicaid
reimbursable service billings shall be in accordance with the OHA Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health
and Chemical Dependency Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf.
134309 Deschutes Counth
OHA 11-13 GT0217-I1
Approved 5/9/2011 69 o1'220
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, OHA
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.
1. Total OHA 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.
2. OHA is not obligated to provide financial assistance for any MHS 20 Services
delivered to individuals that are not properly reported in CPMS (or through other
methods permitted or required by this Service Description or an applicable
Specialized Service Requirement) by the date sixty (60) days after the earlier of
termination of this Agreement, termination of OHA's obligation to provide
financial assistance for MHS 20 Services, or termination of County's obligation to
include the Program Area, in which MHS 20 Services fall, in its CMHP.
B. Disbursement of financial assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA 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:
I. OHA may, upon written request of County, adjust monthly allotments.
2. Upon amendment to the Financial Assistance Award, OHA 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. OHA may reduce the monthly allocation when the county is identified by the
Addictions and Mental Health Division (AMH) as the County of Responsibility of
a patient at the State Hospital and the patient exceeds the length of stay authorized
by OHA by more than 30 days. The reduction of the 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%
State Hospital Cost of Care will be the cost of care identified in the current
Institutional Cost of Care Rates Report published by the OHA Institutional
Revenue Section.
134309 Deschutes County Approved 5/9/2011
OHA 11-13 GT0217-11
70 01 220
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.
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/2011 71 of 220
Service Name: CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
Service ID Code: MHS 22
I. Service Description
Child and Adolescent Mental Health Services (MHS 22) are:
A. Mental health services delivered to individuals through age 17 (or through age 20 if Medicaid -
eligible) who have primary mental, emotional or behavioral conditions diagnosed on Axis 1 of
a completed five -axis DSM diagnosis;
B. Screening, assessment and level of service intensity determination services to identify
appropriate mental health services for individuals described in A above; and
C. Referral and care coordination services with respect to mental health services delivered to
individuals described in A above.
MHS 22 Services are prioritized for individuals described in A above who are at immediate risk of
psychiatric hospitalization or removal from the home due to a mental, emotional or behavioral
disorder or pose a danger to the health and safety of themselves or others.
MHS 22 Services may be delivered, as appropriate, in clinic, home, school or other settings
familiar and comfortable for the individual receiving such services.
II. Performance Requirements
Providers of MHS 22 Services funded through this Agreement must comply with applicable law
including, but not limited to OAR 309-032-1540 (6), (7), (8), & (9) and OAR 309-016-0605
through 309-016-0650, as such rules may be revised from time to time, and maintain a Certificate
of Approval in accordance with OAR 309-012-0130 through 309-012-0220, as such rules may be
revised from time to time.
Providers of MHS 22 Services funded through this Agreement must have current policies and
procedures in place that are acceptable to the State of Oregon, Oregon Health Authority (OHA) by
which to make level of service intensity determinations employing the Integrated Service Array
(ISA). The ISA is a matrix that includes a range of potential service components that are
coordinated, comprehensive, and culturally competent, and include intensive and individualized
home and community-based services for children and adolescents with severe emotional disorders
whose needs have not been adequately addressed in traditional settings. The ISA integrates
inpatient, psychiatric residential and psychiatric day treatment, and community-based care
provided in a way to insure that children and adolescents are served in the most natural
environment possible and that the use of institutional care is minimized. The intensity, frequency,
and blend of these services are based on the mental health needs of the child.
MHS 22 Services funded through this Agreement include level of service intensity determinations
for the ISA only for individuals who are eligible for Medicaid, but who are not enrolled in an
Oregon Health Plan (OHP) Mental Health Organization (MHO), and for individuals who are not
Medicaid eligible. Protocols for the level of service intensity determinations for the ISA must be
134309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/2011 72 of 220
clearly communicated with persons and entities appropriately involved in the individual's
community-based care (Community Partners), such as family members, and representatives of
child welfare, education, juvenile justice and other support and enforcement entities.
Level of service intensity determinations include:
A. Referral documentation that includes a written request from Community Partners to Providers
of MHS 22 services for a level of service intensity determination including consent by the
family or legal guardian and signed Release of Information (ROI) from the family or legal
guardian, and a mental health assessment provided by the Provider authorized to release
assessment, current within the past sixty (60) days; and
B. Administration of the Child and Adolescent Service Intensity Instrument (CASII) for children
ages six and above or the Early Childhood Service Intensity Instrument (ECSII) for children
birth through five years of age.
Providers of MHS 22 Services funded through this Agreement must make ISA level of service
intensity determinations consistent with this Agreement within three (3) business days from receipt
of referral documentation.
The identification of children and youth who would benefit from an array of intensive services
determined by the Level of Service Intensity Determination Data as indicated by the ECSII or
CASII composite score and additional risk factors, includes, but is not limited to the following for
all children:
A. Exceeding usual and customary services in an outpatient setting;
B. Multiple agency involvement;
C. Significant risk of out -of -home placement;
D. History of one or more out -of -home placements;
E. Frequent or imminent admission to acute inpatient psychiatric hospitalization or other intensive
treatment services;
F. Significant caregiver stress;
G. School or child care disruption due to mental health symptomology;
H. Elevating or significant risk of harm to self or others; and
I. Factors that should receive extra emphasis in young children age birth to five:
1. History of abuse or neglect;
2. Conditions interfering with parenting such as poverty, substance abuse, mental health
needs, and domestic violence;
3. Significant relationship disturbance between parent(s); and
4. Child showing significant risk factors for more serious emotional/behavioral challenges
(e.g. problems with social relatedness, significant difficulty with affective/behavioral
self-regulation, multiple developmental delays)
134309 Deschutes County
()HA 11-13 GT0217-11
Approved 5/9/2011 73 (4 '220
Providers of MHS 22 Services funded through this Agreement must be certified to provide
Intensive Community -Based Treatment and Support Services (ICTS), or must refer children who
meet criteria for ISA services to a provider certified as an ICTS provider under OAR 309-032-
1540 (5).
Providers of MHS 22 Services funded through this Agreement must provide or insure the
provision of care coordination and, based on the family's identified needs, supportive services such
as skills training, crisis planning, respite care, and in home support to families of children who
meet criteria for ISA services.
Providers of MHS 22 Services must insure that ISA services funded through this Agreement use
community-based decision-making processes in developing the service coordination section in
ICTS Individual Service and Support Plans as defined in OAR 309-032-1530(2)(c)(B).
Planning will include referral to appropriate types of care and level of service intensity. When
providers of MHS 22 Services refer a child or youth to Psychiatric Day Treatment Services
(PDTS) defined in OAR 309-032-1505(102) or Psychiatric Residential Treatment Services (PRTS)
as defined in OAR 309-032-1505 (100), the providers of MHS 22 Services funded through this
Agreement must submit a written approval provided by OHA for admission to the appropriate
PDTS or PRTS provider as well as documentation of a Level of Service Intensity Determination
Data screening and CASII or ECSII score; the identified ICTS provider, care coordinator, child
and family team members; and the ICTS Individual Service and Support Plan.
When providers of MHS 22 Services refer a child or youth to OHA for long-term psychiatric care
at secure inpatient programs designated by OHA, the referring source will contact the chairperson
of the local Community Coordinating Committee (CCC) and follow the referral process in
accordance with OAR 309-031-0200 through 309-031-0255. All referrals to OHA for long-term
psychiatric care must include a Level of Service Intensity Determination Data screening outcome
and CASII or ECSII score; documentation of the identified ICTS provider, care coordinator, child
and family team members; and the ICTS Individual Service and Support Plan. When a client has
insurance coverage through a third party resource (TPR), the case manager or a designee from the
insurance provider should be notified and encouraged to attend the CCC planning meeting. If
there is no identified ICTS provider and care coordinator when the CCC planning meeting occurs,
the chairperson for the CCC meeting will act as Interim Care Coordinator to facilitate the
formation of a preliminary Child & Family Team and the initial development of an ICTS
Individual Service and Support Plan.
Providers of MHS 22 Services must insure that ISA services funded through this Agreement
includes care coordination for children referred to PDTS, PRTS, subacute treatment, acute
hospitalization, and long-term psychiatric care. Care coordination includes creating linkages to
these programs for the purpose of service coordination planning, attending treatment review
meetings, ongoing participation in treatment during the episode of care at the specific PDTS,
PRTS, subacute, acute hospital, or long-term psychiatric care program and after care planning.
Immediately upon discharge from the Psychiatric Residential Facility or from Long Term
Psychiatric Care the child or youth should be enrolled in the appropriate MHO as defined in OAR
410-141-0000(82).
134309 Deschutes County
OI -1A 11-13 GT0217-I1
Approved 5/9/2011 74 of 220
Providers of MHS 22 Services funded through this Agreement must provide care coordination and
other medically appropriate services and make referrals to the appropriate treatment services for
children who do not meet criteria for ISA services.
III. Special Reporting Requirements
Providers of MHS 22 Services funded through this Agreement must collect and analyze Level of
Service Intensity Determination Data acquired while providing MHS 22 services funded through
this Agreement for quality assurance and quality improvement activities. For each child receiving
MHS 22 Services, Providers must submit to OHA, within sixty (60) days of the end of each
calendar quarter, a report with respect to the collection and analysis of all. Level of Service
Intensity Determination Data in the format required by OHA.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
Providers of MHS 22 Services funded through this Agreement shall assist OHA in the collection
and reporting of data for use in an ISA Progress Review (described in Attachment 2), as indicators
of outcome and performance measures. An ISA Progress Review shall be administered for each
child found eligible for ISA services upon admission and discharge to that level of service. A
child shall be reviewed no less than annually, should the child remain in ISA longer than one (1)
year. Instructions for submission of the ISA Progress Review Report data shall be provided by
OHA as a separate document.
All individuals receiving MHS 22 Services with funds provided under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS record for
MHS 22 Services must be maintained, as specified in OHA' CPMS manual located at
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as it may
be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 22 Services in two different ways. Certain funds (the
"Part A Award") are calculated, disbursed and settled as set forth below. The Part A Award is set
forth in the Financial Assistance Award on MHS 22 lines that contain an "A" in column one.
Other funds (the "Limitation") are not calculated, disbursed or settled under this Agreement. The
Limitation is set forth in the Financial Assistance Award on MHS 22 lines that contain a "B" in
column one. The Limitation is included in this Agreement for budgetary purposes.
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The provider of the Part B service needs to be enrolled as a Medicaid Provider and follow the
procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider
manual. OHA calculates the rates and the claims are processed through OHA' Medicaid
Management Information System (MMIS). OHA calculates the Part B limitation and OHA'
Division of Medical Assistance Programs (DMAP) disburses the payment directly to service
providers on a fee-for-service basis. Rates are available on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109rates.pdf. OHA will
provide notice to Contractor in timely manner if there is a change in rates. All Medicaid
reimbursable service billings shall be in accordance with the OHA Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0000 through 309-016-0450 and the OHA AMH Mental Health
and Chemical Dependency Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf.
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 22 Services is intended to
be general financial assistance to County for MHS 22 Services. Accordingly, OHA will
not track delivery of MHS 22 Services or service capacity on a per unit basis so long as
County offers and delivers MHS 22 Services as part of its CMHP.
a. Total OHA financial assistance for MHS 22 Services under a particular line of the
Financial Assistance Award will not exceed the total funds awarded for MHS 22
Services as specified on that line.
b. OHA is not obligated to provide financial assistance for any MHS 22 Services that
are not properly reported in the Client Process Monitoring System (CPMS) by the
date sixty (60) days after the earlier of termination of this Agreement, termination
of OHA' obligation to provide financial assistance for MHS 22 Services, or
termination of County's obligation to include the Program Area, in which MHS 22
Services fall, in its CMHP.
c. OHA will reduce the financial assistance for MHS 22 Services delivered under a
particular line of the Financial Assistance Award that contain an "A" in column one
as Financial Assistance of a portion of the cost of the services from an individual
receiving such services.
B. Disbursement of Financial Assistance: OHA will disburse the Part A Award for MHS 22
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. OHA may, upon written request of the County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award OHA shall adjust monthly
allotments as necessary to reflect changes in the funds awarded for MHS 22 Services
on that line of the Financial Assistance Award.
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C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and
delivery of MHS 22 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.
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Service Name: REGIONAL ACUTE PSYCHIATRIC INPATIENT SERVICES
Service ID Code: MHS 24
I. Service Description
Regional Acute Psychiatric Inpatient Services (MHS 24) are inpatient psychiatric services
delivered to individuals who are suffering from an acute mental illness, or other mental or
emotional disturbance posing a danger to the health and safety of the individual or others. The
services are primarily delivered on an inpatient basis and are intended to stabilize, control or
ameliorate acute psychiatric dysfunctional symptoms or behaviors in order to return the individual
to a less restrictive environment at the earliest possible time. MHS 24 Services also include
ancillary services such as regional coordination and enhancements to Community Mental Health
Program (CMHP) services that serve to expedite the movement of individuals into and out of
facilities where inpatient psychiatric services are delivered and to divert persons from acute care
services.
II. Performance Requirements
MHS 24 Services funded through this Agreement may only be delivered to the following
individuals:
A. An individual in need of emergency hold services under ORS 426.232 and ORS 426.233; or
B. An individual committed to Oregon Health Authority (OHA) under ORS 426.130; or
C. An individual voluntarily seeking MHS 24 Services provided that service capacity is
available and the individual satisfies one or more of the following criteria:
1. The individual is at high risk for an emergency hold or civil commitment without
voluntary inpatient psychiatric services; or
2. The individual has a history of psychiatric hospitalization and is beginning to
decompensate and for whom a short period of intensive inpatient psychiatric treatment
would reverse the decompensation process; or
3. The individual is an appropriate candidate for inpatient psychiatric treatment but other
inpatient psychiatric treatment resources are unavailable.
D. Hospital and Providers at Secure Residential Treatment Facilities of MHS 24 Services
funded through this Agreement must comply with OAR 309-031-0200 to 309-031-0255as
such rules may be revised from time to time. Facilities in which a Provider delivers MHS 24
Services funded through this Agreement must:
1. If a hospital, be licensed under ORS 441.015 or certified by the Joint Commission on
Accreditation of Health Care Organization ('`JCAHO") for the hospital services; or
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2. Be approved under applicable portions of OAR 309-033-0500 through 309-033-0560,
as such rules may be revised from time to time, for emergency hold beds.
E. Secured Transportation services under MHS 24 will be approved under OAR 309-033-0432
through 309-033-0440, as such rules may be revised from time to time.
III. Special Reporting Requirements
A. Reports ofJCAHO reviews of the facility where a Provider delivers MHS 24 Services funded
through this Agreement must be submitted to OHA within sixty (60) days after the Provider's
receipt of such reports or reviews.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
B. Hospital and Providers at Secure Residential Treatment Facilities of MHS 24 Services
funded through this Agreement must submit the following information to OHA electronically
through the Oregon Patient and Resident Care System (OP/RCS) within 12 hours of an
individual's admission to and discharge from the Provider's facility for MHS 24 Services, as
outlined in the OP/RCS Manual located at
http://www.oregon.gov/OHA/mental health/publications/opres/opres-manual.pdf?ga=t.
C. Contractor must submit an annual accounting report of MHS 24 funds using forms prescribed
by OHA by August 31 for the prior state fiscal year.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance: OHA will provide financial assistance for MHS 24
Services identified in a particular line of the Financial Assistance Award from funds
identified on that line in an amount equal to the amount set forth in that line of the Financial
Assistance Award; provided, however, that OHA's obligation to provide financial assistance
for MHS 24 Services under a particular line of the Financial Assistance Award is conditioned
on delivery, during the period specified on that line, of the number of units of MHS 24
Services service capacity specified on that line
B. Disbursement of financial assistance: OHA will disburse the funds awarded for MHS 24
Services 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. OHA may after 30 days (unless parties agreed otherwise) written notice to County,
reduce the monthly allotments based on under used allotments identified through
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Oregon Patient/Resident Care System (OP/RCS) or through other method permitted or
required by this Service Description or an applicable Specialized Service Requirement.
2. OHA may, upon written request of County, adjust monthly allotments.
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for MHS 24 Services
on that line of the Financial Assistance Award.
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Attachment 1 (revised `Level of Need Determination Data' 1/2010) —
Level of Service Intensity Determination Data
Providers of MHS 22 Services funded through this Agreement must use the CASII as the statewide tool
to assist in the determination for ISA Services for children age six (6) and older and the ECSII for
children birth through age five (5).
Provider shall submit a report to OHA, within sixty (60) calendar days after the end of each calendar
quarter of the Level of Service Intensity Determination Data screenings completed in that quarter.
❑ 1st Quarter (Jan -Mar) ❑ 2nd Quarter (Apr -Jun)
❑ 3rd Quarter (Jul -Sep) ❑ 4th Quarter (Oct -Dec)
Formatting CASII and ECSII data for submission to OHA:
• Data shall be in a comma -delimited format;
Each child shall be represented by a Medicaid ID number and Level of Service Intensity
Determination Date:,
Complete Data Set: A complete data set will be comprised of a minimum of the following elements:
Eight alphanumeric character Medicaid ID number
• Child's date of birth 00/00/0000)
➢ Child's gender
• Date of referral
Referral Source
v Date of Determination
➢ Contractor
➢ Scores for CASII Domains I to VI -B (each score must be in the range 1-5) or ECSII Domains I
to V.
Composite CASII score or ECSII score.
➢ ISA eligibility Y/N (circle one).
➢ Levels of Care recommended — (Note: Base the recommended level of care on both CASII or
ECSII data and other data indicative of the child's and family's needs and/or functioning
• Date the child is determined not to be ISA eligible or the last day the child is considered ISA
eligible. Field will be blank if the child continues to be ISA eligible. A blank field will be
considered complete.
Instructions for submission and validation of Level of Service Intensity Determination Data shall be
provided by OHA as a separate document.
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Attachment 2 (revised `Integrated Service Array' 1/2010) —
Integrated Service Array (ISA) Progress Review Report
The ISA Progress Review is to be administered for each child found eligible for ISA services upon
admission and discharge to that level of service. A child shall be reviewed no less than annually, should
the child remain in ISA longer than one (1) year.
Contractor must submit a Complete Data Set to OHA on those children that were reviewed during the
quarter within sixty (60) calendar days following the end of the calendar quarter.
Complete Data Set: A complete data set will be comprised of the following elements:
1. Child's last name, first name.
2. Child's date of birth (00/00/0000).
3. Date ISA Progress Review was completed using 00/00/0000 format.
4. ISA status of child at time of progress review:
"New", first review.
"Open", continuing review.
"Close", final review.
5. Child's current residence:
Biological/adoptive family member.
Other than relative/friend (Not foster care).
Long-term foster care placement.
Temporary foster care placement.
Residential treatment center.
Other (include statement describing type of residence).
6. Number of times child changed residence for any reason within the last 90 days.
a. indicate the number of times that the child has changed residence, for any reason, in the
past 90 calendar days. Do not include planned respite. Do not include Acute Care
hospitalizations. Do not include vacations or recreational stays with friends or relatives
that are unrelated to changes in the child's condition or the Family's circumstances. Do
include any planned or unplanned stay with friends or relatives, if the stay lasted more
than seven (7) days and was: (a) precipitated by a worsening of the child's condition, a
change in the Family's circumstances, or increased stress in the child's environment and;
(b) the parent or legal guardian was made aware of and permitted the stay. (Note:
Unplanned stays with others not permitted by the parent or legal guardian should be
regarded as runaways rather than changes of residence). Each time that a child moves out
of and then back to, his or her primary residence is counted as two (2) moves.
b. Parent or legal guardian were made aware of and permitted to stay. Each time that a child
moves out of and back to his/her primary residence, count as two (2) stays.
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7. Did parent or adult caregiver participate in current and most recent Child and Family Team
(CFT) meeting? (Include those whose primary role with child is that of paid provider of services,
i.e. clinical, educational or case management services.)
8. Caregiver Rating:
a. Social network over the past thirty (30) calendar days:
(1) No family or social network that could help with raising the child.
(2) Some family or friend social network that could help with raising the child.
(3) Some family or friend social network that actively helps with the raising of the
child.
(4) Significant family and friend social network that actively helps with raising the
child.
(5) NK (Not Known).
b. Child has been producing schoolwork of acceptable quality for his or her ability level
over the past twenty (20) scheduled school days:
(1) Never.
(2) Seldom.
(3) Sometimes.
(4) Frequently.
(5) Very Frequently or Always.
(6) Not applicable (if child has not been in school over past 20 days).
c. Substance abuse over the past thirty (30) days:
0. None.
I . Suspicion of substance abuse.
2. Clear evidence of substance abuse that is interfering with child's ability to
function in at least one role or setting.
3. Clear evidence of substance dependence and / or child requires detoxification.
d. Risk of delinquency in consideration of all acts of delinquency (misdemeanors, felonies
and all status offenses except runaways), with or without awareness by legal authorities:
0. No History.
1. None in past thirty (30) days.
2. Some in past thirty (30) days.
3. Several in past thirty (30) days.
e. Risk of self -harm (includes reckless or intentional risk taking behavior that may endanger
the child):
0. No history.
l . None in past thirty (30) days.
2. Some in past thirty (30) days.
3. Several in past thirty (30) days.
f. History of and risk of danger to others:
0. No history.
1. None in past thirty (30) days.
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g.
2. Some in past thirty (30) days.
History and risk of running away:
0. No history.
1. None in past thirty days.
2. Some in past thirty (30) days.
3. Several in past thirty (30) days.
9. Behavioral and Emotional Rating Scale, 2nd Edition (Bers2) Parent/Caregiver Rating Scale, Raw
Scores of Subscales.
Formatting the ISA Progress Review Data for Submission to OHA:
Instructions for submission of the ISA Progress Review Report data shall be provided by OHA as a
separate document.
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Service Name: COMMUNITY CRISIS SERVICES FOR ADULTS AND CHILDREN
Service ID Code: MHS 25
I. Service Description
Community Crisis Services for Adults and Children (MHS 25) are immediately available mental
health crisis assessment, triage and intervention services delivered to individuals experiencing the
sudden onset of psychiatric symptoms or the serious deterioration of mental or emotional stability
or functioning. MHS 25 Services are of limited duration and are intended to stabilize the
individual and prevent further serious deterioration in the individual's mental status or mental
health condition.
MHS 25 Services includes, but are not limited to, the following services:
A. 24 -hours a day, seven days a week face-to-face or telephone screening to determine the need
for immediate services for any individual requesting assistance or for whom assistance is
requested;
B. 24 -hours a day, seven days a week capability to conduct a face-to-face mental health status
examination of an individual by a Qualified Mental Health Professional (as defined in OAR
309-016-0005) or Qualified Mental Health Associate (as defined in OAR 309-016-0005), to
determine the individual's condition and the interventions necessary to stabilize the
individual;
C. A mental health assessment concluding with written recommendations by a Qualified Mental
Health Professional or a Qualified Mental Health Associate regarding the need for further
treatment;
D. In the case ofa child, appropriate child and family, psychological, psychiatric and other
medical interventions delivered by a Qualified Mental Health Professional and are specific to
the assessment, identified in the initial treatment plan, and any community placements
necessary to protect and stabilize the child as quickly as possible;
E. In the case of an adult, appropriate psychological, psychiatric and other medical interventions
delivered by a Qualified Mental Health Professional, that are specific to the assessment and
identified in the initial treatment plan, and any community placements necessary to protect
and stabilize the individual as quickly as possible;
F. Arrangement for the provision of involuntary psychiatric services at a hospital or non-
hospital facility approved by Oregon Health Authority (OHA), when a person's behavior
requires it;
G. Pre -commitment services, including:
1. A pre -commitment investigation of an individual who has been placed on an
emergency psychiatric hold or for whom two persons have petitioned the court for the
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person's commitment to OHA. The investigation may only be conducted by a Certified
Mental Health Investigator (as defined in OAR 309-033-0920) who has not provided to
the individual any of the crisis services described above.
2. The development of a treatment plan to:
a. Divert an individual from a commitment hearing; or
b. If the individual is committed, to provide for the initial post -hearing care, custody
and treatment of the individual.
3. Assigning and placing a committed individual in a treatment service appropriate to the
individual's needs and monitoring the care, custody and treatment of a committed
person under County's jurisdiction whether the individual is placed at an inpatient
facility, on trial visit or outpatient commitment at an outpatient setting.
4. Ensuring that all legal procedures are performed as required by statute and
administrative rule.
H. Disaster response -crisis counseling services. including:
For the purpose of responding to a specified local disaster event, funds may be awarded
through an amendment to the Financial Assistance Award, for the following services:
1. To respond to local disaster events by:
a. Providing crisis counseling and critical incident stress debriefing within County to
disaster victims; police, firefighters and other "first -responders"; disaster relief
shelters; and the community -at -large.
b. Coordinating crisis counseling services with County Emergency Operations
Manager (CEOM); and providing crisis counseling, and stress management
services to Emergency Operations Center staff according to agreements
established between the Community Mental Health Program (CMHP) and
CEOM.
2. To assist other CMHPs in the provision of services described in Section H (l)(a) above
as part of a mutual aid agreement.
II. Performance Requirements
Providers of MHS 25 Services funded through this Agreement must comply with OAR 309-032-
1500 through 309-032-1565 and OAR 309-032-1540 (6), (7), (8), & (9), as such rules may be
revised from time to time.
Providers of MHS 25 Services funded through this Agreement must maintain a Certificate of
Approval in accordance with OAR 309-012-0130 though OAR 309-012-0220, as such rules may
be revised from time to time.
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III. Special Reporting Requirements
Except for those who are initially screened out, all individuals receiving MHS 25 Services with
funds provided under this Agreement must be enrolled in the Client Process Monitoring System
(CPMS), and the individual's CPMS record for MHS 25 Services must be maintained, as specified
in OHA' CPMS manual, located at
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, as it may be
revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The funds awarded for MHS 25 Services are intended
to be general financial assistance to County for MHS 25 Services. Accordingly, OHA will
not track delivery of MHS 25 Services or service capacity on a per unit basis so long as
County offers and delivers MHS 25 Services as part of its CMHP. Total OHA financial
assistance for MHS 25 Services under a particular line of the Financial Assistance Award
shall not exceed the total funds awarded for MHS 25 Services as specified on that line.
B. Disbursement of Financial Assistance: OHA will disburse the funds awarded for MHS 25
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:
I . OHA may, upon written request of County, adjust monthly allotments.
2. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for MHS 25 Services on
that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery
of MHS 25 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.
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Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR YOUTH &
YOUNG ADULTS IN TRANSITION (DESIGNATED)
Service ID Code: MHS 26
I. Service Description
Non -Residential Mental Health Services for Youth & Young Adults In Transition (Designated)
(MHS 26) are mental health services delivered to individuals through 25 years of age who are
under the jurisdiction of the Juvenile Panel of the Psychiatric Security Review Board (JPSRB) or
in the Young Adults in Transition (YAT) program, specified in the Financial Assistance Award,
and have a mental or emotional disorder posing a danger to the health and safety of themselves
or others. The purpose of MHS 26 Services is to provide mental health services in community
settings that reduce or ameliorate the disabling effects of mental or emotional disorders. Non -
Residential Mental Health Services for Youth & Young Adults in Transition (Designated)
include:
A. Care coordination and residential case management services;
B. Vocational and social services;
C. Rehabilitation;
D. Support to obtain and maintain housing;
E. Abuse investigation and reporting;
F. Medication and medication monitoring;
G. Skills training;
H. Mentoring;
1. Peer support services;
J. Emotional support;
K. Occupational therapy;
L. Recreation;
M. Supported employment;
N. Supported education;
O. Secure transportation; and
P. Individual, family and group counseling and therapy.
II. Performance Requirements
Services to individuals through 25 years of age under the jurisdiction of the JPSRB, or in the
Young Adults in Transition (YAT) program, will be delivered with the least possible disruption
to positive relationships, and will incorporate the following:
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The rapport between professional and individual will be given as much of an emphasis in service
planning as other case management approaches;
Services will be coordinated with applicable adjunct programs serving both children and adults,
so as to facilitate smoother transitions and improved integration of services and supports across
both adolescent and adult systems;
Services will be engaging and relevant to youth and young adults;
Services will accommodate the critical role of peers and friends;
The Individual Service and Support Plan will include a safety component to insure that identity
development challenges and boundary issues are not cause for discontinuing service;
The Individual Service and Support Plan will include a specific section addressing services and
supports unique to the developmental progress of Youth and Young Adults in Transition
including school completion, employment, independent living skills, budgeting, finding a home,
making friends, parenting and family planning, and delinquency prevention;
The Young Adult Service Delivery Team or its designee shall provide direction to provider
regarding services to be delivered to the youth or young adult; and
Secured Transportation services under MHS 26 will be approved by OHA on a case by case
basis.
III. Special Reporting Requirements
A. County shall provide Oregon Health Authority (OHA) with a summary report of MHS 26
Services delivered with funds provided under this Agreement within 45 days after the end
of each State fiscal year or within 40 days of termination, whichever occurs first.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-11 18
Reports must be prepared using forms and procedures prescribed by OHA.
B. All individuals receiving MHS 26 Services with funds provided under this Agreement
must be enrolled in the Client Process Monitoring System (CPMS), and the individual's
CPMS record for MHS 26 Services must be maintained, as specified in OHA' CPMS
manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?;;a=t, and
as it may be revised from time to time.
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IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 26 Services in two different ways. Certain funds
(the "Part A Award") are calculated, disbursed and settled as set forth below. The Part A Award
is set forth in the Financial Assistance Award on MHS 26 lines that contain an "A" in column
one. Other funds (the "Limitation") are not calculated, disbursed or settled under this
Agreement. The provider of the Part B service needs to be enrolled as a Medicaid Provider and
follow the procedures for billing OHA for Medicaid mental health services outlined in the
Medicaid provider manual. OHA calculates the rates and the Part B Limitation and the claims are
processed through OHA' Medicaid Management Information System (MMIS). OHA' Division
of Medical Assistance Programs (DMAP) disburses the payment directly to service providers on
a fee-for-service basis. Rates are available on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109rates.pdf. OHA will
provide notice to Contractor in timely manner if there is a change in rates. All Medicaid
reimbursable service billings shall be in accordance with OHA' Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0000 through 309-016-0755 and the OHA AMH Mental Health
and Chemical Dependency Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mental health/pub l ications/codebooks/manual .pd f.
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 26 Services is intended
to be general financial assistance to County or Contractor for MHS 26 Services.
Accordingly, OHA will not track delivery of MHS 26 Services under a particular line of
the Financial Assistance Award on a per unit basis so long as County or Contractor offers
and delivers MHS 26 Services to the individual designated on that line of the Financial
Assistance Award. Total OHA financial assistance for MHS 26 Services under a
particular line of the Financial Assistance Award shall not exceed the total funds awarded
for MHS 26 Services as specified on that line, subject to the following:
1. OHA is not obligated to provide financial assistance for any MHS 26 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 sixty (60) days after the earlier of
termination of this Agreement, termination of OHA' obligation to provide
financial assistance for MHS 26 Services, or termination of County's obligation to
include the Program Area, in which MHS 26 Services fall, in its CMHP.
2. OHA will reduce the financial assistance for MHS 26 Services delivered under a
particular line of the Financial Assistance Award containing and "A" in the first
column by the amount received by a Provider of MHS 26 Services, as payment of
a portion of the cost of the services from an individual receiving such services.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the Part A
Award for MHS 26 Services identified in a particular line of the Financial Assistance
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Award to County or Contractor in substantially equal monthly allotments during the
period specified in that line of the Financial Assistance Award, subject to the following:
1. OHA may, after 30 days (unless parties agreed otherwise) written notice to
County, reduce the monthly allotments based on under used allotments or non-
delivery of services identified through CPMS or through other method permitted
or required by this Service Description or an applicable Specialized Service
Requirement;
2. OHA may, upon written request of county, adjust monthly allotments; and
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for MHS 26
Services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the delivery of
MHS 26 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).
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Service Name: RESIDENTIAL MENTAL HEALTH .fREA'TMENT SERVICES FOR
YOUTH & YOUNG ADULTS IN TRANSITION
Service ID Code: MHS 27
1. Service Description
Residential Mental Health Treatment Services for Youth & Young Adults in Transition (MHS
27) are mental health services delivered to individuals through 25 years of age for individuals
under the jurisdiction of the Juvenile Panel of the Psychiatric Security Review Board (JPSRB) or
in the Youth and Young Adults in Transition program. Residential Mental Health Treatment
Services for Youth and Young Adults in Transition (MHS 27) are:
A. Services delivered on a 24-hour basis to individuals 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 long-term care to remain in the community; and
B. Only those individuals who the Young Adult Service Delivery Team determines are
unable to live independently without supervised intervention, training, or support.
The specific MHS 27 Services delivered to an individual are determined based upon an
individualized assessment of care and treatment needs and are intended to promote the well
being, health, resiliency and recovery of the individual through the availability ofa wide -range
of residential service options.
MHS 27 Services delivered in appropriately licensed and certified programs or facilities 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. Money and household management;
D. Supervision of daily living activities such as skill development focused on nutrition,
personal hygiene, clothing care and grooming, and communication skills for social,
health care, and community resources interactions;
E. Provision of care including assumption ofa responsibility for the safety and well-being of
the individual;
F. Administration, supervision and monitoring of prescribed and non -prescribed medication,
and client education on medication awareness;
G. Provision or arrangement of routine and emergency transportation;
H. Developing skills to self manage emotions;
I. Management ofa diet, prescribed by a physician, requiring extra effort or expense in
preparation of food;
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J. Management of physical or health problems including, but not limited to, diabetes and
eating disorders;
K. Skill training;
L. Mentoring, peer delivered services and peer support services;
M. Positive use of leisure time and recreational activities;
N. Supported Education;
O. Supported Employment;
P. Occupational Therapy; and
Q. Recreation.
H. Performance Requirements
The Young Adult Service Delivery Team or its designee shall provide direction to the provider
regarding the prioritization of individuals for admission.
Services to Youth and Young Adults in Transition will be delivered with the least possible
disruption to positive relationships, and will incorporate the following:
A. The rapport between professional and individual will be given as much of an emphasis in
service planning as other case management approaches;
B. Services will be coordinated with applicable adjunct programs serving both children and
adults so as to facilitate smoother transitions and improved integration of services and
supports across both adolescent and adult systems;
C. Services will be engaging and relevant to Youth & Young Adults in Transition;
D. Services will accommodate the critical role of peers and friends;
E. The Individual Service and Support Plan will include a safety component to insure that
identity development challenges and boundary issues are not cause for discontinuing
service; and
F. The Individual Service and Support Plan will include a specific section addressing
services and supports unique to the developmental progress of Youth & Young Adults in
Transition including school completion, employment, independent living skills,
budgeting, finding a home, making friends, parenting and family planning, and
delinquency prevention.
Services to JPSRB Youth and Young Adults in Transition shall be delivered in support of the
conditional release plan as set forward by the JPSRB Board.
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III. Special Reporting Requirements
County or Contractor must complete and deliver to Oregon Health Authority (OHA) the
"Personal Care Data Form For Residential Facilities" for any individual receiving MHS 27
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 27
Services, MHS 27 Services to the individual end or the payment rate for the individual changes.
An individual's payment rate may only be changed after consultation with and approval by OHA
and only if the MHS 27 Services for that individual are funded from the Residential Limitation
(as defined below).
If County has authorized or anticipates authorizing delivery of MHS 27 Services to an individual
with funds from the Residential Limitation (as defined below) and wishes to reserve MHS 27
service capacity for that individual for a short period of time when the individual is not actually
receiving the services, the provider must submit a written Reserved Service Capacity Payment
(RSCP) Request and Contract Amendment Request to OHA under OAR 309-011-0105 through
309-01 1-0115. If OHA approves the RSCP and Contract Amendment Request, OHA and
County shall execute an amendment to the Financial Assistance Award to reduce Funding, Part
A, and Residential Limitation, Part B, and add funds necessary to make the approved payments
to reserve the service capacity to the Part A Award. OHA shall have no obligation to make the
payments unless and until the Financial Assistance Award has been so amended.
All individuals receiving MHS 27 Services with funds provided under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS record for
MHS 27 Services must be maintained, as specified in OHA' CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual nib.pdf?ga=t.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 27 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 27 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 27 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. OHA will provide financial assistance for MHS
27 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 27 Services delivered under that
line of the Financial Assistance Award during the period specified in that line, subject
to the following:
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Total OHA payment for MHS 27 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 27 Services as specified in that line of the Financial
Assistance Award;
ii. OHA is not obligated to provide financial assistance for any MHS 27 Services
that are not properly reported in CPMS by the date sixty (60) days after the earlier
of termination of this Agreement, termination of OHA's obligation to provide
financial assistance for MHS 27 Services, or termination of County's or
Contractor's obligation to include the Program Area, in which MHS 27 Services
fall, in its Community Mental Health Program (CMHP); and
ii. OHA will reduce the financial assistance for MHS 27 Services delivered under a
particular line of the Financial Assistance Award containing an "A" in column
one by the amount received by a Provider of MHS 27 Services, as payment of a
portion of the cost of the services, from an individual receiving such services with
funds awarded in that line of the Financial Assistance Award.
2. Disbursement of Financial Assistance. OHA will disburse funds awarded for MHS
27 Services identified in a particular line of the Financial Assistance Award with an
"A" in column one, to County or Contractor in substantially equal monthly allotments
during the period specified in that line of the Financial Assistance Award, subject to
the following:
OHA may, after 30 days (unless parties agreed otherwise) written notice to
County, reduce the monthly allotments based on under used allotments identified
through CPMS or through other reports required or permitted by this Service
Description or applicable Specialized Service Requirement;
ii. OHA may, upon written request of County, adjust monthly allotments; and
iii. Upon amendment to the financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for MHS 27
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 ofthis Agreement between actual OHA
disbursements of funds awarded for MHS 27 Services under a particular line of the
Financial Assistance Award containing an "A" in column one and amounts due for
such services provided by County based on the rate set forth in the special condition
identified in that line of the Financial Assistance Award. For purposes ofthis section,
amounts due to County is determined by 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.
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B. Residential Limitation. The Residential Limitation Part B, is disbursed by OHA directly
to service providers based on monthly rates authorized by County or Contractor after
consultation with OHA, subject to the following:
1. All payment rates authorized by County or Contractor under this Section IV (B) for
delivery of MHS 27 Services must meet the following requirements:
i. The rates must be reasonable under the facts and circumstances in existence at the
time each rate is set, including but not limited to the state of the market for MHS
27 Services in the geographic area in which the services will be delivered and the
needs of the particular individual receiving services; and
ii. County or Contractor may (i) set different rates for delivery of MHS 27 Services
to different individuals and (ii) revise existing rates to reflect cost of living
adjustments or other scheduled increases in payment for MHS 27 Services to the
extent approved or authorized by the Oregon Legislative Assembly or the
Legislative Emergency Board.
iii. County or Contractor must document its methodology for determining a particular
rate and furnish such documentation to OHA. County or Contractor shall retain
such documentation in accordance with section 10 of Exhibit E of this
Agreement.
2. County or Contractor shall not authorize, in aggregate under this Section IV (B),
financial assistance for MHS 27 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 by the
provider from a client, or another on behalf of the client, in support of client care and
services provided;
3. The monthly rate will be prorated for any month in which the individual is not served
for a portion of the month;
4. Financial assistance will be reduced (offset) by the amount of client resources
received by the provider from the client or the client's health insurance in support of
client care and services provided; and
5. The Residential Limitation is included in this Agreement for budgetary purposes. If
OHA anticipates that payments for MHS 27 Services authorized by County or
Contractor under this Section IV (B) will exceed the amount of the Residential
Limitation, OHA may unilaterally reduce the award of funds, as set forth in the
Financial Assistance award, for any other MHS Service or Services to the extent of
the general fund portion of the anticipated Residential Limitation shortfall. OHA and
County or Contractor shall execute an appropriate amendment to the Financial
Assistance Award to reflect the reduction of the Part A Award and the increase in the
Residential Limitation.
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Service Name: RESIDENTIAL TREATMENT -SERVICES
Service ID Code: MHS 28
I. Service Description
Residential Treatment Services (MHS 28) are:
A. Services delivered on a 24-hour basis to individuals 18 years of age or older with mental
or emotional disorders who have been hospitalized or are at immediate risk of
hospitalization, who need continuing services to avoid hospitalization or who are a
danger to themselves or others or who otherwise require continuing care to remain in the
community; and
B. Services delivered to individuals who the County, in conjunction with the Oregon Health
Authority (OHA) determines are unable to live independently without supervised
intervention, training or support are eligible for MHS 28 Services funded through this
Agreement.
The specific MHS 28 Services delivered to an individual are determined based upon an
individualized assessment of treatment needs and development of plan of care that are intended
to promote the well being, health and recovery of the individual through the availability ofa
wide -range of residential service options.
MHS 28 Services delivered in Residential Treatment Facilities (as defined in OAR 309-035-
0100 through 309-035-0190) (RTF) or Residential Treatment Homes (as defined in OAR 309-
035-0250 through 309-035-0460) (RTH), or another licensed setting approved by OHA include,
but are not limited to, the following:
A. Crisis stabilization services, such as accessing psychiatric, medical, or qualified
professional intervention to protect the health and safety of the individual and others;
B. Timely, appropriate access to crisis intervention to prevent or reduce acute, emotional
distress, which might necessitate psychiatric hospitalization;
C. Management of personal money and expenses;
D. Supervision of daily living activities and life skills such as training with nutritional
wellness, personal hygiene, clothing care and grooming, communication with social
skills, health care, household management and using community resources;
E. Provision of care including assumption ofa responsibility for the safety and well-being of
the individual;
F. Administration and supervision of prescribed and non -prescribed medication;
G. Provision or arrangement of routine and emergency transportation;
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H. Management of aggressive or self-destructive behavior;
1. Management of a diet, prescribed by a physician, requiring extra effort or expense in
preparation of food; and
J. Management of physical or health problems, including, but not limited to, seizures or
incontinency.
Financial assistance is dependent upon an individual meeting defined criteria, established by the
Oregon Health Authority (OHA) and posted on the OHA, Addictions and Mental Health (AMH)
website. OHA and its designees have the authority to review Clinical records and have direct
contact with individuals. The County and any providers must notify individuals in writing
within five state business days of a determination on admission, as defined by OHA policy,
posted on the OHA AMH website.
II. Performance Requirements
A provider of MHS 28 services shall give first priority in admission to referrals from individuals
transitioning from the State Hospitals, and referrals of individuals on the State Hospital wait list.
A Provider of MHS 28 Services funded through this Agreement must deliver the Services in a
facility licensed as a Residential Treatment Facility or Secured Residential Treatment Facility
under OAR 309-035-0100 through 309-035-0190 or as a Residential Treatment Home under
OAR 309-035-0250 through 309-035-0460, as such rules may be revised from time to time.
III. Special Reporting Requirements
County must complete and deliver to OHA the form as prescribed by OHA for any individual
receiving MHS 28 Services funded through this Agreement when the individual is transferred to
another residence or facility operated by the Provider, the individual is transferred to another
Provider of MHS 28 Services, MHS 28 Services to the individual end or the payment rate for the
individual changes. An individual's payment rate may only be changed after consultation with
and approval by OHA and only if the MHS 28 Services for that individual are funded from the
Residential Limitation (as defined below).
If County has authorized or anticipates authorizing delivery of MHS 28 Services to an individual
and wishes to reserve MHS 28 service capacity for that individual for a short period of time
when the individual is not actually receiving the services, County must submit a written
Reserved Service Capacity Payment (RSCP) Request and Contract Amendment Request to OHA
under OAR 309-01 1-0105 through 309-011-0115. If OHA approves the RSCP and Contract
Amendment Request, OHA 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. OHA shall have no obligation to
make the payments unless and until the Financial Assistance Award has been so amended.
All individuals receiving MHS 28 Services with funds provided under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS) database within 24 hours of admission
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and disenrolled within 24 hours of discharge, and the individual's CPMS record for MHS 28
Services must be maintained, as specified in OHA's CPMS manual located at:
http://www.oregon.aov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as it
may be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 28 Services in two different ways. Certain funds
(the "Part A Award") are calculated, disbursed and settled as set forth in Section IV (A) below.
The Part A Award is set forth in the 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.
Part B Limitation: The provider of the service needs to be enrolled as a Medicaid Provider and
follow the procedures for billing OHA for Medicaid mental health services outlined in the
Medicaid provider manual. OHA calculates the rates and the claims are processed through OHA'
Medicaid Management Information System (MMIS). OHA calculates the Part B limitation and
OHA' Division of Medical Assistance Programs (DMAP) disburses the payment directly to
service providers on a fee-for-service basis. OHA sets procedures and rates for the Limitation.
Rates are available on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109rates.pdf. OHA will
provide notice to County in timely manner if there is a change in rates. All Medicaid
reimbursable service billings shall be in accordance with the OHA Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health
and Chemical Dependency Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf.
A. The Part A Award will be calculated, disbursed and settled as follows:
1. Calculation of Financial Assistance. OHA will provide financial assistance for MHS
28 Services identified in a particular line of the 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:
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i. Total OHA 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;
ii. OHA is not obligated to provide financial assistance for any MHS 28 Services
that are not properly reported in CPMS by the date 60 days after the earlier of
termination or expiration of this Agreement, termination ofOHA' obligation to
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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 (CMHP); and
111.OHA 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 by a Provider of MHS 28 services, as payment of a
portion of the cost of the services from an individual receiving such services.
2. Disbursement of Financial Assistance. Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA 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:
i. OHA may, after 30 days (unless parties agreed otherwise) written notice to
County, reduce the monthly allotments based on under used allotments identified
in CPMS or through other reports required or permitted by this Service
Description or applicable Special Terms and Conditions..
ii. OHA may, upon written request of County, adjust monthly allotments.
iii. Upon amendment to the Financial Assistance Award, OHA 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 OHA
disbursements of funds 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 provided by County based on the rate set forth in the special condition
identified in that line of the Financial Assistance Award. For purposes of this section,
amounts due to County is determined by 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 Reserved
Service Capacity Payment.
B. Residential Limitation. The Residential Limitation, Part B is disbursed by OHA directly
to service providers based on monthly rates authorized by County after consultation with
OHA, subject to the following:
1. All payment rates authorized by County under this Section IV (B) for delivery of
MHS 28 Services must meet the following requirements:
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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.
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 by the provider
from a client, or another on behalf of the client, in support of client care and services
provided;
3. The monthly rate will be prorated for any month in which the individual is not served
for a portion of the month;
4. Financial assistance will be reduced (offset) by the amount of client resources
received by the provider from the client or client's health insurance in support of
client care and services provided;
5. The Residential Limitation is included in this Agreement for budgetary purposes. If
OHA anticipates that payments for MHS 28 Services authorized by County under this
Section IV (B) will exceed the amount of the Residential Limitation, OHA may
unilaterally reduce the award of funds, as set forth in the Financial Assistance award,
for any other MHS Service or Services to the extent of the general fund portion of the
anticipated Residential Limitation shortfall. OHA and County shall execute an
appropriate amendment to the Financial Assistance Award to reflect the reduction of
the Part A Award and the increase in the Residential Limitation; and
6. OHA is not obligated to provide financial assistance for any MHS 28 Services that
are not properly reported through CPMS by the date 60 days after the earlier of
termination or expiration of this Agreement, termination of OHA' obligation to
provide financial assistance for MHS 28 Services or termination of County's
obligation to include the Program Area, in which MHS 28 Services fall, in its CMHP.
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Service Name:
SUPERVISION SERVICES FOR INDIVIDUALS UNDER THE
JURISDICTION OF THE ADULT AND JUVENILE PANELS OF THE
PSYCHIATRIC SECURITY REVIEW BOARD
Service ID Code: MHS 30
I. Service Description
Supervision Services For Individuals Under the Jurisdiction of the Adult and Juvenile Panels of the
Psychiatric Security Review Board (MHS 30) include assessment and evaluation services
delivered to individuals residing in the Oregon State Hospital (OSH) or a hospital or facility
designated by the Oregon Health Authority (OHA) and supervision services delivered to
individuals while on conditional release from OSH or a hospital or facility designated by OHA.
MHS 30 Services include:
A. The assessment and evaluation for the Court and for the Psychiatric Security Review Board
(PSRB) of an individual for conditional release from OSH or a hospital or facility designated
by OHA or placement on a waiting list for conditional release from OSH or a hospital or
facility designated by OHA to determine if the individual can be treated in the community,
including identification of the specific requirements for the community placement of an
individual;
B. Supervision and Urinalysis Drug Screen (UADS) of individuals while on conditional release
from OSH or a hospital or facility designated by OHA consistent with the PSRB conditional
release order;
C. Coordination with OSH or a hospital or facility designated by OHA on transition activities
related to conditional release of an individual; and
D. Administrative activities related to the supervision services described above, including but
not limited to:
1. Modification of conditional release orders;
2. Revocations of conditional release, due to violation(s) of conditional release orders, and
readmission to OSH; and
3. Response to Law Enforcement Data System notifications as a result of contact by the
individual receiving MHS 30 Services with law enforcement agencies.
II. Performance Requirements:
Providers of MHS 30 Services funded through this Agreement must comply with OAR 309-032-
1540 (4), as such rules may be revised from time to time.
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Providers of MHS 30 Services funded through this Agreement must 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.
III. Special Reporting Requirements:
A. County must submit a copy of the Conditional Release Plan to OHA for all individuals
conditionally released from OSH or a hospital or facility designated by OHA and receiving
MHS 30 Services with funds provided under this Agreement.
B. County must submit a copy of each individual's conditional release monthly progress report,
no later than the 15th of each month following the month MHS 30 Services were delivered
with funds provided under this Agreement,.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
C. All individuals receiving MHS 30 Services with funds provided under this Agreement must
be enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS
record for MHS 30 Services must be maintained, as specified in OHA' CPMS manual
located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as it
may be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance. OHA will provide financial assistance for MHS 30 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 30 Services delivered under that line of the Financial Assistance Award during the period
specified in that line, subject to the following:
1. Total OHA financial assistance for MHS 30 Services delivered under a particular line in the
Financial Assistance Award shall not exceed the total funds awarded for MHS 30 Services as
specified in that line in the Financial Assistance Award; and
2. OHA is not obligated to pay for any MHS 30 Services that are not properly reported in
CPMS (or through other method permitted or required by this Service Description or an
applicable Specialized Service Requirement) by the date sixty (60) days after the earlier of
termination of this Agreement, termination of OHA's obligation to provide financial
assistance for MHS 30 Services, or termination of County's obligation to include the
Program Area, in which MHS 30 Services fall, in its Community Mental Health Program
(CMHP).
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B. Disbursement of Financial Assistance: Unless a different disbursement method is specified in
that line of the Financial Assistance Award, OHA will disburse the Part A funds awarded for
MHS 30 Services 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. OHA may after 30 days (unless parties agreed otherwise) written notice to County reduce
the monthly allotments based on under -used allotments identified through CPMS or through
other method permitted or required by this Service Description or an applicable Specialized
Service Requirement;
2. OHA may, upon written request of County, adjust monthly allotments; and
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments
as necessary to reflect changes in the funds awarded for MHS 30 Services on that line of the
Financial Assistance Award.
C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have
occurred during the term of this Agreement between actual OHA disbursements of funds
awarded for MHS 30 Services under a particular line of the Financial Assistance Award and
amounts due for such services provided by County based on the rate set forth in the special
condition identified in that line of the Financial Assistance Award. For purposes of this section,
amounts due to County is determined by 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 permitted or required
by this Service Description or an applicable Specialized Service Requirement).
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Service Name: ENHANCED CARE AND ENHANCED CARE OUTREACH SERVICES
Service ID Code: MHS 31
I. Service Description
Enhanced Care Services and Enhanced Care Outreach Services (MHS 31) are intended to enable
an individual to leave, or avoid placement in, the geriatric treatment units at the Oregon State
Hospital (OSH). MHS 31 Services are outpatient community mental health and psychiatric
rehabilitation services delivered to individuals that are Seniors and People with Disabilities
(SPD) service need eligible and who have been deemed eligible by the Enhanced Care Services
(ESC) Coordinator. Eligibility criteria includes, but is not limited to the following:
A. Severe and persistent mental illness or behavioral disorders;
B. Reside in a nursing facility, residential care facility, assisted living facility or foster home
operated by a Provider licensed by the Department of Human Services (DHS) Seniors
and People with Disabilities Division (SPD); and
C. Exhibit symptoms and related behaviors requiring a high level of service including, but
not limited to:
1. History of self -endangering behaviors with a likelihood of continued self -
endangering behaviors without 24-hour supervision;
2. Aggressive behavior that could not be managed in a lesser level of care;
3. Intrusive or sexually inappropriate behavior ;
4. Inability to set and maintain appropriate personal boundaries requiring a high
level of management and supervision;
5. Intractable psychiatric symptoms requiring intensive management, problematic
medication needs and ongoing potential adjustments of multiple medications
requiring 24-hour supervision;
6. Documented history of failed community placements; and
7. Length of stay at a psychiatric hospital and been denied placement in a lesser
level of care.
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Requirements for MHS 3 I also include:
1. Evaluation: All individuals shall be evaluated by the provider and local SPD
licensed facility staff prior to placement; and
2. Transition/Discharge: CMHP or its designee shall notify Enhanced Care Services
(ECS) Coordinator prior to transition from ECS. The CMHP or its designee shall
notify the ECS Coordinator within three working days of any change in an
individual's medical or psychiatric condition which jeopardizes the placement.
II. Performance Requirements
Providers of MHS 3 I Services funded through this Agreement must comply with OAR 309-032-
1540 (3), as such rules may be revised from time to time.
Providers of MHS 31 Services funded through this Agreement must maintain a Certificate of
Approval in accordance with OAR 309-012-0130 through 309-012-0220, as such rules may be
revised from time to time.
MHS 31 Services funded through this Agreement may only be delivered to individuals who
satisfy the requirements for receipt of nursing facility or community based care under Medicaid
as specified in OAR 41 1-015-0000 through 41 1-015-0100, as such rules may be revised from
time to time, and who receive such services in a nursing facility, residential care facility, assisted
living facility or foster home operated by a Provider that has entered into an agreement with the
SPD Division to provide services to designated individuals and that is licensed by DHS', SPD
Division.
If County wishes to use MHS 31 funds made available under this Agreement for delivery of
MHS 31 Services to otherwise eligible individuals not residing in an SPD facility, County must
receive a variance from the Oregon Health Authority (OHA) in accordance with OAR 309-032-
1565, as such rules may be revised from time to time.
III. Special Reporting Requirements
Providers of MHS 31 Services funded through this Agreement must complete and submit the
following forms to OHA in accordance with the instructions in the forms:
A. Monthly Enhanced Care Services Census Report;
B. Enhanced Care Services Referral Outcome Form;
C. ECS Data Base Part I;
D. ECS Data Base Part II; and
E. Enhanced Care Staffing Requirement Report Form.
All individuals receiving MHS 31 Services with funds provided under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS record for
MHS 31 Services must be maintained, as specified in OHA' CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as it
may be revised from time to time.
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IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 31 Services in two different ways, through Part A
and part B ("Limitation") Awards. The Award is set in the Financial Assistance Award on MHS
31 lines in column one that contain an "A" for Part A or "B" for Part B Award.
The provider of the service needs to be enrolled as a Medicaid Provider and follow the
procedures for billing OHA for Medicaid mental health services outlined in the Medicaid
provider manual. OHA calculates the rates and the Part B Limitation and the claims are
processed through OHA's Medicaid Management Information System (MMIS). OHA's
Division of Medical Assistance Programs (DMAP) disburses the payment directly to service
providers on a fee-for-service basis. Rates are available on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109rates.pdf. OHA will
provide notice to County in timely manner if there is a change in rates. All Medicaid
reimbursable service billings shall be in accordance with the OHA Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health
and Chemical Dependency Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf.
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 31 Services is intended
to be general financial assistance to County for MHS 31 Services. Accordingly, OHA
will not track delivery of MHS 31 Services on a per unit basis so long as County offers
and delivers MHS 31 Services as part of its CMHP. Total OHA financial assistance for
MHS 31 Services under a particular line of the Financial Assistance Award shall not
exceed the total funds awarded for MHS 31 Services as specified on that line.
B. Disbursement of financial assistance: OHA will disburse the Part A Award for MHS 31
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. OHA may, upon written request of County, adjust monthly allotments.
4. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes for MHS 31 Services on that line of the
Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and
delivery of MHS 31 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.
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Service Name: ADULT FOSTER CARE SERVICES
Service ID Code: MHS 34
Service Description
Adult Foster Care Services (MHS 34) are services delivered to individuals with chronic or severe
mental illness who have been hospitalized or are at immediate risk of hospitalization, are in need
of continuing services to avoid hospitalization, or who pose a danger to the health and safety of
themselves or others, and who are unable to live by themselves without supervision. MHS 34
Services are delivered in a family home or facility with five or fewer individuals receiving MHS
34 Services. MHS 34 Services are delivered, in part, either by relatives, as defined in OAR 309-
040-0305(57), referred to herein as Relative Foster Care, or by non relatives, referred to herein as
Non -Relative Foster Care. The purpose of MHS 34 Services is to maintain the individual at his
or her maximum level of functioning or to improve the individual's skills to the extent that he or
she may live more independently.
MHS 34 Services 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, social skills,
health care, household management and using community resources;
E. Provision of care including assuming the responsibility for the safety and well-being of
the individual;
F. Administration and supervision of prescribed and non -prescribed medication;
G. Provision or arrangement of routine and emergency transportation;
H. Management of aggressive or self-destructive behavior;
I. Management of a diet, prescribed by a physician, requiring extra effort or expense in
preparation of food; and
J. Management of physical or health problems, including seizures or incontinence.
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II. Performance Standards
Providers of Non -Relative Foster Care MHS 34 Services funded by the Oregon Health Authority
(OHA) must comply with OAR 309-040-0300 through 309-040-0455, as such rules may be
revised from time to time.
Prior to commencement of both Relative and Non -Relative Foster Care MHS 34 Services funded
by OHA for an individual, County or its designee must develop and submit to OHA for review
and approval a personal care plan for the individual. After commencement of MHS 34 Services,
the County must insure that the Provider of MHS 34 Services delivers the Services to the
individual in accordance with the personal care plan. County must complete a new personal care
plan annually for each individual receiving MHS 34 services funded by OHA and review the
plan at least every 180 days or as needed and revise the plan as necessary.
County must assist OHA in licensing and certifying homes providing Non -Relative Foster Care
MHS 34 Services funded by OHA by performing the following tasks within timelines required in
the above -referenced administrative rules:
A. For new licenses and certifications, inspection of the homes, and completion and
submission to OHA of the following forms, as prescribed by OHA: (a) Foster Home
License or Certification Application; (b) Foster Home Inspection Form; (c) Criminal
History Check; and (c) any other information necessary for licensing or certifying the
residences;
B. For renewal of existing licenses and certifications, inspection of the homes, and
completion and submission to OHA of the Foster Home License/Certification Evaluation
Forms; and
C. Assistance to currently -licensed and potential new foster homes providing MHS 34
Services to meet statutory requirements for training and testing by:
1. Maintaining and distributing copies of OHA' "Basic Training Course and Self -Study
Manual" and associated video tapes;
2. Making test site(s) available, administering tests provided by OHA, and mailing
completed tests promptly to OHA for scoring.
OHA will make the final determination on issuance and renewal of licenses and
certifications, based on information submitted by the County and as required above.
III. Special Reporting Requirements
All individuals receiving Relative and Non -Relative Foster Care MHS 34 Services with funds
provided under this Agreement must be enrolled in the Client Process Monitoring System
(CPMS), and the individual's CPMS record for MHS 34 Services must be maintained, as
specified in OHA' CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as it
may be revised from time to time.
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Enrollments in CPMS for Relative and Non -Relative Foster Care must include the applicable
code for `Living Arrangement' of the client.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 34 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 34 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 34 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. OHA will provide financial assistance for MHS
34 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 34 Services delivered under that
line of the Financial Assistance Award during the period specified in that line, subject
to the following:
i. Total OHA payment for MHS 34 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 34 Services as specified in that line of the Financial
Assistance Award;
ii. OHA is not obligated to provide financial assistance for any MHS 34 Services
that are not properly reported in CPMS by the date sixty (60) days after the earlier
of termination of this Agreement, termination ofOHA's obligation to provide
financial assistance for MHS 34 Services, or termination of County's obligation to
include the Program Area, in which MHS 34 Services fall, in its Community
Mental Health Program (CMHP); and
iii. OHA will reduce the financial assistance for MHS 34 Services delivered under a
particular line of the Financial Assistance Award containing an "A" in column
one by the amount received, by a Provider of MHS 34 Services as payment of a
portion of the cost of the services from an individual receiving such services with
funds awarded in that line of the Financial Assistance Award.
2. Disbursement of Financial Assistance. OHA will disburse the Part A funds awarded
for MHS 34 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:
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i. OHA may after notice to County, reduce the monthly allotments based on under
delivery of services identified through CPMS;
ii. OHA may, upon written request of County adjust monthly allotments; and
iii. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary to reflect changes in the funds awarded for MHS 34
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 OHA
disbursements of funds awarded for MHS 34 Services under a particular line of the
Financial Assistance Award containing an "A" in column one and amounts due for
such services provided by County based on the rate set forth in the special condition
identified in that line of the Financial Assistance Award. For purposes of this section,
amounts due to County is determined by 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
B. Part B Limitation. The provider of the service needs to be enrolled as a Medicaid Provider and
follow the procedures for billing OHA for Medicaid mental health services outlined in the
Medicaid provider manual. OHA calculates the rates and the claims are processed through
OHA's Medicaid Management Information System (MMIS). OHA calculates the Part B
limitation and OHA's Division of Medical Assistance Programs (DMAP) disburses the payment
directly to service providers on a fee-for-service basis. Rates are available on the OHA website at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109rates.pdf. OHA will
provide notice to County in a timely manner if there is a change in rates. All Medicaid
reimbursable service billings shall be in accordance with the OHA Mental Health and
Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services
Rule as listed in OAR 309-016-0600 through 309-016-0755 and the OHA AMH Mental Health
and Chemical Dependency Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf.
C. County shall not authorize, in aggregate, financial assistance for MHS 34 Services funded by
OHA during the period specified in the Financial Assistance Award, in excess of the Adult
Foster Care Limitation. Total aggregate financial assistances means the total of all financial
assistance authorized before reducing payments to account for client resources received by the
Provider from a client, or another on behalf of the client, in support of client care and services
provided.
D. The monthly rate will be prorated for any month in which the individual is not served for a
portion of the month.
E. Financial Assistance will be reduced (offset) by the amount of client resources received by the
Provider from the client in support of client care and services provided.
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F. The Adult Foster Care Limitation is included in this Agreement for budgetary purposes. If OHA
anticipates that financial assistance for MHS 34 Services authorized by County will exceed the
amount of the Adult Foster Care Limitation, OHA 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
necessary to offset OHA's general fund cost of the payments authorized by County in excess of
the Adult Foster Care Limitation. OHA and County shall execute an appropriate amendment to
the Financial Assistance Award to reflect the reduction in the funds awarded for the other MHS
Service or Services and the increase in the Adult Foster Care Limitation.
G. OHA is not obligated to pay for any MHS 34 Services that are not properly reported through
CPMS by the date 60 days after expiration or termination of this Agreement, whichever date is
earlier.
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Service Name: OLDER/DISABLED ADULT MENTAL HEALTH SERVICES
Service 1D Code: MHS 35
I. Service Description
Older/Disabled Adult Mental Health Services (MHS 35) are:
A. if Specialized Service Requirement 35A applies, specialized geriatric mental health services
delivered to older/disabled adults with mental health illness, as such services are further
described in the 35A Specialized Service Requirement; or
B. If Specialized Service Requirement 35B applies, residential services delivered to individuals
with severe and persistent mental health illness, as such services are further described in the
35B Specialized Service Requirement.
II. Performance Requirements
Funds awarded for MHS 35 Services on lines in the Financial Assistance Award specifying that
Specialized Service Requirement 35A applies may only be expended on MHS 35 Services
described in paragraph A below and funds awarded for MHS 35 Services on lines in the Financial
Assistance Award specifying that Specialized Service Requirement 35B applies may only be
expended on MHS 35 Services described in paragraph B below:
A. If Specialized Service Requirement 35A applies, the funds awarded for MHS 35 Services
may only be expended on community based care services for older/disabled adults with
mental health illness who are determined eligible for residential services from DHS' Seniors
and People with Disabilities (SPD) Division. Such services include, but are not limited to,
medication management, quarterly interagency staffing and follow-up services after
treatment in local or state inpatient psychiatric hospitals, or indirect services, including but
not limited to, screening, referral, and consultation and training to agencies and caregivers
who provide services that may affect older/disabled adults with mental health illness; or
B. If Specialized Service Requirement 35B applies, the funds awarded for MHS 35 Services
may only be expended on residential services for older/disabled adults with severe and
persistent mental health illness who are determined not eligible for, yet require, residential
services from DHS' SPD Division and who meet service need eligibility for Medicaid
financed residential services under OAR 411-015-0000 through 411-015-0100 and are
residing in a facility whose operator is licensed by the SPD Division and has contracted with
the SPD Division to deliver residential services to specified individuals.
If indirect services, as described in Section I1 (A) above, are delivered with MHS 35 funds
provided under this Agreement, those services must be available to relevant agencies and
caregivers in the geographic area served by the CMHP operated by or contracted for by County
and must be coordinated with protective services provided by DHS'SPD Division and County's
mental health crisis/commitment service.
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All MHS 35 Services delivered with funds provided under this Agreement that are subject to
Specialized Service Requirement 35A must be delivered by a Qualified Mental Health
Professional (as defined in OAR 309-016-0605(37)) (QMHP) and in compliance with OAR 309-
032-1500 through 309-032-1565, Standards for Adult Mental Health Services, as such rules may
be revised from time to time. The QMHP delivering such services must have a background with
the older/disabled adult population or be participating in relevant training programs to acquire such
knowledge.
III. Special Reporting Requirements
County shall provide summary reports on its delivery of MHS 35 Services that are supported with
funds provided under this Agreement that are subject to Specialized Service Requirement 35A.
The reports must be submitted within 45 days of the end of each State fiscal year (ending June 30)
and after the termination of this Agreement.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by the Oregon Health Authority
(OHA).
All individuals receiving MHS 35B Services with funds provided under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS record for
MHS 35B Services must be maintained, as specified in OHA' CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as it may
be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The funds awarded for MHS 35 Services are intended to
be general financial assistance to County for MHS 35 Services. Accordingly, OHA will not
track delivery of MHS 35 Services or service capacity on a per unit basis so long as County
offers and delivers MHS 35 Services as part of its CMHP. Total OHA financial assistance for
MHS 35 Services under a particular line of the Financial Assistance Award shall not exceed
the total funds awarded for MHS 35 Services as specified on that line.
B. Disbursement of financial assistance: OHA will disburse the Part A funds awarded for MHS
35 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. OHA may, upon written request of County, adjust monthly allotments; and
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2. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for MHS 35 Services
on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery
of MHS 35 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.
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Service Name: PRE -ADMISSION SCREENING AND RESIDENT REVIEW SERVICES
Service ID Code: MHS 36
I. Service Description
Pre -admission Screening and Resident Review Services (MHS 36) are evaluation services
delivered to individuals:
(a) Referred for placement in Medicaid -certified long-term care nursing facilities if they are
exhibiting symptoms of a serious mental health illness, or
(b) Residing in Medicaid -certified long-term care nursing facilities experiencing a significant
change in mental health status.
Pre -admission Screening and Resident Review Services must determine if:
a. Individuals have a serious mental health illness; and
b. If those determined to have a serious mental health illness are appropriately placed in a
nursing facility or need inpatient psychiatric hospitalization.
II. Performance Requirements
Providers of MHS 36 Services funded through Medicaid must comply with the Nursing Home
Reform Act, under the Omnibus Budget Reconciliation Act OBRA 1987, as amended by OBRA
1990, including, but not limited to, 42 U.S.C. 1396r(e) 7, and OAR 309-048-0050 through 309-
048-0130, as such laws and rules may be revised from time to time. Providers must 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.
County must insure that all individuals referred for MHS 36 Services by licensed nursing facilities
in County (or in the region served by the CMHP operated by or contractually affiliated with
County, whichever area is larger) receive MHS 36 review and evaluation services.
All MHS 36 Services funded through Medicaid must be delivered by a Qualified Mental Health
Professional (as defined in OAR 309-016-0605) or a Licensed Medical Practitioner (as defined in
OAR 309-032-1505).
III. Special Reporting Requirements
Providers of MHS 36 Services funded through Medicaid must complete and deliver to the Oregon
Health Authority's (OHA) Addictions and Mental Health Division (AMH), within 21 days after a
review, form AMH 0438 and form AMH 0440, with respect to that review.
All individuals receiving MHS 36 Services with funds provided under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS record for
MHS 36 Services must be maintained, as specified in the OHA' CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mhpdf?ga=t , and as it may
be revised from time to time.
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OHA 11-13 GT0217-11
IV. Financial Assistance Calculation and Disbursement Procedures
OHA provides financial assistance for MHS 36 Services in Part 13 ("Limitation") Awards. The
Award is set in the Financial Assistance Award on MHS 36 lines in column one that contain "B"
for Part 13 Award.
The provider of the service needs to be enrolled as a Medicaid Provider and follow the procedures
for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual.
OHA calculates the rates and the Part B limitation and the claims are processed through OHA'
Medicaid Management Information System (MMIS). OHA' Division of Medical Assistance
Programs (DMAP) disburses the payment directly to service providers on a fee-for-service basis.
Rates are available on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh01 09rates.pdf. OHA will
provide notice to County in timely manner if there is a change in rates. All Medicaid reimbursable
service billings shall be in accordance with the OHA' Mental Health and Developmental Disability
Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-
016-0600 through 309-016-0755 and OHA' AMH Mental Health and Chemical Dependency
Medicaid Provider Manual available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf, and as it may be
revised from time to time.
All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health
and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health
Services Rule as listed in OAR 309-016-0600 through 309-016-0755.
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Service Name: MHS SPECIAL PROJECTS
Service ID Code: MHS 37
I. Service Description
MHS Special Projects (MHS 37) are mental health services within the scope of ORS 430.630
delivered on a demonstration or emergency basis for a specified period of time.
Each project is described in a separate exhibit to this MHS 37 Service Description. When the
Financial Assistance Award contains a line awarding funds for MHS 37 Services, that line will
contain a special condition specifying the exhibit to this MHS 37 Service Description that
describes the project for which the funds are awarded.
The specific MHS 37 Services to be provided under this Agreement are described in exhibits, if
any, to this MHS 37 Service Description, which exhibits are incorporated herein by this reference.
II. Performance Requirements
Providers of MHS 37 Services funded through this Agreement with Medicaid dollars must comply
with OAR 309-016-0000 through 309-016-0755. See exhibits, if any, to this MHS 37 Service
Description.
III. Special Reporting Requirements
See exhibits. if any, to this MHS 37 Service Description.
IV. Payment Procedures
See exhibits, if any, to this MHS 37 Service Description.
Even if the Financial Assistance Award awards funds for MHS 37 Services, the Oregon Health
Authority (OHA) shall have no obligation to provide financial assistance for any MHS 37 Services
under this Agreement (even if funds therefore are disbursed to County) unless a special project
description is attached to this Service Description as an exhibit.
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Exhibit MHS 37 -Start -Up
L 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 begin, expand, or improve Mental Health Services. These expenses are
distinct from routine operating expenses incurred in the course of providing ongoing 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.
When Oregon Health Authority (OHA) funds in the amount of $5,000 and above are to be used
for purchase or renovation of real property, County must contact the Community Housing,
Employment & Supports Unit of the Addictions and Mental Health Division and follow
procedures as prescribed by that Unit.
Start -Up funds are typically disbursed prior to initiation of services. Funds awarded are used to
cover approved allowable Start -Up expenditures as described in Exhibit J that will be needed to
provide the services planned and delivered at the specified site(s).
IL Performance Requirements
The funds awarded for this special project may be expended only in accordance with Exhibit J,
Start -Up Procedures, which is incorporated herein by this reference.
III. Special Reporting Requirements
A. County must prepare and submit reports to the Oregon Health Authority (OHA) on the
expenditure of the funds awarded for this special project and any special conditions which
are specified in the Financial Assistance Award. The reports must be prepared in
accordance with forms prescribed by OHA and procedures described in Exhibit J, Start -Up
Procedures.
B. When OHA Start -Up funds in the amount of $1,000 and above are to be used for purchase
of a vehicle, as security for the County's performance of its obligations under this
Agreement, the County grants to OHA a security interest in, all of the County's right,
title, and interest in and to the goods, i.e. the vehicle. The County agrees that from time to
time, at its expense, the County will promptly execute and deliver all further instruments
and documents, and take all further action, that may be necessary or desirable, or that
OHA may reasonably request, in order to perfect and protect the security interest granted
under this Agreement or to enable OHA to exercise and enforce its rights and remedies
under this Agreement with respect to the vehicle. County must forward a copy of the title
registration application showing OHA' Addictions and Mental Health Division (AMH) as
the Security Interest Holder to OHA within five (5) days of the acquisition from the seller.
File Security Interest Holder information with DMV as follows:
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Oregon Health Authority
Addictions and Mental Health Division
Attention: Contracts Administrator
500 Summer Street NE, E86
Salem, Oregon 97301
Vehicles costing $1,000 or more must be used to provide the service for which OHA
approved the Start -Up funds awarded. Dedicated use must continue for the useful life of the
vehicle or five (5) years, whichever is less.
The following steps describe the process for removal of liens:
a. To release a vehicle title on which OHA is listed security interest holder County or
any subcontractor(s) must make a request in writing to OHA. The request must
specify why the vehicle is being disposed of and the intended use of any funds
realized from the transaction.
b. If approved, the original title is signed off by OHA and forwarded to the County.
C. The following circumstances require special written authorization from OHA prior to
acquisition when using Start -Up funds awarded. These circumstances should be
communicated to OHA within fourteen (14) days of the anticipated acquisition date.
a. When Leasing:
i. Acquisition of real property, vehicles, or capital items pursuant to a Lease;
ii. Acquisition of real property, vehicles, or capital items where another party, in
addition to OHA, will also become a secured party (lienholder) at the time of
acquisition;
iii. Renovations or alterations of real property where County is not the owner of the
property and OHA has no security interest in the property.
b. Other:
i. A change in the intended use of Start -Up funds awarded or a change in the
amount or date of anticipated acquisition indicated on County's request for
payment of Start -Up funds, for those acquisitions requiring OHA's interest to be
secured.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: OHA 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 J, Start -Up)
incurred by a Provider in implementing the special project described herein, subject to the
requirements of Exhibit J, Start -Up and subject to the following additional restrictions:
1. Total OHA 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
134309 Deschutes County
DHA 11-13 GT0217-I I
Approved 5/9/2011 120 of 220
2. OHA is not obligated to reimburse any special project expenditures that are not
properly reported to OHA using forms prescribed by OHA and procedures contained
in Exhibit J within sixty (60) days after the earlier of:
i. Termination of this Agreement,
ii. Termination of OHA's obligation to provide financial assistance for MHS 37
Services; or
iii. Termination of County's obligation to include the Program Area, in which MHS
37 Services fall, in its Community Mental Health Program (CMHP).
3. Funds will be awarded for actual allowable expenses up to the limit approved in the
Start -Up & Expenditure Inventory Form.
4. After execution of the Agreement or any amendment(s) for Start -Up payments,
County may request an advance of funds it anticipates using in the subsequent one
hundred twenty (120) days.
B. Disbursement of Financial Assistance: OHA will disburse the funds awarded for this
special project in a particular line of the Financial Assistance Award after OHA's receipt,
review and approval of County's properly completed "Start -Up Request & Expenditure
Form", as described in and in accordance with Exhibit J, Start -Up.
County shall keep a copy of all requests for payment using the Start -Up Request &
Expenditure Form.
County shall keep a copy of all Expenditure Reports for Start -Up services using the Start -Up
Request & Expenditure Form. County is responsible for requiring its subcontractors to
comply with expenditure reporting requirements and furnishing evidence of filing OHA's
security interest on applicable items. OHA may inspect these reports, which must include
the following by service element:
a. The amount advanced;
b. The amount expended on each allowable category, and the amount expended on each
item listed for items needing special written approval authorization;
c. Copies of all subcontractor contracts awarding Start -Up payments. Such contracts must
require subcontractors to execute dedicated use contracts and other security
documentation as required in this Exhibit.
Each County shall maintain supporting documentation for all expenditures (i.e., receipts).
C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may
have occurred during the term of this Agreement between actual OHA disbursements of
funds awarded for 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 OHA and procedures outlined in Exhibit J,
Start -Up Procedures.
134309 Deschutes County
OHA 11-13 GT0217-I 1
Approved 5/9/2011 121 or220
County shall submit all Start -Up Request & Expenditure Reports at the level of detail
prescribed by OHA. Any reports not submitted by thirty (30) calendar days after the
expiration date of the contract shall not be accepted or owed by OHA.
In the event County fails to submit an expenditure report when due for itself or its
subcontractor(s), fails to submit security interests, vehicle titles, or other instrument as
required by OHA to secure the State's interest, or reports unauthorized expenditures, or
reports under expenditures without accompanying repayment, OHA may act, at its
option, to recover Start -Up payments as follows:
a. Bill the County for subject payment;
b. Following thirty (30) days' non -response to the billing, initiate a payment
reduction schedule against any current payments or advances being made to
County; or
c. Take other action needed to obtain payment.
134309 Deschutes County
OHA 11-13 GT0217-1 1
Approved 5/9/2011 122 of 220
EXHIBIT MHS 37 -Supported Education to MHS 37 Service Description
MHS Special Projects
Service Description
This special project, known as Supported Education is to help people with serious mental health
illness meet their education and recovery goals to become gainfully employed through
participation in an education program (i.e. Adult High School Diploma, GED program, or
postsecondary education).
II. Performance Requirements
County shall use the funds awarded under this Agreement for this special project to provide
Supported Education to adults with serious mental health illness by adhering to the fidelity
model. County must provide such services as follows:
A. Supported Education services to a minimum of twenty (20) consumers with serious
mental health illness per quarter;
B. Place a minimum of 30% of the individuals identified in Paragraph A above in an
educational setting; and
C. Each Supported Education participant will complete a recovery measure questionnaire
upon:
1. Service entry;
2. Every three months while receiving Supported Education services; and
3. At service discharge.
The recovery measure questionnaire will be determined by the Oregon Health Authority
(OHA). Completed questionnaires are to be mailed to OHA quarterly, no later than the
30th of October, January, April, and July during the period for which funds are awarded
under this Agreement.
III. Special Reporting Requirements
County must provide a quarterly summary report on delivery of MHS 37 Supported Education
Services funded in whole or in part with funds provided under this Agreement to OHA'
Addictions and Mental Health Division (AMH) no later than the 30th of October, January, April,
and July during the period for which funds are awarded for MHS 37 Services under this
Agreement.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
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OHA 11-13 GT0217-1I
Approved 5/9/2011 123 of 220
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: Funds awarded for this special project are intended
to be general financial assistance to County for the special project. Accordingly, OHA
will not track delivery of special project services or services capacity on a per unit basis
except as necessary to verify that the performance requirements set forth above have been
met. Total OHA financial assistance for this special project shall not exceed the total
funds awarded for this special project as specified in the Financial Assistance Award.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the funds
awarded for this special project on a particular line of the Financial Assistance Award to
County in substantially equal monthly allotments during the period specified in the
Financial Assistance Award, subject to the following:
1. OHA may, upon written request of County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for this special
project on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will reconcile any discrepancies that may
have occurred during the term of this Agreement between actual OHA disbursements of
funds awarded for Supported Education services, as described herein, under a particular
line of the Financial Assistance Award and satisfaction of the minimum performance
requirements, based on data properly reported in CPMS or through reports required or
permitted by this MHS 37 Supported Education Service Description.. County
acknowledges that County's performance of the Services is essential to OHA's ability to
conduct its duties. County and OHA agree that if County should fail to meet minimum
performance requirements, OHA's losses would be difficult to determine. Nonetheless,
the parties estimate in good faith that the amount of such loss would be 5% of the total
Supported Education funding awarded to County for funding of this Agreement.
Therefore, the parties agree that if County should fail to timely complete performance of
the Services, County shall owe OHA 5% of the total Supported Education funding
awarded to County for funding of this Agreement in liquidated damages.
134309 Deschutes County_
OHA 11-13 GT021 7-11
Approved 5/9/2011 124 of 220
Exhibit MHS 37 - Mental Health Rental Assistance Services - Housing
MHS Special Projects
I. Service Description
Rental Assistance Services (RAS) are intended to assist clients in paying for rental housing who
are 18 years of age or older with serious mental health illness, as defined in OAR 309-036-
0105(11), other mental or emotional disorders who have been hospitalized at the Oregon State
Hospital (OSH) or Blue Mountain Recovery Center (BMRC), or are moving from a structured
residential setting, such as a Residential Treatment Facility, a Secure Residential Treatment
Facility, or a Residential Treatment Home. RAS will allow clients to live as independently as
possible in the community and to access the appropriate support services.
Rental Assistance Services include:
Rental assistance in the form of cash payments made on behalf of individuals to cover a portion
of the monthly rent and utilities which may include payment of associated move -in costs, such as
cleaning and security deposits. RAS payments per client shall not exceed the average of the one
bedroom Housing Assistance Payment paid by the Housing Authority serving the County.
County shall insure rental housing units are inspected annually to insure unit is in a clean and
sanitary condition, and that all major appliances are in good working order.
Targeted outcomes include:
A. Decrease the OSH readmission rate;
B. Decrease Length Of Stay (LOS) in structured residential housing; and
C. Increase number of civilly committed clients transitioning to independent living.
Priority Populations to be served, in order of priority:
A. Civil Commitment;
B. Clients moving out of structured residential setting;
C. Clients discharged from OSH or BMRC;
D. Clients with history of OSH or BMRC visits; and
E. Clients who without supportive housing would otherwise enter OSH or BMRC.
Local Administration — Mental Health Services:
Local Administration — Mental Health Services can be used to provide program oversight for the
Rental Assistance Services (RAS) program. Local Administration — Mental Health Services
eligible activities may include, but is not limited to:
1. RAS program staff expenses as described in the 'Letter of Interest for Rental Assistance
Services Program. This letter is available from the Oregon Health Authority (OHA); and
134309 Deschutes County Approved 5/9/2011 125 of 220
OHA 11-13 GT0217-I I
2. RAS data collection and documentation of service delivery in compliance with state and
federal requirements.
II. Performance Requirements
All clients receiving Rental Assistance payments funded through this Agreement must have an
Individual Support and Services Plan (ISSP) and be enrolled in Out -Patient services.
Utilization requirements for Mental Health Rental Assistance Services providers will be
identified in a special condition in a particular line in the Financial Assistance Award.
III. Special Reporting Requirements
For each calendar quarter (or portion thereof) during the period for which financial assistance is
awarded under this Agreement for Rental Assistance Services, the County shall submit written
quarterly progress reports on the delivery of Rental Assistance Services no later than thirty (30)
calendar days after the end of the subject quarter. Reports should be substantially in the format
described in Attachment #1 Rental Assistance Services -Housing attached hereto, and
incorporated herein by this reference, and submitted to:
Oregon Health Authority
Addictions and Mental Health Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1 1 18
Reports must be prepared using forms and procedures prescribed by OHA.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance. OHA will provide financial assistance to County for
Rental Assistance Services identified in a particular line of the Financial Assistance
Award in an amount equal to the amount of cash assistance actually paid by County on
behalf of the clients for rent assistance, as described above, under that line of the
Financial Assistance Award during the period specified in that line, subject to the
following:
1. Total OHA financial assistance for all Rental Assistance Services delivered under a
particular line of the Financial Assistance Award shall not exceed the total funds
awarded for Rental Assistance Services as specified in that line of Financial
Assistance Award;
2. OHA is not obligated to provide Financial Assistance for any Rental Assistance
Services that are not properly reported to OHA in the quarterly reports described
above; and
134309 Deschutes County
OHA II-13GT0217-11
Approved 5/9/2011 126 of 220
3. OHA will not provide Financial Assistance, under this Agreement, for more than 24
months of Rental Assistance Services Payments for any particular individual unless
approved in advance and in writing by OHA.
B. Disbursement of Financial Assistance. Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the funds
awarded for Rental Assistance Services 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 OHA may after 30 days (unless parties agreed otherwise) written notice to County,
reduce the monthly allotments based on under utilized allotments identified through
the required quarterly reports;
2. OHA may, upon written request of County, adjust monthly allotments; and
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly
allotments as necessary, to reflect changes in the funds awarded for Rental Assistance
Services on that line of the Financial Assistance Award.
C. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may
have occurred during the term of this Agreement between actual OHA disbursements of
funds awarded for Rental Assistance Services under a particular line of the Financial
Assistance Award and amounts due for such services provided by County based on the
cash assistance paid on behalf of the individuals for rent assistance under that line of the
Financial Assistance Award during the period specified in that line, as properly reported
in the quarterly reports described above. If the County meets performance standards
identified in I1. Performance Requirements and has remaining funds unspent, OHA will
allow the carryover of those funds to the following biennium. Carried over funds must be
used for Rental Assistance Services.
134309 Deschutes County
OHA 11-13 GT0217-I 1
Approved 5/9/2011 127 of 220
Attachment #1
ADDICTIONS AND MENTAL HEALTH DIVISION
500 Summer Street NE E-86
Salem OR 97301-1118
Effective Date:
Quarterly Report
(Rental Assistance Services (RAS))
General Instructions
Purpose. The quarterly report tracks data pertaining to rental assistance services (RAS) received by
clients participating in the RAS Pilot Program. This report will provide descriptive and quantitative
information for the purposes of program evaluation and planning.
Applicability. County shall complete this report for each quarter in which RAS funding is utilized.
Organization of the Report. The quarterly report is organized in the following manner:
Part 1: Summary. This section of the report provides an overview of the activities carried out,
challenges encountered and actions taken.
Part 2. Data Summary. This worksheet provides information on the characteristics of the
clients assisted by this program. The worksheet needed to complete this report is included.
Part 3. Utilization Summary. This section of the report provides information on rental
assistance utilization.
Part 4. Financial Information. This section of the report is to be completed by all Counties
receiving RAS funding.
Final Assembly of Report. After the entire report is assembled, please number every page sequentially.
Mark any questions that do not apply to your project with "N/A" for not applicable.
Filing Requirements. The information in this package shall be submitted to OHA' Addictions and
Mental Health Division thirty (30) calendar days after the end of each subject quarter.
Reporting period:
134309 Deschutes County
OHA 11-13 GT0217-11
January to March
April to June
July to September
October to December
Due date: April 30
Due date: July 30
Due date: October 30
Due date: January 30
Approved 5/9/2011 128 of 220
Rental Assistance Services
Quarterly Report
County
Contract#
Contracted Provider
(if applicable)
Reporting Period (month/year)
from: to:
1 hereby certify that all the information stated in this report is true and accurate.
Name & address of person completing report
Phone: (include area code)
Fax #: (include area code)
E-mail:
Signature of County Official Date
Name & Title of County Official
E-mail address:
Part 1 Summary.
Describe on a page(s) attached to this report.
Question #1 - Program Overview.
Please briefly describe the activities carried out during this quarter. List your specific objectives and
briefly describe your success in meeting those objectives.
Question #2 — Challenges & Actions
Please briefly describe any challenges or difficulties that were encountered and what actions were taken
to address those issues.
Part 3. Utilization Summary.
1. Projected Level of Clients to be Served. In the table below, enter the number of clients to be served
in the current quarter.
Projected Level
Clients to receive rental assistance in the current
quarter.
134309 Deschutes County
01 -IA 11-13 Gr0217-11
Approved 5/9/2011
129 or220
2. Clients Assisted with Rental Assistance. In the tables below, enter the number of clients who
received rental assistance services during this quarter.
Rental Assistance Services
Number of Clients Served
# at end
of qtr.
ENROLLEES
EXITED
a. Number carrying over from previous quarter, June 30
b. Number who enrolled/exited July 1 to September 30
B
c. Number who enrolled/exited October 1 to December 31
C
d. Number who enrolled/exited January 1 to March 31
D
e. Number who enrolled/exited April 1 to June 30
E
f. Total number who accessed rental assistance for the
year (A+B+C+D+E=F)
g. Number unduplicated from response f
(e.g. eliminate additional enrollments for clients who enroll
more than once)
Support Services
Number of Clients Served
# at end
of qtr.
ENROLLEES
EXITED
a. Number carrying over from previous quarter, June 30
b. Number who enrolled/exited July 1 to September 30
B
c. Number who enrolled/exited October 1 to December 31
C
d. Number who enrolled/exited January 1 to March 3I
D
e. Number who enrolled/exited April 1 to June 30
E
f. Total number who accessed support services for the year
(A+B+C+D+E=F)
g. Number unduplicated from response f
(e.g. eliminate additional enrollments for clients who enroll
more than once)
134309 Deschutes Count)
ORA II -13G10217 -II
Approved 5/9/201 1 130 or 220
3. Rental Assistance Utilization.
# of
Rent
Months
Average
Rental
Assistance
Average
Months of
Assistance
# of
Unduplicated
Clients
Biennial Capacity
a. Rental assistance provided on July 1 to September 30
b. Rental assistance provided on October 1 to December 31
c. Rental assistance provided on January 1 to March 31
d. Rental assistance provided April 1 to June 30
e. Total # of rental assistance provided for the year
(A+B+C+D=E)
Part 4. Financial Information.
This exhibit provides information about available funds and expenditures. Expenditures are amounts
spent for eligible activities. Do not include other sources or in-kind items, such as the value of services
or materials provided by volunteers.
1. RAS Expenditures (totals by eligible activity) for quarter ending
a. Expenditures for rental assistance
$
b. Expenditures for Local Administration oversight
$
c. Total Expenditures for this quarter
$
Comments/Explanation:
2. Summary of Rental Assistance Services Expenditures
134309 Deschutes County_
O[IA 11-13 GT0217-1 I
Approved 5/9/2011
131of220
Remaining Balance
a. Total Funds Available for Biennium
( to )
$
b. Total Funds Spent as of Last Quarter
(period ending )
$
c. Balance (a -b)
d. Total Funds Spent Current Quarter
(period ending )
$
e. Balance (c -d)
$
134309 Deschutes County_
O[IA 11-13 GT0217-1 I
Approved 5/9/2011
131of220
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Rental Assistance
64
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Approved 5/9/2011
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EXHIBIT MHS 37 -Peer Delivered Services (PDS) to MHS 37 Service Description
MHS Special Projects
Service Description
This special project is known as the Peer Delivered Services (PDS) project. "Peer
Delivered Services" means an array of agency or community-based services and supports
provided by peers and peer support specialists to individuals or family members with
similar lived experience, that are designed to support the needs of individuals and
families as applicable. This support may be financially compensated or voluntary. The
PDS project will assist the establishment or expansion of PDS in a specified geographic
area for the period of the Agreement.
II. Performance Requirements
County shall use the funds awarded under this Agreement for this special project to
implement PDS in a manner that benefits individuals with a severe and persistent mental
illness.
III. Special Reporting Requirements
Within 30 days after the end of each subject quarter, the County shall submit to the
Oregon Health Authority's (OHA) Addictions and Mental Health Division (AMH), a
quarterly report that includes:
1. Amount of funds spent as of the end of the reporting period;
2. Description of PDS implementation progress, technical assistance needs, and any
relevant implementation challenges;
3. Number of persons with severe and persistent mental illness who were trained or
received PDS services during the quarter; and
4. Outcome measures to include:
a. Shortened hospital stays;
b. Improved ability to cope with mental illness
c. Reduced crisis events
d. Increased access to community support resources
e. Improved quality of life
f. Increased level of empowerment
Reports shall be submitted to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
134309 Deschutes County
OHA 1 I-13 GT0217-11
Approved 5/9/2011 140 or 220
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: Funds awarded for this special project are
intended to be general financial assistance to County for this special project.
Accordingly, OHA will not track delivery of special project services or service
capacity on a per unit basis except as necessary to verify that the performance
requirements set forth above have been met. Total OHA financial assistance for
this special project shall not exceed the total funds awarded for this special project
as specified in the Financial Assistance Award.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
funds awarded for this special project on a particular line of the Financial
Assistance Award to County in substantially equal monthly allotments during the
period specified in the Financial Assistance Award, subject to the following:
1. OHA may, upon written request of County adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments to reflect changes in the funds awarded for this special
project on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm
implementation of the special project described herein and satisfaction of the
minimum performance requirements, based on data properly reported through
reports required or permitted by this special project description or the MHS 37
Service Description.
134309 Deschutes County
OHA Il -130T0217-]1
Approved 5/9/2011 141 of 220
Service Name: EVIDENCE -BASED SUPPORTED EMPLOYMENT SERVICES
Service ID Code: MHS 38
I. Service Description
Evidence -Based Supported Employment Services (MHS 38) are services delivered to
individuals with serious mental health illness to enable them to obtain and maintain
employment. Evidence -Based Supported Employment Services include:
A. Supervision and job training;
B. On-the-job visitation;
C. Consultation with the employer;
D. Job coaching;
E. Counseling;
F. Skills training; and
G. Transportation
Evidence -Based Supported Employment Services are provided in the context of paid
competitive employment.
Only individuals with serious mental health illness who satisfy the following
requirements are eligible for Evidence -Based Supported Employment Services funded
through this Agreement:
A. The individual is receiving MHS 20 Services, whether or not funded through this
Agreement; and
B. The individual needs Evidence -Based Supported Employment Services to
maintain competitive employment.
II. Performance Requirements
A. Providers of MHS 38 Services funded through this Agreement shall maintain a
Certificate of Approval in accordance with OAR 309-012-0130 through 309-012-
0220, as such rules may be revised from time to time.
B. Providers of Evidence -Based Supported Employment Services funded through
this Agreement shall:
1. Provide the Dartmouth College model of Individual Placement and
Support (IPS) Supported Employment.
2. Maintain "Good Fidelity", based on the Dartmouth College IPS Supported
Employment Fidelity Scale, as demonstrated by annual fidelity reviews
conducted by an independent contractor, satisfactory to OHA.
134309 Deschutes County
OFIA 11-13 GT0217-1 I
Approved 5/9/2011 142 of 220
3. Upon reaching "Exemplary Fidelity", based on the Dartmouth College IPS
Supported Employment Fidelity Scale, cause fidelity reviews to be
completed by an independent contractor, satisfactory to OHA, every 18
months.
C. Utilization requirements for Evidence -Based Supported Employment providers
will be identified in a special condition subject to funds awarded in a particular
line in the Financial Assistance Award.
D. Each Evidence -Based Supported Employment participant will complete a
recovery measure questionnaire upon:
1. Service entry;
2. Every three months while receiving Supported Employment Services; and
3. Service discharge.
The recovery measure questionnaire will be determined by the Oregon Health
Authority (OHA). Completed questionnaires shall be sent to OHA quarterly, no
later than the 30th of October, January, April, and July during the period for which
funds are awarded under this Agreement.
E. All individuals receiving MHS 38 Services under this Agreement must be
enrolled in the Client Process Monitoring System (CPMS), and the individual's
CPMS record for MHS 38 Services must be maintained, as specified in OHA'
CPMS manual located at
http://www.oregon.gov/OHA/mentalhealth/publications//pmsmanual mh.pdf?ga
=t, and as it may be revised from time to time.
III. Special Reporting Requirements
County must provide a quarterly summary report, on delivery of MHS 38 Services
funded in whole or in part with funds provided under this Agreement, to OHA in writing
no later than the 15th of October, January, April, and July during the period for which
funds are awarded for MHS 38 Services under this Agreement.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
134309 Deschutes County
OFIA 11-13 GT0217-11
Approved 5/9/2011 143 of 220
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The funds awarded for MHS 38 Services are
intended to be general financial assistance to County for MHS 38 Services.
Accordingly, OHA will not track delivery of MHS 38 Services or services
capacity on a per unit basis except as necessary to verify that the performance
requirements set forth have been met. Total OHA financial assistance for MHS 38
Services under a particular line of the Financial Assistance Award shall not
exceed the total funds awarded for MHS 38 Services as specified on that line.
B. Disbursement of Financial Assistance: OHA will disburse the funds awarded for
MHS 38 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. OHA may, upon written request of County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded
for MHS 38 Services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for Evidence -Based Supported Employment
Services, as described herein, under a particular line of the Financial Assistance
Award and satisfaction of the minimum performance requirements, based on data
properly reported in CPMS and/or through reports required or permitted by this
MHS 38 Service Description. For purposes of this section, if County does not
meet minimum performance requirements OHA may take back 5% of the total
Supported Employment Services funding awarded to County for the funding
period of this Agreement.
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O1IA 11-13 GT0217-1 I
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Service Name: PROJECTS FOR ASSISTANCE IN TRANSITION
FROM HOMELESSNESS (PATH) SERVICES
Service ID Code: MHS 39
I. Service Description
The PATH program is designed to support the delivery of eligible services to persons
who are:
A. Homeless or at imminent risk of homelessness;
B. Have serious mental health illnesses; and
C. May have co-occurring substance use disorders.
Eligible services are as follows:
1. Outreach services;
2. Screening and diagnostic treatment services;
3. Habilitation and rehabilitation services;
4. Community mental health services;
5. Alcohol and drug treatment services;
6. Staff training, including the training of individuals who work in shelters, mental
health clinics, substance abuse programs, and other sites where individuals who are
homeless require services;
7. Case management services;
8. Supportive and supervisory services in residential settings;
9. Referrals for primary health services, job training, educational services, and
relevant housing services; and
10. Housing services as specified in Section 522 (b) (10) of the Public Health Service
Act (PHSA), 42 USC 290cc-22(b)(10) , including:
i. Minor renovation, expansion, and repair of housing.
ii. Planning of housing.
iii. Technical assistance in applying for housing assistance.
iv. Improving the coordination of housing services.
v. Security deposits.
vi. Costs associated with matching eligible individuals who are homeless with
appropriate housing situations.
vii. One-time rental payments to prevent eviction.
OHA places particular emphasis on outreach, screening and diagnostic services. OHA also
emphasizes that case management, community mental health services, and alcohol and
drug treatment services funded by PATH are meant to be transitions services.
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II. Performance Requirements
Providers of MHS 39 Services funded through this Agreement must comply with OAR
309-032-0175 through 309-032-0210, as such rules may be revised from time to time, and
must maintain a Certificate of Approval in accordance with OAR 309-012-0130 through
309-012-0220, as such rules may be revised from time to time.
Services provided must be eligible services as stated in the Public Health Services Act,
Section 522 (b).
Providers of MHS 39 Services funded through this Agreement shall:
A. Assist the Oregon Health Authority (OHA), upon request, in the development of an
annual application requesting continued funding for MHS 39 Services, including
the development of a Budget and an Intended Use Plan for Projects for Assistance
in Transition from Homelessness (PATH) funds consistent with federal
requirements in Section 526, Part C, Public Health Service Act; and
B. Provider minimum requirements:
1. At least 85% of individuals serviced must be PATH -eligible and not currently
enrolled in community mental health services.
2. Of the total individuals who are PATH -enrolled, 75% must be transitioned into
permanent housing.
3. Of the total individuals who are PATH -enrolled, 100% must be engaged in
community mental health services.
4. Active participation in the local Continuum of Care.
5. Attendance at semi-annual PATH provider meetings.
6. Attendance at PATH Technical Assistance trainings as requested by OHA.
7. Development of an annual PATH Intended Use Plan including a line item budget
and budget narrative.
8. Participation in annual PATH program site reviews conducted by OHA.
9. Participation in Federal site reviews as needed or requested by OHA.
III. Special Reporting Requirements
Providers of MHS 39 Services funded through this Agreement must submit:
A. Annual on-line report on the activities conducted and services provided during the
year with the funds awarded under this Agreement for MHS 39 services. The
report must comply with federal requirements for PATH program, as authorized
through the Public Health Service Act, Part C, Section 521, as amended, 42 U.S.C.
290cc-21 et seq.; Stewart B. McKinney Homeless Assistance Amendments Act of
1990, Public Law 101-645, Providers must supply actual utilization numbers for
the Federal Voluntary Outcomes Measures within the annual on-line report.
134309 Deschutes County Approved 5/9/2011 146 of 220
OHA II-13GT0217-II
B. Quarterly written report documenting PATH eligible expenditures and actual
utilization and demographic data due no later than forty-five (45) days following
the end of the reporting period.
Reports shall be submitted to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
All individuals receiving MHS 39 Services with funds provided under this Agreement must
be enrolled in the Client Process Monitoring System (CPMS), and the individual's CPMS
record for MHS 39 Services must be maintained, as specified in OHA' CPMS manual
found at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga=t, and as
it may be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The funds awarded for MHS 39 Services are
intended to be general financial assistance for MHS 39 Services. Accordingly,
OHA will not track delivery of MHS 39 Services on a per unit basis except as
necessary to verify that the performance requirements set forth in the special
condition identified in a particular line of the Financial Assistance Award 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. Total OHA
financial assistance for MHS 39 Services under a particular line of the Financial
Assistance Award shall not exceed the total funds awarded for MHS 39 Services as
specified on that line.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line of the Financial Assistance Award, OHA will disburse the
financial assistance awarded for MHS 39 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. OHA may, upon written consent of County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
MHS 39 Services on that line of the Financial Assistance Award.
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OHA 11-13 GT0217-1 I
Approved 5/9/2011 147 of 220
C. Agreement Settlement: Agreement Settlement will reconcile any discrepancies
that may have occurred during the term of this Agreement between actual OHA
disbursements of funds awarded for PATH services, as described herein, under a
particular line of the Financial Assistance Award and satisfaction of the minimum
performance requirements, based on data properly reported in CPMS and/or
through reports required or permitted by this MHS 39 Service Description. For
purposes of this section, if County does not meet minimum performance
requirements OHA may take back 5% of the total PATH funding awarded to
County for the funding period of this Agreement.
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/2011 148 of 220
Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR
ADULTS (DESIGNATED)
Service ID Code: MHS 201
I. Service Description
Non -Residential Mental Health Services For Adults (Designated) (MHS 201) are mental
health services delivered to individuals specified in the Financial Assistance Award who
have a serious mental illness, or other mental or emotional disturbance posing a danger to
the health and safety of themselves or others.
Non -Residential Mental Health Services For Adults (Designated) include:
A. Case management services;
B. Vocational and social services;
C. Rehabilitation;
D. Support to obtain and maintain housing;
E. Medication and medication monitoring;
F. Emotional support;
G. Individual, family and group counseling and therapy;
H. Sex offender treatment; and
I. Interpreter services.
II. Performance Requirements
Providers of MHS 201 Services shall provide coordination of care services for county of
responsibility residents in residential treatment programs, which include extended care
managed services, regardless of the location. The coordination of care shall include
participation in the residential provider's treatment planning process and in planning for
the individual's transition to outpatient services. Services funded through this Agreement
for any resident will be time limited and subject to review and revision by OHA.
Providers of MHS 201 Services funded through this Agreement must:
A. Comply with OAR 309-032-1500 through 309-032-1565, as such rules may be
revised from time to time;
B. Maintain a Certificate of Approval, for the delivery of clinical services, in
accordance with OAR 309-012-0130 through OAR 309-012-0220, as such rules
may be revised from time to time; and
C. Investigate and report allegations of abuse regarding served individuals and
provide protective services to those individuals to prevent further abuse. The
investigation, reporting and protective services must be completed in compliance
with ORS 430.731 through 430.768 and OAR 407-045-0000 through 407-045-
0980, as such statutes and rules may be revised from time to time.
134309 Deschutes County Approved 5/912011 149 of 220
OHA 11-13 GT0217-I 1
III. Special Reporting Requirements
A. County shall provide the Oregon Health Authority (OHA) with a summary report
of MHS 201 Services delivered with funds provided under this Agreement within
45 days after the end of the 12 -month period ending June 30, during the term of
this Agreement, and after the termination of this Agreement.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
B. Submit information and data on abuse reports, investigations and protective
services involving individuals to whom the Provider provides MHS 201 Services,
as such information and data is reasonably requested by OHA in order to fully
understand allegations and reports of abuse, the resulting investigations and
protective services and any corrective actions.
C. All individuals receiving MHS 201 Services with funds provided under this
Agreement must be enrolled in the Client Process Monitoring System (CPMS),
and the individual's CPMS record for MHS 201 Services must be maintained, as
specified in OHA' CPMS manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga
=t, and as it may be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
OHA provides financial assistance for MHS 201 Services in two different ways, through
Part A and Part B ("Limitation") Awards. The Award is set in the Financial Assistance
Award on MHS 201 lines in column one that contain an "A" for Part A or "B" for Part B
Award.
Part B Limitation - The provider of the service needs to be enrolled as a Medicaid
Provider and follow the procedures for billing OHA for Medicaid mental health services
outlined in the Medicaid provider manual. OHA calculates the rates and the claims are
processed through OHA's Medicaid Management Information System (MMIS). OHA
calculates the Part B limitation and OHA's Division of Medical Assistance Programs
(DMAP) disburses the payment directly to service providers on a fee-for-service basis.
Rates are available on the OHA website located at
http://egov.oregon.gov/OHA/mentalhealth/publications/codebooks/mh0109 rates. pdf.
OHA will provide notice to Contractor in timely manner if there is a change in rates. All
Medicaid reimbursable service billings shall be in accordance with the OHA Mental
Health and Developmental Disability Services Medicaid Payment for Rehabilitative
Mental Health Services Rule as listed in OAR 309-016-0000 through 309-016-0450 and
134309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/201 1 150 of 220
the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual
available on the OHA website located at
http://www.oregon.gov/OHA/mentalhealth/publications/codebooks/manual.pdf.
The Part A Award financial assistance will be calculated, disbursed and settled as
follows:
A. Calculation of Financial Assistance: OHA will pay for MHS 201 Services
identified in a particular line of the Financial Assistance Award with an "A" in
Column one, multiplied by the number of units of MHS 201 Services delivered
under that line of the Financial Assistance Award during the period specified in
that line, subject to the following:
1. Total OHA 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.
2. OHA is not obligated to provide financial assistance for any MHS 201
Services delivered to individuals who are not properly reported in CPMS
(or through other method permitted or required by this Service Description
or an applicable Specialized Service Requirement) by the date sixty (60)
days after the earlier of termination of this Agreement, termination of
OHA's obligation to provide financial assistance for MHS 201 Services,
or termination of County's obligation to include the Program Area, in
which MHS 201 Services fall, in its CMHP.
3. OHA will reduce the financial assistance for MHS 201 Services delivered
under a particular line of the Financial Assistance Award containing and
"A" in Column one by the amount received by a Provider of MHS 201
Services, as payment of a portion of the cost of the services from an
individual receiving such services.
B. Disbursement of Financial Assistance: Unless a different disbursement method is
specified in that line ofthe Financial Assistance Award, OHA 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. OHA may, upon written request of County, adjust monthly allotments;
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
MHS 201 Services on that line ofthe Financial Assistance Award.
3. OHA may after 30 days (unless parties agreed otherwise) written notice to
County, reduce the monthly allotments based on under used allotments
identified through CPMS or through other method permitted or required by
this Service Description or an applicable Specialized Service Requirement;
134309 Deschutes County Approved 5/9/2011 151 o1220
OHA 11 -13G10217 -I1
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 reports required or permitted by this Service
Description or an applicable Specialized Service Requirement.
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/201 1 152 or 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT B-2
SPECIALIZED SERVICE REQUIREMENTS
Not all Services described in Exhibit B-2 may be covered in whole or in part with financial
assistance pursuant to Exhibit C of this Agreement. Only Services whose costs are covered in
whole or in part with financial assistance pursuant to Exhibit C, as amended from time to time,
are subject to this Agreement.
134309 Deschutes Count'
OHA 11-13 GT0217.11
Approved 5/9/2011 153 of 220
Service Name(s): Adult Alcohol and Drug Residential Treatment Services
Service ID Code: A&D 61
Specialized Service: Intensive Treatment and Recovery Services
Exhibit B-2 Code: 61A
I. Service Description (exceeding Exhibit B-1, A&D 61)
Funds awarded for A&D 61 Services that are identified in the Financial Assistance
Award as subject to this Specialized Service Requirement may only be expended on
A&D 61 Services that are delivered in residential alcohol and other drug treatment
programs (as defined in OAR 309-032-1505). Families referred by the Department of
Human Services -Children, Adults and Families Division (CAF) not covered by the
Oregon Health Plan shall receive first priority followed by any person needing residential
treatment while parenting children under the age of 18. In addition, providers must have
written admission polices and procedures in place for individuals who appropriately use
prescribed medications to treat addiction. Written policies and procedures must include
referrals to alternate treatment resources for those not admitted to the program. A&D
6I A Services delivered with funds provided under this Agreement, in addition to the
services otherwise described in the A&D 61 Service Description, include a recovery
oriented system of care for addicted parents involved in or at risk of involvement with
child welfare and self-sufficiency programs (CAF) that includes the following:
1. Effective transitions for clients moving from one level of care to another level of
care;
Collaborative case planning and management with CAF as evidenced by staffing
notes, progress notes, or other documentation; and
2.
3. Coordination and referral services for client's family members including early
childhood services for infants and toddlers and recovery support services for
spouses and older children.
II. Performance Standards
A) All individuals receiving addiction services with funds provided under this
Agreement and subject to this A&D 61A Specialized Service Requirement must
be clients involved in, or individuals at risk of involvement with, child welfare or
CAF self-sufficiency programs
B) County is responsible for the following outcome for those clients referred to in
Section I of this Specialized Service Requirement:
• Continuum of Care- Clients who are stabilized and who no longer meet
American Society of Addiction Medicine Level III criteria must receive at
least one face-to-face service in an outpatient setting within 7 days of
transitioning from residential treatment.
III. Reporting Requirements (exceeding Exhibit B-1, A&D 61)
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OITA 11-13 GT0217-I1
Approved 5/9/2011 154 of 220
A. One copy of Intensive Treatment and Recovery Services (ITRS) referral form is
filed in client records.
B. Clients will be enrolled in Client Processing Monitoring System (CPMS) using a
dedicated provider number for the ITRS program as specified in OHA's CPMS
manual located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpms-
manual/ad2009cpms-manual.pdf?ga=t
IV. Financial Assistance Calculation and Disbursement Procedures (exceeding ExhibitB-1,
A&D 61)
None.
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OHA 11-13 GT0217-I I
Approved 519/2011 155 of 220
Service Name(s): CONTINUUM OF CARE SERVICES
Service ID Code: A&D 66
Specialized Service: INTENSIVE TREATMENT AND RECOVERY SERVICES
Exhibit B-2 Code: 66A
I. Service Description (exceeding Exhibit B-1, A&D 66)
Funds awarded for A&D 66 Services that are identified in the Financial Assistance
Award as subject to this Specialized Service Requirement may only be expended on
A&D 66 Services that are delivered in outpatient programs (as defined by the American
Society of Addiction Medicine, Patient Placement, Continued Stay and Discharge
Criteria, Second Edition -Revised (ASAM PPC -2R) as referenced in OAR 309-032-1500
to 309-032-1565). Continuum of Care Services (A&D 66) must be provided in a manner
that is informed by generally accepted research applied to the populations served through
this Agreement. Individuals with a prescription for medications used to treat addiction
may not be denied services based on the appropriate use of these medications. In
addition, these funds may be expended on peer delivered recovery support services
provided by approved out-patient programs. Peer delivered recovery support services
include an array of agency or community- based services and supports provided by peers
to individuals or family members with similar lived experience that are designed to
support the recovery needs of individuals and families. Peer delivered recovery support
services must be provided by individuals holding documentation for completion of an
AMH approved training program. Families referred by the DHS' Children, Adults and
Families (CAF) not covered by the Oregon Health Plan shall receive first priority
followed by any person needing outpatient addiction treatment parenting children under
the age of 18. A&D 66 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 A&D 66 Service Description:
A) A recovery oriented system of care for addicted parents involved in or at risk of
involvement with child welfare and self-sufficiency programs that includes the
following:
1. Effective transitions for individuals moving from one level of care to another
level of care;
2. Collaborative case planning and management with CAF as evidenced by
staffing notes, progress notes, or other documentation;
3. Coordination and referral services for an individual's family members
including early childhood services for infants and toddlers and recovery
support services for spouses and older children; and
4. A referral packet (includes an assessment and Intensive Treatment and
Recovery Service (ITRS) referral form) for individuals referred to residential
treatment.
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OHA 11-13 GT0217-1 I
Approved 5/9/2011 156 of 220
II. Performance Standards
A. All individuals receiving addiction services with funds provided under this
Agreement and subject to this Specialized Service Requirement must be
individuals involved in or at risk of involvement with child welfare or self-
sufficiency programs in CAF.
13. The County is responsible for the following outcomes for those individuals
referred to in section one:
1. Parent/Child Reunification- Sixty percent of parents involved in the child
welfare system who have regularly participated in treatment and followed
their treatment plan for at least 30 days retain custody of their children;
2. Retention in addiction treatment for at least 90 days; and
3. Utilization requirements for individuals who receive outpatient addiction
treatment under ITRS will be identified in a special condition subject to funds
awarded in a particular line in the Financial Assistance Award, Exhibit C.
These funds are used to increase capacity and cannot be used to supplant
already existing resources.
Providers ofA&D 66A Services funded through this Agreement must participate in client
outcome studies conducted by OHA.
III. Reporting Requirements (exceeding Exhibit 13-1, A&D 66)
• A copy of ITRS referral form is filed in an individual's records with CAF and the
treatment provider.
• Addiction treatment providers will use a dedicated provider number on the Client
Processing and Monitoring System form indicating that this individual is part of
ITRS.
IV. Financial Assistance Calculation and Disbursement Procedures (exceeding Exhibit B-
1, A&D 66)
None.
134309 Deschutes County
OHA I1-13GT0217-II
Approved 5/9/2011 157 of 220
Service Name: CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
Service ID Code: MHS 22
Specialized Service: TREATMENT FOSTER CARE SERVICES
Exhibit B-2 Code: 22A
I. Service Description and Performance Requirements (exceeding Exhibit B-1, MHS 22)
Funds awarded for MHS 22 Services that are identified in the Financial Assistance Award
as subject to this Specialized Service Requirement are reserved in Oregon Health
Authority's (OHA) budget for delivery of individual skills training services to Medicaid -
eligible children residing in specialty foster homes approved by DHS' Children, Adults and
Family Division (CAF).
II. Performance Standards (exceeding Exhibit B-1, MHS 22)
None.
III. Reporting Requirements (exceeding Exhibit B-1, MHS 22)
None.
IV. Financial Assistance Calculation and Disbursement Procedures (exceeding Exhibit B -I,
MHS 22)
Funds awarded for MHS 22 Services that are identified in the Financial Assistance Award
as subject to this Specialized Service Requirement (the "MHS 22A Limitation") are not
calculated, disbursed or settled under this Agreement, but is calculated by OHA'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 MHS 22A Limitation is referenced in this Agreement for budgetary purposes.
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/2011 158 of 220
Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR
YOUTH AND YOUNG ADULTS IN TRANSITION (DESIGNATED
Service ID Code: MHS 26
Specialized Service: EARLY PSYCHOSIS PROJECT (EPP)
Exhibit B-2 Code: 26A
I. Service Description (exceeding Exhibit B-1, MHS 26; excludes designation
requirements)
Funds awarded for MHS 26 Services that are identified in the Financial Assistance
Award as subject to this Specialized Service Requirement may only be expended on
MHS 26 Services that are delivered in the Early Psychosis Project (EPP). MHS 26
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 26 Service Description:
A. Psychosis treatment services and intervention are provided to reduce long-term
disability associated with psychosis to individuals who are uninsured and not
enrolled in Medicaid, following the EPP guidelines.
Psychosis treatment services include:
1. Outreach and engagement;
2. Assessment and treatment using a multi -disciplinary team
consisting of a psychiatrist, social worker, occupational therapist, nurse, and
vocational specialist;
3. Multi -family psycho -education;
4.
5.
6.
7.
work settings.
Cognitive behavioral therapy;
Vocational and educational support;
Prescribing medication using a low dose protocol; and
Support for the individual in home, community, school, and
B. Services will be coordinated with applicable adjunct programs serving both
children and adults so as to facilitate smoother transitions and improved
integration of services and supports across both adolescent and adult systems.
II. Performance Standards (exceeding Exhibit B-1, MHS 26)
None
III. Reporting Requirements (exceeding Exhibit B-1, MHS 26)
A. Maintain the client's Client Process Monitoring System (CPMS) record for MHS
26A Services provided, using a dedicated provider number assigned for the Early
134309 Deschutes Count
OHA 11-13 GT0217-11
Approved 5/9/2011 159 01'220
Psychosis Project (EPP) as specified in Oregon Health Authority's CPMS manual
located at:
http://www.oregon.gov/OHA/mentalhealth/publications/cpmsmanual mh.pdf?ga
and as it may be revised from time to time.
B. Submit quarterly reports to Mid Valley Behavioral Care Network (MVBCN)
using the MVBCN Web Application Portal located at https://db.mvbcn.org/ts/en-
US/Default.aspx.
IV. Financial Assistance Calculation Disbursement and Settlement Procedures
(exceeding Exhibit B-1, MHS 26)
Agreement Settlement: (exceeds Exhibit B-1, MHS 26)
Agreement Settlement will be used to confirm the offer and delivery of MHS 26A
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 applicable
Specialized Service Requirement.
t34309 Deschutes County
01IA 1I -13G10217-11
Approved 5/9/2011 160 or220
Service Name: RESIDENTIAL TREATMENT SERVICES
Service ID Code: MHS 28
Specialized Service: SECURE RESIDENTIAL TREATMENT FACILITY
Exhibit B-2 Code: 28A
Service Description and Performance Requirements (exceeding Exhibit B-1, MHS
28)
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. MHS
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:
a. Rehabilitative services such as mental health assessment, diagnosis, and treatment
plan development;
b. Monitoring and management of psychotropic medications;
c. Development of behavioral programs;
d. Establishment of a therapeutic milieu;
e. Group and individual skills training;
f. 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 309-032-0180(8)) 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.
County must perform a standardized level of care assessment prior to admission. MHS 28
Services delivered under this Agreement that are subject to this Specialized Service
13-1309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/2011 161 of 220
Requirement may only be delivered to individuals who meet the standardized criteria
developed by OHA for this level of care. The standardized criteria will be posted on the
OHA AMH web page. Priority will be for individuals ready to discharge from the State
Hospitals. OHA will have the right to review admissions and continued stay
determinations.
II. Reporting Requirements (exceeding Exhibit B-1, MHS 28)
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
OHA' AMH.
III. Financial Assistance Calculation, Disbursement and Settlement Procedures
(exceeding Exhibit B-1, MHS 28)
None
134309 Deschutes Counnv
OIiA 11-13 GT0217-11
Approved 5/9/201 1 162 of 220
Service Name: ADULT FOSTER CARE SERVICES
Service ID Code: MHS 34
Specialized Service: RELATIVE FOSTER CARE
Exhibit B-2 Code: 34A
I. Service Description (exceeding Exhibit B-1, MHS 34)
Relative Foster Care is personal care as detailed in a personal care plan provided to an
adult client, age I8 or older, by a relative caregiver in a private residence setting that
promotes the client's safety and independence.
II. Performance Requirements (exceeding Exhibit B-1, MHS 34)
For new Relative Foster Care providers, County must complete an inspection of the
provider's home and submit to the Oregon Health Authority (OHA) the following
documents, as prescribed by OHA:
(a) County's letter of support;
(b) Approved Criminal Record Check (CRC) for the foster care provider and all
persons 16 years of age and older living in the home (not including the client);
and.
(c) The personal care plan and other information as requested by OHA for OHA
approval of the Relative Foster Care provider.
For renewal of existing Relative Foster Care providers, County must complete an
inspection of the home and submit to OHA a completed Relative Foster Care Renewal
Form. Relative Foster Care providers must renew their applications every two years.
III. Reporting Requirements (exceeding Exhibit B-1, MHS 34)
None
IV. Financial Assistance Calculation and Disbursement Procedures (exceeding Exhibit
B-1, MHS 34)
None
134309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/2011 163 of 220
Service Name: OLDER\DISABLED MENTAL HEALTH SERVICES
Service Element ID Code: MHS 35
Specialized Service: GERO-SPECIALIST
Exhibit B-2 Code: 35A
I. Service Description
Older/Disabled Adult Mental Health Services (MHS 35) Specialized Service
Requirement (MHS 35A) are specialized geriatric mental health services delivered
directly or indirectly to older/disabled adults with mental health illness.
II. Performance Requirements
The funds awarded for MHS 35A Services may only be expended on community based
care services for older/disabled adults with mental health illness who are determined
eligible for residential services from DHS' Seniors and People with Disabilities (SPD)
Division. Such services include, but are not limited to, medication management,
quarterly interagency staffing and follow-up services after treatment in local or state
inpatient psychiatric hospitals, or indirect services, including but not limited to,
screening, referral, and consultation and training to agencies and caregivers who provide
services that may affect older/disabled adults with mental health illness.
If indirect services, as described above, are delivered with MHS 35A funds provided
under this Agreement, those services must be available to relevant agencies and
caregivers in the geographic area served by the CMHP operated by or contracted for by
County and must be coordinated with protective services provided by DHS' SPD
Division and County's mental health crisis/commitment service.
All MHS 35A Services delivered with funds provided under this Agreement must be
delivered by a Qualified Mental Health Professional (as defined in OAR 309-016-0605)
(QMHP) and in compliance with OAR 309-032-1500 through 309-032-1565, Standards
for Adult Mental Health Services, as such rules may be revised from time to time.
QMHP' delivering such services must have a background with the older/disabled adult
population or be participating in relevant training programs to acquire such knowledge.
Providers of MHS 35 Services delivered with funds provided under this Agreement that
are subject to this Specialized Service Requirement must insure that staff providing such
services:
A. Regularly access a psychiatrist or nurse practitioner for case and medication
review for individuals receiving MHS 35 Services;
B. Regularly participate in interdisciplinary team meetings with DHS' Seniors and
People with Disabilities (SPD) staff or contractors serving individuals receiving
MHS 35 Services;
134309 Deschutes County
01 -IA II-13GT0217-11
Approved 5/9/2011 164 of 220
C. Provide discharge assistance (from in-patient psychiatric hospitals) and provide,
or arrange for, short term follow-up services for individuals receiving MHS 35
Services; and
D. Be available to County's crisis team and DHS' SPD protective services for
consultation on geriatric cases.
III. Special Reporting Requirements
County shall provide summary reports on its delivery of MHS 35A Services that are
supported with funds provided under this Agreement. The reports must be submitted
within 45 days of the end of each State fiscal year (ending June 30) and after the
termination of this Agreement.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1 1 18
Reports must be prepared using forms and procedures prescribed by the Oregon Health
Authority (OHA).
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The funds awarded for MHS 35A Services
are intended to be general financial assistance to County for MHS 35A Services.
Accordingly, OHA will not track delivery of MHS 35A Services or service
capacity on a per unit basis so long as County offers and delivers MHS 35A
Services as part of its CMHP. Total OHA financial assistance for MHS 35A
Services under a particular line of the Financial Assistance Award shall not
exceed the total funds awarded for MHS 35A Services as specified on that line.
B. Disbursement of financial assistance: OHA will disburse the funds awarded for
MHS 35A 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:
134309 Deschutes County
011A 11-13 GT0217-11
Approved 5/9/2011 165 of 220
1. OHA may, upon written request of County, adjust monthly allotments; and
1. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
MHS 35A Services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the delivery
of MHS 35 Services by County as part of its CMHP, based on data properly
reported in reports required or permitted by this Specialized Service Requirement.
134309 Deschutes County Approved 5/9/2011
OIIA 1I-13GT0217-I1
166 of 220
Service Name: OLDER/DISABLED ADULT MENTAL HEALTH SERVICES
Service ID Code: MHS 35
Specialized Service: SPD RESIDENTIAL
Exhibit B-2 Code: 35B
Service Description
Older/Disabled Adult Mental Health Services (MHS 35) Specialized Service
Requirement (MHS 35B) are residential services delivered directly or indirectly to
individuals with severe and persistent mental health illness.
II. Performance Requirements
Providers of MHS 35 Services delivered with funds provided under this Agreement that
are subject to this Specialized Service Requirement must, with respect to each individual
receiving MHS 35 Services, enter into and maintain a written agreement with DHS'
Seniors and People with Disabilities Division (SPD) and the Provider of residential
services to that individual that addresses: approval of SPD or its designee for the
placement, the services to be provided by each entity. and an annual review of the
appropriateness of the placement.
The funds awarded for MHS 35B Services may only be expended on residential services
for older/disabled adults with severe and persistent mental health illness who are
determined not eligible for, yet require, residential services from DHS' SPD Division and
who meet service need eligibility for Medicaid financed residential services under OAR
411-015-0000 through 411-015-0100 and are residing in a facility whose operator is
licensed by the SPD Division and has contracted with the SPD Division to deliver
residential services to specified individuals.
III. Special Reporting Requirements
Providers of MHS 35 Services delivered with funds provided under this Agreement that
are subject to this Specialized Service Requirement must notify the Oregon Health
Authority's (OHA), Addictions and Mental Health Division (AMH), when the Provider
discontinues such services to an individual whose services are delivered with funds
provided under this Agreement that are subject to this Specialized Service Requirement.
Providers of MHS 35 Services delivered with funds provided under this Agreement that
are subject to this Specialized Service Requirement must be able to provide a copy of all
written agreements described above to OHA upon request.
Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by the Oregon Health
Authority (OHA).
134309 Deschutes Count}
OHA 11-13 GT0217-I 1
Approved 5/9/201 t 167 of 220
All individuals receiving MHS 35B Services with funds provided under this Agreement
must be enrolled in the Client Process Monitoring System (CPMS), and the individual's
CPMS record for MHS 35B Services must be maintained, as specified in OHA's CPMS
manual located at:
http://www.oregon.gov/OHA/mental health/publications/cpmsmanual mh.pcif? ga=t , and
as it may be revised from time to time.
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
A. Calculation of Financial Assistance: The funds awarded for MHS 35B Services
are intended to be general financial assistance to County for MHS 35B Services.
Accordingly, OHA will not track delivery of MHS 3513 Services or service
capacity on a per unit basis so long as County offers and delivers MHS 35B
Services as part of its CMHP. Total OHA financial assistance for MHS 35B
Services under a particular line of the Financial Assistance Award shall not
exceed the total funds awarded for MHS 35B Services as specified on that line.
B. Disbursement of financial assistance: OHA will disburse the funds awarded for
MHS 35A 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. OHA may, upon written request of County, adjust monthly allotments; and
2. Upon amendment to the Financial Assistance Award, OHA shall adjust
monthly allotments as necessary, to reflect changes in the funds awarded for
MHS 35A Services on that line of the Financial Assistance Award.
C. Agreement Settlement: Agreement Settlement will be used to confirm the delivery
of MHS 35B 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 reports required or permitted by this Specialized Service
Requirement.
134309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/2011 168 of 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
CONTRACTOR:
DATE:
PROGRAM AREA:
EXHIBIT C
FINANCIAL ASSISTANCE AWARD
AGREEMENT #:
REFERENCE #:
Start/End CPMS Approved Approved Serv. Unit EX HIB B2 Spec
Part Dates Name Service Funds Start-up Units Type Codes Cond #
SE#:
134309 Deschutes County
OHA 11-13 GT0217-I I
Approved 5/9/2011 169 of 220
OREGON HEALTH AUTHORITY
Financial Assistance Award Amendment (FAAA)
2011-2013
CONTRACTOR: DESCHUTES COUNTY Contract#: 134309
DATE: 06/03/2011 Reference#: 001
ALCOHOL AND DRUG SERVICES
SECTION: 1
SERVICE REQUIREMENTS MEET EXHIBIT B AND, IF INDICATED, EXHIBIT B-2
Start/End CPMS
Part Dates Name
Approved
Service Funds
Approved Serv. Unit EXHIB B2 Spec
Start-up Units Type Codes Cond#
SE# 3 LOCAL ADMIN ADDICTIONS SVCS
A 7/2011- 6/2012 N/A $3,500 $0 0. NA N/A A0001 1
SUBTOTAL SE# 3 $3,500 $0
SE# 66 CONTINUUM OF CARE
A 7/2011- 6/2012 N/A
A 7/2011- 6/2012 N/A
SUBTOTAL SE# 66
$115,084 $0 0. NA 66A A0001 3
$476,143 $0 0, NA N/A A0001 2
$591,227 $0
SE# 70 PREVENTION SERVICES
C 7/2011- 6/2012 N/A $91,874 $0 0. NA N/A A0001 4
SUBTOTAL SE# 70 $91,874 $0
SE# 80 PROBLEM GAMBLING PREVENTION
A 7/2011- 6/2012 N/A $29,000 $0 0. NA N/A
SUBTOTAL SE# 80 $29,000 $0
SE# 81 PROBLEM GAMBLING TREATMENT
A 7/2011- 6/2012 N/A $70,000 $0 0. NA N/A
SUBTOTAL SE# 81 $70,000 $0
TOTAL SECTION 1 $785,601 $0
TOTAL AUTHORIZED - FOR ALCOHOL AND DRUG SERVICES $785,601
TOTAL AUTHORIZED FOR THIS FAAA: $785,601
OREGON HEALTH AUTHORITY
Financial Assistance Award Amendment (FAAA)
CONTRACTOR: DESCHUTES COUNTY Contract#: 134309
DATE: 06/03/2011
REASON FOR FAAA (for information only):
REF#: 001
This Financial Assistance Award is for Alcohol or Other Drug Abuse
Prevention and Treatment and Problem Gambling Services within the
Governor's 2011-13 Balanced Budget (GBB), Amounts continue service levels
through June 30, 2012 that are approved on an ongoing basis as of March 1,
2011. Additional ongoing changes approved after that date will be
reflected in a subsequent Financial Assistance Award Amendment. Payment of
funds in this Financial Assistance Award is subject to Legislative approval
of the Oregon Health Authority's 2011-13 Budget, at the level proposed in
the Governor's Balanced Budget or higher.
The following special condition(s) apply to funds as indicated by the
special condition number in column 9. Each special condition set forth
below may be qualified by a full description in the Financial Assistance
Award.
A0001 1 Local Administration - Addictions Services (A&D 03) Financial
Assistance Associated with Addictions Services: The financial
assistance subject to this special condition is awarded for local
administration of services in the Addictions Services Program
Area, specifically for Problem Gambling Services. If County
terminates its obligation to include Problem Gambling services in
its CMHP, OHA shall have no obligation, after the termination,
pay or disburse to County financial assistance subject to this
special condition.
to
A0001 2 The exPenditure of financial assistance awarded subject to this
special condition must result in the delivery of A&D 66 services
to a minimum
services and
System on or
of 397 unduplicated individuals receiving outpatient
newly enrolled in the Client Process Monitoring
after the first day of the biennium. Cases enrolled
for less than 30 continuous days and without evidence of
treatment engagement in the clinical record do not count toward
the service delivery requirement. Individuals enrolled in A&D
66A-ITRS services do not count toward this service delivery
requirement with the exception of individuals who are
simultaneously participating in a synthetic opioid treatment
program. Under delivery of services subject to this financial
assistance may result in recovery of funds at the rate of $1,200
per individual.
A0001 3 The expenditure of financial assistance awarded subject to this
special condition must result in the delivery of A&D 66A - ITRS
services to at least 33 unduplicated individuals receiving
outpatient services and newly enrolled in the Client Process
Monitoring System dedicated provider number on or after the first
day of the biennium. Cases enrolled for less than 30 continuous
days and without evidence of treatment engagement in the clinical
record do not count toward the service delivery requirement.
Under delivery of services subject to this financial assistance
may result in recovery of funds at the rate of $3,000 per
individual.
A0001 4 The financial assistance awarded for A&D 70 will be disbursed in
substantially equal quarterly allotments.
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EXPLANATION OF FINANCIAL ASSISTANCE AWARD
The Financial Assistance Award set forth above and any Financial Assistance Award amendment
must be read in conjunction with this explanation for purposes of understanding the rights and
obligations of OHA and County reflected in the Financial Assistance Award.
1. Format and Abbreviations in Financial Assistance Award
a. Heading. The heading of the Financial Assistance Award consists of the following
information (1) County name, (2) the identification number of the Agreement of
which the Financial Assistance Award is a part, and (3) the date of the Financial
Assistance Award (which should be on or about the date of this Agreement). The
Financial Assistance Award is then broken down by Program Area, with all Services
in a particular Program Area that are awarded funds grouped together under the
Program Area heading. The Financial Assistance Award may also be labeled as
Section 1. This Section designation has no relevance to the original Financial
Assistance Award and should be ignored. The Financial Assistance Award also
contains a reference number which is used for administrative tracking purposes only
and has no legal significance.
b. Financial and Service Information. Each Service awarded funds is listed by its
Service number and name (full or abbreviated). The amount of financial assistance
awarded for the Service and certain other Service information is listed below the
Service number and name on one or more lines. Financial assistance awarded for a
particular Service may not be used to cover the costs of any other Service, except as
permitted by section 3.a of Exhibit E of this Agreement. The funds set forth on a
particular line will be disbursed in accordance with and are subject to the restrictions
set forth on that line. The awarded funds, disbursement information and restrictions
on a particular line are displayed in a columnar format as follows:
(i)
Column 1, Part: This column will contain the character A, B or C to indicate
the method by which OHA will disburse the awarded funds. The disbursement
method indicated in this column will usually be consistent with the
disbursement method set forth in the Service Description for the particular
Service. Occasionally, a disbursement method different than that set forth in the
Service Description is necessary. And if a disbursement method specified in
this column is different than the method set forth in the Service Description, the
method specified in this column shall control. This column only identifies the
disbursement method and is not relevant to determining whether County is
ultimately entitled to payment. Payment entitlement is determined in
accordance with the basis of payment set forth in the applicable Service
Description and any disbursements to County in excess of the payments County
is entitled to, as determined in accordance with the applicable basis of payment
and through the Agreement Settlement process, will be recovered by OHA in
accordance with the terms of this Agreement. The characters A, B and C
signify the following disbursement methods:
134309 Deschutes Count
OITA 11-13 GT0217-I1
Approved 5/9/2011 170 of 220
(a) The character A means OHA will disburse the awarded funds to County in
substantially equal monthly allotments during the period set forth in
column 2.
(b) The character B means the funds are disbursed and paid under another
agreement and are set forth in this Agreement for tracking purposes.
(c) The character C means OHA will disburse the awarded funds in the
manner specified in column 9.
(ii) Column 2, Start/End dates: These dates specify the period during which it is
expected that the Service or Service capacity, as applicable, will be delivered
utilizing the approved service funds set forth on that line of the Financial
Assistance Award. For purposes of disbursement method A (described above),
these dates also specify the period during which the approved service funds will
be disbursed to County
(iii) Column 3, CPMS Name: When a CPMS Name appears in this column the
approved service funds set forth on that line of the Financial Assistance Award
may only be expended on the delivery of the specified Service to the specified
individual. When the approved service funds are not intended for any particular
individual, an N/A designation will appear in this column. The CPMS name is
coded and consists of the following: the second, third, and fourth characters of
the person's last and first name followed by the person's birth date (year,
month, and day).
(iv) Column 4, Approved Service Funds: This is the amount awarded for delivery
of the Service and is OHA's maximum obligation during the period specified on
that line in support of the Services described on that line of the Financial
Assistance Award
(v) Column 5, Approved Start-up: if funds appear in this column they may only
be used to cover one-time expenses incurred in initiating, expanding or
upgrading the specified Service or for other special one-time expenses related to
the Service. Start-up funds may only be spent for the purposes specified in the
special conditions appearing in column 9. Start-up funds may only be expended
in accordance with Exhibit J of this Agreement and with start-up procedures
within the applicable Service Elements.
(vi) Column 6, Service Units: This is the amount of Service or Service capacity, as
applicable, that OHA anticipates County to deliver during the period specified
and utilizing the approved Service funds set forth on that line of the Financial
Assistance Award. The Service or Service capacity, as applicable, must be
delivered in relatively equal amounts over the course of the period specified on
that line of the Financial Assistance Award. This column will read zero if the
basis of payment set forth in the applicable Service Description is not tied to
actual delivery of Services or Service capacity. This column must be read in
conjunction with column 7.
134309 Deschutes County
OI -1A H-13 GT0217-I I
Approved 5/9/2011 171 of -220
(vii) Column 7, Unit Type: The unit type is the unit of measurement associated
with the Service units set forth in column 6. The unit types are expressed in
three character designations that have the following meanings:
(a) CSD: One CSD (or Client Service Day) is one day of Service or Service
capacity, as applicable, delivered to one individual or made available for
delivery to one individual, as applicable.
(b) N/A: N/A means unit type is not applicable to the particular line
(c) SLT: One SLT (or Slot) is the delivery or capacity to deliver, as
applicable, the Service to an individual during the entire period specified
in the corresponding line of the Financial Assistance Award.
(viii) Column 8, Exhibit B-2 Codes: The codes appearing in this column correspond
to the Specialized Service Requirement Codes for the Specialized Service
Requirements described in Exhibit B-2. If one or more Specialized Service
Requirement Code appears in this column, the Service must be delivered in
accordance with the Specialized Service Requirements when the Service is
delivered with approved service funds set forth on that line of the Financial
Assistance Award.
(ix) Column 9, Special Conditions: These are the special conditions, if any, that
must be complied with when providing the Service using approved service
funds set forth on that line of the Financial Assistance Award. For certain
Services, the special conditions specify the rate at which financial assistance
will be calculated for delivery of that Service or delivery of capacity for that
Service. The special conditions are identified by an alphanumeric code. A table
or tables listing the special conditions by alphanumeric code is included in the
Financial Assistance Award
2. Format and Abbreviations in Financial Assistance Award Amendments. The format
and abbreviations in a Financial Assistance Award amendment are the same as those used
in the initial Financial Assistance Award. If a Financial Assistance Award amendment
amends the financial and service information in the Financial Assistance Award, each
financial and service information line in the amendment will either amend an existing line
in the financial and service information of the Financial Assistance Award or constitute a
new line added to the financial and service information of the Financial Assistance Award.
A financial and service information line in a Financial Assistance Award amendment (an
"Amending Line") amends an existing line of the Financial Assistance Award (a
"Corresponding Line") if the line in the Financial Assistance Award amendment awards
funds for the same Service, specifies the same CPMS Name (if applicable), and specifies
the same Exhibit B-2 codes as an existing line (as previously amended, if at all) in the
Financial Assistance Award and specifies a date range falling within the date range
specified in that existing line (as previously amended, if at all). If an Amending Line has a
positive number in the approved service funds column, those funds are added to the
approved service funds of the Corresponding Line for the period specified in the Amending
Line. If an Amending Line has a negative number in the approved service funds column,
those funds are subtracted from the approved service funds of the Corresponding Line for
period specified in the Amending Line. If an Amending Line has a positive number in the
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/2011 172 of 220
service units column, those service units are added to the service units in the Corresponding
Line for the period specified in the Amending Line. If an Amending Line has a negative
number in the service units column, those units are subtracted from the service units in the
Corresponding Line for the period specified in the Amending Line. All Special Conditions
identified in a Corresponding Line apply to funds identified on an Amending Line (unless a
Special Condition or portion thereof on an Amending Line specifies a rate). If an
Amending Line contains a Special Condition or portion of a Special Condition that
specifies a rate, that Special Condition or portion thereof replaces, for the period specified
in the Amending Line, any Special Condition or portion thereof in the Corresponding Line
that specifies a rate. Ifa financial and service information line in a Financial Assistance
Award amendment is not an Amending Line, as described above, it is a new line added to
the Financial Assistance Award.
134309 Deschutes County
Oi-IA 11-13 GT0217-I 1
Approved 5/9/2011 173 of 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT D
SPECIAL TERMS AND CONDITIONS
1. County Expenditures on Addiction Services. In accordance with ORS 430.345 to
430.380 (the "Mental Health Alcoholism and Drug Services Account" also known as the
"Beer and Wine Tax Account"), County shall maintain its 2011-2012 financial contribution
to alcohol and other drug treatment and prevention services at an amount not less than that
for fiscal year 2010-201 1. Furthermore, and in accordance with the Beer and Wine Tax
Account, County shall maintain its 2012-2013 financial contribution to alcohol and other
drug treatment and prevention services at an amount not less than that for fiscal year 2011-
2012. OHA may waive all or part of the financial contribution requirement in
consideration of severe financial hardship or any other grounds permitted by law.
2. Limitations on use of Financial Assistance Awarded for Addiction Services. Financial
assistance awarded under this Agreement for Addiction Services (as reflected in the
Financial Assistance Award), may not be used:
a. To provide inpatient hospital services;
b. To make cash payments to intended recipients of health services;
c. To purchase or improve land, to purchase, construct or permanently improve (other
than minor remodeling) any building or other facility or to purchase major medical
equipment;
d. To satisfy any requirement for expenditure of non-federal funds as a condition for
receipt of federal funds (whether the federal funds are Federal Funds under this
Agreement or otherwise);
e. With respect to federal Substance Abuse Prevention and Treatment Block Grant
moneys only, to purchase Services from any person or entity other than a public or
non-profit entity; or
f. To carry out any program prohibited by section 256(b) of the Health Omnibus
Programs Extension Act of 1988 (codified at 42 USC 300ee-5).
134309 Deschutes County
OHA 11-13 GT0217-1 I
Approved 5/9/2011 174 of 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT E
GENERAL TERMS AND CONDITIONS
1. Disbursement and Recovery of Financial Assistance.
a. Disbursement Generally. Subject to the conditions precedent set forth below, OHA
shall disburse the financial assistance described in the Financial Assistance Award to
County in accordance with the procedures set forth below and, as applicable, in the
Service Descriptions and the Financial Assistance Award. Disbursement procedures
may vary by Service.
(1) Disbursement of Financial Assistance Awarded for Services in Financial
Assistance Award. As set forth in the Service Description for a particular
Service, OHA will generally disburse financial assistance that is described in
the Financial Assistance Award to County in monthly allotments in advance of
actual delivery of the Service.
(2) Disbursements Remain Subject to Recovery. All disbursements of financial
assistance under this Agreement, including disbursements made directly to
Providers, remain subject to recovery from County, in accordance with Section
1.c.(1), as an Underexpenditure, Overexpenditure or Misexpenditure.
b. Conditions Precedent to Disbursement. OHA's obligation to disburse financial
assistance to County under this Agreement is subject to satisfaction, with respect to
each disbursement, of each of the following conditions precedent:
(1) No County default as described in Section 6 of Exhibit F has occurred.
(2) County's representations and warranties set forth in Section 4 of Exhibit F are
true and correct on the date of disbursement with the same effect as though
made on the date of disbursement.
c. Recovery of Financial Assistance.
(1) Notice of Underexpenditure, Overexpenditure or Misexpenditure. If OHA
believes there has been an Underexpenditure or Overexpenditure (as defined in
Exhibit A) of moneys disbursed under this Agreement, OHA shall provide
County with written notice thereof and OHA and County shall engage in the
process described in Section 1.c.(2) below. If OHA believes there has been a
Misexpenditure (as defined in Exhibit A) of moneys disbursed to County under
this Agreement, OHA shall provide County with written notice thereof and
OHA and County shall engage in the process described in Section 1.c.(3) below.
(2) Recovery of Underexpenditure or Overexpenditure.
(a) County's Response. County shall have 90 calendar days from the
effective date of the notice of Underexpenditure or Overexpenditure to
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OHA 11-13 GT0217-1 I
Approved 5/9/2011 175 of 220
pay OHA in full or notify OHA that it wishes to engage in the appeals
process set forth in Section 1.c.(2)(b) below. If County fails to respond
within that 90 day time period, County shall promptly pay the noticed
Underexpenditure or Overexpenditure.
(b) Appeals Process. If County notifies OHA that it wishes to engage in the
appeals process, County and OHA shall engage in non-binding
discussions to give the County an opportunity to present reasons why it
believes that there is no Underexpenditure or Overexpenditure, or that the
amount of the Underexpenditure or Overexpenditure is different than the
amount identified by OHA, and to give OHA the opportunity to reconsider
its notice. County and OHA may negotiate an appropriate apportionment
of responsibility for the repayment of an Underexpenditure or
Overexpenditure. At County request, OHA will meet and negotiate with
County in good faith concerning appropriate apportionment of
responsibility for repayment of an Underexpenditure or Overexpenditure.
In determining an appropriate apportionment of responsibility, County and
OHA may consider any relevant factors. An example ofa relevant factor
is the extent to which either party contributed to an interpretation of a
statute, regulation or rule prior to the expenditure that was officially
reinterpreted after the expenditure. If OHA and County reach agreement
on the amount owed to OHA, County shall promptly repay that amount to
OHA by issuing payment to OHA or by directing OHA to withhold future
payments pursuant to Section 1.(c)(2)(c) below. If OHA and County
continue to disagree as to whether there has been an Underexpenditure or
Overexpenditure or as to the amount owed, the parties may agree to
consider further appropriate dispute resolution processes, including,
subject to Department of Justice and County Counsel approval,
arbitration.
(c) Recovery From Future Payments. To the extent that OHA is entitled to
recover an Underexpenditure or Overexpenditure pursuant to Section
1.c.(2), OHA may recover the Underexpenditure or Overexpenditure by
offsetting the amount thereof against future amounts owed to County by
OHA, including, but not limited to, any amount owed to County by OHA
under any other contract or agreement between County and OHA, present
or future. OHA shall provide County written notice of its intent to recover
the amount of the Underexpenditure or Overexpenditure from amounts
owed County by OHA as set forth in this Section, and shall identify the
amounts owed by OHA which OHA intends to offset, (including the
contracts or agreements, if any, under which the amounts owed arose and
from those OHA wishes to deduct payments from). County shall then
have 14 calendar days from the date of OHA's notice in which to request
the deduction be made from other amounts owed to County by OHA and
identified by County. OHA shall comply with County's request for
alternate offset. In the event that OHA and County are unable to agree on
which specific amounts, owed to County by OHA, OHA may offset in
order to recover the amount of the Underexpenditure or Overexpenditure,
then OHA may select the particular contracts or agreements between OHA
and County and amounts from which it will recover the amount of the
134309 Deschutes County
OHA 11-13 GT0217-I I
Approved 5/9/2011 176 or 220
(3)
Underexpenditure or Overexpenditure, after providing notice to the
County and within the following limitations: OHA shall first look to
amounts owed to County (but unpaid) under this Agreement. if that
amount is insufficient, then OHA may look to any other amounts currently
owing or owed in the future to County by OHA. In no case, without the
prior consent of County, shall OHA deduct from any one payment due to
County under the contract or agreement from which OHA is offsetting
funds an amount in excess of twenty-five percent (25%) of that payment.
OHA may look to as many future payments as necessary in order to fully
recover the amount of the Underexpenditure or Overexpenditure.
Recovery of Misexpenditure.
(a) County's Response. From the effective date of the notice of
Misexpenditure, County shall have the lesser of (1) 60 calendar days, or
(2) if a Misexpenditure relates to a federal government request for
reimbursement, 30 calendar days fewer than the number of days (if any)
OHA has to appeal a final written decision from the federal government,
to either:
i. Make a payment to OHA in the full amount of the noticed
Misexpenditure identified by OHA; or
ii. Notify OHA that County wishes to repay the amount of the noticed
Misexpenditure from future payments pursuant to Section
1.c.(3)(c). below; or
Notify OHA that it wishes to engage in the applicable appeal
process set forth in Section 1.c.(3)(b). below.
If County fails to respond within the time required by this Section, ORA
may recover the amount of the noticed Misexpenditure from future
payments as set forth in Section 1.c.(3)(b). below.
(b) Appeal Process. If County notifies OHA that it wishes to engage in an
appeal process with respect to a noticed Misexpenditure, the parties shall
comply with the following procedures, as applicable:
i. Appeal from OHA-Identified Misexpenditure. If OHA's notice of
Misexpenditure is based on a Misexpenditure solely of the type
described in Section 21(b) or (c) of Exhibit A, County and OHA
shall engage in the process described in this Section to resolve a
dispute regarding the noticed Misexpenditure. First, County and
OHA shalt engage in non-binding discussions to give the County an
opportunity to present reasons why it believes that there is, in fact,
no Misexpenditure or that the amount of the Misexpenditure is
different than the amount identified by OHA, and to give OHA the
opportunity to reconsider its notice. County and OHA may negotiate
an appropriate apportionment of responsibility for the repayment of
a Misexpenditure. At County request, OHA will meet and negotiate
with County in good faith concerning appropriate apportionment of
responsibility for repayment of a Misexpenditure. In determining an
appropriate apportionment of responsibility, County and OHA may
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OIIA 11-13 G1.0217-11
Approved 5/9/2011 177 of 220
134309 Deschutes County
OHA 11-13 GT0217-11
consider any relevant factors. An example of a relevant factor is the
extent to which either party contributed to an interpretation of a
statute, regulation or rule prior to the expenditure that was officially
reinterpreted after the expenditure. If OHA and County reach
agreement on the amount owed to the OHA County shall promptly
repay that amount to OHA by issuing payment to OHA or by
directing OHA to withhold future payments pursuant to Section
1.c.(3)(c) below. If OHA and County continue to disagree as to
whether there has been a Misexpenditure or as to the amount owed,
the parties may agree to consider further appropriate dispute
resolution processes, including, subject to Department of Justice and
County Counsel approval, arbitration.
ii. Appeal from Federal -Identified Misexpenditure.
A. If OHA's notice of Misexpenditure is based on a
Misexpenditure of the type described in Section 21(a) of
Exhibit A and the relevant federal agency provides a process
either by statute or administrative rule to appeal the
determination of improper use of federal funds, the notice of
disallowance or other federal identification of improper use of
funds, and if the disallowance is not based on a federal or state
court judgment founded in allegations of Medicaid fraud or
abuse, then County may, prior to 30 days prior to the
applicable federal appeals deadline, request that OHA appeal
the determination of improper use, notice of disallowance or
other federal identification of improper use of funds in
accordance with the process established or adopted by the
federal agency. If County so requests that OHA appeal the
determination of improper use of federal funds, federal notice
of disallowance or other federal identification of improper use
of funds, the amount in controversy shall, at the option of
County, be retained by the County or returned to OHA pending
the final federal decision resulting from the initial appeal. If
the County does request, prior to the deadline set forth above,
that OHA appeal, OHA shall appeal the determination of
improper use, notice of disallowance or other federal
identification of improper use of funds in accordance with the
established process and shall pursue the appeal until a decision
is issued by the Departmental Grant Appeals Board of the
Oregon Health Authority (the "Grant Appeals Board")
pursuant to the process for appeal set forth in 45 C.F.R.
Subtitle A, Part 16, or an equivalent decision is issued under
the appeal process established or adopted by the federal
agency. County and OHA shall cooperate with each other in
pursuing the appeal. If the Grant Appeals Board or its
equivalent denies the appeal then either County, OHA, or both
may, in their discretion, pursue further appeals. Regardless of
any further appeals, within 90 days of the date the federal
decision resulting from the initial appeal is final, County shall
Approved 5/9/2011 178 of 220
134309 Deschutes County
OIIA I I-13GT0217-11
repay to OHA the amount of the noticed Misexpenditure
(reduced, if at all, as a result of the appeal) by issuing payment
to OHA or by directing OHA to withhold future payments
pursuant to Section l .c.(3)(c) below. To the extent that County
retained any of the amount in controversy while the appeal was
pending, the County shall pay to OHA the interest, if any,
charged by the federal government on such amount.
B. If the relevant federal agency does not provide a process either
by statute or administrative rule to appeal the determination of
improper use of federal funds, the notice of disallowance or
other federal identification of improper use of funds or County
does not request that OHA pursue an appeal 30 days prior to
the applicable federal appeals deadline, and if OHA does not
appeal, then within 90 days of the date the federal
determination of improper use of federal funds, the federal
notice of disallowance or other federal identification of
improper use of funds is final County shall repay to OHA the
amount of the noticed Misexpenditure by issuing a payment to
OHA or by directing OHA to withhold future payments
pursuant to Section l .c.(3)(c) below.
C. If County does not request that OHA pursue an appeal of the
determination of improper use of federal funds, the notice of
disallowance or other federal identification of improper use of
funds, prior to 30 days prior to the applicable federal appeals
deadline but OHA nevertheless appeals. County shall repay to
OHA the amount of the noticed Misexpenditure (reduced, if at
all, as a result of the appeal), within 90 days of the date the
federal decision resulting from the appeal is final, by issuing
payment to OHA or by directing OHA to withhold future
payments pursuant to Section l .c.(3)(c). below.
D. Notwithstanding Section 1.c.(3)(a)(i) through iii., if the
Misexpenditure was expressly authorized by a OHA rule or an
OHA writing that applied when the expenditure was made, but
was prohibited by federal statutes or regulations that applied
when the expenditure was made, County will not be
responsible for repaying the amount of the misexpenditure to
OHA, provided that:
(1)
Where post -expenditure official reinterpretation of
federal statutes or regulations results in a Misexpenditure,
County and OHA will meet and negotiate in good faith an
appropriate apportionment of responsibility between them
for repayment of the Misexpenditure.
(ii) For purposes of this Section, an OHA writing must
interpret this Agreement or an OHA rule and be signed
by the Director of OHA or by the Assistant Director of
Addictions and Mental Health Services Division.
Approved 5/9/201 I 179 of 220
OHA shall designate an alternate officer in the event the
Addictions and Mental Health Services Division is
abolished. Upon County request, OHA shall notify
County of the names of the individual officers listed
above. OHA shall send OHA writings described in this
paragraph to County by mail and email and to CMHP
directors by email.
(iii) The writing must be in response to a request from County
for expenditure authorization, or a statement intended to
provide official guidance to County or counties generally
for making expenditures under this Agreement. The
writing must not be contrary to this Agreement or
contrary to law or other applicable authority that is
clearly established at the time of the writing.
(iv) If OHA writing is in response to a request from
County for expenditure authorization, the request must be
in writing and signed by the director of a County
department with authority to make such a request or by
the County Counsel. It must identify the supporting data,
provisions of this Agreement and provisions of applicable
law relevant to determining if the expenditure should be
authorized.
(v) An OHA writing expires on the date stated in the writing,
or if no expiration date is stated, six years from the date
of the writing. An expired OHA writing continues to
apply to County expenditures that were made in
compliance with the writing and during the term of the
writing.
(vi) OHA may revoke or revise an OHA writing at any time if
it determines in its sole discretion that the writing allowed
expenditure in violation of this Agreement or law or any
other applicable authority.
(vii) OHA rule does not authorize an expenditure that this
Agreement prohibits.
(c) Recovery From Future Payments. To the extent that OHA is entitled to
recover a Misexpenditure pursuant to Section 1.c.(3)(b)(i) and (ii)., OHA
may recover the Misexpenditure by offsetting the amount thereof against
future amounts owed to County by OHA, including, but not limited to,
any amount owed to County by OHA under this Agreement or any amount
owed to County by OHA under any other contract or agreement between
County and OHA, present or future. OHA shall provide County written
notice of its intent to recover the amount of the Misexpenditure from
amounts owed County by OHA as set forth in this Section, and shall
identify the amounts owed by OHA which OHA intends to offset
(including the contracts or agreements, if any, under which the amounts
owed arose and from those OHA wishes to deduct payments from).
134309 Deschutes County
OHA 11-13 GT0217-11
Approved 5/9/2011 180 or220
County shall then have 14 calendar days from the date of OHA's notice in
which to request the deduction be made from other amounts owed to
County by OHA and identified by County. OHA shall comply with
County's request for alternate offset. In the event that OHA and County
are unable to agree on which specific amounts, owed to County by OHA,
OHA may offset in order to recover the amount of the Misexpenditure,
then the OHA may select the particular contracts or agreements between
OHA and County and amounts from which it will recover the amount of
the Misexpenditure, after providing notice to the County, and within the
following limitations: OHA shall first look to amounts owed to County
(but unpaid) under this Agreement. If that amount is insufficient, then
OHA may look to any other amounts currently owing or owed in the
future to County by OHA. In no case, without the prior consent of
County, shall OHA deduct from any one payment due County under the
contract or agreement from which OHA is offsetting funds an amount in
excess of twenty-five percent (25%) of that payment. OHA may look to
as many future payments as necessary in order to fully recover the amount
of the Misexpenditure.
(4) Additional Provisions related to parties rights/obligations with respect to
Underexpenditures, Overexpenditures and Misexpenditures.
a. County shall cooperate with OHA in the Agreement Settlement process.
b. OHA's right to recover Underexpenditures, Overexpenditures and
Misexpenditures from County under this Agreement is not subject to or
conditioned on County's recovery of any money from any other entity.
c. If the exercise ofOHA's right to offset under this provision requires the
County to complete a re -budgeting process, nothing in this provision shall
be construed to prevent the County from fully complying with its
budgeting procedures and obligations, or from implementing decisions
resulting from those procedures and obligations.
d. Nothing in this provision shall be construed as a requirement or agreement
by the County to negotiate and execute any future contract with OHA.
e. Nothing in this Section shall be construed as a waiver by either party of
any process or remedy that might otherwise be available.
2. Use of Financial Assistance. County shall use the financial assistance disbursed to
County under this Agreement solely to cover actual Allowable Costs reasonably and
necessarily incurred to deliver Services during the term of this Agreement.
3. Award Adjustments
a. County may use funds awarded in a Program Area to cover actual Allowable Costs
reasonably and necessarily incurred to deliver Services in that Program Area, from
the effective date of this Agreement through the termination or expiration of this
Agreement, in addition to the financial assistance provided to County under this
Agreement expressly for those Services, up to 10 percent of the aggregate financial
assistance awarded to County at the time the use occurs (as such award is reflected in
the Financial Assistance Award without giving effect to any prior adjustments under
this Section 3 and other than from Federal Funds) for other Services in that Program
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OI -IA 11-13 GT0217-I1
Approved 5/9/2011 181 of220
Area (other than financial assistance provided to County for MHS 30, MHS 26, MHS
27, MHS 201, MHS 37 -Start -Up, A&D 71, A&D 61, A&D 60 -Start -Up, A&D 80,
A&D 81 and A&D 82 which is not subject to this 10 percent use adjustment). If
County uses financial assistance described in the Financial Assistance Award in
reliance on this Section 3.a, County shall promptly notify in writing of such use.
b. Financial Assistance disbursed to County under this Agreement (other than financial
assistance disbursed to County for A&D 81 and A&D 82) that County would be
entitled to retain if used prior to the termination or expiration of this Agreement (as
calculated in accordance with the methodologies set forth in the applicable Service
Descriptions), may be retained by County even if not used prior to the termination or
expiration of this Agreement provided that other provisions of this Agreement do not
require the financial assistance to be used by County prior to termination or
expiration of this Agreement and provided further that County uses the financial
assistance solely to deliver future Services in the specified Program Area.
4. Appointment of County Financial Assistance Administrator. County shall, by a duly
adopted order or resolution of the County Board of Commissioners or County Court
("Authorizing Resolution"), appoint a County officer to administer this Agreement
("County Financial Assistance Administrator"). The Authorizing Resolution shall
authorize the County Financial Assistance Administrator to amend the Financial Assistance
Award on behalf of County, by execution and delivery of amendments to this Agreement in
the name of County in hard copy, or electronically. The Authorizing Resolution may
authorize the County Financial Assistance Administrator to authorize others to take one or
more of the foregoing actions on behalf of County. Unless the Authorizing Resolution
clearly vests such authority in the County Financial Assistance Administrator, OHA will
not treat the County Financial Assistance Administrator as authorized to amend, on behalf
of County, any part of this Agreement other than the Financial Assistance Award absent
further authorization from the County Board of Commissioners or County Court. County
shall furnish OHA with a copy of the Authorizing Resolution. County shall immediately
notify OHA if the County Board of Commissioners or County Court revokes or alters the
Authorizing Resolution. if County chooses to name a new County Financial Assistance
Administrator, County shall adopt a new Authorizing Resolution and promptly furnish a
copy thereof to OHA.
5. Amendments Proposed by OHA.
a. Amendments of Financial Assistance Award. County shall review all proposed
amendments to the Financial Assistance Award prepared and presented to County by
OHA in accordance with this Section 5.a. promptly after County's receipt thereof.
Amendments to the Financial Assistance Award will be presented to County in
electronic form. OHA may withdraw a proposed amendment by and effective upon
written notice to County.. If not sooner accepted or rejected by County, or withdrawn
by OHA, a proposed amendment shall be deemed rejected by County 60 days after
County's receipt thereof and OHA's offer to amend the Financial Assistance Award
shall be automatically revoked. If County chooses to accept a proposed amendment
presented in electronic form, County shall return the proposed amendment to OHA
signed by the County Financial Assistance Administrator. Upon OHA's actual
physical receipt and signature of a proposed amendment signed by the County
Financial Assistance Administrator but otherwise unaltered, the proposed amendment
shall be considered accepted by the parties and the Financial Assistance Award as
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OHA 11-13 GT0217-11
Approved 5/9/2011 182 of 220
amended by the proposed amendment, shall become the Financial Assistance Award
under this Agreement. If County returns a proposed amendment altered in any way
(other than by signature of the County Financial Assistance Administrator), OHA
may, in its discretion, accept the proposed amendment as altered by County but only
if the County Financial Assistance Administrator has initialed each alteration. A
proposed amendment altered by County and returned to OHA shall be considered
accepted by OHA on the date OHA initials each alteration and on that date the
Financial Assistance Award, as amended by the proposed amendment (as altered),
shall become the Financial Assistance Award
b. Other Amendments. County shall review all proposed amendments to this
Agreement prepared and presented to County by OHA, other than those described in
Section 5.a. of this Exhibit, promptly after County's receipt thereof. If County does
not accept a proposed amendment within 60 days of County's receipt thereof, County
shall be deemed to have rejected the proposed amendment and the offer to amend the
Agreement, as set forth in the proposed amendment, shall be automatically revoked.
If County chooses to accept the proposed amendment, County shall return the
proposed amendment to OHA signed by a duly authorized County official. Upon
OHA's actual physical receipt and signature of a proposed amendment signed by a
duly authorized County official but otherwise unaltered, the proposed amendment
shall be considered accepted by the parties and this Agreement shall be considered
amended as set forth in the accepted amendment. If County returns a proposed
amendment altered in any way (other than by signature of a duly authorized County
official), OHA may, in its discretion, accept the proposed amendment as altered by
County but only if a duly authorized County official has initialed each alternation. A
proposed amendment altered by County and returned to OHA shall be considered
accepted by OHA on the date OHA initials each alteration and on that date this
Agreement shall be considered amended as set forth in the accepted amendment.
6. Provider Contracts. Except when the Service Description expressly requires the Service
or a portion thereof to be delivered by County directly and subject to Section 7 of this
Exhibit E, County may use financial assistance provided under this Agreement for a
particular Service to purchase that Service, or a portion thereof, from a third person or
entity (a "Provider") through a contract (a "Provider Contract"). Subject to Section 7 of
this Exhibit E, County may permit a Provider to purchase the Service, or a portion thereof,
from another person or entity under a subcontract and such subcontractors shall also be
considered Providers for purposes of this Agreement and the subcontracts shall be
considered Provider Contracts under this Agreement. County shall not permit any person
or entity to be a Provider unless the person or entity holds all licenses, certificates,
authorizations and other approvals required by applicable law to deliver the Service.
Except for MHS 20 emergency services, if County purchases a Service, or portion thereof,
from a Provider, the Provider Contract must be in writing and contain each of the
provisions set forth on Exhibit H, in substantially the form set forth therein, in addition to
any other provisions that must be included to comply with applicable law, that must be
included in a Provider Contract under the terms of this Agreement or that are necessary to
implement Service delivery in accordance with the applicable Service Descriptions,
Specialized Service Requirements and special conditions. County shall maintain an
originally executed copy of each Provider Contract at its office and shall furnish a copy of
any Provider Contract to OHA upon request. County may purchase MHS 20 emergency
services according to County's policies and pay for these services upon receipt of an
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Approved 5/9/2011 183 of 220
itemized invoice, purchase order, or other proper billing instrument evidencing the services
rendered, or by a Provider Contract containing the provisions set forth in Exhibit H, if
required by County policy.
7. Provider Monitoring. County shall monitor each Provider's delivery of Services and
promptly report to OHA when County identifies a deficiency in a Provider's delivery of a
Service or in a Provider's compliance with the Provider Contract between the Provider and
County. County shall promptly take all necessary action to remedy any identified
deficiency. County shall also monitor the fiscal performance of each Provider and shall
take all lawful management and legal action necessary to pursue this responsibility. In the
event of a deficiency in a Provider's delivery of a Service or in a Provider's compliance
with the Provider Contract between the Provider and County, nothing in this Agreement
shall limit or qualify any right or authority OHA has under state or federal law to take
action directly against the Provider.
8. Alternative Formats and Translation of Written Materials, Interpreter Services. In
connection with the delivery of Services, County shall:
a. Make available to a Client, without charge to the Client, upon the Client's or OHA's
request, any and all written materials in alternate, if appropriate, formats as required
by OHA's administrative rules or by OHA's written policies made available to
County.
b. Make available to a Client, without charge to the Client, upon the Client's or OHA's
request, any and all written materials in the prevalent non-English languages in the
area served by County's CMHP.
c. Make available to a Client, without charge to the Client, upon the Client's or OHA's
request, oral interpretation services in all non-English languages in the area served by
County's CMHP.
d. Make available to Clients with hearing impairment, without charge to the Client,
upon the Client's or OHA's request, sign language interpretation services and
telephone communications access services.
For purposes of the foregoing, "written materials" includes, without limitation, all written
materials created or delivered in connection with the Services and all Provider Contracts
related to this Agreement.
9. Reporting Requirements. If County delivers a Service directly, County shall prepare and
furnish the following information to OHA when that Service is delivered:
a. Client, Service and financial information as specified in the Service Description.
b. All additional information and reports that OHA reasonably requests.
10. Operation of CMHP. County shall operate or contract for the operation of a CMHP
during the term of this Agreement. If County uses funds provided under this Agreement
for a particular Service, County shall include that Service in its CMHP from the date it
begins using the funds for that Service until the earlier of (a) termination or expiration of
this Agreement, (b) termination by OHA of OHA's obligation to provide financial
assistance for that Service in accordance with Section 8 of Exhibit F or (c) termination by
the County, in accordance with Section 8 of Exhibit F, of County's obligation to include in
its CMHP a Program Area that includes that Service.
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11. OHA Reports.
a. To the extent resources are available to OHA to prepare and deliver the information,
OHA shall, during the term of this Agreement, provide County with the following
reports:
(1) Summary reports to County and County's Providers from CPMS data and other
Client data reported to OHA under this Agreement; and
(2) Monthly reports to County that detail disbursement of financial assistance under
the Financial Assistance Award for the delivery of Services.
b. OHA shall prepare and send to each Provider to whom OHA makes direct payments
on behalf of County under this Agreement during a calendar year, an IRS Form 1099
for that year specifying the total payments made by OHA to that Provider.
12. Technical Assistance. During the term of this Agreement, OHA shall provide technical
assistance to County in the delivery of Services to the extent resources are available to
OHA for this purpose. If the provision of technical assistance to the County concerns a
Provider, OHA may require, as a condition to providing the assistance, that County take all
action with respect to the Provider reasonably necessary to facilitate the technical
assistance.
13. Payment of Certain Expenses. if OHA requests that an employee of County or a
Provider or a citizen of County attend OHA training or an OHA conference or business
meeting and County has obligated itself to reimburse the individual for travel expenses
incurred by the individual in attending the training or conference, OHA may pay those
travel expenses on behalf of County but only at the rates and in accordance with the
reimbursement procedures set forth in the Oregon Accounting Manual
(www.oregon.gov/DAS/SCD/SARS/policies/oam/ 10.35.00.PR.pdf?ga=t) as of the date the
expense was incurred and only to the extent that OHA determines funds are available for
such reimbursement.
14. Effect of Amendments Reducing Financial Assistance. If County and OHA amend this
Agreement to reduce the amount of financial assistance awarded for a particular Service,
County is not required by this Agreement to utilize other County funds to replace the funds
no longer received under this Agreement as a result of the amendment and County may,
from and after the date of the amendment, reduce the quantity of that Service included in
its CMHP commensurate with the amount of the reduction in financial assistance awarded
for that Service. Nothing in the preceding sentence shall affect County's obligations under
this Agreement with respect to financial assistance actually disbursed by OHA under this
Agreement or with respect to Services actually delivered.
15. Resolution of Disputes over Additional Financial Assistance Owed County After
Termination or Expiration. If, after termination or expiration of this Agreement,
County believes that OHA disbursements of financial assistance under this Agreement for a
particular Service are Tess than the amount of financial assistance that OHA is obligated to
provide to County under this Agreement for that Service, as determined in accordance with
the applicable financial assistance calculation methodology, County shall provide OHA
with written notice thereof. OHA shall have 90 calendar days from the effective date of
County's notice to pay County in full or notify County that it wishes to engage in a dispute
resolution process. If OHA notifies County that it wishes to engage in a dispute resolution
process, County and OHA's Deputy Director for Addictions and Mental Health Services
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Division shall engage in non-binding discussion to give OHA an opportunity to present
reasons why it believes that it does not owe County any additional financial assistance or
that the amount owed is different than the amount identified by County in its notices, and
to give County the opportunity to reconsider its notice. If OHA and County reach
agreement on the additional amount owed to County, OHA shall promptly pay that amount
to County. if OHA and County continue to disagree as to the amount owed, the parties
may agree to consider further appropriate dispute resolution processes, including, subject to
Department of Justice and County Counsel approval, binding arbitration. Nothing in this
Section shall preclude the County from raising underpayment concerns at any time prior to
termination or expiration of this Agreement under Section 16 below.
16. Alternative Dispute Resolution. The parties should attempt in good faith to resolve any
dispute arising out of this agreement. This may be done at any management level,
including at a level higher than persons directly responsible for administration of the
agreement. In addition, the parties may agree to utilize a jointly selected mediator or
arbitrator (for non-binding arbitration) to resolve the dispute short of litigation.
17. Nothing in this Agreement shall cause or require County or OHA to act in violation of state
or federal constitutions, statutes, regulations or rules. The parties intend this limitation to
apply in addition to any other limitation in this Agreement, including limitations in Section
1 of this Exhibit E.
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2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT F
STANDARD TERMS AND CONDITIONS
1. Governing Law, Consent to Jurisdiction. This Agreement shall be governed by and
construed in accordance with the laws of the State of Oregon without regard to principles
of conflicts of law. Any claim, action, suit or proceeding (collectively, "Claim") between
the parties that arise from or relate to this Agreement shall be brought and conducted
solely and exclusively within a circuit court in the State of Oregon of proper jurisdiction.
THE PARTIES, BY EXECUTION OF THIS AGREEMENT, HEREBY CONSENT TO
THE IN PERSONAM JURISDICTION OF SAID COURTS. Except as provided in this
section, neither party waives any form of defense or immunity, whether sovereign
immunity, governmental immunity, immunity based on the eleventh amendment to the
Constitution of the United States or otherwise, from any Claim or from the jurisdiction of
any court. The parties acknowledge that this is a binding and enforceable Agreement and,
to the extent permitted by law, expressly waive any defense alleging that either party
does not have the right to seek judicial enforcement of this Agreement.
2. Compliance with Law. Both parties shall comply with laws, regulations and executive
orders to which they are subject and which are applicable to the Agreement or to the
delivery of Services. Without limiting the generality of the foregoing. Both parties
expressly agree to comply with the following laws, regulations and executive orders to
the extent they are applicable to the Agreement: (a) all applicable requirements of state
civil rights and rehabilitation statutes, rules and regulations; (b) all state laws governing
operation of Community Mental Health Programs, including without limitation, all
administrative rules adopted by OHA related to Community Mental Health Programs, as
may be revised; (c) all state laws requiring reporting of Client abuse; (d) ORS 659A.400
to 659A.409, ORS 659A.145 and all regulations and administrative rules established
pursuant to those laws in the construction, remodeling, maintenance and operation of any
structures and facilities, and in the conduct of all programs, services and training
associated with the delivery of Services. 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. All employers, including County and OHA
that employ subject workers who provide Services in the State of Oregon shall comply
with ORS 656.017 and provide the required Workers' Compensation coverage, unless
such employers are exempt under ORS 656.126.
3. Independent Contractors. The parties agree and acknowledge that their relationship is
that of independent contracting parties and that County is not an officer, employee, or
agent of the State of Oregon as those terms are used in ORS 30.265 or otherwise.
4. Representations and Warranties.
a. County represents and warrants as follows:
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(1)
Organization and Authority. County is a political subdivision of the State of
Oregon duly organized and validly existing under the laws of the State of Oregon.
County has full power, authority and legal right to make this Agreement and to
incur and perform its obligations hereunder.
(2) Due Authorization. The making and performance by County of this Agreement
(a) have been duly authorized by all necessary action by County and (b) do not
and will not violate any provision of any applicable law, rule, regulation, or order
of any court, regulatory commission, board, or other administrative agency or any
provision of County's charter or other organizational document and (c) do not and
will not result in the breach of, or constitute a default or require any consent under
any other agreement or instrument to which County is a party or by which County
may be bound or affected. No authorization, consent, license, approval of, filing
or registration with or notification to any governmental body or regulatory or
supervisory authority is required for the execution, delivery or performance by
County of this Agreement.
Binding Obligation. This Agreement has been duly executed and delivered by
County and constitutes a legal, valid and binding obligation of County,
enforceable in accordance with its terms subject to the laws of bankruptcy,
insolvency, or other similar laws affecting the enforcement of creditors' rights
generally.
(4) Services. To the extent services are performed by County, the delivery of each
Service will comply with the terms and conditions of this Agreement and meet the
standards for such Service as set forth herein, including but not limited to, any
terms, conditions, standards and requirements set forth in the Financial Assistance
Award and applicable Service Description.
b. OHA represents and warrants as follows:
(3)
(1)
Organization and Authority. OHA has full power, authority and legal right to
make this Agreement and to incur and perform its obligations hereunder.
(2) Due Authorization. The making and performance by OHA of this Agreement (a)
have been duly authorized by all necessary action by OHA and (b) do not and will
not violate any provision of any applicable law, rule, regulation, or order of any
court, regulatory commission, board, or other administrative agency and (c) do
not and will not result in the breach of, or constitute a default or require any
consent under any other agreement or instrument to which OHA is a party or by
which OHA may be bound or affected. No authorization, consent, license,
approval of, filing or registration with or notification to any governmental body or
regulatory or supervisory authority is required for the execution, delivery or
performance by OHA of this Agreement, other than approval by Department of
Justice if required by law.
Binding Obligation. This Agreement has been duly executed and delivered by
OHA and constitutes a legal, valid and binding obligation of OHA, enforceable in
accordance with its terms subject to the laws of bankruptcy, insolvency, or other
similar laws affecting the enforcement of creditors' rights generally.
c. Warranties Cumulative. The warranties set forth above are in addition to, and not in
lieu of, any other warranties provided.
(3)
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5. Ownership of Intellectual Property.
a. Except as otherwise expressly provided herein, or as otherwise required by state or
federal law, OHA will not own the right, title and interest in any intellectual property
created or delivered by County or a Provider in connection with the Services. With
respect to that portion of the intellectual property that the County owns, County
grants to OHA a perpetual, worldwide, non-exclusive, royalty -free and irrevocable
license, subject to any provisions in the Agreement that restrict or prohibit
dissemination or disclosure of information, to (1) use, reproduce, prepare derivative
works based upon, distribute copies of, perform and display the intellectual property,
(2) authorize third parties to exercise the rights set forth in Section 5.a.(1) on OHA's
behalf, and (3) sublicense to third parties the rights set forth in Section 5.a.(1).
b. If state or federal law requires that OHA or County grant to the United States a
license to any intellectual property, or if state or federal law requires that OHA or the
United States own the intellectual property, then County shall execute such further
documents and instruments as OHA may reasonably request in order to make any
such grant or to assign ownership in the intellectual property to the United States or
OHA. To the extent that OHA becomes the owner of any intellectual property
created or delivered by County in connection with the Services, OHA will grant a
perpetual, worldwide, non-exclusive, royalty -free and irrevocable license, subject to
any provisions in the Agreement that restrict or prohibit dissemination or disclosure
of information, to County to use, copy, distribute, display, build upon and improve
the intellectual property.
c. County shall include in its Provider Contracts terns and conditions necessary to
require that Providers execute such further documents and instruments as OHA may
reasonably request in order to make any grant of license or assignment of ownership
that may be required by federal or state law.
6. County Default. County shall be in default under this Agreement upon the occurrence
of any of the following events:
a. County fails to perform, observe or discharge any of its covenants, agreements or
obligations set forth herein.
b. Any representation, warranty or statement made by County herein or in any
documents or reports made in connection herewith or relied upon by OHA to measure
the delivery of Services, the use or expenditure of financial assistance or the
performance by County is untrue in any material respect when made;
c. County (1) applies for or consents to the appointment of, or taking of possession by, a
receiver, custodian, trustee, or liquidator of itself or all of its property, (2) admits in
writing its inability, or is generally unable, to pay its debts as they become due, (3)
makes a general assignment for the benefit of its creditors, (4) is adjudicated a
bankrupt or insolvent, (5) commences a voluntary case under the Federal Bankruptcy
Code (as now or hereafter in effect), (6) files a petition seeking to take advantage of
any other law relating to bankruptcy, insolvency, reorganization, winding -up, or
composition or adjustment of debts, (7) fails to controvert in a timely and appropriate
manner, or acquiesces in writing to, any petition filed against it in an involuntary case
under the Bankruptcy Code, or (8) takes any action for the purpose of effecting any of
the foregoing; or
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d. A proceeding or case is commenced, without the application or consent of County, in
any court of competent jurisdiction, seeking (1) the liquidation, dissolution or
winding -up, or the composition or readjustment of debts, of County, (2) the
appointment of a trustee, receiver, custodian, liquidator, or the like of County or of all
or any substantial part of its assets, or (3) similar relief in respect to County under any
law relating to bankruptcy, insolvency, reorganization, winding -up, or composition or
adjustment of debts, and such proceeding or case continues undismissed, or an order,
judgment, or decree approving or ordering any of the foregoing is entered and
continues unstayed and in effect for a period of sixty consecutive days, or an order for
relief against County is entered in an involuntary case under the Federal Bankruptcy
Code (as now or hereafter in effect).
e. The delivery of any Service fails to comply with the terms and conditions of this
Agreement or fails to meet the standards for Service as set forth herein, including but
not limited to, any terms, condition, standards and requirements set forth in the
Financial Assistance Award and applicable Service Description.
7. OHA Default. OHA shall be in default under this Agreement upon the occurrence of
any of the following events:
a. OHA fails to perforin, observe or discharge any of its covenants, agreements, or
obligations set forth herein; or
b. Any representation. warranty or statement made by OHA herein or in any documents
or reports made in connection herewith or relied upon by County to measure
performance by OHA is untrue in any material respect when made.
8. Termination.
a. County Termination. County may terminate this Agreement in its entirety or may
terminate its obligation to include a particular Program Area in its CMHP:
(1)
For its convenience, upon at least three calendar months advance written notice
to OHA, with the termination effective as of the first day of the month
following the notice period;
(2) Upon 45 days advance written notice to OHA, if County does not obtain
funding, appropriations and other expenditure authorizations from County's
governing body, federal, state or other sources sufficient to permit County to
satisfy its performance obligations under this Agreement, as determined by
County in the reasonable exercise of its administrative discretion.
Upon 30 days advance written notice to OHA, if OHA is in default under this
Agreement and such default remains uncured at the end of said 30 day period or
such longer period, if any, as County may specify in the notice; or
(4) Immediately upon written notice to OHA, if Oregon statutes or federal laws,
regulations or guidelines are modified, changed or interpreted by the Oregon
Legislative Assembly, the federal government or a court in such a way that
County no longer has the authority to meet its obligations under this Agreement.
b. OHA Termination. OHA may terminate this Agreement in its entirety or may
terminate its obligation to provide financial assistance under this Agreement for one
or more particular Services described in the Financial Assistance Award:
(3)
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(1)
For its convenience, upon at least three calendar months advance written notice
to County, with the termination effective as of the first day of the month
following the notice period.
(2) Upon 45 days advance written notice to County, if OHA does not obtain
funding, appropriations and other expenditure authorizations from federal, state
or other sources sufficient to meet the payment obligations of OHA under this
Agreement, as determined by OHA in the reasonable exercise of its
administrative discretion. Notwithstanding the preceding sentence, OHA may
terminate this Agreement in its entirety or may terminate its obligation to
provide financial assistance under this Agreement for one or more particular
Services, immediately upon written notice to County or at such other time as it
may determine if action by the Oregon Legislative Assembly or Emergency
Board reduces OHA's legislative authorization for expenditure of funds to such
a degree that OHA will no longer have sufficient expenditure authority to meet
its payment obligations under this Agreement, as determined by OHA in the
reasonable exercise of its administrative discretion, and the effective date for
such reduction in expenditure authorization is less than 45 days from the date
the action is taken.
(3)
Immediately upon written notice to County if Oregon statutes or federal laws,
regulations or guidelines are modified, changed or interpreted by the Oregon
Legislative Assembly, the federal government or a court in such a way that
OHA no longer has the authority to meet its obligations under this Agreement or
no longer has the authority to provide the financial assistance from the funding
source it had planned to use.
(4) Upon 30 days advance written notice to County, if County is in default under
this Agreement and such default remains uncured at the end of said 30 day
period or such longer period, if any, as OHA may specify in the notice.
Immediately upon written notice to County, if any license or certificate required
by law or regulation to be held by County or a Provider to deliver a Service
described in the Financial Assistance Award is for any reason denied, revoked,
suspended, not renewed or changed in such a way that County or a Provider no
longer meets requirements to deliver the Service. This termination right may
only be exercised with respect to the particular Service or Services impacted by
loss of necessary licensure or certification.
(6) Immediately upon written notice to County, if OHA determines that County or
any of its Providers have endangered or are endangering the health or safety of a
Client or others.
c. OHA and County agree that this Agreement extends to September 1, 2013, but only
for the purpose of amendments to adjust the allocated budget (Exhibit C) for Services
performed, or not performed, by County during the 2011-2013 biennium and prior to
July 1, 2013. If there is more than one amendment modifying Exhibit C, the
amendment shall be applied to Exhibit C in the order in which the amendments are
executed by County and OHA. In no event is the County authorized to provide any
Services under this Agreement, and County is not required to provide any Services
under this Agreement, after June 30, 2013.
(5)
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9. Effect of Termination.
a. Entire Agreement.
0)
Upon termination of this Agreement in its entirety, OHA shall have no further
obligation to pay or disburse financial assistance to County under this
Agreement, whether or not OHA has paid or disbursed to County all financial
assistance described in the Financial Assistance Award except (a) with respect
to funds described in the Financial Assistance Award, to the extent OHA's
disbursement of financial assistance for a particular Service, the financial
assistance for which is calculated on a rate per unit of service or service
capacity basis, is less than the applicable rate multiplied by the number of
applicable units of Service or Service capacity of that type performed or made
available from the effective date of this Agreement through the termination
date, and (b) with respect to funds described in the Financial Assistance Award,
to the extent OHA's disbursement of financial assistance for a particular
Service, the financial assistance for which is calculated on a cost reimbursement
basis, is less than the cumulative actual Allowable Costs reasonably and
necessarily incurred with respect to delivery of that Service, from the effective
date of this Agreement through the termination date.
(2) Upon termination of this Agreement in its entirety, County shall have no further
obligation under this Agreement to operate a CMHP.
b. Individual Program Area or Service.
(1)
Upon termination of OHA's obligation to provide financial assistance under this
Agreement for a particular Service, OHA shall have no further obligation to pay
or disburse any financial assistance to County under this Agreement for that
Service, whether or not OHA has paid or disbursed to County all financial
assistance described in the Financial Assistance Award for that Service except
(a) with respect to funds described in the Financial Assistance Award and if the
financial assistance for that Service is calculated on a rate per unit of service or
service capacity basis, to the extent that OHA's prior disbursement of financial
assistance for that Service is less than the applicable rate multiplied by the
number of applicable units of Service or Service capacity of that type performed
or made available during the period from the first day of the period for which
the funds were awarded through the earlier of the termination of OHA's
obligation to provide financial assistance for that Service or the last day of the
period for which the funds were awarded, and (b) with respect to funds
described in the Financial Assistance Award and if the financial assistance for
that Service is calculated on a cost reimbursement basis, to the extent that
OHA's prior disbursement of financial assistance for that Service is less than
the cumulative actual Allowable Costs reasonably and necessarily incurred by
County with respect to delivery of that Service, during the period from the
effective date of this Agreement through the termination of OHA's obligation to
provide financial assistance for that Service.
(2) Upon termination of OHA's obligation to provide financial assistance under this
Agreement for a particular Service, County shall have no further obligation
under this Agreement to include that Service in its CMHP.
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(3)
Upon termination of County's obligation to include a Program Area in its
CMHP, OHA shall have (a) no further obligation to pay or disburse financial
assistance to County under this Agreement for Local Administration (LA01) of
Services in that Program Area whether or not OHA has paid or disbursed to
County all financial assistance described in the Financial Assistance Award for
local administration of Services in that Program Area and (b) no further
obligation to pay or disburse any financial assistance to County under this
Agreement for Services in that Program Area, whether or not OHA has paid or
disbursed to County all financial assistance described in the Financial
Assistance Award for those Services except (1) with respect to funds described
in the Financial Assistance Award, to the extent OHA's disbursement of
financial assistance for a particular Service falling within that Program Area, the
financial assistance for which is calculated on a rate per unit of service or
service capacity basis, is less than the applicable rate multiplied by the number
of applicable units of Service or Service capacity of that type performed or
made available during the period from the effective date of this Agreement
through the termination of County's obligation to include the Program Area, in
which that Service falls, in County's CMHP, and (2) with respect to funds
described in the Financial Assistance Award, to the extent OHA's disbursement
of financial assistance for a particular Service falling within that Program Area,
the financial assistance for which is calculated on a cost reimbursement basis, is
less than the cumulative actual Allowable Costs reasonably and necessarily
incurred by County with respect to delivery of that Service, during the period
from the effective date of this Agreement through the termination of County's
obligation to include the Program Area, in which that Service falls, in County's
CMHP.
(4) Upon termination of County's obligation to include a Program Area in its
CMHP, County shall have no further obligation under this Agreement to include
that Program Area in its CMHP.
c. Disbursement Limitations. Notwithstanding subsections (a) and (b) above:
(1)
Under no circumstances will OHA be obligated to provide financial assistance
to County for a particular Service in excess of the amount awarded under this
Agreement for that Service as set forth in the Financial Assistance Award; and
(2) Under no circumstances will OHA be obligated to provide financial assistance
to County from funds described in the Financial Assistance Award in an amount
greater than the amount due County under the Financial Assistance Award for
Services, as determined in accordance with the financial assistance calculation
methodologies in the applicable Services Descriptions.
d. Survival. Exercise of a termination right set forth in Section 8 of this Exhibit F or
expiration of this Agreement in accordance with its terms, shall not affect County's
right to receive financial assistance to which it is entitled hereunder, as described in
subsections (a) and (b) above and as determined through the Agreement Settlement
process, or County's right to invoke the dispute resolution processes under Sections
14 and 15 of Exhibit E. Notwithstanding subsections (a) and (b) above, exercise of
the termination rights in Section 8 of this Exhibit F or expiration of this Agreement in
accordance with its terms, shall not affect County's obligations under this Agreement
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or OHA's right to enforce this Agreement against County in accordance with its
terms, with respect to financial assistance actually disbursed by OHA under this
Agreement, or with respect to Services actually delivered. Specifically, but without
limiting the generality of the preceding sentence, exercise of a termination right set
forth in Section 8 of this Exhibit F or expiration of this Agreement in accordance with
its terms shall not affect County's representations and warranties, reporting
obligations, record-keeping and access obligations, confidentiality obligations,
obligation to comply with applicable federal requirements, the restrictions and
limitations on County's use of financial assistance actually disbursed by OHA
hereunder, County's obligation to cooperate with OHA in the Agreement Settlement
process, or OHA's right to recover from County, in accordance with the terms of this
Agreement, any financial assistance disbursed by OHA under this Agreement that is
identified as an Underexpenditure, Overexpenditure or Misexpenditure. If a
termination right set forth in Section 8 of this Exhibit F is exercised, both parties shall
make reasonable good faith efforts to minimize unnecessary disruption or other
problems associated with the termination.
10. Limitation of Liabilities. NEITHER PARTY SHALL BE LIABLE TO THE OTHER
FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR
RELATED TO THIS AGREEMENT. NEITHER PARTY SHALL BE LIABLE FOR
ANY DAMAGES OF ANY SORT ARISING SOLELY FROM THE TERMINATION
OF THIS AGREEMENT OR ANY PART HEREOF IN ACCORDANCE WITH ITS
TERMS.
11. Insurance. County shall require Providers to maintain insurance as set forth in Exhibit I,
which is attached hereto.
12. Records Maintenance, Access and Confidentiality.
a. Access to Records and Facilities. OHA, 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 the County 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. In addition, County shall permit authorized representatives of OHA to
perform site reviews of all Services delivered by County.
b. Retention of Records. County shall retain and keep accessible all books,
documents, papers, and records that are directly related to this Agreement, the
financial assistance provided hereunder or any Service, for a minimum of six years,
or such longer period as may be required by other provisions of this Agreement or
applicable law, following the termination or expiration of this Agreement. If there
are unresolved audit or Agreement Settlement questions at the end of the applicable
retention period, County shall retain the records until the questions are resolved.
c. Expenditure Records. County shall document the use and expenditure of all
financial assistance paid by OHA under this Agreement. Unless applicable federal
law requires County to utilize a different accounting system, County shall create and
maintain all use and expenditure records in accordance with generally accepted
accounting principles and in sufficient detail to permit ORA to verify how the
financial assistance paid by OHA under this Agreement was used or expended.
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d. Client Records. If County delivers a Service directly, County shall create and
maintain a Client record for each Client who receives that Service, unless the Service
Description precludes delivery of the Service on an individual Client basis and
reporting of Service commencement and termination information is not required by
the Service Description. The Client record shall contain:
(1) Client identification;
(2) Problem assessment;
(3) Treatment, training and/or care plan;
(4) Medical information when appropriate; and
(5) Progress notes including Service termination summary and current assessment
or evaluation instrument as designated by OHA in administrative rules.
County shall retain Client records in accordance with OAR 166-150-0005 through
166-150-0215 (State Archivist). Unless OAR 166-150-0005 through 166-150-0215
requires a longer retention period, Client records must be retained for a minimum of
six years from termination or expiration of this Agreement.
e. Safeguarding of Client Information. County shall maintain the confidentiality of
Client records as required by applicable state and federal law, including without
limitation. ORS 179.495 to 179.507, 45 CFR Part 205, 42 CFR Part 2, any
administrative rule adopted by OHA implementing the foregoing laws, and any
written policies made available to County by OHA. County shall create and maintain
written policies and procedures related to the disclosure of Client information, and
shall make such policies and procedures available to OHA for review and inspection
as reasonably requested by OHA.
13. Force Majeure. Neither OHA nor County shall be held responsible for delay or default
caused by fire, civil unrest, labor unrest, natural causes, or war which is beyond the
reasonable control of OHA or County, respectively. Each party shall, however, make all
reasonable efforts to remove or eliminate such cause of delay or default and shall, upon
the cessation of the cause, diligently pursue performance of its obligations under this
Agreement. Each party may terminate this Agreement upon written notice to the other
party after reasonably determining that the delay or breach will likely prevent successful
performance of this Agreement.
14. Assignment of Agreement, Successors in Interest.
a. County shall not assign or transfer its interest in this Agreement without prior written
approval of OHA. Any such assignment or transfer, if approved, is subject to such
conditions and provisions as OHA may deem necessary. No approval by OHA of any
assignment or transfer of interest shall be deemed to create any obligation of OHA in
addition to those set forth in the Agreement.
b. The provisions of this Agreement shall be binding upon and shall inure to the benefit
of the parties hereto, and their respective successors and permitted assigns.
15. No Third Party Beneficiaries. OHA and County are the only parties to this Agreement
and are the only parties entitled to enforce its terms. The parties agree that County's
performance under this Agreement is solely for the benefit of OHA to assist and enable
OHA to accomplish its statutory mission. Nothing in this Agreement gives, is intended to
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give, or shall be construed to give or provide any benefit or right, whether directly,
indirectly or otherwise, to third persons any greater than the rights and benefits enjoyed
by the general public unless such third persons are individually identified by name herein
and expressly described as intended beneficiaries of the terms of this Agreement.
16. Amendment. No amendment, modification or change of terms of this Agreement shall
bind either party unless in writing and signed by both parties and when required by the
Department of Administrative Services and Department of Justice. Such amendment,
modification or change, if made, shall be effective only in the specific instance and for
the specific purpose given. The parties, by signature of its authorized representative,
hereby acknowledge that they have read this Agreement, understand it, and agree to be
bound by its terms and conditions.
17. Severability. The parties agree that if any term or provision of this Agreement is
declared by a court of competent jurisdiction to be illegal or in conflict with any law, the
validity of the remaining terms and provisions shall not be affected, and the rights and
obligations of the parties shall be construed and enforced as if the Agreement did not
contain the particular term or provision held to be invalid.
18. Notice. Except as otherwise expressly provided in this Agreement, any communications
between the parties hereto or notices to be given hereunder shall be given in writing by
personal delivery, facsimile, or mailing the same, postage prepaid to County or OHA at
the address or number set forth below, or to such other addresses or numbers as either
party may indicate pursuant to this section. Any communication or notice so addressed
and mailed shall be effective five (5) days after mailing. Any communication or notice
delivered by facsimile shall be effective on the day the transmitting machine generates a
receipt of the successful transmission, if transmission was during normal business hours
of the recipient, or on the next business day, if transmission was outside normal business
hours of the recipient. To be effective against OHA, any notice transmitted by facsimile
must be confirmed by telephone notice to OHA's Office of Contracts and Procurement
(503)945-5818. To be effective against County, any notice transmitted by facsimile must
be confirmed by telephone notice to County's Cortrsc+ 5Petidj; 5t - +514, •541- 312
Any communication or notice given by personal delivery shall be effective when actually
delivered.
Notices to Oregon Health Authority: April D. Barrett or delegate
Office of Contracts & Procurement
250 Winter Street NE, Room 306
Salem, OR 97301
Notices to County:
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Deschutes County Health Services
2577 NE Courtney Drive
Bend, OR 97701
Attn: Nancy England
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19. Headings. The headings and captions to sections of this Agreement have been inserted for
identification and reference purposes only and shall not be used to construe the meaning or
to interpret this Agreement.
20. Counterparts. This Agreement may be executed in several counterparts, all of which
when taken together shall constitute one agreement binding on all parties, notwithstanding
that all parties are not signatories to the same counterpart. Each copy of this Agreement so
executed shall constitute an original.
21. Integration and Waiver. This Agreement, including all Exhibits, constitutes the entire
agreement between the parties on the subject matter hereof. There are no understandings,
agreements, or representations, oral or written, not specified herein regarding this
Agreement. The failure of either party to enforce any provision of this Agreement shall not
constitute a waiver by that party of that or any other provision. No waiver or consent shall
be effective unless in writing and signed by the party against whom it is asserted.
22. Construction. This Agreement is the product of extensive negotiations between OHA and
representatives of county governments. The provisions of this Agreement are to be
interpreted and their legal effects determined as a whole. An arbitrator or court interpreting
this Agreement shall give a reasonable, lawful and effective meaning to the Agreement to
the extent possible, consistent with the public interest.
23. Contribution. If any third party makes any claim or brings any action. suit or proceeding
alleging a tort as now or hereafter defined in ORS 30.260 ("Third Party Claim") against a
party (the "Notified Party") with respect to which the other party ("Other Party") may have
liability, the Notified Party must promptly notify the Other Party in writing of the Third
Party Claim and deliver to the Other Party a copy of the claim, process, and all legal
pleadings with respect to the Third Party Claim. Either party is entitled to participate in the
defense of a Third Party Claim, and to defend a Third Party Claim with counsel of its own
choosing. Receipt by the Other Party of the notice and copies required in this paragraph
and meaningful opportunity for the Other Party to participate in the investigation, defense
and settlement of the Third Party Claim with counsel of its own choosing are conditions
precedent to the Other Party's liability with respect to the Third Party Claim.
With respect to a Third Party Claim for which the State is jointly liable with the County (or
would be if joined in the Third Party Claim ), the State shall contribute to the amount of
expenses (including attorneys' fees), judgments, fines and amounts paid in settlement
actually and reasonably incurred and paid or payable by the County in such proportion as is
appropriate to reflect the relative fault of the State on the one hand and of the County on
the other hand in connection with the events which resulted in such expenses, judgments,
fines or settlement amounts, as well as any other relevant equitable considerations. The
relative fault of the State on the one hand and of the County on the other hand shall be
determined by reference to, among other things, the parties' relative intent, knowledge,
access to information and opportunity to correct or prevent the circumstances resulting in
such expenses, judgments, fines or settlement amounts. The State's contribution amount in
any instance is capped to the same extent it would have been capped under Oregon law if
the State had sole liability in the proceeding.
With respect to a Third Party Claim for which the County is jointly liable with the State (or
would be if joined in the Third Party Claim), the County shall contribute to the amount of
expenses (including attorneys' fees), judgments, fines and amounts paid in settlement
actually and reasonably incurred and paid or payable by the State in such proportion as is
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appropriate to reflect the relative fault of the County on the one hand and of the State on
the other hand in connection with the events which resulted in such expenses, judgments,
fines or settlement amounts, as well as any other relevant equitable considerations. The
relative fault of the County on the one hand and of the State on the other hand shall be
determined by reference to, among other things, the parties' relative intent, knowledge,
access to information and opportunity to correct or prevent the circumstances resulting in
such expenses, judgments, fines or settlement amounts. The County's contribution amount
in any instance is capped to the same extent it would have been capped under Oregon law if
it had sole liability in the proceeding.
24. County shall take all reasonable steps to cause its Provider(s) that are not units of local
government as defined in ORS 190.003, if any, to indemnify, defend, save and hold
harmless the State of Oregon and its officers, employees and agents ("Indemnitee") from
and against any and all claims, actions, liabilities, damages, losses, or expenses (including
attorneys' fees) arising from a tort (as now or hereafter defined in ORS 30.260) caused, or
alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of
County's Provider or any of the officers, agents, employees or subcontractors of the
contractor( "Claims"). It is the specific intention of the parties that the Indemnitee shall, in
all instances, except for Claims arising solely from the negligent or willful acts or
omissions of the Indemnitee, be indemnified by the contractor from and against any and all
Claims.
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2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT G
REQUIRED FEDERAL TERMS AND CONDITIONS
In addition to the requirements of section 2 of Exhibit F, County shall comply with the following
federal requirements. For purposes of this Agreement, all references to federal and state laws are
references to federal and state laws as they may be amended from time to time.
1. Miscellaneous Federal Provisions. County shall comply and require all Providers to
comply with all federal laws, regulations, and executive orders applicable to the Agreement
or to the delivery of Services. Without limiting the generality of the foregoing, County
expressly agrees to comply and require all Providers to comply with the following laws,
regulations and executive orders to the extent they are applicable to the Agreement: (a)
Titles VI and VII of the Civil Rights Act of 1964, as amended, (b) Sections 503 and 504 of
the Rehabilitation Act of 1973, as amended, (c) the Americans with Disabilities Act of
1990, as amended, (d) Executive Order 11246, as amended, (e) the Health Insurance
Portability and Accountability Act of 1996, (f) the Age Discrimination in Employment Act
of 1967, as amended, and the Age Discrimination Act of 1975, as amended, (g) the
Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended, (h) all
regulations and administrative rules established pursuant to the foregoing laws, (i) all other
applicable requirements of federal civil rights and rehabilitation statutes, rules and
regulations, (j) all federal law governing operation of Community Mental Health Programs,
including without limitation, all federal laws requiring reporting of Client abuse. These
laws, regulations and executive orders are incorporated by reference herein to the extent
that they are applicable to the Agreement and required by law to be so incorporated. No
federal funds may be used to provide Services in violation of 42 USC 14402.
2. Equal Employment Opportunity. If this Agreement, including amendments, is for more
than $10,000, then County shall comply and require all Providers to comply with Executive
Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order
11375, and as supplemented in Department of Labor regulations (41 CFR Part 60).
3. Clean Air, Clean Water, EPA Regulations. If this Agreement, including amendments,
exceeds $100,000 then County shall comply and require all Providers to comply with all
applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act
(42 U.S.C. 1857(h)), the Federal Water Pollution Control Act as amended (commonly
known as the Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but not
limited to Section 508 (33 U.S.C. 1368). Executive Order 11738, and Environmental
Protection Agency regulations (2 CFR Part 1532), which prohibit the use under
non-exempt Federal contracts, grants or loans of facilities included on the EPA List of
Violating Facilities. Violations shall be reported to OHA, HHS and the appropriate
Regional Office of the Environmental Protection Agency. County shall include and require
all Providers to include in all contracts with subcontractors receiving more than $100,000,
language requiring the subcontractor to comply with the federal laws identified in this
section.
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4. Energy Efficiency. County shall comply and require all Providers to comply with
applicable mandatory standards and policies relating to energy efficiency that are contained
in the Oregon energy conservation plan issued in compliance with the Energy Policy and
Conservation Act (Pub. L. 94-163).
5. Truth in Lobbying. The County certifies, to the best of the County's knowledge and belief
that:
a. No federal appropriated funds have been paid or will be paid, by or on behalf of
County, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any federal contract, grant, loan or cooperative
agreement.
b. If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with this federal contract, grant, loan or
cooperative agreement, the County shall complete and submit Standard Form LLL,
"Disclosure Form to Report Lobbying' in accordance with its instructions.
c. The County shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients
and subcontractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this Agreement was made or entered into. Submission of this certification is a prerequisite
for making or entering into this Agreement imposed by section 1352, Title 31,of the U.S.
Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000 and not more than $100,000 for each such failure.
6. HIPAA Compliance. OHA is a Covered Entity for purposes of the Health Insurance
Portability and Accountability Act and the federal regulations implementing the Act
(collectively referred to as HIPAA), and in accordance with OAR 125-055-0100 through
OAR 125-055-0130. OHA must comply with HIPAA to the extent that any Services or
obligations of OHA arising under this Agreement are covered by HIPAA. County shall
determine if County is subject to HIPAA in the performance of any Service or other
obligations under this Agreement. To the extent that County is subject to HIPAA, County
shall comply and require all Providers to comply with the following:
a. Privacy and Security Of Individually Identifiable Health Information.
Individually Identifiable Health Information about specific individuals is confidential.
Individually Identifiable Health Information relating to specific individuals may be
exchanged between County and OHA for purposes directly related to the provision of
Services to Clients which are funded in whole or in part under this Agreement.
However, County shall not use or disclose any Individually Identifiable Health
Information about specific individuals in a manner that would violate OHA Privacy
Rules, OAR 943-014-000 through 943-014-0017. et. seq., or OHA Notice of Privacy
Practices, if done by OHA. A copy of the most recent OHA Notice of Privacy
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OHA I 1-13 GT0217-1 I
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Practices can be found at htt ://www.dhs.state.or.us/.olicy/admin/privacylist.htm, or may
be obtained from OHA. County shall adopt and implement reasonable
administrative, physical and technical safeguards to protect the security of Client
information consistent with OFIA Security Policies applicable to Information Users,
which policies can be found at
htt.://www.dhs.state.or.us/•olicv/admin/infosecurit 1ist.htm.
b. Data Transactions Systems. If County intends to exchange electronic data
transactions with OHA in connection with claims or encounter data, eligibility or
enrollment information, authorizations or other electronic transaction, County shall
execute an EDI Trading Partner Agreement with OHA and shall comply with OHA
EDI Rules.
c. Consultation and Testing. If County reasonably believes that the County's or
OHA's data transactions system or other application of HIPAA privacy or security
compliance policy may result in a violation of HIPAA requirements, County shall
promptly consult OHA's Information Security Office. County or OHA may initiate a
request for testing of HIPAA transaction requirements, subject to available resources
and OHA's testing schedule.
7. Resource Conservation and Recovery. County shall comply and require all Providers to
comply with all mandatory standards and policies that relate to resource conservation and
recovery pursuant to the Resource Conservation and Recovery Act (codified at 42 USC
6901 et. seq.). Section 6002 of that Act (codified at 42 USC 6962) requires that preference
be given in procurement programs to the purchase of specific products containing recycled
materials identified in guidelines developed by the Environmental Protection Agency.
Current guidelines are set forth in 40 CFR Part 247.
8. Audits.
a. County shall comply, if applicable, require all Providers to comply, with the
applicable audit requirements and responsibilities set forth in the Office of
Management and Budget Circular A-133 entitled "Audits of States, Local
Governments and Non -Profit Organizations."
b. Sub -recipients shall also be required to comply with applicable Code of Federal
Regulations (CFR) sections and OMB Circulars governing expenditure of federal
funds. State, local and Indian Tribal Governments and governmental hospitals must
follow OMB A-102. Non -profits, hospitals, colleges and universities must follow 2
CFR Part 215. Sub -recipients shall be required to monitor any organization to which
funds are passed for compliance with CFR and OMB requirements.
9. Debarment and Suspension. County shall not permit any person or entity to be a
Provider if the person or entity is listed on the non -procurement portion of the General
Service Administration's "List of Parties Excluded from Federal Procurement or
Nonprocurement Programs" in accordance with Executive Orders No. 12549 and No.
12689, "Debarment and Suspension". (See 2 CFR part 180). This list contains the names
of parties debarred, suspended, or otherwise excluded by agencies, and contractors declared
ineligible under statutory authority other than Executive Order No. 12549. Providers with
awards that exceed the simplified acquisition threshold shall provide the required
certification regarding their exclusion status and that of their principals prior to award.
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10. Drug -Free Workplace. County shall comply and require all Providers to comply with the
following provisions to maintain a drug-free workplace: (i) County certifies that it will
provide a drug-free workplace by publishing a statement notifying its employees that the
unlawful manufacture, distribution, dispensation, possession or use of a controlled
substance, except as may be present in lawfully prescribed or over-the-counter
medications, is prohibited in County's workplace or while providing services to OHA
clients. County's notice shall specify the actions that will be taken by County against its
employees for violation of such prohibitions; (ii) Establish a drug-free awareness program
to inform its employees about: The dangers of drug abuse in the workplace, County's
policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation,
and employee assistance programs, and the penalties that may be imposed upon employees
for drug abuse violations; (iii) Provide each employee to be engaged in the performance of
services under this Agreement a copy of the statement mentioned in paragraph (i) above;
(iv) Notify each employee in the statement required by paragraph (i) above that, as a
condition of employment to provide services under this Agreement, the employee will:
abide by the terms of the statement, and notify the employer of any criminal drug statute
conviction for a violation occurring in the workplace no later than five (5) days after such
conviction; (v) Notify OHA within ten (10) days after receiving notice under subparagraph
(iv) above from an employee or otherwise receiving actual notice of such conviction; (vi)
Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or
rehabilitation program by any employee who is so convicted as required by Section 5154 of
the Drug -Free Workplace Act of 1988; (vii) Make a good -faith effort to continue a drug-
free workplace through implementation of subparagraphs (i) through (vi) above; (viii)
Require any Provider to comply with subparagraphs (i) through (vii) above; (ix) Neither
County, or any of County's employees, officers, agents or Provider may provide any
service required under this Agreement while under the influence of drugs. For purposes of
this provision, "under the influence" means: observed abnormal behavior or impairments in
mental or physical performance leading a reasonable person to believe the County or
County's employee, officer, agent or Provider or has used a controlled substance,
prescription or non-prescription medication that impairs the County or County's employee,
officer, agent or Provider's performance of essential job function or creates a direct threat
to OHA clients or others. Examples of abnormal behavior include, but are not limited to:
hallucinations, paranoia or violent outbursts. Examples of impairments in physical or
mental performance include, but are not limited to: slurred speech, difficulty walking or
performing job activities; (x) Violation of any provision of this subsection may result in
termination of this Agreement.
11. Pro -Children Act. County shall comply and require all Providers to comply with the Pro -
Children Act of 1994 (codified at 20 USC section 6081 et. seq.).
12. Medicaid Services. To the extent County provides any Service whose costs are paid in
whole or in part by Medicaid, County shall comply with all applicable federal and state
laws and regulation pertaining to the provision of Medicaid Services under the Medicaid
Act, Title XIX, 42 USC Section 1396 et. Seq., including without limitation:
a. Keep such records as are necessary to fully disclose the extent of services provided to
individuals receiving Medicaid assistance and shall furnish information to any state or
federal agency responsible for administering the Medicaid program regarding any
payments claimed by such person or institution for providing Medicaid Services as
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the state or federal agency may from time to time request. 42 USC Section
1396a(a)(27); 42 CFR 431.107(b)(1) & (2).
b. Comply with all applicable disclosure requirements set forth in 42 CFR 1002.3(a) and
42 CFR 455 Subpart (B).
c. Maintain written notices and procedures respecting advance directive in compliance
with 42 USC Section 1396(a)(57) and (w), 42 CFR 431.107(b)(4), and 42 CFR 489
subpart 1.
d. Certify when submitting any claim for the provision of Medicaid Services that the
information submitted is true, accurate and complete. County shall acknowledge
County's understanding that payment of the claim will be from federal and state
funds and that any falsification or concealment of a material fact may be prosecuted
under federal and sate laws.
e. Entities receiving $5 million or more annually (under this Agreement and any other
Medicaid Agreement) for furnishing Medicaid health care items or services shall, as a
condition of receiving such payments, adopt written fraud, waste and abuse policies
and procedures in compliance with Section 6032 of the Deficit Reduction Act of
2005. 42 USC § 1396a(a)(68).
13. ADA. County shall comply with Title 11 of the Americans with Disabilities Act of 1990
(codified at 42 USC 12131 et. seq.) in the construction, remodeling, maintenance and
operation of any structures and facilities, and in the conduct of all programs, services and
training associated with the delivery of Services.
14. Agency -Based Voter Registration. County shall comply with the Agency -based Voter
Registration sections of the National Voter Registration Act of 1993 which require voter
registration opportunities to be offered where an individual may apply for or receive an
application for public assistance.
15. Special Federal Requirements Applicable to Addiction Services.
a. Women's Services. if County provides A&D 61 or A&D 62 Services, County must:
(1) Treat the family as a unit and admit both women and their children if
appropriate.
(2) Provide or arrange for the following services to pregnant women and women
with dependent children:
(a) Primary medical care, including referral for prenatal care;
(b) Pediatric care, including immunizations, for their children;
(c) Gender -specific treatment and other therapeutic interventions, e.g. sexual
and physical abuse counseling, parenting training, and child care;
(d) Therapeutic interventions for children in custody of women in treatment,
which address, but are not limited to, the children's developmental needs
and issues of abuse and neglect; and
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(e) Appropriate case management services and transportation to ensure that
women and their children have access to the services in (a) through (d)
above.
b. Pregnant Women. If County provides any A&D Services other than A&D 70
Services, County must:
(1)
Within the priority categories, if any, set forth in a particular Service
Description, give preference in admission to pregnant women in need of
treatment who seek, or are referred for, and would benefit from, such Services;
(2) Perform outreach to inform pregnant women of the availability of treatment
Services targeted to them and the fact that pregnant women receive preference
in admission to these programs;
If County has insufficient capacity to provide treatment Services to a pregnant
woman, refer the women to another Provider with capacity or if no available
treatment capacity can be located, refer the women to OHA's Addictions and
Mental Health Division for referral to another provider in the state. If capacity
cannot be located, AMH will make available interim services within 48 hours,
including a referral for prenatal care.
c. Intravenous Drug Abusers. If County provides any A&D Services other than A&D
70 Services. County must:
(3)
(1)
Within the priority categories, if any, set forth in a particular Service
Description and subject to the preference for pregnant women described above,
give preference in admission to intravenous drug abusers;
(2) Programs that receive funding under the grant and that treat individuals for
intravenous substance abuse, upon reaching 90 percent of its capacity to admit
individuals to the program, must provide notification of that fact to the State
within seven days.
If County receives a request for admission to treatment from an intravenous
drug abuser, County must, unless it succeeds in referring the individual to
another Provider with treatment capacity , admit the individual to treatment not
later than:
(3)
(a) 14 days after the request for admission to County is made; or
(b) 120 days after the date of such request if no Provider has the capacity to
admit the individual on the date of such request and, if interim Services
are made available not less than 48 hours after such request
(4) For purposes of (3) above, "Interim Services" means:
(a) Services for reducing the adverse health effects of such abuse, for
promoting the health of the individual, and for reducing the risk of
transmission of disease, including counseling and education about HIV
and tuberculosis, the risks of needle sharing, the risks of transmission of
disease to sexual partners and infants, and steps that can be taken to ensure
that HIV and tuberculosis transmission does not occur;
(b) Referral for HIV or TB treatment Services, where necessary; and
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Approved 5/9/201 I 204 of 220
(c) Referral for prenatal care if appropriate, until the individual is admitted to
a Provider's Services.
(d) If County treats recent intravenous drug users (those who have injected
drugs within the past year) in more than one-third of its capacity, County
shall carry out outreach activities to encourage individual intravenous
drug abusers in need of such treatment to undergo treatment, and shall
document such activities.
d. Infectious Diseases. If County provides any A&D Services other than A&D 70
Services, County must:
(1)
Complete a risk assessment for infectious disease including Human
Immunodeficiency Virus (HIV) and tuberculosis, as well as sexually transmitted
diseases, based on protocols established by OHA, for every individual seeking
Services from County; and
(2) Routinely make tuberculosis services available to each individual receiving
Services for alcohol/drug abuse either directly or through other arrangements
with public or non-profit entities and, if County denies an individual admission
on the basis of lack of capacity, refer the individual to another provider of
tuberculosis Services.
(3)
For purposes of (2) above, "tuberculosis services" means:
(a) Counseling the individual with respect to tuberculosis;
(b) Testing to determine whether the individual has contracted such disease
and testing to determine the form of treatment for the disease that is
appropriate for the individual; and
(c) Appropriate treatment services.
e. OHA Referrals. If County provides any A&D Services other than A&D 70 services,
County must, within the priority categories, if any, set forth in a particular Service
Description and subject to the preference for pregnant women and intravenous drug
users described above, give preference in A&D service delivery to persons referred
by OHA.
f. Barriers to Treatment. Where there is a barrier to delivery of an A&D Service due
to culture, gender, language, illiteracy, or disability, County shall develop support
services available to address or overcome the barrier, including:
(1) Providing, if needed, hearing impaired or foreign language interpreters.
(2) Providing translation of written materials to appropriate language or method of
communication.
(3) Providing devices that assist in minimizing the impact of the barrier.
(4) Not charging clients for the costs of measures, such as interpreters, that are
required to provide nondiscriminatory treatment.
g. Misrepresentation. County shall not knowingly or willfully make or cause to be
made any false statement or representation of a material fact in connection with the
furnishing of items or Services for which payments may be made by OHA.
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h. Oregon Residency. A&D Services funded through this Agreement may only be
provided to residents of Oregon. Residents of Oregon are individuals who live in
Oregon. There is no minimum amount of time an individual must live in Oregon to
qualify as a resident so long as the individual intends to remain in Oregon. A child's
residence is not dependent on the residence of his or her parents. A child living in
Oregon may meet the residency requirement if the caretaker relative with whom the
child is living is an Oregon resident.
i. Tobacco Use. If County has A&D Services treatment capacity that has been
designated for children, adolescents, pregnant women, and women with dependent
children, County must implement a policy to eliminate smoking and other use of
tobacco at the facilities where the Services are delivered and on the grounds of such
facilities.
J•
Client Authorization. County must comply with 42 CFR Part 2 when delivering an
Addiction Service that includes disclosure of Client information for purposes of
eligibility determination. County must obtain Client authorization for disclosure of
billing information, to the extent and in the manner required by 42 CFR Part 2, before
a Disbursement Claim is submitted with respect to delivery of an Addiction Service
to that individual.
17. Community Mental Health Block Grant. All funds, if any, awarded under this
Agreement for MHS 20, MHS 22, MHS 37 or MHS 38 Services are subject to the federal
use restrictions and requirements set forth in Catalog of Federal Domestic Assistance
Number 93.958 and to the federal statutory and regulatory restrictions imposed by or
pursuant to the Community Mental Health Block Grant portion of the Public Health
Services Act, 42 USC 300x-1 et. seq., and County shall comply with those restrictions.
18. Substance Abuse Prevention and Treatment. To the extent County provides any Service
whose costs are paid in whole or in part by the Substance Abuse, Prevention, and
Treatment Block Grant, County shall comply with federal rules and statutes pertaining to
the Substance Abuse, Prevention, and Treatment Block Grant, including the reporting
provisions of the Public Health Services Act (42 USC 300x through 300x-66). Regardless
of funding source, to the extent County provides any substance abuse prevention or
treatment services, County shall comply with the confidentiality requirements of 42 CFR
Part 2.
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OHA 11-13 GT0217-11
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT H
REQUIRED PROVIDER CONTRACT PROVISIONS
1. Expenditure of Funds. Provider may expend the funds paid to Provider under this
Contract solely on the delivery of , subject to the following limitations
(in addition to any other restrictions or limitations imposed by this Contract):
a. Provider may not expend on the delivery of any funds paid to
Provider under this Contract in excess of the amount reasonable and necessary to
provide quality delivery of
b. If this Contract requires Provider to deliver more than one service, Provider may not
expend funds paid to Provider under this Contract for a particular service on the
delivery of any other service.
c. If this Contract requires Provider to deliver alcohol, drug abuse and addiction
services, Provider may not use the funds paid to Provider under this Contract for such
services:
(1)
(2)
(3)
To provide inpatient hospital services;
To make cash payments to intended recipients of health services;
To purchase or improve land, to purchase, construct or permanently improve
(other than minor remodeling) any building or other facility or to purchase
major medical equipment;
(4) To satisfy any requirement for expenditure of non-federal funds as a condition
for receipt of federal funds (whether the federal funds are received under this
Contract or otherwise);
With respect to federal Substance Abuse Prevention and Treatment Block Grant
moneys only, to purchase services from any person or entity other than a public
or non-profit entity; or
(6) To carry out any program prohibited by section 245(b) of the Health Omnibus
Programs Extension Act of 1988 (codified at 42 USC 300ee(5)).
d. Provider may expend funds paid to Provider under this Contact only in accordance
with federal OMB Circular A-87 as that circular is applicable on allowable costs.
2. Records Maintenance, Access and Confidentiality.
a. Access to Records and Facilities. County, the Oregon Health Authority, the
Secretary of State's Office of the State of Oregon, the Federal Government, and their
duly authorized representatives shall have access to the books, documents, papers and
records of Provider that are directly related to this Contract, the funds paid to
Provider hereunder, or any services delivered hereunder for the purpose of making
audits, examinations, excerpts, copies and transcriptions. In addition, Provider shall
(5)
134309 Deschutes County
OHA 11-13 GT0217-11
ApproNed 5/9/2011 207 of 220
permit authorized representatives of County and the Oregon Health Authority to
perform site reviews of all services delivered by Provider hereunder.
b. Retention of Records. Provider shall retain and keep accessible all books,
documents, papers, and records, that are directly related to this Contract, the funds
paid to Provider hereunder or to any services delivered hereunder, for a minimum of
6 years, or such longer period as may be required by other provisions of this Contract
or applicable law, following the termination or expiration of this Contract. If there
are unresolved audit or other questions at the end of the six-year period, Provider
shall retain the records until the questions are resolved.
c. Expenditure Records. Provider shall document the expenditure of all funds paid to
Provider under this Contract. Unless applicable federal law requires Provider to
utilize a different accounting system, Provider shall create and maintain all
expenditure records in accordance with generally accepted accounting principles and
in sufficient detail to permit County and the Oregon Health Authority to verify how
the funds paid to Provider under this Contract were expended.
d. Client Records. Unless otherwise specified in this Contract, Provider shall create
and maintain a client record for each client who receives services under this Contract.
The client record must contain:
(5)
Client identification;
Problem assessment;
Treatment, training and/or care plan;
Medical information when appropriate; and
Progress notes including service termination summary and current assessment
or evaluation instrument as designated by the Oregon Health Authority in
administrative rules.
Provider shall retain client records in accordance with OAR 166-150-0005 through
166-150-0215 (State Archivist). Unless OAR 166-150-0005 through 1 16-150-0215
requires a longer retention period, client records must be retained for a minimum of
six years from termination or expiration of this contract.
e. Safeguarding of Client Information. Provider shall maintain the confidentiality of
client records as required by applicable state and federal law, including without
limitation, ORS 179.495 to 179.507, 45 CFR Part 205, 42 CFR Part 2, any
administrative rule adopted by the Oregon Health Authority, implementing the
foregoing laws, and any written policies made available to Provider by County or by
the Oregon Health Authority. Provider shall create and maintain written policies and
procedures related to the disclosure of client information, and shall make such
policies and procedures available to County and the Oregon Health Authority for
review and inspection as reasonably requested by County or the Oregon Health
Authority.
f. CPMS Enrollment. As specified in the Oregon Health Authority's Client Process
Monitoring System (`CPMS") manual (for Alcohol, Drug Abuse and Addiction
Services or Mental Health Services, as appropriate), Provider shall enroll in CPMS,
each client receiving a service under this Contract and maintain that client's CPMS
134309 Deschutes Counts
O1 -1A 11-13 GT0217-1 1
Approved 5/9/2011 208 of 220
record as specified in the CPMS manual available at
http://www.oregon.g_ov/OHA/mentalhealth/publications/main.shtm1
3. Alternative Formats of Written Materials. In connection with the delivery of Services,
Provider shall:
a. Make available to a Client, without charge to the Client, upon the Client's, the
County's or the Oregon Health Authority's request, any and all written materials in
alternate, if appropriate, formats as required by the Oregon Health Authority's
administrative rules or by the Oregon Health Authority's written policies made
available to Provider.
b. Make available to a Client, without charge to the Client, upon the Client's, County's
or the Oregon Health Authority's request, any and all written materials in the
prevalent non-English languages in the area served by Provider.
c. Make available to a Client, without charge to the Client, upon the Client's, County's
or the Oregon Health Authority's request, oral interpretation services in all non-
English languages in the area served by Provider.
d. Make available to a Client with hearing impairments, without charge to the Client,
upon the Client's, County's or the Oregon Health Authority's request, sign language
interpretation services and telephone communications access services.
For purposes of the foregoing, "written materials" includes, without limitation, all written
materials created or delivered in connection with the services and all provider contracts
related to this Agreement.
4. Reporting Requirements. Provider shall prepare and furnish the following information to
County and the Oregon Health Authority when a service is delivered under this Contract:
a. Client, service and financial information as specified in the applicable service
description attached hereto and incorporated herein by this reference.
b. All additional information and reports that County or the Oregon Health Authority
reasonably requests.
5. Compliance with Law. Provider shall comply with all state and local laws, regulations,
executive orders and ordinances applicable to the Contract or to the delivery of services
hereunder. Without limiting the generality of the foregoing, Provider expressly agrees to
comply with the following laws, regulations and executive orders to the extent they are
applicable to the Contract: (a) all applicable requirements of state civil rights and
rehabilitation statutes, rules and regulations; (b) all state laws governing operation of
community mental health programs, including without limitation, all administrative rules
adopted by the Oregon Health Authority related to community mental health programs; (c)
all state laws requiring reporting of client abuse; (d) ORS 659A.400 to 659A.409, ORS
659A.145 and all regulations and administrative rules established pursuant to those laws in
the construction, remodeling, maintenance and operation of any structures and facilities,
and in the conduct of all programs, services and training associated with the delivery of
services under this Contract. These laws, regulations and executive orders are incorporated
by reference herein to the extent that they are applicable to the Contract and required by
law to be so incorporated. All employers, including Provider, that employ subject workers
who provide services in the State of Oregon shall comply with ORS 656.017 and provide
the required Workers' Compensation coverage, unless such employers are exempt under
134309 Deschutes County Approved 5/9/2011 209 of220
OHA 11-13 GT0217-1 l
ORS 656.126. In addition, Provider shall comply, as if it were County thereunder, with the
federal requirements set forth in Exhibit G to the certain 201 1-2013 Intergovernmental
Agreement for the Financing of Community Addictions and Mental Health Services
between County and the Oregon Health Authority dated as of , which Exhibit
is incorporated herein by this reference. For purposes of this Contract, all references in this
Contract to federal and state laws are references to federal and state laws as they may be
amended from time to time.
6. Unless Provider is a State of Oregon governmental agency, Provider agrees that it is an
independent contractor and not an agent of the State of Oregon, the Oregon Health
Authority or County.
7. To the extent permitted by applicable law, Provider shall defend (in the case of the state of
Oregon and the Oregon Health Authority, subject to ORS Chapter 180), save and hold
harmless the State of Oregon, the Oregon Health Authority, County, and their officers,
employees, and agents from and against all claims, suits, actions, losses, damages,
liabilities, costs and expenses of any nature whatsoever resulting from, arising out of or
relating to the operations of the Provider, including but not limited to the activities of
Provider or its officers, employees, subcontractors or agents under this Contract.
8. Provider understands that Provider may be prosecuted under applicable federal and state
criminal and civil laws for submitting false claims, concealing material facts,
misrepresentation, falsifying data system input, other acts of misrepresentation, or
conspiracy to engage therein.
9. Provider shall only conduct transactions that are authorized by the County for transactions
with the Oregon Health Authority that involve County funds directly related to this
Contract.
10. First tier Provider(s) that are not units of local government as defined in ORS 190.003 shall
obtain, at Provider's expense, and maintain in effect with respect to all occurrences taking
place during the term of the contract, insurance requirements as specified in Exhibit I of the
certain 2011-2013 Intergovernmental Agreement for the Financing of Community
Addictions and Mental Health Services between County and the Oregon Health Authority
dated as of , which Exhibit is incorporated herein by this reference.
11 Provider(s) that are not units of local government as defined in ORS 190.003, shall
indemnify, defend, save and hold harmless the State of Oregon and its officers, employees
and agents ("Indemnitee") from and against any and all claims, actions, liabilities,
damages, losses, or expenses (including attorneys' fees) arising from a tort (as now or
hereafter defined in ORS 30.260) caused, or alleged to be caused, in whole or in part, by
the negligent or willful acts or omissions of Provider or any of the officers, agents,
employees or subcontractors of the contractor( "Claims"). It is the specific intention of the
parties that the Indemnitee shall, in all instances, except for Claims arising solely from the
negligent or willful acts or omissions of the Indemnitee, be indemnified by the Provider
from and against any and all Claims
12. Provider shall include sections 1 through 10, in substantially the form set forth above, in all
permitted Provider Contracts under this Agreement.
134309 Deschutes County
OHA 11-13 GT0217-1 1
Approved 57912011 210 of 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT I
PROVIDER INSURANCE REQUIREMENTS
County shall require its first tier Providers(s) that are not units of local government as defined in
ORS 190.003, if any, to: i) obtain insurance specified under TYPES AND AMOUNTS and
meeting the requirements under ADDITIONAL INSURED, "TAIL" COVERAGE, NOTICE OF
CANCELLATION OR CHANGE, and CERTIFICATES OF INSURANCE before the Providers
perform under contracts between County and the Providers (the "Provider Contracts"), and ii)
maintain the insurance in full force throughout the duration of the Provider Contracts. The
insurance must be provided by insurance companies or entities that are authorized to transact the
business of insurance and issue coverage in the State of Oregon and that are acceptable to
OHA. County shall not authorize Providers to begin work under the Provider Contracts until the
insurance is in full force. Thereafter, County shall monitor continued compliance with the
insurance requirements on an annual or more frequent basis. County shall incorporate
appropriate provisions in the Provider Contracts permitting it to enforce Provider compliance
with the insurance requirements and shall take all reasonable steps to enforce such
compliance. Examples of "reasonable steps" include issuing stop work orders (or the equivalent)
until the insurance is in full force or terminating the Provider Contracts as permitted by the
Provider Contracts, or pursuing legal action to enforce the insurance requirements. In no event
shall County permit a Provider to work under a Provider Contract when the County is aware that
the Provider is not in compliance with the insurance requirements. As used in this section, a
"first tier" Provider is a Provider with whom the County directly enters into a Provider Contract.
It does not include a subcontractor with whom the Provider enters into a contract.
TYPES AND AMOUNTS.
1. WORKERS COMPENSATION. Insurance in compliance with ORS 656.017, which
requires all employers that employ subject workers, as defined in ORS 656.027, to
provide workers' compensation coverage for those workers, unless they meet the
requirement for an exemption under ORS 656.126(2). Employers Liability insurance
with coverage limits of not less than $500,000 must be included.
2. PROFESSIONAL LIABILITY
z
Required by OHA I Not required by OHA.
Professional Liability Insurance covering any damages caused by an error, omission
or negligent act related to the services to be provided under the Provider Contract,
with limits not less than the following, as determined by OHA, or such lesser amount
as OHA approves in writing:
134309 Deschutes County
OHA 11-13 GT0217-I1
Approved 5/9/2011 211 of 220
Z Per occurrence for all claimants for claims arising out of a single accident or
occurrence:
Provider Contract not -to -exceed under this
Agreement:
Required Insurance Amount:
$0 - $1,000,000.
$1,000,000.
$1,000,001. - $2,000,000.
$2,000,000.
$2,000,001. - $3,000,000.
$3,000,000.
In excess of $3,000,001.
$4,000,000.
3. COMMERCIAL GENERAL LIABILITY
® Required by OHA
Not required by OHA.
Commercial General Liability Insurance covering bodily injury, death, and property damage
in a form and with coverages that are satisfactory to OHA. This insurance shall include
personal injury liability, products and completed operations. Coverage shall be written on an
occurrence form basis, with not less than the following amounts as determined by OHA, or
such lesser amount as OHA approves in writing:
Bodily Injury, Death and Property Damage:
Per occurrence for all claimants for claims arising out of a single accident or
occurrence:
rovider Contract not -to -exceed under this t Required Insurance Amount:
Agreement:
$0 - $1,000,000.
$1,000,000.
$1,000,001. - $2,000,000.
$2,000,000.
$2,000,001. - $3,000,000.
$3,000,000.
In excess of $3,000,001.
$4,000,000.
4. AUTOMOBILE LIABILITY INSURANCE
R
Required by OHA [ Not required by OHA.
Automobile Liability Insurance covering all owned, non -owned and hired vehicles.
This coverage may be written in combination with the Commercial General Liability
Insurance (with separate limits for "Commercial General Liability" and "Automobile
Liability"). Automobile Liability Insurance must be in not less than the following
amounts as determined by OHA, or such lesser amount as OHA approves in writing:
134309 Deschutes County
OHA I1-13GT0217-1I
Approved 5/9/2011 212 of 220
Bodily Injury, Death and Property Damage:
Per occurrence for all claimants for claims arising out of a single accident or
occurrence:
Provider Contract not -to -exceed under this
Agreement:
Required Insurance Amount:
$0 - $1,000,000.
$1,000,000.
$1,000,001. - $2,000,000.
$2,000,000.
$2,000,001. - $3,000,000.
$3,000,000.
In excess of $3,000,001. $4,000,000.
5. ADDITIONAL INSURED. The Commercial General Liability insurance and
Automobile Liability insurance must include the State of Oregon, its officers, employees
and agents as Additional Insureds but only with respect to the Provider's activities to be
performed under the Provider Contract. Coverage must be primary and non-contributory
with any other insurance and self-insurance.
6. "TAIL" COVERAGE. If any of the required insurance policies is on a "claims made"
basis. such as professional liability insurance, the Provider shall maintain either "tail"
coverage or continuous "claims made" liability coverage, provided the effective date of
the continuous "claims made- coverage is on or before the effective date of the Provider
Contract, for a minimum of 24 months following the later of : (i) the Provider's
completion and County 's acceptance of all Services required under the Provider Contract
or, (ii) the expiration of all warranty periods provided under the Provider Contract.
Notwithstanding the foregoing 24 -month requirement, if the Provider elects to maintain
"tail"" coverage and if the maximum time period "tail- coverage reasonably available in the
marketplace is less than the 24 -month period described above, then the Provider may
request and OHA may grant approval of the maximum "tail " coverage period reasonably
available in the marketplace. If OHA approval is granted, the Provider shall maintain "tail"
coverage for the maximum time period that "tail" coverage is reasonably available in the
marketplace.
7 NOTICE OF CANCELLATION OR CHANGE. The Provider or its insurer must
provide 30 days' written notice to County before cancellation of, material change to,
potential exhaustion of aggregate limits of, or non -renewal of the required insurance
coverage(s).
8. CERTIFICATE(S) OF INSURANCE. County shall obtain from the Provider a
certificate(s) of insurance for all required insurance before the Provider performs under
the Provider Contract. The certificate(s) or an attached endorsement must specify: i) all
entities and individuals who are endorsed on the policy as Additional Insured and ii) for
insurance on a "claims made"" basis, the extended reporting period applicable to "tail" or
continuous "claims made" coverage.
134309 Deschutes County_
OHA 11-13 GT0217-1 I
Approved 5/9/2011 213 (>1.220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH
SERVICES
EXHIBIT J
START-UP PROCEDURES
A&D Special Projects (AD 60 -Start -Up)
MHS Special Projects (MHS 37 -Start -Up)
INTRODUCTION
Start -Up funds are awarded for expenses necessary to begin, expand, or improve services. These
expenses are distinct from routine operating expenses incurred in the course of providing
ongoing services.
Start -Up funds are typically disbursed prior to initiation of services. Funds are used to cover
costs such as employee salaries and training, furnishings and supplies, renovation of facilities
under $5,000, and purchase of vehicles and other capital items that will be needed to provide the
services planned and delivered at the specified sites.
Requirements for Start -Up Payment
Payment of Start -Up funds is subject to the following requirements and any special conditions
which are specified in Exhibit C.
1. Basis and Method of Payment
a. Funds are paid for actual allowable expenses up to the limit specified for Start -
Up. Allowable expenses for each service element are limited to those listed under
Allowable Start -Up Expenditures in this Exhibit J. OHA must approve payment
for all Start -Up funds.
b. After execution of the Contract or any amendment(s) awarding Program Start -Up
funds, County may request an advance of funds it anticipates using in the
subsequent 120 days. Ordinarily, OHA will not release funds earlier than 90days
prior to the projected first day of service. However, under justifiable
circumstances, OHA may release funds earlier.
c. A request for payment of Start -Up funds may only be made using forms and
procedures prescribed by OHA. Special instructions are applicable as follows:
(1)
134309 Deschutes Counts
OHA 11-13 GT0217-11
When OHA Start -Up funds in the amount of $1,000 and above are to be
used for purchase of a vehicle, as security for the County's performance of
its obligations under this Agreement, the County grants to the OHA a
security interest in, all of the County's right, title, and interest in and to the
goods, i.e. the vehicle. The County agrees that from time to time, at its
expense, the County will promptly execute and deliver all further
Approved 5/9/2011 214 of 220
instruments and documents, and take all further action, that may be
necessary or desirable, or that the OHA may reasonably request, in order
to perfect and protect the security interest granted under this Agreement or
to enable the OHA to exercise and enforce its rights and remedies under
this Agreement with respect to the vehicle. County must forward a copy of
the title registration application showing Addictions and Mental Health
Division as the Security Interest Holder to OHA within five (5) days of the
acquisition from the seller. File Security Interest Holder information as
follows:
Oregon Health Authority
Addictions and Mental Health Division
500 Summer Street NE, E86
Salem, OR 97301
(2) When County requests payment of Start -Up funds, the request must be
made on forms prescribed by OHA.
2. Special Written Approval Authorizations
When using Start -Up funds the following circumstances require special written
authorization from OHA prior to acquisition. These circumstances should be
communicated to OHA within 14 days of the anticipated acquisition date.
a. WHEN LEASING:
(1) Acquisition of real property, vehicles or capital items pursuant to a Lease;
(2) Acquisition of real property, vehicles, or capital items where another
party, in addition to OHA, will also become a secured party (lienholder) at
the time of acquisition;
Renovations or alterations of real property where County is not the owner
of the property and OHA has no security interest in the property.
(3)
b. OTHER:
(1)
A change in the intended use of Start -Up funds or a change in the amount
or date of anticipated acquisition indicated on County's request for
payment of Start -Up funds, for those acquisitions requiring OHA's interest
to be secured.
3. Release of Payments
Following review and approval of County's request for payment of Start -Up funds and
any ancillary documentation, OHA will issue an advance of funds to County as
applicable. These funds will generally be issued as a separate check on a weekly basis;
however, requests processed in time for the monthly allotment process will be included in
the allotment. The request for funds should be communicated to OHA within 14 days of
134309 Deschutes County_
OHA 11-13 GT0217-I I
Approved 5/9/2011 215 of 220
the anticipated acquisition date. Approval of special requests will be made on a limited
basis only.
County will keep a copy of all Requests for Payment of Start -Up funds and report actual
expenditures to OHA on the same form using procedures prescribed by OHA.
4. Start -Up Expenditure Documentation Maintained by County
County shall maintain an Expenditure Report for Start -Up payments. County also is
responsible for requiring its Providers to comply with expenditure reporting requirements
and furnishing evidence of filing OHA's security interest on applicable items. OHA may
inspect these reports. The reports must include the following by service element:
a. The amount advanced;
b. The amount expended on each allowable category, and the amount expended on
each item listed as required in section 2 above and pre -approved by OHA;
c. Copies of all Provider Contracts awarding Start -Up funds. Such Provider
Contracts must require Providers to have executed dedicated use agreements and
the other security documentation described in this Exhibit J.
County must maintain supporting documentation for all expenditures (i.e., receipts).
5. Expenditure Reports to OHA
County must submit Start -Up expenditure reports separately for each OHA Start -Up
request. Expenditure reports are due within 90 days following the effective date of the
award, or within 60 days of termination or expiration of the Agreement. County shall
report actual expenditure of Start -Up funds, using forms and procedures prescribed by
OHA, and forward expenditure reports to OHA.
6. Recovery of Start -Up Funds
In the event County fails to submit an expenditure report when due for itself or its
Provider(s), fails to submit security interests, vehicle titles, or other instrument as
required by OHA to secure the State's interest, or reports unauthorized expenditures, or
reports under expenditures without accompanying repayment, OHA may act, at its
option, to recover Start -Up funds as follows:
a. Bill County for subject funds;
b. Following 30 days nonresponse to the billing, initiate an allotment reduction
schedule against any current payments or advances being made to County; or
c. Take other action needed to obtain payment.
134309 Deschutes Count\
OHA 11-13 GT0217-1 1
Approved 5/9/2011 216 of 220
7. Dedicated Use Requirement
Vehicles costing $1,000 or more must be used to provide the service for which OHA
approved the Start -Up funds. Dedicated use must continue for the useful life of the
vehicle or five years whichever is less.
8. Removal of Liens
The following steps describe the process for removal of liens:
a. To release a vehicle title on which OHA is listed security interest holder, County
or any of its' Providers, must make a request in writing to OHA. The request
must specify why the vehicle is being disposed of and the intended use of any
funds realized from the transaction.
If approved, the original title is signed off by OHA and forwarded to County.
134309 Deschutes County
OHA 11-13GT0217-I I
Approved 5/9/2011 217 of 220
ALLOWABLE START-UP EXPENDITURES
Addictions and Mental Health Division
Policies: Start -Up funds:
1. Must be expended consistent with County's request for payment of Start -Up funds,
and/or any required itemized budget, as approved by OHA.
2. Must be expended only for items and services listed below.
3. Must not be used for personnel costs, facility costs (as defined below) or equipment lease
costs (including vehicle leases) in any month in which the provider receives OHA-funded
service payments, or room and board payments for clients. If, however, some or all
clients in a new program are not enrolled when a program opens, and this delay results in
a loss of service payment or room and board revenue, Phase -In funds may be used to
make up for those lost revenues up to 30 days.
4. Are subject to dedicated use requirements and other procedures for securing the State's
interest, as described within this Exhibit J.
Exceptions to the policies stated above and/or the itemized list below must be approved in
writing by AMH.
Allowable Costs (includes costs incurred during client trial visits)
1. Personnel Costs: Costs for personnel hired to work at program/facility incurred prior to
the date clients are enrolled.
a. Salaries and wages;
b. OPE costs; and
c. Professional contract services (e.g., Psychiatrist, Specialized Treatment Providers, etc.).
2. Facility Costs:
a. Lease/mortgage payments and deposits;
b. Property taxes and maintenance fees not included in, lease or mortgage payments;
c. Utility costs, including hook-up fees; or,
d. Equipment rental costs.
3. Program Staff Training:
a. Training materials;
b. Training fees;
c. Trainer fees; and
d. Travel costs (excluding out of state).
134309 Deschutes County Approved 5/9/2011 218 of 220
OHA 11-13 GT0217-I1
4. Services and Supplies:
a. Program and office supplies;
b. Initial supplies of food, maintenance, and housekeeping items; or
c. Initial insurance premiums, (general, liability, and professional liability insurance;
5. Capital Outlay
a. Furnishings and equipment appropriate for the type of service being provided,
e.g., household furnishings and appliances for residential programs. work-related
equipment for vocational programs;
b. Technical or adaptive equipment needed by clients but not available through the
Adult and Family Services (client medical card), Vocational Rehabilitation, or
other appropriate service agency;
c. Office furnishings and equipment proportionate to size of residential
program/staff being implemented;
d. Vehicle purchases or down payment; lease payments and deposits; as well as
costs for purchase and/or installation of necessary adaptive equipment such as
lifts or ramps;
e. Renovation of real property costing less than $5,000.
134309 Deschutes County
(OHA 11-13 GT0217-11
Approved 5/9/2011 219 of 220
2011-2013 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF COMMUNITY ADDICTIONS AND MENTAL HEALTH SERVICES
EXHIBIT K
Catalogue of Federal Domestic Assistance (CFDA) Number Listing
134309 Deschutes Count:
OHA 11-13 GT0217-11
Approved 5/9/2011 220 of 220
Deschutes County
Service
Description #
Service Description Name
Vendor or
Sub-recjpient
All Funding Sources
CFDA #(s)
MHS 01
Local Administration - Mental
Health Services
Vendor
Medicaid
General Fund
93.778
A&D 03
A&D 60
Local Administration -
Addictions Services (Problem
Gambln.
Special Prtiects
Lottery
N/A
A&D 61
Adult Alcohol and Drug
Residential Treament
_
N/A
A&D 62
Housing Services For
Dependent Children Whose
Parents are in Alcohol and
Drug Residential Treatment
N/A
A&D 63
Peer Delivered Services
N/A
A&D 66
Continuum of Care Services
Sub -recipient
OLCC - 20
OLCC - 40
IDPF - Outpatient
SAPT Block Grant
General Fund
93.959
A&D 67
Alcohol and Drug Residential
Capacity Services
N/A
A&D 70
Prevention Services
Sub -recipient
OLCC - 40
SAPT Block Grant
General Fund
93.959
A&D 71
Youth Alcohol and Drug
Residential Treatment Services
Drug Treatment Court Services
N/A
N/A
A&D 72
A&D 73
Integrated Co-Occuring
Disorders (COD) Treatment
Services
N/A
A&D 80
Problem Gambling Prevention
Services
Lottery
A&D 81
Problem Gambling Treatment
Services
Lottery
_
A&D 82
MHS 20
Problem Gambling Special
Pro.ects
Non -Residential Mental Health
Services For Adults - General
Sub -recipient
Vendor
N/A
CMHS Block Grant
Medicaid
General Fund
General Fund Match
93.958
93.778
2011-2013 Exhibit K Deschutes County
Deschutes County
Service
Description #
Service Description Name
Vendor or
Sub -recipient
All Funding Sources
CFDA #(s)
MHS 22
Child and Adolescent Mental
Health Services
Sub -recipient
Vendor
CMHS Block Grant
Medicaid
General Fund
General Fund Match
93.958
93.778
MHS 24
Regional Acute Psychiatric
Inpatience Services
General Fund
MHS 25
Community Crisis Services for
Adults and Children
General Fund
MHS 26
Non Residential Youth and
Young Adults Mental Health
Services In Transition
(Designated)
N/A
MHS 27
Residential Mental Health
Treatment Services for Youth
and Young Adults In Transition
N/A
MHS 28
Residential Treatment Services
Vendor
Medicaid
General Fund Match
General Fund
93.778
MHS 30
Community Treatment and
Supervision Services for
Individuals Under the
Jurisdiction of the Adult and
Juvenile Panels of the
Psychiatric Security Review
Boards
General Fund
MHS 31
Enhanced Care/Enhanced
Care Outreach Services
Vendor
Medicaid
General Fund Match
93.778
MHS 34
Adult Foster Care Services
Vendor
Medicaid
General Fund
General Fund Match
93.778
MHS 35
Older/Disability Adult Mental
Health Services
General Fund
MHS 36
Pre -Admission Screening and
Resident Review Services
Vendor
Medicaid
General Fund Match
93.778
MHS 37
MHS Special Projects
General Fund
MHS 38
Evidence -Based Supported
Employment Services
General Fund
MHS 39
Projects For Assistance In
Transition From Homelessness
(PATH) Services
N/A
MHS 201
Non -Residential Mental Health
Services For Adults
(Designated)
General Fund
2011-2013 Exhibit K Deschutes County
For Recording Stamp Only
BEFORE THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON
A Resolution Appointing a Financial Assistance
Administrator for Deschutes County Health
Services and Authorizing the County
Administrator to Approve Related Contracts.
*
*
RESOLUTION NO. 2011-021
WHEREAS, Deschutes County, acting through the Health Services Department will enter into
contracts for the provision of health services and the performance of physical health, behavioral health,
developmental disability and addiction services and environmental health services and the agreement
between the State of Oregon and Deschutes County requires that the County appoint a Financial
Assistance Administrator; and
WHEREAS, the Financial Assistance Administrator should be a person knowledgeable about the
available public health, environmental health and behavioral health services and capable of dealing with
a large volume of transactions in a timely manner; now therefore:
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES
COUNTY, OREGON, as follows:
Section 1. Scott Johnson, the Director of the Deschutes County Health Services Department, is duly
appointed as the Deschutes County Financial Assistance Administrator with respect to
contracts pertaining to the Health Services Department. Such appointment shall continue in
effect so long as Scott Johnson is an employee of the Deschutes County Health Services
Department and until a successor is appointed.
Section 2. By Board policy, the Financial Assistance Administrator is authorized to perform the
functions of such appointment and is charged with authorizing contracts as set forth in the
Health Services Department Financial Assistance Contract, Biennial Plan and Strategic Plan,
as adopted by the Board. The Health Services Department includes the Behavioral Health,
and Public Health divisions. The Financial Assistance Administrator may sign on behalf of
the Health Services Department contracts, subcontracts with third party service providers,
contract amendments, grants, and intergovernmental agreements, which do not exceed a
dollar amount of $50,000, and documents with no fiscal implications.
Section 3. The County Administrator may sign all contracts, subcontracts with third party service
providers, contract amendments, grants and intergovernmental agreements, in excess of
$50,000 but not to exceed $150,000.
PAGE 1 OF 2 - RESOLUTION NO. 2011-021
DATED this ...C—clay of
ATTEST:
, 2011.
BOARD OF COUNTY COMMISSIONERS
OF DESCHUTES COUNTY, OREGON
TAMMY BANEY, Chair
ANTHONY DEBONE, Vice Chair
Recording Secretary ALAN UNGER, Commissioner
PAGE 2 OF 2 — RESOLUTION NO. 2011-021
Certificate of Self-insurance
This is to certify that Deschutes County, Oregon is a self-insured entity pursuant
to ORS 30.282 and has established a self-insured fund against liability and
property damage arising out of any tort claims against its programs, officers,
agents, employees and volunteers acting within the scope of their employment.
This coverage is applicable under any Deschutes County agreement.
Please refer inquiries to:
Deschutes County Risk Management
Erik Kropp, Risk Manager (541) 388-6584
Judy Sumners, Claims Coordinator (541) 385-1749
Ken Harms, Loss Prevention Specialist (541) 617-4747
1300 NW Wall St., Ste. 200, Bend, OR 97701
no expiration
March 4, 2011
Department of Administrative Services
Erik Kropp, Deputy County Administrator
1300 NW Wall St, Suite 200 • Bend, Oregon 97701
(541 ) 388-6584 • FAX (541] 385-3202
www.deschutes.or.us
To whom it may concern,
The purpose of this letter is to certify that Deschutes County, Oregon, is and has been since at least
1990, a self-insured entity pursuant to ORS 30.282 and has established a self-insurance fund for liability
arising out of any tort claims against any of its programs, officers, agents, employees and volunteers
acting within the scope of their employment during this period. This coverage is applicable under any
Deschutes County agreement.
Sincerely,
Erik Kropp
Deputy County Administrator
Enhancing the Lives of Citizens by Delivering Quality Services in a Cost -Effective Manner