Loading...
HomeMy WebLinkAboutDoc 401 - Telecare Agrmt - Res Trmt HomeDeschutes County Board of Commissioners 1300 NWWall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org AGENDA REQUEST & STAFF REPORT For Board Business Meeting of August 31, 2011 DATE: August 11,2011 FROM: Lori Hill, Adult Treatment Supervisor Phone: 322-7535 Health Services-Behavioral Health Division TITLE OF AGENDA ITEM: Consideration of Board Signature of Document #2011-401, Agreement between Telecare Mental Health Services of Oregon, Inc. and Deschutes County Health Services (DCHS). PUBLIC HEARING ON THIS DATE? No BACKGROUND AND POLICY IMPLICATIONS: Telecare Mental Health Services of Oregon, Inc. provides 24-hour secure residential treatment facilities for individuals with mental or emotional disorders who have been hospitalized and need services to avoid further hospitalization because they are a danger to themselves or others. In regards to contract number 2011-401, Telecare will provide 24-hour Residential Treatment Home (RTH) services for up to ten (10) residents that have been jointly approved by County and Telecare. Residential Treatment Services are behavioral health services delivered on a 24-hour basis to individuals eighteen (18) years of age or older with mental or emotional disorders who have been hospitalized, who are at immediate risk of hospitalization, who need to continue services to avoid hospitalization or who are a danger to themselves or others or who otherwise require continuing care to remain in the community. Residential Treatment Services include services delivered to individuals who the County, in conjunction with the Oregon Health Authority (OHA) has determined are unable to live independently without supervised intervention, training or support and are eligible for services funded under this Agreement. Telecare will invoice Division of Medical Assistance Programs (DMAP) in accordance with procedures and forms prescribed by OHA. County agrees to pay Telecare funds that are received by County through OHA by amendment to State Contract #134309. Funding for operation and facilities will be in accordance with a budget submitted by Telecare to OHA and County and approved by both OHA and County. FISCAL IMPLICATIONS: Maximum compensation is $1,185,000 RECOMMENDATION & ACTION REQUESTED: Behavioral Health requests approval. ATTENDANCE: Lori Hill, Adult Treatment Supervisor & Nancy England, Contract Specialist DISTRIBUTION OF DOCUMENTS: Executed copies to: Nancy England, Contract Specialist, Health Services DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be retumed to the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form electronically to the Board Secretary.) Please complete all sections above the Official Review line. Date: I August 3, 2011 I Department: , Health Services, Behavioral Health i Contractor/Supplier/Consultant Name: I Telecare Mental Health Services of Oregon, Inc., Contractor Contact: I Gemma Lim ! Contractor Phone #: []1f337-7950 Type of Document: Personal Services Contract Goods and/or Services: Telecare Mental Health Services of Oregon, Inc. provides 24-hour secure residential treatment facilities for individuals with mental or emotional disorders who have been hospitalized and need services to avoid further hospitalization because they are a danger to themselves or others .. Background & History: Telecare provides 24-hour Residential Treatment Home (RTH) services for up to ten (10) residents that have been jointly approved by County and Telecare. Residential Treatment Services are behavioral health services delivered on a 24-hour basis to individuals eighteen (18) years of age or older with mental or emotional disorders who have been hospitalized, who are at immediate risk of hospitalization, who need continue services to avoid hospitalization or who are a danger to themselves or others or who otherwise require continuing care to remain in the community. Residential Treatment Services include services delivered to individuals who the County, in conjunction with the Oregon Health Authority (OHA) has determined are unable to live independently without supervised intervention, training or support and are eligible for services funded under this Agreement. Telecare will invoice Division of Medical Assistance Programs (DMAP) in accordance with procedures and forms prescribed by OHA. County agrees to pay Telecare funds that are received by County through OHA by amendment to State Contract #134309. Funding for operation and facilities will be in accordance with a budget submitted by Telecare to OHA and County and approved by both OHA and County. Agreement Starting Date: lLuly 1, 2011 I Ending Date: I June 30,2012 Annual Value or Total Payment: L:M@mum comQ.ensationis $1,185,000. I ~ Insurance Certificate Received (check box) Insurance Expiration Date: I July 1, 2012 I 8/312011 /' Check all that apply: o RFP, Solicitation or Bid Process o Informal quotes «$150K) [3j Exempt from RFP, Solicitation or Bid Process (specify -see DCC §2.37) Funding Source: (Included in current budget? ~ Yes 0 No If No, has budget amendment been submitted? 0 Yes 0 No Is this a Grant Agreement providing revenue to the County? 0 Yes [3j 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: ~yJ;l1gland, Contract Specialist Phone #: i 541-322-7516 I Department Director Approval: ___ --_"':"?)..J.8'""""",-IL+I­___~~_~'-I~""""/ Si gn80" Date Distribution of Document: Return both originals to Nancy England, Behavioral Health Department. Official Review~ County Signature Required (check one): 0 BOCC 0 Department Director (if <$25K) o Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ____-' Legal Review Date Document Number =20,,"-1,--,1,--4..:.;:O~1,--______ 8/3120 II REVIEWED LEGAL COUNSEL For Recording Stamp Only DESCHUTES COUNTY SERVICES AGREEMENT AGREEMENT NO. 2011-401 This Agreement (the "Agreemenr) is made and entered into by and between Deschutes County, a political subdivision of the State of Oregon, hereinafter referred to as "County," and Telecare Mental Health Services of Oregon, Inc., 1080 Marina Village Pkwy, Suite 100, Alameda, CA 94501, hereinafter referred to as "Contractor. II WHEREAS, Contractor has acquired two properties to be licensed as residential treatment homes that have been approved by County and State of Oregon (hereinafter referred to as "Facilities") for behavioral health clients; and WHEREAS, the parties agree that residential treatment homes is a preferred behavioral health care model in Central Oregon to provide residential behavioral health services; WHEREAS, Contractor owns, manages and is capable of operating the Facilities; and WHEREAS, County is authorized pursuant to ORS 430.670 to obtain, by contract, the services necessary to operate a community behavioral health program; and WHEREAS, Contractor has available staff for the performance of the services described in this Agreement; and WHEREAS, Contractor has obtained and shall continue to qualify for approval from the State of Oregon, Oregon Health Authority ("aHA") for purposes of providing services under this Agreement; now, therefore, IT IS HEREBY AGREED by and between the parties above mentioned, for and in consideration of the mutual promises hereinafter stated as follows: 1. Effective Date. The effective date of this Agreement shall be July 1, 2011. Unless extended or terminated earlier in accordance with its terms, this Agreement shall terminate when County accepts Contractors completed performance or on June 30, 2012, whichever date occurs last. Agreement termination shall not extinguish or prejudice County's right to enforce this Agreement with respect to any default by Contractor that has not been cured. 2. Contractor's Services. Contractor shall provide 24-hour Residential Treatment Home (RTH) services for up to ten (10) residents that have been jointly approved by County and Contractor. Contractor shall provide RTH services described in the attached Service DeSCription, titled "Residential Treatment Services", Service 10 code MHS 28, Exhibit 1A and in accordance with OAR 309-035-0250 through 309­ 035-0460, in the Facilities. Contractor shall also provide out-patient mental health services to RTH residents in accordance with OAR 309-16-0600 through 309-016-0650 "Medicaid Payment for Rehabilitative Mental Health Services and OAR 309-032-1500 through 309-032-1565 "Integrated Services and Supports Rule". Contractor shall screen and assess client for tobacco use, and offer tobacco cessation resources to clients choosing to quit. 3. Regulations and Duties. Contactor shall comply with all applicable provisions, including applicable Service DeSCriptions attached thereto, in place at the time this Agreement is executed and effective July 1, 2011, (Contract #134309, the "Contract") between the Oregon Health Authority ("aHA") and Deschutes County, as the same may be amended, replaced and/or renewed from time to time. Contractor agrees to comply with the rules and regulations of County, applicable provisions in the Contract between County and the aHA, incorporated herein by reference, as of the effective date of such regulations, applicable provisions of the Administrative Rules and Procedures of the aHA, applicable Federal regulations and all provisions of Federal and State statutes, rules and regulations relating to Contractor's performance of services under this Agreement. Any act or duty of County, imposed upon County by aHA, which, by the nature of this PAGE 1 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Agreement, County determines to be within the scope of this Agreement and is to be performed by Contractor, Contractor shall perform on behalf of County. No federal funds may be used to provide services in violation of 42 USC 14402. 4. Reporting. A. Contractor shall document the expenditure of all funds paid to Contractor under this Agreement. Unless applicable federal law requires Contractor to utilize a different accounting system, Contractor shall create and maintain all expenditure records in accordance with generally accepted accounting principles and in sufficient detail to permit County and the Oregon Health Authority to verify how the funds paid to Contractor under this Agreement were expended. B. Contractor agrees to prepare and furnish such reports and data as may be required by County and the Oregon Health Authority, including but not limited to client records which contain client identification, problem assessment, treatment (including any training and/or care plan), appropriate medical information, and progress notes, including a service termination summary and current assessment or evaluation instrument as designated by the Oregon Health Authority in the administrative rules. Contractor shall retain client records in accordance with OAR 166-150-0005 through 166-150-0215 (State Archivist). Unless OAR 166-150-0005 through 116-150-0215 requires a longer retention period, client records must be retained for a minimum of seven (7) years from termination or expiration of this Agreement. It is understood that due to the limited nature of Contractor's services under this Agreement, not all of these documents will have been prepared by Contractor and therefore need not be furnished. Oregon Health Authority Client Process Monitoring System (CPMS) data, Community Mental Health Provider Report, and Termination Service Recording Form shall, if necessary, be completed in accordance with Oregon Health Authority requirements and submitted to Oregon Health Authority through County. Contractor agrees to, and does hereby grant County and the Oregon Health Authority the right to reproduce, use and disclose for County or Oregon Health Authority purposes, all or any part of the reports, data, and technical information furnished to County under this Agreement. Contractor shall make available to County, Oregon Health Authority and any client of Contractor as defined in Exhibit "A" of the Contract referenced in Exhibit 1, paragraph 1 A., of this Agreement, any and all written materials in alternate formats in compliance with Oregon Health Authority's policies or administrative rules. For purposes of the foregoing, "written materials" includes, without limitation, all work product and contracts related to this Agreement. C. Contractor shall prepare and furnish the following information to Oregon Health Authority when a Service is delivered: 1) Client, Service and financial information as specified in the Service Description. 2) All additional information and reports that Oregon Health Authority or County reasonably requests. D. Contractor shall submit reports as requested by County. All notices, bills and payments shall be made in writing and may be given by personal delivery or by mail. Notices, bills, and payments sent by mail should be addressed as follows: Contractor: Telecare Mental Health Service of Oregon, Inc. 1080 Marina Village Pkwy, Suite 100 Alameda, CA 94501 Phone: (510) 337-7950 Attn: Marshall Langfeld County: Deschutes County Health Services 2577 NE Courtney Dr. Bend, OR 97701 Phone: (541) 322-7535 Attn: Lori Hill 5. Access to Records. Contractor shall maintain fiscal records and all other records pertinent to this Agreement. A. All fiscal records shall be maintained pursuant to generally accepted accounting standards, and other records shall be maintained to the extent necessary to clearly reflect actions taken. PAGE 2 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 / 1) Contractor shall retain and keep accessible all books, documents, papers and records that are directly related to this Agreement, the funds paid to Contractor hereunder or to any services delivered hereunder, for a minimum of seven (7) years, or such longer period as may be required. 2) If an audit, litigation or other action involving this Agreement is started before the end of the seven-year (7) period, the records shall be retained until all issues arising out of the action are resolved. B. County, the Oregon Health Authority, the Secretary of State's Office of the State of Oregon, the Federal Government, and their duly authorized representatives shall have the right to direct access to all of Contractor's books, documents, papers and records related to this Agreement, the funds paid to Contractor hereunder, or any services delivered hereunder for the purpose of conducting audits and examinations, making copies, excerpts and transcripts. In addition, Contractor shall permit authorized representatives of County and the Oregon Health Authority to perform site reviews of all services delivered by Contractor hereunder. 1) These records also include licensed software and any records in electronic form, including but not limited to computer hard drives, tape backups and other such storage devices. County shall reimburse Contractor for Contractor's cost of preparing copies. 2) At Contractor's expense, the County, the Secretary of State's Office of the State of Oregon, the Federal Government, and their duly authorized representatives, shall have license to enter upon Contractor's premises to access and inspect the books, documents, papers, computer software, electronic files and any other records of the Contractor which are directly pertinent to this Agreement. 3) If Contractor's dwelling is Contractor's place of business, Contractor may, at Contractor's expense, make the above records available at a location acceptable to the County. 6. Confidentiality. Contractor shall maintain confidentiality of information obtained pursuant to this Agreement as follows: A. Contractor shall not use, release or disclose any information Contractor shall not use, release or disclose any information concerning any employee, client, applicant or person doing business with the County for any purpose not directly connected with the administration of County's or the Contractor's responsibilities under this Agreement except upon written consent of the County, and if applicable, the employee, client, applicant or person. B. The Contractor shall ensure that its agents, employees, officers and subcontractors with access to County and Contractor records understand and comply with this confidentiality provision. C. Contractor shall treat all information as to personal facts and circumstances obtained on Medicaid eligible individuals as privileged communication, shall hold such information confidential, and shall not disclose such information without the written consent of the individual, his or her attorney, the responsible parent of a minor child, or the child's guardian, except as required by other terms of this Agreement. D. Nothing prohibits the disclosure of information in summaries, statistical information, or other form that does not identify particular individuals. E. Personally identifiable health information about applicants and Medicaid reCipients will be subject to the transaction, security and privacy provisions of the Health Insurance Portability and Accountability Act ("HIPAA"). F. Contractor shall cooperate with County in the adoption of policies and procedures for maintaining the privacy and security of records and for conducting transactions pursuant to HIPAA requirements. G. This Agreement may be amended in writing in the future to incorporate additional requirements related to compliance with HIPAA. H. If Contractor receives or transmits protected health information, Contractor shall enter into a PAGE 3 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Business Associate Contract with County, which, if attached hereto, shall become a part of this Agreement. I. Individually Identifiable Health Information about specific individuals is confidential. Individually Identifiable Health Information relating to specific individuals may be exchanged between County and OHA for purposes directly related to the provision of Services to Clients which are funded in whole or in part under this Agreement. Contractor 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 Contractor by County or by the Oregon Health Authority. Contractor 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. 7. County Monitoring and Site Visits. Contractor agrees that services provided under this Agreement by Contractor, Facilities used in conjunction with such services, client records, Contractor's policies, procedures, performance data, financial records, and other similar documents and records of Contractor, that pertain, or may pertain, to services under this Agreement, shall be open for inspection by County, or its agents, at any reasonable time during business hours. Contractor agrees to retain such records and documents for a period of seven (7) years, or such longer period as may be prescribed for such records and documents by the State of Oregon Archivist or until the conclusion of any dispute or proceeding related to the services under this Agreement or involving the records of Contractor, whichever is longer. Contractor shall permit County and OHA to make site visits upon reasonable notice to monitor the delivery of services under this Agreement. 8. Payment of Agreement. Subject to availability of funds, Contractor will receive payment for providing the services described in Paragraph 2. A. Contractor shall bill DMAP in accordance with procedures and forms prescribed by OHA for all Part B funds (as defined in Exhibit 1) that are approved by OHA as part of Contractor's budget. Contractor agrees that payment for these services shall be DMAP's responsibility and not County's responsibility. Contractor shall not invoice or expect payment from County for services billed to DMAP under this subsection. 1) All Extended Care Services reimbursable service billings shall be in accordance with OHA Medicaid General Provider Rules 410-120-1280 and 410-120-1360-1380 and MHS Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0650. 2) Contractor shall bill all Personal Care Services in accordance with forms and procedures prescribed by OHA. 3) Contractor agrees to complete, monitor and obtain all prior authorizations as needed for Extended Care Service and Personal Care Service billing submissions. B. County agrees to pay to Contractor, all "Part A" funds received by County which are allocated by OHA for services (described in Exhibit 1) provided by Contractor or are expenditures approved by OHA in Contractor budget. 1) Contractor agrees to invoice County on a monthly basis for all Part A funds that are approved by the OHA as part of Contractor's budget and paid to the County by amendment to the contract. County agrees to make approved payments to Contractor within thirty (30) days of receipt of invoice. 2) Contractor agrees to complete and submit all documentation of expenditures for Part A funds as required by OHA and County and to comply with all requirements of the Service Description in which funding is allocated. C. Funding for operation of the facilities will be in accordance with a budget submitted by Contractor to OHA and County and approved by OHA and County in negotiation with Contractor thirty days (30) prior to the anniversary of this Agreement. D. Any extension of services for the period after June 30,2012 will be by separate agreement. PAGE 4 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 9. Payments in Future Years beyond June 30, 2012. Not later than April 2012, Contractor and County shall meet to review this Agreement and negotiate the program and reporting requirements, protocols and payment to be paid by County and OHA to Contractor beginning after July 1,2012. The parties may at that time also negotiate payment methods and amounts for one or more years after 2012. 10. Recovery of Funds. Expenditures of Contractor may be charged to this Agreement only if they: (1) are in payment for services performed under this Agreement; (2) conform to applicable State and Federal regulations and statutes; (3) are in payment of an obligation incurred during the period of this Agreement; and (4) when added to other compensation pursuant to this Agreement are not in excess of 100% of the maximum amount detailed in Exhibit 1. If Contractor fails to provide an acceptable audit performed by a certified public accountant for federal funds received under this Agreement, or if federal authorities demand the repayment of federal funds received under this Agreement. County may recover all federal funds paid under this Agreement, unless a smaller amount is disallowed or demanded, If OHA disallows or requests repayment for any funds paid under this Agreement due to Contractors' acts or omissions, Contractor shall make payment to the County of the amount disallowed or requested. In the event that the OHA determines that County is responsible for the repayment of any funds owed to the OHA by Contractor, Contractor agrees to make such payment within ten (10) days of notification by County or the OHA of said determination by the OHA. 11. Retention of Revenue and Earned Interest. Fees and third-party reimbursements, including all amounts paid pursuant to Title XIX of the Social Security Act by the OHA, for services rendered by Contractor, and interest earned on such funds in the possession of Contractor, shall be retained by Contractor provided that such amounts are received on account a behavioral health service described in Exhibit 1 of this Agreement and complies with the standards of the OHA. 12. Withholding of Payments. Notwithstanding any other payment provision of this Agreement, should Contractor fail to submit required reports required by Section 4(A) and Exhibits 1, 2 and 3 when due, or fail to perform or document the performance of contracted services, County shall immediately withhold payments under this Agreement until the required reports have been submitted by the Contractor. 13. Termination. All or part of this Agreement may be terminated by mutual consent of both parties, or by either party at any time for convenience upon three (3) months notice in writing to the other party. The County may also terminate all or part of this Agreement for any of the causes specified below: A. With thirty (30) days written notice, if funding to the County from Federal, State, or other sources is not obtained or is not continued at levels sufficient to allow for purchase of the indicated quantity of services. The County will give more notice whenever possible. B. With sixty (60) days written notice, if Federal or State regulations are modified or changed in such a way that services are no longer allowable for purchase under this Agreement. C. Upon notice of denial, revocation, or non-renewal of any letter of approval, license, or certificate required by law or regulation to be held by the Contractor to provide a service element under this Agreement. D. With thirty (30) days written notice, if Contractor fails to provide services, or fails to meet any performance standard as specified by the County in this Agreement (or subsequent modifications to this Agreement) within the time speCified herein, or any extensions thereof. E. Upon written or oral notice, if County has evidence that the Contractor has endangered or is endangering the health and safety of clients, residents, staff, or the public. PAGE 5 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 F. Failure of the Contractor to comply with the provisions of this Agreement or any applicable Federal, State and local laws and rules which may be cause for termination of this Agreement. The circumstances under which this Agreement may be terminated by either party under this paragraph may involve major or minor violations. Major violations include, but are not limited to: 1) Acts or omissions that jeopardize the health, safety, or security of clients. 2) Misuse of funds. 3) Intentional falsification of records. In the case a failure to perform jeopardizes the safety and security of any residents of the facilities covered under this Agreement, the Contractor, the County and the OHA shall jOintly conduct an investigation to determine whether an emergency exists and what corrective action will be necessary. Such investigation shall be completed in accordance with OHA procedures and the Agreement. The Contractor may also terminate all or part of this Agreement for the cause specified below: 1) With (30) days written notice, if the "Part A" funding is not paid to Contractor as outlined in 7(8). 14. Encumbrance or Expenditure After Notice of Termination. Contractor shall not make expenditures, enter into contracts, or encumber funds in its possession that belong to the County, after notice of termination or termination as set out above, without prior written approval from County. 15. Independent Contractor. Contractor is engaged hereby as an independent contractor, as defined in ORS 670.600 and will be so deemed for purposes of the following: A. Contractor will be solely responsible for payment of any Federal or State taxes required as a result of this Agreement. 8. Contractor shall be solely responsible for and shall have control over the means, methods, techniques, sequences and procedures of performing the work, and shall be solely responsible for the errors and omissions of its employees, subcontractors and agents. For goods and services to be provided under this Agreement, Contractor agrees to: 1) perform the work in a good, workmanlike, and timely manner; 2) comply with all applicable legal requirements; 3) take all precautions necessary to protect the safety of all persons at or near facilities, including employees and patients of Contractor and County; 4) take full responsibility for wages and entitlements of Contractor's employees assigned to or furnishing services at facilities. C. It is agreed by and between the parties that Contractor is not carrying out a function on behalf of the County, OHA or State of Oregon, and County, OHA and State of Oregon do not have the right of direction or control of the manner in which Contractor delivers services under this Agreement or exercise any control over the activities of the Contractor. Contractor is not an officer, employee or agent of County as those terms are used in ORS 30.265. D. County is not, by virtue of this Agreement, a partner or joint venturer with Contractor in connection with activities carried on under this Agreement, and shall have no obligation with respect to Contractor's debts or any other liabilities of each and every nature. E. The Contractor is an independent contractor for purposes of the Oregon Workers' Compensation law (ORS Chapter 656) and is solely liable for any Workers' Compensation coverage under this Agreement. 16. Contractor and Subcontractors. Contractor agrees to make all provisions of this Agreement with the County applicable to any subcontractor performing work under this Agreement. Contactors who perform the work without the assistance of labor or any employee, as determined under ORS Chapter 656 and rules adopted pursuant thereto, need not obtain Workers Compensation coverage. PAGE 6 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 17. Constraints. A. The Provisions of ORS 279B.220, 279B.230, and 279B.235, are by this reference incorporated and made a part of this Agreement: 1) Contractor shall pay employees for overtime work performed under this Agreement in accordance and otherwise comply with applicable provisions of ORS 653.010 to 653.261 and the Fair Labor Standards Act of 1938 ("FLSA") (29 U.S.C 201 et. seq.). B. This Agreement is expressly subject to the debt limitation of Oregon counties set forth in Article XI, Section 10, of the Oregon Constitution, and is contingent upon funds being appropriated therefore. Any provisions herein, which would conflict with law, are deemed inoperative to that extent. C. Contractor agrees that no person shall, on the grounds of race, color, creed, national origin, sex, marital status, or age, suffer discrimination in the performance of this Agreement when employed by Contractor. Unless exempted under the rules, regulations and relevant orders of the Secretary of Labor, 41 CFR, Chapter 60, Contractor agrees to comply with (i) all provisions of Executive Order No. 11246, as amended by Executive Order No. 11375 of the President of the United States dated September 24, 1965 as supplemented in Department of Labor regulations (41 CFR Part 60), (ii) Titles VI and VII of the Civil Rights Act of 1964 as amended, (iii) Sections 503 and 504 of the Rehabilitation Act of 1973 as amended and 45 CFR 84.4, which states, "No qualified person shall, on the basis of handicap, be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination under any program or activity which receives or benefits from Federal financial assistance" (iv) the Age Discrimination in Employment Act of 1974, as amended, and the Age Discrimination Act of 1975, as amended (v) the Vietnam Era Veterans' Readjustment Assistance Act of 1975, (vi) all applicable rules regulations and order of the Secretary of Labor concerning equal opportunity in employment and the provisions of ORS Chapters 659 and 659A (vii) Title II of the Americans with Disabilities Act of 1990 as amended (42 USC 12131 et. Seq.), ORS 30.670 to 30.685, and all regulations and administrative rules established pursuant to those laws in the construction, remodeling, maintenance and operation of any structures and facilities, and in the conduct of all programs, services and training associated with services delivered under the Agreement (viii) all regulations and administrative rules established pursuant to the foregoing laws, (ix) all other applicable requirements of federal civil rights and rehabilitation statutes, rules and regulations, and (x) all federal laws governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring reporting of Client abuse. These laws, regulations and executive orders are incorporated by reference herein to the extent that they are applicable to the Agreement and required by law to be so incorporated. No federal funds may be used to provide Work in violation of 42 USC 14402. D. If the limitation amount specified in this Agreement for Title XIX Clinic Services exceeds $100,000, Contractor shall provide the State of Oregon with written assurance that Contractor will comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 USC 1857 (h), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) including but not limited to Section 508 of the Clean Water Act (33 USC 1368) Executive Order 11738 and Environmental Protection Agency regulations (40 CFR Part 15) which prohibit the use under non-exempt Federal contracts, grants or loans of facilities included on the EPA List of Violating Facilities. Violations shall be reported to the OHA, HHS and the appropriate Regional Office of the Environmental Protection Agency. E. Contractor shall comply with Federal rules and statutes pertaining to the Addictions and Mental Health (AMH) and Social Security (formerly Title XX) Block Grant(s); including the Public Health Services Act, especially sections 1914 (b)(1-5), 1915 (c}(12), 1916 (b)(2) and Public Law 97-35. F. The individual signing on behalf of Contractor hereby certifies and swears under penalty of perjury that she/he is authorized to act on behalf of Contractor. G. The provisions of Deschutes County Code, Section 2.37.150 are incorporated herein by reference. 18. Partnership. County is not, by virtue of this Agreement, a partner or jOint venturer with Contractor in connection with activities carried out under this Agreement, and shall have no obligation with respect to PAGE 7 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Contractor's debts or any other liabilities of each and every nature. Unless Contractor is a State of Oregon governmental agency, Contractor agrees that it is an independent contractor and not an agent of the State of Oregon, the Oregon Health Authority or County. 19. Hold Harmless. A. To the fullest extent authorized by law Contractor shall defend (in the case of the state of Oregon and the Oregon Health Authority, subject to ORS Chapter 180), save, hold harmless and indemnify the County, the State of Oregon and the Oregon Health Authority their officers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities costs and expenses of any nature resulting from or arising out of, or relating to the activities of Contractor or its officers, employees, contractors, or agents under this Agreement, including without limitation any claims that the work, the work product or any other tangible or intangible items delivered to County by Contractor that may be the subject of protection under any state or federal intellectual property law or doctrine, or the County's use thereof, infringes any patent, copyright, trade secret, trademark, trade dress, mask work utility design or other proprietary right of any third party. B. Contractor shall have control of the defense and settlement of any claim that is subject to subparagraph a of this paragraph; however neither Contractor nor any attorney engaged by Contractor shall defend the claim in the name of Deschutes County or any department or agency thereof, nor purport to act as legal representative of the County or any of its departments or agencies without first receiving from the County's legal counsel, in a form and manner determined appropriate by the County's legal counsel, authority to act as legal counsel for the County, nor shall Contractor settle any claim on behalf of the Count without the approval of the County's legal counsel. C. To the extent permitted by Article XI, Section 10, of the Oregon Constitution and the Oregon Tort Claims Act, ORS 30.260 through 30.300, County shall defend, save, hold harmless and indemnify Contractor and its officers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities costs and expenses of any nature resulting from or arising out of, or relating to the activities of County or its officers, employees, contractors, or agents under this Agreement. 20. Insurance. Prior to the effective date of this Agreement, Contractor shall obtain, at Contractor's expense, and maintain in effect all insurance requirements as specified in Exhibit 2. 21. Settlement of Disputes. Differences between a Contractor and County, or between contractors, will be resolved when possible at appropriate management levels, followed by consultation between boards, if necessary. 22. Financial Audit. Contractor shall provide a copy of its financial review or financial audit conducted by a certified public accountant within ninety (90) days following the end of each fiscal year. 23. Assignment. Contractor shall not assign this Agreement without the prior written consent of County. 24. Renewal. This Agreement may be renewed, subject to the following conditions: (1) renewal will be based on the County Annual Implementation Plan approved by the OHA, and (2) renewal is subject to the availability of funding. 25. Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules, regulations, executive orders and policies. Debt Limitation. This Agreement is expressly subject to the debt limitation of Oregon counties set forth in Article XI, Section 10, of the Oregon Constitution, and is contingent upon funds being appropriated therefore. A. Any provisions herein, which would conflict with law, are deemed inoperative to that extent. B. Contractor shall comply with all federal, state and local laws, regulations, executive orders and ordinances applicable to the Agreement. PAGE 8 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 C. Without limiting the generality of the foregoing, Contractor expressly agrees to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: 1) Titles VI and VII of the Civil Rights Act of 1964, as amended; 2) Sections 503 and 504 of the Rehabilitation Act of 1973, as amended; 3) the Americans with Disabilities Act of 1990, as amended and ORS 659A.112 through 659A.139; 4) Executive Order 11246, as amended; 5) the Health Insurance Portability and Accountability Act of 1996; 6) the Age Discrimination in Employment Act of 1967, as amended, and the Age Discrimination Act of 1975, as amended; 7) the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended; 8) ORS Chapter 659A, as amended; 9) all regulations and administrative rules established pursuant to the foregoing laws; and 10) all other applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. 11) all federal law governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring reporting of 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. 12) Contractor shall comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented in Department of Labor regulations (41 CFR Part 60). 13) If Agreement maximum compensation, including amendments, exceeds $100,000 then Contractor shall comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but not limited to Section 508 (33 U.S.C. 1368). Executive Order 11738, and Environmental Protection Agency regulations (2 CFR Part 1532), which prohibit the use under non-exempt Federal contracts, grants or loans of facilities included on the EPA List of Violating Facilities. Violations shall be reported to the Oregon Health Authority, Human Services (HHS) and the appropriate Regional Office of the Environmental Protection Agency. 14) Contractor shall comply with applicable mandatory standards and policies relating to energy efficiency that are contained in the Oregon energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163). 15) Contractor shall not knowingly and willfully make or cause to be made any false statement or representation of a material fact in connection with the furnishing of items or Services for which payments may be made by OHA. 16) Contractor may not use the funds paid under this Agreement for the following services: a) To provide inpatient hospital services; b) To make cash payments to intended reCipients of health services; c) To purchase or improve land, to purchase, construct or permanently improve (other than minor remodeling) any building or other facility or to purchase major medical equipment; d) To satisfy any requirement for expenditure of non-federal funds as a condition for receipt of federal funds (whether the federal funds are received under this Agreement or otherwise); e) With respect to Substance Abuse Prevention and Treatment Block Grant moneys only, to purchase services from any person or entity other than a public or non-profit entity; or f) To carry out any program prohibited by section 245(b) of the Health Onmibus Programs Extension Act of 1988 (codified at 42 USC 300ee(E). 17) Contractor may expend funds paid to Contractor under this Agreement only in accordance with federal OMB Circular A-87 as that circular is applicable to allowable costs. 18) To the extent Contractor provides any service whose costs are paid in whole or in part by Medicaid, Contractor shall comply with the federal and state Medicaid statutes and regulations applicable to the service, including but not limited to: a) Keep such records as may be necessary to disclose the extent of services furnished to clients and, upon request, furnish such records or other information to the OHA, the Medicaid fraud section of the Oregon Department of Justice and the Secretary of Health and Human Services; f b) Comply with all applicable disclosure requirements set forth in 42 CFR Part 455, Subpart B; PAGE 9 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I c) Comply with any applicable advance directive requirements specified in 42 CFR Section 431.107(b)(4); and d) Comply with the certification requirements of 42 CFR Sections 455.18 and 455.19. 19) Contractor shall comply with the Pro-Children Act of 1995 (codified at 20 USC Section 6081 et. seq.). 26. Additional Federal Law Compliance Requirements. A. Contractor shall comply with all applicable federal, state and local laws, administrative rules, ordinances and regulations. B. Prohibitions Against Lobbying. 1) Contractor, or any person, firm or corporation acting on behalf of Contractor, certifies that no funds paid under this Agreement will be used to influence or attempt to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment. or modification of any federal contract, grant, loan or cooperative agreement. 27. Reductions in Agreement Fundinq. A. Any funds spent by Contractor for purposes not authorized by this Agreement shall either be paid directly by the Contractor to the County or, if not so paid, at the discretion of County, shall be applied to future payments from County to the Contractor. Payments by County in excess of authorized amounts that have not been repaid by the Contractor within thirty (30) days after the Agreement's expiration or after notification by the County, whichever date is earlier, shall be deducted from future payments from County to the Contractor or may justify termination of the Agreement. B. In the event that a statutorily required operating license or letter of approval is not extended or is suspended, County's obligation to provide reimbursement for services or program expenses hereunder will cease on the date of termination of this Agreement (whether in whole or in part) or the date of expiration or suspension of the license or letter of approval, whichever date is earlier. 28. Attorney Fees. In the event an action, suit or proceeding, including appeal there from, is brought for breach of any of the terms of this Agreement, or for any controversy arising out of this Agreement, each party shall be responsible for its own attorney's fees, expenses, costs and disbursements for said action, suit, proceeding or appeal. 29. Entire Agreement. This Agreement constitutes the entire Agreement between the parties on the subject matter hereof. There are no understandings, contracts, or representations, oral or written, not specified herein regarding this Agreement. 30. Survival. The provisions of paragraphs 3 to 12, 17 to 20, 22 to 27, shall survive the termination or expiration of this Agreement. PAGE 10 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 DATED this __day COUNTY: ATTEST: Recording Secretary CONTRACTOR: ________.2011 Deschutes County Health Services BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON TAMMY BANEY, Chair TONY DEBONE, Vice Chair AlAN UNGER, Commissioner Telecare Corporation MARSHALL LANGFELD. VP and CFO V; /'7 f/F.r a ~p~,.., c.J7!'.u"iI; J • PAGE 11 OF 11 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 ( 1 EXHIBIT 1 DESCHUTES COUNTY SERVICES AGREEMENT STATEMENT OF WORK, COMPENSATION PAYMENT TERMS AND SCHEDULE Definitions: Adult Mental Health Initiative (AMHI): AMHI is a system reform project initiated by the Oregon Health Authority (OHA). The purpose of the initiative is to improve the system of community-based long term care and residential services for people who have been in the Oregon State Hospital. The proposal is to shift resources and authority from the State of Oregon to Mental Health Organizations and counties for the referral and management of individuals placed in state hospital and residential facilities. This would only include people involved in or at risk of the civil commitment process. Residential Treatment Services: For the purposes of this Agreement, Residential Treatment Services are behavioral health services delivered on a 24-hour basis to individuals eighteen (18) years of age or older with mental or emotional disorders who have been hospitalized, who are at immediate risk of hospitalization, who need continuing services to avoid hospitalization or who are a danger to themselves or others or who otherwise require continuing care to remain in the community. Residential Treatment Services includes services delivered to individuals who the County, in conjunction with the OHA has determined are unable to live independently without supervised intervention, training or support and are eligible for MHS 28 Services funded through this Agreement. Division of Medical Assistance Programs (DMAP): An office of the Oregon Health Authority responsible for coordinating Medical Assistance Programs, including the OHP Medicaid Demonstration and the Children's Health Insurance Program (CHIP). DMAP writes and administers the state Medicaid rules for medical services, contracts with providers, maintains records of client eligibility and processes and pays DMAP providers. Extended Care Services: Non-OHP Medicaid rehabilitative services that are reimbursed on a fee for service basis. These services are billed with the use of specially designated Non-Oregon Health Plan (OHP) Medicaid Extended Care Services billing codes. Use of these codes requires prior authorization by the County and Accountable Behavioral Health Alliance (ABHA). t Part A Funds: These funds are dispersed directly to Deschutes County by State of Oregon through Intergovernmental Contract for Financing of Community Mental Health Services. IPart B Funds: These funds are awarded to Deschutes County by State of Oregon through I IIntergovernmental Contract for Financing of Community Mental Health Services as a limitation amount only. Funds are not dispersed directly to Deschutes County. The OHA's Division of Medical Assistance Programs (DMAP) disburses the award up to the limitation amount directly to the service provider on a fee-for-service basis. f, Personal Care Services: Services delivered in Residential Treatment Homes or Facilities that include but are not limited to the following: crisis stabilization, money and household management, supervision -\ PAGE 1 OF4 EXHIBIT 1 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 f l of daily living activities, provision of care for safety and well-being, administration and supervision of medication, provision and arrangement of routine transportation, behavior management, management of diet and physical health problems. 1. Contractor shall perform the following work: Service 1: Residential Treatment Home (RTH): A. The purpose of RTH services is to stabilize resident's psychiatric symptoms, improve independent living skills, and then discharge the resident into an appropriate and safe level of community services of less intensity as clinically appropriate. B. Contractor shall provide 24-hour RTH services to up to ten (10) residents. Contractor shall provide RTH services described in the attached Service Description titled "Residential Treatment Services, Service ID code MHS 28, Exhibit 1 A and in accordance with OAR 309-035-0250 through 309-035-0460, in homes at two locations in Deschutes County. Services shall include: 1. Non-Residential Adult Mental Health Services, Service ID Code MHS 20 B, Exhibit 1 B; 2. Non-Residential Adult Mental Health Services (Designated), Service ID Code MHS 201, Exhibit 1-D; Medicaid reimbursable service billings in accordance with the OHA Medicaid General Provider Rules 410-120-1280 and 410-120-1360-1380; OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0650; and Integrated Services and Supports Rule 309­ 032-1500 through 309-032-1565. 3. Contractor must enroll all clients served in Oregon State's Client Process Monitoring System (CPMS) database within twenty-four (24) hours of admission and disenroll within twenty-four (24) hours of discharge. 4. Residential Screening Process: The Contractor must jOintly participate with the County in a screening process for all potential admissions to a RTH facility. Contractor understands that the County must also approve any client admitted to the facility. C. The Contractor's Facility where RTH services are provided must: 1. Currently have in place and maintain throughout the life of this Agreement, licensing as a Residential Treatment Home as defined in OAR 309-035-0250 through 309-035-0460. 2. Contractor must obtain and maintain any other licenses and/or certifications as necessary or required by law or administrative rule for a provider of RTH services and as an operator of the facility. This will include Contractor maintaining approval under OAR 309-012-0130 through 309-012-220, "Certificates of Approval for Mental Health Services". 3. Contractor agrees to provide only those outpatient behavioral health services that are required for Contractor's role as a residential treatment provider. Contractor agrees to not utilize this certification to establish or provide any other outpatient services within Deschutes County unless expressly approved by County under separate agreement. D. Contractor shall provide RTH services to Clients who meet the following criteria: 1. Be 18 years or older; and 2. Be referred by the Oregon Health Authority (OHA) Adult Mental Health Initiative (AMHI) and approved by County in collaboration with the program treating referral hospital, responsible Community Mental Health Program (CMHP) and/or the mental health Organization (if enrolled) responsible for the Client. (See Exhibit 'I E, "Referrals"); and 3. Have an Axis I Diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders; and 4. Be currently approved for Long Term Psychiatric Care by AMHI; or 5. Be referred directly by Deschutes County in accordance with County Bed Referral procedures (Exhibit 1 E); or 6. Be a Medicaid eligible client in a benefit category that allows for payments for Medicaid Rehabilitative Services. 2. County Services. County shall provide Contractor, at County's expense, with material and services described as follows: PAGE 2 OF 4 -EXHIBIT 1 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I 1. County will maintain primary responsibility for screening and approval of admissions to the residential treatment facilities and will provide Residential Specialist staff to participate in this process. Screenings will be conducted in coordination with Contractor's RTH staff, however, any resident accepted for admission to the facility must also be approved by the County for placement. Residential Specialist staff will also provide regular outreach and coordination with Contractor's RTH staff. 2. County agrees to provide a letter of support to Contractor as part of certification application outlined in 1 (B){2) for Contractor to operate as an Outpatient Mental Health Provider within Deschutes County and to provide the required monitoring and oversight in coordination with Addictions and Mental Health Division. 3. County agrees to provide all other out-patient behavioral health services including but not limited to: medication management, individual and group therapy and supported employment services. 3. Consideration. Subject to availability of funds, Contractor will receive payment for providing the services described in Exhibit 1, Paragraph 1. A. Contractor shall bill DMAP in accordance with procedures and forms prescribed by OHA for all services funded under Part B dollars. Contractor agrees that payment for these services shall be DMAP's responsibility and not County's responsibility. Contractor shall not invoice or expect payment from County for services billed to DMAP under this subsection. i) All Extended Care Services reimbursable service billings shall be in accordance with the OHA Medicaid General Provider Rules 410-120-1280 and 410-120-1360-1380 and MHS Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309-016-0650. ii) Contractor shall bill all Personal Care Services in accordance with forms and procedures prescribed by OHA. iii) Contractor agrees to complete, monitor and obtain all prior authorizations as needed for Extended Care Service and Personal Care Service billing submissions. B. County agrees to pay to Contractor, all "Part A" funds received by County which are allocated by OHA for services provided by Contractor as described in this Exhibit. i) Contractor agrees to invoice County on a monthly basis for Part A payments that are approved by the OHA as part of Contractor's budget and paid to the County by amendment to State Contract #134309. County agrees to make approved payments to Contractor within 30 days of receipt of invoice and receipt of funds from the OHA. ii) Contractor agrees to complete and submit all documentation of expenditures for all Part A funds as required by OHA and the County and to comply with all requirements of the Service Description in which funding is allocated. C. Funding for operation of the facilities will be in accordance with a budget submitted by Contractor to OHA and County and approved by OHA and County. D. Contractor shall be entitled to reimbursement for expenses as set forth in Exhibit 5 0 YES rgj NO [Check one] 4. The maximum compensation. A. The maximum consideration under this Agreement shall be $1,185,000. County will pay Contractor up to the total maximum amount allocated by Oregon Health Authority for Contractor services to the County under OHA Contract #134309. All funds allocated to County as "Part B" payments will be paid directly to the Contractor by DMAP on the County's behalf. All funds allocated to County for services provided by the Contractor as "Part A" payments, will be paid to the Contractor directly by the County. All funds will be paid in accordance with a budget that is approved by Oregon Health Authority. B. All funds awarded to Contractor under this Agreement are subject to Oregon Health Authority monitoring and adjustment. All adjustments in funds awarded will be made by amendment to the OHA Contract #134309. Oregon Health Authority will monitor and adjust funds awarded throughout the term of this Agreement at Oregon Health Authority discretion. C. Recovery of Overpayment: All payments made to Contractor under this Agreement are subject to recovery by OHA and/or the County in accordance with OAR 410-120-1397 Recovery of Overpayments PAGE 3 OF 4 -EXHIBIT 1 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I to Providers --Recoupments and Refunds and Service Element Descriptions for MHS 28, MHS 20, MHS 201 and MHS 37 funds: i. If a federal audit of the work rendered by Contractor under this Agreement results in a refund to or disallowance by the federal government of funds paid to Contractor under this Agreement, Oregon Health Authority and/or County may recover from Contractor the amount of the refund or disallowance and any applicable Oregon Health Authority matching funds. ii. If Contractor expends funds paid to Contractor under this Agreement for purposes not authorized by this Agreement, Oregon Health Authority and/or County may recover the amount of the unauthorized expenditure from Contractor. iii. If billings under this Agreement result in payments to Contractor to which Contractor is not entitled, Oregon Health Authority and/or County, after giving written notification to Contractor, may withhold from payments due to Contractor such amounts, over such periods of time as are necessary to recover the amount of overpayment. D. Contractor may also receive funding for Start-up Special Projects as outlined in Service ID Code MHS-37, Exhibit 1-C. 5. Schedule of Performance or Delivery. a. County's obligation to pay depends upon Contractor's delivery or performance in accordance with the schedule listed in Exhibit 1, Paragraph 1. b. County will only pay for completed work that conforms to the terms of the Agreement. 6. Renewal. This Agreement may be renewed as outlined in this Agreement and subject to the following conditions: a. Renewal will be based on the County Annual Implementation Plan approved by the OHA. b. Renewal is subject to the availability of funding. 7. Modification of Exhibit 1-A through 1-0, State Requirements for Behavioral Health Subcontract In the event the State of Oregon modifies the terms of SE 28, 20, 37 or 201, it is understood that this Agreement will also be deemed revised accordingly without further action of the parties. Authority to change this Exhibit to comply fully with Deschutes County's Intergovernmental Contract with the State of Oregon shall rest with the Director of Telecare Corporation and the Deschutes County Health Services Director. Both parties must agree for the Exhibit to be modified. PAGE 4 OF 4 -EXHIBIT 1 -PERSONAL SERVICES CONTRACT No. 2010-001 EXHIBIT 1-A Service Name: RESIDENTIAL TREATMENT SERVICES Service ID Code: MHS 28 I. Service Description Residential Treatment Services (MHS 28) are: A. Services delivered on a 24-hour basis to individuals 18 years of age or older with mental or emotional disorders who have been hospitalized or are at immediate risk of hospitalization, who need continuing services to avoid hospitalization or who are a danger to themselves or others or who otherwise require continuing care to remain in the community; and B. Services delivered to individuals who the County, in conjunction with the Oregon Health Authority (OHA) determines are unable to live independently without supervised intervention, training or support are eligible for MHS 28 Services funded through this Agreement. The specific MHS 28 Services delivered to an individual are determined based upon an individualized assessment of treatment needs and development of plan of care that are intended to promote the well being, health and recovery of the individual through the availability of a wide-range of residential service options. MHS 28 Services delivered in Residential Treatment Facilities (as defined in OAR 309-035-0100 through 309­ 035-0190) (RTF) or Residential Treatment Homes (as defined in OAR 309-035-0250 through 309-035-0460) (RTH), or another licensed setting approved by OHA include, but are not limited to, the following: A. Crisis stabilization services, such as accessing psychiatric, medical, or qualified professional intervention to protect the health and safety of the individual and others; B. Timely, appropriate access to crisis intervention to prevent or reduce acute, emotional distress, which might necessitate psychiatric hospitalization; C. Management of personal money and expenses; D. Supervision of daily living activities and life skills such as training with nutritional weliness, personal hygiene, clothing care and grooming, communication with social skills, health care, household management and using community resources; E. Provision of care including assumption of a responsibility for the safety and well-being of the individual; F. Administration and supervision of prescribed and non-prescribed medication; G. Provision or arrangement of routine and emergency transportation; H. Management of aggressive or self-destructive behavior; I. Management of a diet, prescribed by a physician, requiring extra effort or expense in preparation of food; and J. Management of physical or health problems, including, but not limited to, seizures or incontinency. Financial assistance is dependent upon an individual meeting defined criteria, established by the Oregon Health Authority (OHA) and posted on the OHA, Addictions and Mental Health (AMH) website. OHA and its designees have the authority to review Clinical records and have direct contact with individuals. The County and any providers must notify individuals in writing within five state business days of a determination on admission, as defined by OHA policy, posted on the OHA AMH website. PAGE 1 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 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 309-011-0105 through 309-011-0115. If OHA approves the RSCP and Contract Amendment Request, OHA and County shall execute an amendment to the OHA Contract #134309 to reduce Residential Limitation, Part 8, 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 OHA Contract #134309 has been so amended. All individuals receiving MHS 28 Services with funds provided under this Agreement must be enrolled in the Client Process Monitoring System (CPMS) database within 24 hours of admission and disenrolled within 24 hours of discharge, and the individual's CPMS record for MHS 28 Services must be maintained, as specified in OHA's CPMS manual located at: http://www.oregon.gov/OHAlmentalhealth/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 n) are calculated, disbursed and settled as set forth in Section IV (A) below. The Part A Award is set forth in the OHA Contract #134309 on MHS 28 lines that contain an "An in column one. Other funds (the "Residential Limitation") are not calculated, disbursed or settled under this Agreement. These funds are set forth in the OHA Contract #134309 on MHS 28 lines that contain a "8" in column one and are paid as described in Section IV (8) below. Part 8 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 8 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/OHAlmentalhealth/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/OHAlmentalhealth/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 OHA Contract #134309 with an "An in column one from funds identified on that line in an amount equal to the rate set forth in the special condition identified in PAGE 2 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 that line of the OHA Contract #134309, multiplied by the number of units of MHS 28 Services delivered under that line of the OHA Contract #134309 during the period specified in that line, subject to the following: i. Total OHA payment for MHS 28 Services delivered under a particular line in the OHA Contract #134309 containing an "An in column one shall not exceed the total funds awarded for MHS 28 Services as specified in that line of the OHA Contract #134309; ii. OHA is not obligated to provide financial assistance for any MHS 28 Services that are not properly reported in CPMS by the date 60 days after the earlier of termination or expiration of this Agreement, termination of OHA' obligation to provide financial assistance for MHS 28 Services, or termination of County's obligation to include the Program Area, in which MHS 28 Services fall, in its Community Mental Health Program (CMHP); and iii. OHA will reduce the financial assistance for MHS 28 Services delivered under a particular line of the OHA Contract #134309 containing an U An 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 OHA Contract #134309, OHA will disburse funds awarded for MHS 28 Services identified in a particular line of the OHA Contract #134309 with an "An in column one, to County in substantially equal monthly allotments during the period specified in that line of the OHA Contract #134309, subject to the following: i. OHA may, after 30 days (unless parties agreed otherwise) written notice to County, reduce the monthly allotments based on under used allotments identified in CPMS or through other reports 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 OHA Contract #134309, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 28 Services on that line of the OHA Contract #134309. 3. Agreement Settlement. Agreement Settlement will reconcile any discrepancies that may have occurred during the term of this Agreement between actual OHA disbursements of funds awarded for MHS 28 Services under a particular line of the OHA Contract #134309 containing an "An 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 OHA Contract #134309. For purposes of this section, amounts due to County is determined by the actual amount of services delivered under that line of the OHA Contract #134309 during the period specified in that line of the OHA Contract #134309, as properly reported in CPMS or through other method required or permitted by this Service Description or an applicable Specialized Service Requirement. The settlement process will not apply to funds awarded for an approved Reserved Service Capacity Payment. B. Residential Limitation. The Residential Limitation, Part B is disbursed by OHA directly to service providers based on monthly rates authorized by County after consultation with OHA, subject to the following: 1. All payment rates authorized by County under this Section IV (B) for delivery of MHS 28 Services must meet the following requirements: i. The rates must be reasonable under the facts and circumstances in existence at the time each rate is set, including but not limited to the state of the market for MHS 28 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 PAGE 3 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 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 servedfor a portion of the month; 4. Financial assistance will be reduced (offset) by the amount of client resources received by the provider from the client or client's health insurance in support of client care and services provided; 5. The Residential Limitation is included in this Agreement. If OHA anticipates that payments for MHS 28 Services authorized by County under this Section IV (B) will exceed the amount of the Residential Limitation, OHA may unilaterally reduce the award of funds, as set forth in the OHA Contract #134309, for any other MHS Service or Services to the extent of the State of Oregon's general fund portion of the anticipated Residential Limitation shortfall. OHA and County shall execute an appropriate amendment to the OHA Contract #134309 to reflect the reduction of the Part A Award and the increase in the Residential Limitation; and 6. OHA is not obligated to provide financial assistance for any MHS 28 Services that are not properly reported through CPMS by the date 60 days after the earlier of termination or expiration of this Agreement, termination of OHA' obligation to provide financial assistance for MHS 28 Services or termination of County's obligation to include the Program Area, in which MHS 28 Services fall, in its CMHP. PAGE 4 OF 4 -EXHIBIT 1-A -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 EXHIBIT 1-B Service Name: NON-RESIDENTIAL MENTAL HEALTH SERVICES FOR ADULTS (GENERAL) Service 10 Code: MHS 20 I. Service Description Non-Residential Mental Health Services For Adults (General) (MHS 20) are mental health services delivered to persons diagnosed with serious mental health illness, or other mental or emotional disturbance posing a danger to the health and safety of themselves or others. Non-Residential Mental Health Services for Adults (General) shall include one or more of the following: A. Case management services; B. Vocational and social services; C. Rehabilitation; D. Support to obtain and maintain housing; E. Medication and medication monitoring; F. Emotional support; G. Individual, family and group counseling and therapy; H. Sex offender treatment; and I. Interpreter services II. Performance Requirements Providers of MHS 20 shall provide coordination of care services for county of responsibility residents in residential treatment programs, which include extended care managed services, regardless of the location. The coordination of care shall include participation in the residential provider's treatment planning process and in planning for the individual's transition to outpatient services. Providers of MHS 20 Services funded through this Agreement must: A. Comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time; B. Maintain a Certificate of Approval, for the delivery of clinical services, in accordance with OAR 309-012­ 0130 through OAR 309-012-0220, as such rules may be revised from time to time; and C. Investigate and report allegations of abuse regarding served individuals and provide protective services to those individuals to prevent further abuse. The investigation, reporting and protective services must be completed in compliance with ORS 430.735 through 430.765 and OAR 407-045-0000 thro~gh 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/OHAlmentalhealth/publications/cpmsmanuaLmh.pdf?ga=t, and as it may be revised from time to time. PAGE 1 OF 3 -EXHIBIT 1-B -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 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 OHA Contract #134309 on MHS 20 lines in column one (1) that contain an !lA" 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/OHNmentalhealth/publications/codebooks/mh01 09rates.pdf. OHA will provide notice to Contractor in timely manner if there is a change in rates. All Medicaid reimbursable service billings shall be in accordance with the OHA Mental Health and Developmental Disability Services Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0600 through 309­ 016-0755 and the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/OHNmentalhealth/publications/codebooksImanual.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 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 OHA Contract #134309 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 OHA Contract #134309, OHA will disburse the Part A Award for MHS 20 Services identified in a particular line of the OHA Contract #134309 to County in substantially equal monthly allotments during the period specified in that line of the OHA Contract #134309, subject to the following: 1. OHA may, upon written request of County, adjust monthly allotments. 2. Upon amendment to the OHA Contract #134309, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 20 Services on that line of the OHA Contract #134309. 3. OHA may reduce the monthly allocation when the county is identified by the Addictions and Mental Health Division (AMH) as the County of Responsibility of a patient at the State Hospital and the patient exceeds the length of stay authorized by OHA by more than 30 days. The reduction of the monthly allocation will be based on the following table: PAGE 2 OF 3 -EXHIBIT 1-B DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I I State Hospital Cost of Care will be the cost of care identified in the current I nstitutional Cost of Care Rates Report published by the OHA Institutional Revenue Section C. Agreement Settlement: Agreement Settlement will be used to confirm the offer and delivery of MHS 20 Services by County as part of its CMHP, based on data properly reported in CPMS or through other reports required or permitted by this Service Description or an applicable Specialized Service Requirement. Days Beyond Authorization I Percentage of State Hospital Cost of . Care i ! 0-30 0% i 31-60 25% 61 -90 50% i 91 -120 75% 121 and over 100% PAGE 3 OF 3 -EXHIBIT 1-B DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 EXHIBIT 1-C Service Name: MHS SPECIAL PRO ..IECTS 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 OHA Contract #134309 contains a line awarding funds for MHS 37 Services, that line will contain a special condition specifying the exhibit to this MHS 37 Service description that describes the project for which the funds are awarded. The specific MHS 37 Services to be provided under this Agreement are described in exhibits, if any, to this MHS 37 Service Description, which exhibits are incorporated herein by this reference. II. Performance Requirements Providers of MHS 37 Services funded through this Agreement with Medicaid dollars must comply with OAR 309­ 016-0000 through 309-016-0755. See exhibits, if any, to this MHS 37 Service Description. III. Special Reporting Requirements See exhibits, if any, to this MHS 37 Service Description. IV. Payment Procedures See exhibits, if any, to this MHS 37 Service Description. Even if the OHA Contract #134309 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. PAGE 1 OF 1 -EXHIBIT 1-C DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 EXHIBIT 1-D 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 OHA Contract #134309 who have a serious mental illness, or other mental or emotional disturbance posing a danger to the health and safety of themselves or others. Non-Residential Mental Health Services For Adults (Designated) include: A. Case management services; B. Vocational and social services; C. Rehabilitation; D. Support to obtain and maintain housing; E. Medication and medication monitoring; F. Emotional support; G. Individual, family and group counseling and therapy; H. Sex offender treatment; and I. Interpreter services. II. Performance Requirements Providers of MHS 201 Services shall provide coordination of care services for county of responsibility residents in residential treatment programs, which include extended care managed services, regardless of the location. The coordination of care shall include participation in the residential provider's treatment planning process and in planning for the individual's transition to outpatient services. Services funded through this Agreement for any resident will be time limited and subject to review and revision by OHA. Providers of MHS 201 Services funded through this Agreement must: A. Comply with OAR 309-032-1500 through 309-032-1565, as such rules may be revised from time to time; B. Maintain a Certificate of Approval, for the delivery of clinical services, in accordance with OAR 309-012­ 0130 through OAR 309-012-0220, as such rules may be revised from time to time; and C. Investigate and report allegations of abuse regarding served individuals and provide protective services to those individuals to prevent further abuse. The investigation, reporting and protective services must be completed in compliance with ORS 430.731 through 430.768 and OAR 407-045-0000 through 407­ 045-0980, as such statutes and rules may be revised from time to time. III. Special Reporting Requirements A. County shall provide the Oregon Health Authority (OHA) with a summary report of MHS 201 Services delivered with funds provided under this Agreement within 45 days after the end of the 12-month period ending June 30, during the term of this Agreement, and after the termination of this Agreement. Submit reports to: Oregon Health Authority Addictions and Mental Health Services Division Attention: Contracts Administrator 500 Summer Street N.E. E86 Salem, OR 97301-1118 PAGE 1 OF 3 -EXHIBIT 1-D -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I i Reports must be prepared using forms and procedures prescribed by OHA I 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. I 1 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: 1 http://www.oregon.gov/OHAImentalhealth/publications/cpmsmanuaLmh.pdf?ga=t. and as it may be J revised from time to time. IV. Financial Assistance Calculation, Disbursement and Settlement Procedures 1 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 OHA Contract #134309 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 1 procedures for billing OHA for Medicaid mental health services outlined in the Medicaid provider manual. OHA I 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. I Rates are available on the OHA website located at http://egov.oregon.gov/OHAImentalhealth/publications/codebooks/mh0109rates.pdf. I 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 I Medicaid Payment for Rehabilitative Mental Health Services Rule as listed in OAR 309-016-0000 through 309­ 016-0450 the OHA AMH Mental Health and Chemical Dependency Medicaid Provider Manual available on the OHA website located at http://www.oregon.gov/OHAImentalhealth/publications/codebooks/manual.pdf. i J 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 OHA Contract #134309 with an "A" in Column one, multiplied by the number of units of MHS 201 I I 4 Services delivered under that line of the OHA Contract #134309 during the period specified in that line, subject to the following: I 1. Total OHA financial assistance for MHS 201 Services under a particular line of the OHA Contract #134309 shall not exceed the total funds awarded for MHS 201 Services as specified on that line. ~ 1 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) I ! 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. 1 3. OHA will reduce the financial assistance for MHS 201 Services delivered under a particular line of I I the OHA Contract #134309 containing and "AI! 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 i receiving such services. I B. Disbursement of Financial Assistance: Unless a different disbursement method is specified in that line of the OHA Contract #134309, OHA will disburse the Part A Award for MHS 201 Services identified in a PAGE 2 OF 3 -EXHIBIT 1-0 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I J particular line of the OHA Contract #134309 to County in substantially equal monthly allotments during the period specified in that line of the OHA Contract #134309, subject to the following: II I 1. OHA may, upon written request of County, adjust monthly allotments; 1 2. Upon amendment to the OHA Contract #134309, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 201 Services on that line of the OHA Contract #134309. 3. OHA may after 30 days (unless parties agreed otherwise) written notice to County, reduce the monthly allotments based on under used allotments identified through CPMS or through other 1 method permitted or required by this Service Description or an applicable Specialized Service Requirement;f j C. Agreement Settlement: Agreement Settlement will be used to confirm the delivery of MHS 201 Services I to the individuals specified in the OHA Contract #134309 by County as part of its CMHP, based on data properly reported in CPMS or through other reports required or permitted by this Service Description or an applicable Specialized Service Requirement. PAGE 3 OF 3 EXHIBIT 1-D -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 1I j j 1 I j I I 1 1 EXHIBIT 1-E USE OF COUNTY BEDS IN RESIDENTIAL TREATMENT HOMES Use of the Six "County Beds" in Residential Treatment Homes in Deschutes County Purpose of this Agreement: To outline the use of County beds in State-supported residential programs in the residential treatment homes in Deschutes County. Funding: • AMH will make the service payment to the residential provider for any resident in a County bed, regardless of the length of stay even if less than 30 days. The resident does not need to be Medicaid eligible for placement, but all eligible residents will be. • If the client does not have Medicaid, County will also make a request to AMH for payment of R&B. Types of clients the County may place in a County Bed may include, but not be limited to (examples): • A discharge from a local acute care unit who is a placement problem and needs additional stabilization; • A client in the community who is deteriorating or at risk of commitment, but not yet meeting commitment criteria; • A client who may be new to the community, has a history of mental illness and is in an unstable living situation; • Relief for a family who is caring for difficult a client in the home. A 2-3 month placement may help the family to continue as the primary care provider; • A client on probation, in and out of jail due to a mental illness related infraction and needing longer term stabilization; • Post-commitment, a client who need longer stabilization but is not necessarily eligible for a state hospital level of care and who has not qualified for AMHI; and • A client in the state hospital or the community who needs residential placement but has not traditionally been eligible due to lack of Medicaid eligibility. Length of stay • While some clients may need longer or shorter term placement, the goal would be to use this as transitional stabilization with a typical length of stay 30-90 days. Criteria General criteria -does not need to meet all for placement • Major mental illness as primary diagnosis. May also have dual diagnosis of substance abuse/dependence, a developmental disability and/or medical issues. • Must have a need for treatment for stabilization. A need for housing only would not meet the criteria for residential placement in a County bed. • Difficult to manage in the community and likely involved with other systems. • Recent or impending crisis. • Does not need acute care stabilization. • Client agrees to remain clean and sober. • Client agrees to placement for a minimum of 30 days • Client would typically be voluntary, except possibly for some clients under civil commitment. Referral Process • All referrals will be made from within Deschutes County to a designated DCHS staff person. If we are unable to fill all Deschutes County beds, DCHS will consider an AMHI referral to fill the bed. If this occurs, the next AMHI discharge will be converted back to a County bed to maintain 6-bed capacity within the system. • A review team comprised of supervisory and housing staff will review referrals, prioritize between multiple referrals based on level of need, and determine appropriateness for placement. PAGE 1 OF 2 -EXHIBIT 1-E -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I I I I I i f 1 1 I, • The designated team member will coordinate with the residential program for final review and placement approval. Treatment needs from facility: • Ability to manage multiple issues in addition to mental illness (primarily substance abuse, developmental disabilities and medical issues). • Provide an environment that is inviting especially to a younger population. Note: we would anticipate that young males may have a particular need for this placement PAGE 2 OF 2 -EXHIBIT 1-E -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 EXHIBIT 2 DESCHUTES COUNTY SERVICES AGREEMENT Agreement No. 2011-401 INSURANCE REQUIREMENTS Contractor shall at all times maintain in force at Contractor's expense, each insurance noted below. Insurance coverage must apply on a primary or non-contributory basis. All insurance policies, except Professional Liability, shall be written on an occurrence basis and be in effect for the term of this Agreement. Policies written on a "claims made" basis must be approved and authorized by Deschutes County. Contractor Name: Telecare Mental Health Services of Oregon, Inc. Workers Compensation insurance in compliance with DRS 656.017, requIring Contractor and all subcontractors to provide workers' compensation coverage for all subject workers, or provide certification of exempt status under DRS 656.126(2). Employer's Liability Insurance with coverage limits of not less than $500,000 must be included. Professional Liability insurance with an occurrence combined single limit of not less than: Per Occurrence limit Annual Aggregate limit o $500,000 0 $500,000 [gI $1,000,000 0 $1,000,000 o $2,000,000 [gI $2,000,000 Professional Liability insurance covers damages caused by error, omiSSion, or negligent acts related to professional services provided under this Agreement. The policy must provide extended reporting period coverClge, sometimes referred to as "tail coverage" for claims made within two years after this Agreement is completed. Contractor shall maintain either "tail" coverage or continuous "claims made" liability coverage, provided the effective date of the continuous "claims made" coverage is on or before the effective date of the Agreement, for a minimum of 24 months following the later of: (a) the Contractor's completion and County's acceptance of all Services required under the Agreement or, (b) the expiration of all warranty periods provided under the Agreement. Notwithstanding the foregoing 24-month period described above, then the Contractor may request and OHA may grant approval of the maximum "tail" coverage period reasonably available in the marketplace. If OHA approval is granted, the Contractor shall maintain "tail" coverage for the maximum time period that the "tail" coverage is reasonably available in the marketplace. [gI R~q uired by County o Not required by County (one box must be checked) Commercial General Liability insurance with a combined single limit of not less than: Per Single Claimant and Incident All Claimants Arising from Single Incident o Oregon Tort Claims Act limits 0 Oregon Tort Claims Act limits [gI $1,000,000 0 $2,000,000 o $2,000,000 [gI $3,000,000 Commercial General Liability insurance includes coverage for personal injury, bodily injury, advertiSing injury, property damage, premises, operations, products, completed operations and contractual damages. This insurance shall include personal injury liability, products and completed operations and shall be written on an occurrence form basis. The Oregon Legislature has adopted legislation which establishes tort claims limits for actions against local public bodies, including their officers, agents and employees. The tort claims act limits are automatically adjusted on July 1 every year. By separate endorsement, the policy shall name Deschutes County, the State of Oregon, the Oregon Health Authority, their officers, agents, employees and volunteers as an additional insured. The additional insured endorsement shall not include declarations that reduce any per occurrence or aggregate insurance limit. The contractor shall provide additional coverage based on any outstanding claim(s) made against policy limits to ensure that minimum insurance limits required by the County are maintained. Construction contracts may include aggregate limits that apply on a "per location" or "per project" basis. PAGE 1 OF 2 -EXHIBIT 2 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Automobile Liability insurance with a combined single limit of not less than: Per Occurrence o $500,000 x $1,000,000 o $2,000,000 Automobile Liability insurance covering all owned, non-owned and hired vehicles, includes coverage for bodily injury and property damage resulting from operation of a motor vehicle. Commercial Automobile Liability Insurance shall provide coverage for any motor vehicle (symbol 1 on some insurance certificates) driven by or on behalf of Contractor during the course of providing services under this Agreement. Commercial Automobile Liability is required for contractors that own business vehicles registered to the business. Examples include: plumbers, electricians or construction contractors. An Example of an acceptable personal automobile policy is a contractor who is a sole proprietor that does not own vehicles registered to the business . \. x Required by County 0 Not required by County one box must be checked Additional Requirements. Contractor shall pay all deductibles and self-insured retentions. A cross-liability clause or separation of insured's condition must be included in all commercial general liability policies required by this Agreement. Contractor's coverage will be primary in the event of loss. Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Agreement. The Contractor or its insurer shall provide at least thirty (30) days written notice to County before cancellation, termination, material change. potential exhaustion of aggregate limits, non-renewal or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or. if applicable, the self-insured retention level. For commercial general and automobile liability coverage, the Certificate shall also provide, by policy endorsement, that Deschutes County, the State of Oregon, their agents, officers, employees and volunteers are additional insureds with respect to Contractor's services provided under this Agreement. The endorsement must be in a format acceptable to Deschutes County. If requested, complete copies of insurance policies shall be provided to the County. Risk Management review Date PAGE 2 OF 2 -EXHIBIT 2 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Exhibit 3 Disclosure of Protected Health Information 1. Purpose. The purpose of this exhibit is to set forth the terms and conditions of disclosure of "protected health information" (as defined in Section 2.1 of this exhibit) between Contractor and COUNTY. It is the intent of COUNTY and Contractor that this exhibit will meet the requirements of 45 CFR § 164.504(e) of the privacy regulations and 45 CFR § 164.314(a) of the security regulations promulgated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (collectively the "HIPAA Regulations"). 2. Use And Disclosure Of PHI. 2.1 Definitions. For purposes of this exhibit, the term "protected health information" (PHI) means Individually Identifiable Health Information transmitted or maintained in any form or medium. "Individually Identifiable Health Information" is information, including demographic information, that: (a) relates to (i) the past, present or future physical or mental health or condition of an individual person, (ii) the provision of health care to an individual person, or (iii) the past, present or future payment for the proviSion of health care to an individual person; and (b) identifies that person (or with respect to which there is a reasonable basis to believe the information can be used to identify the person). Terms used by but not otherwise defined in this exhibit shall have the same meaning as those in 45 CFR Parts 160, 162, and 164. 2.2 Security and Confidentiality. If Contractor discloses any PHI to COUNTY, or if COUNTY creates or receives any PHI on behalf of Contractor, COUNTY will maintain the security and confidentiality of such PHI in County's possession as is required by the HIPAA Regulations. Contractor shall maintain the security and confidentiality of any PHI received by Contractor. 2.3 Use and Disclosure. Neither Contractor nor COUNTY not use or disclose PHI except as permitted by this exhibit or other parts of this Agreement, or as required by law. 2.4 Disclosure Procedure. Unless such disclosure is required by law, neither COUNTY nor Contractor may disclose PHI unless: (a) the disclosing party first obtains reasonable assurances from the person to whom the PHI is disclosed that the PHI will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and (b) the person notifies the disclosing party of any instances of which the person is aware of breaches of confidentiality of the PHI. 3. Other Obligations. 3.1 Safeguards. COUNTY and Contractor will use appropriate safeguards to prevent use or disclosure of PHI otherwise than as permitted by this exhibit. 3.2 Reports. COUNTY will report to Contractor any use or disclosure of PHI by COUNTY or its Workforce not provided for by this exhibit of which COUNTY becomes aware. Contractor will report to COUNTY any use or disclosure of PHI by Contractor or its officers, employees or agents not provided for by this exhibit of which Contractor becomes aware. Agents. COUNTY will ensure that any agents, including subcontractors, to whom COUNTY provides PHI received from Contractor (or created or received by COUNTY on behalf of Contractor) agree to the same restrictions and conditions that apply to COUNTY with respect to such PHI. Contractor will ensure that any agents, including subcontractors, to whom Contractor provides PHI received from COUNTY (or created or received by Contractor on behalf of COUNTY) agree to the same restrictions and conditions that apply to Contractor with respect to such PHI. PAGE 1 OF 2 -EXHIBIT 3 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 3.3 Availability. COUNTY and Contractor shall make PHI in either's possession available to the individual who is the subject of the PHI as required by the HIPAA Regulations. 3.4 Amendment. COUNTY and Contractor shall make available PHI in its or their possession for amendment of the PHI by the person identified in the PHI and incorporate any such amendments in accordance with the HIPAA Regulations. 3.5 Access. If COUNTY has PHI in a designated record set, COUNTY will provide Contractor, upon Contractor's reasonable request, access for inspection of County's books, records, policies, practices and procedures concerning the use and disclosure of PHI for purposes of assisting Contractor with its obligations for record keeping and compliance with complaint investigations and compliance reviews as required by the HIPAA Regulations. If Contractor has PHI in a designated record set, Contractor will provide COUNTY, upon COUNTY'S reasonable request, access for inspection of Contractor's books, records, policies, practices and procedures concerning the use and disclosure of PHI for purposes of assisting COUNTY with its obligations for record keeping and compliance with complaint investigations and compliance reviews as required by the HIPAA Regulations. 4. Accounting Of Disclosures. Although COUNTY and Contractor do not anticipate making disclosures other than for the purposes of this Agreement, COUNTY and Contractor will maintain records of all disclosures of PHI made otherwise than for the purposes of this Agreement, including the date of the disclosure, the name and address (if known) of the recipient of the PHI, a brief description of the PHI disclosed, and the purpose of the disclosure as necessary to permit Contractor and COUNTY to respond to a request by an individual for an accounting of disclosures in accordance with 45 CFR § 164.528. Each party will make such record available to the other party upon request. 5. Disclosure To U.S. Department Of Health And Human Services. Each party will make its internal practices, books, and records relating to the use and disclosure of PHI received from the other party (or created or received by one party on behalf of the other party) available to the Secretary of the United States Department of Health and Human Services, for purposes of determining County's and Contractor's compliance with the HIPAA Regulations. 6. Procedure Upon Termination. Upon termination of this Agreement, COUNTY and Contractor will, if feasible, return or destroy all PHI that the party maintains in any form, and will retain no copies of such PHI or, if the parties agree that return or destruction is not feasible, each party will continue to extend the protections of this exhibit to such PHI, and limit further use of the PHI to those purposes that make the return or destruction of the PHI infeasible. 7. No Third Party Beneficiaries. There are no third party beneficiaries to the Agreement or this exhibit. PAGE 2 OF 2 -EXHIBIT 3 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 EXHIBIT 4 DESCHUTES COUNTY SERVICES AGREEMENT Agreement No. 2011-401 Expense Reimbursement 1. Travel and Other Expenses. (When travel and other expenses are reimbursed.) a. It is the policy of the County that all travel shall be allowed only when the travel is essential to the normal discharge of the County responsibilities. 1) All travel shall be conducted in the most efficient and cost effective manner resulting in the best value to the County. 2) Travel expenses shall be reimbursed for official County business only. 3) County shall not reimburse Contractor for any item that is not otherwise available for reimbursement to an employee of Deschutes County per Deschutes County Finance Policy F-1, "REIMBURSEMENT FOR MISCELLANEOUS EXPENSES AND EXPENSES INCURRED WHILE TRAVELING ON COUNTY BUSINESS," dated 11/8/06. 4) County may approve a form other than the County Employee Reimbursement Form for Contractor to submit an itemized description of travel expenses for payment. 5) Personal expenses shall not be authorized at any time. 6) All expenses are included in the total maximum Agreement amount. b. Travel expenses shall be reimbursed only in accordance with rates approved by the County and only when the reimbursement of expenses is specifically provided for in Exhibit 1, paragraph 3 of this Agreement. c. The current approved rates for reimbursement of travel expenses are set forth in the above described policy. d. County shall not reimburse for any expenses related to alcohol consumption or entertainment. e. Except where noted, detailed receipts for all expenses shall be provided. f. Charge slips for gross amounts are not acceptable. g. County shall not reimburse Contractor for any item that is not otherwise available for reimbursement to an employee of Deschutes County. 2. Approved reimbursements: a. Mileage. Contractor shall be entitled to mileage for travel in a private automobile while Contractor is acting within the course and scope of Contractor's duties under this Agreement and driving over the most direct and usually traveled route to and from Bend, Oregon. 1) Reimbursement for mileage shall be equal to but not exceed those set by the United States General Services Administration rGSA") and are subject to change accordingly. 2) To qualify for mileage reimbursement, Contractor shall hold a valid, current driver's license for the class of vehicle to be driven and carry personal automobile liability insurance in amounts not less than those required by this Agreement. 3) No mileage reimbursement shall be paid for the use of motorcycles or mopeds. b. Meals. 1) Any reimbursement for meals shall be for actual cost of meals incurred by Contractor while acting within the course and scope of Contractor's duties under this Agreement. 2) For purposes of calculating individual meals where the Contractor is entitled only to a partial day reimbursement, the following maximum allocation of the meal expenses applies: a) Breakfast, $10; b) Lunch, $12; c) Dinner, $22. 3) Except in the event of necessary overnight travel as provided below, partial day meal expenses shall be reimbursed as follows and only while Contractor is acting within the course and scope of Contractor's duties under this Agreement: a) Breakfast expenses are reimbursable if Contractor is required to travel more than two (2) hours: before the start Contractor's regular workday (i.e. 8:00 a.m.). b) Lunch expenses are reimbursable only if Contractor is required to travel overnight and begins the journey before 11 :00 am or ends the journey after 11 :00 a.m. PAGE 1 OF 2 -EXHIBIT 4 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 c) Dinner expenses are reimbursable only if Contractor is required to travel more than two (2) hours after Contractor's regular workday (Le. 5:00 p.m.). 4) Breakfast and dinner expenses are reimbursable during Contractor's necessary overnight travel while acting within the course and scope of Contractor's duties under this Agreement and shall not exceed those set by the GSA. and are subject to change accordingly. c. Lodging. 1) County shall reimburse Contractor for Contractor's actual cost of lodging necessary to provide service to the County and shall not exceed the maximum lodge set by the GSA for Bend, Oregon. 2) Reimbursement rates for lodging are not considered "per diem" and receipts are required for reimbursement. d County shall not reimburse Contractor in excess of the lowest fair for any airline ticket or vehicle rental charges. 3. Exceptions. Contractor shall obtain separate written approval of the County Administrator for any exceptions to the expense items listed above prior to incurring any expense for which reimbursement shall be sought. PAGE 2 OF 2 -EXHIBIT 4 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Exhibit 5 DESCHUTES COUNTY SERVICES AGREEMENT Agreement No. 2011-401 Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules, regulations, executive orders and policies. Conflicts of Interest Contractor certifies under penalty of perjury that the following statements are true to the best of Contractor's knowledge: 1. If Contractor is currently performing work for the County, State of Oregon or federal government, Contractor by signature to this Agreement declares certifies that; Contractor's Work to be performed under this Agreement create no potential or actual conflict of interest as defined by ORS 244 and no rules or regulations of Contractor's employee agency (County State or Federal) would prohibit Contractor's Work under this Agreement. Contractor is not an "officer," "employee." or "agent" of the County, as those terms are used in ORS 30.265. 2. Miscellaneous Federal Provisions. Contractor shall comply with all federal laws. regulations, and executive orders applicable to the Contractor or to the delivery of Services. Without limiting the generality of the foregOing. Contractor agrees to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: a. Titles VI and VII of the Civil rights Act of 1964, as amended; b. Sections 503 and 504 of the Rehabilitation Act of 1973, as amended; c. the Americans with Disabilities Act of 1990. as amended; d. Executive Order 11246, as amended, e. the Health Insurance Portability and Accountability Act of 1996; f. the Age of Discrimination in Employment Act of 1967. as amended. and the Age of Discrimination Act of 1975, as amended; g. the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended; h. all regulations and administrative rules established pursuant to the foregoing laws; i. all other applicable requirements of federal civil rights and rehabilitation statutes. ruls and regulations; j. all federal law governing operation of Community Mental Health Programs. including without limitation. all federal laws requiring reporting of 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. 3 Equal Employment Opportunity. Contractor shall com ploy with Executive Order 11246. entitled "Equal Employment Opportunity." as amended by Executive Order 11375. and as supplemented in Department of Labor regulations (41 CFR Part 60). 4. Clean Air, Clean Water, EPA Regulations. If Agreement maximum compensation, including amendments. exceeds $100.000 then Contractor shall comply with all applicable standards. orders. or requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 1857 (h)). the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) (33 U.S.C. 1251 to 1387). specifically including, but not limited to Section 508 (33 U.S.C. 1368). Executive Order 11738. and Environmental Protection Agency regulations (2 CFR Part 1532). which prohibit the use under non-exempt Federal contracts. grants or loans of facilities included on the EPA List of Violating Facilities. Violations shall be repoted to Oregon Health Authority, the State of Oregon Health and Human Services (HHS) and the appropriate Regional Office of the Environmental Protection Agency. 5. Energy Efficiency. Contractor shall comply with applicable mandatory standards and policies relating to energy efficiency that are contained in the Oregon energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163). PAGE 1 OF 2 -EXHIBIT 5 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 6. Resource Conservation and Recovery. Contractor shall comply with all mandatory standards and policies that relate to resource conservation and recovery pursuant to the Resource Conservation and Recovery Act (codified at 42 USC 6901 et. seq.). Section 6002 of that Act (codified at 42 USC 6962) requires that preference be given in procurement programs to the purchase of specific products containing recycled materials identified in guidelines developed by the Environmental Protection Agency. Current guidelines are set forth in 40 CFR Part 247. 7. Audits. a. Contractor shall comply, if applicable, with the applicable audit requirements and responsibilities set forth in the Office of Management and Budget Circular A-133 entitled "Audits of States, Local Governments and Non-Profit Organizations." b. Contractor shall also be required to comply with applicable Code of Federal Regulations (CFR) sections and OMB Circulars governing expenditure of federal funds. State, local and Indian Tribal Governments and governmental hospitals must follow OMB A-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. 8. No federally appropriated funds have been paid or shall be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. a. If any funds other than federally appropriated funds have been paid or shall be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, Contractor agrees to complete and submit Standard Form-LLL "Disclosure Form to Report Lobbying," in accordance with its instructions. 1) Standard Form-LLL and instructions are located in 45 CFR Part 93 Appendix B. 2) If instructions require filing the form with the applicable federal entity, Contractor shall then as a material condition of this Contract also file a copy of the Standard Form-LLL with the Oregon Health Authority. 3) This filing shall occur at the same time as the filing in accordance with the instructions. b. Contractor understands this certification is a material representation of fact upon which the County and the Oregon Health Authority has relied in entering into this Agreement. Contractor further understands that submission of this certification is a prerequisite, imposed by 31 USC 1352 for entering into this Agreement. c. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. d. Contractor shall include the language of this certification in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly. e. Contractor is solely responsible for all liability arising from a failure by Contractor to comply with the terms of this certification. f. Contractor promises to indemnify County for any damages suffered by County as a result of Contractor's failure to comply with the terms of this certification. 9. Contractor understands that, if this Agreement involves federally appropriated funds, this certification is a material representation of facts upon which reliance was placed when this Agreement was made or entered into, submission of this certification is a prerequisite for make or entering into this Agreement imposed by Section 1352, Title 311, U.S. Code and that any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each failure. Contractor Signature Date PAGE 2 OF 2 -EXHIBIT 5 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 Exhibit 6 DESCHUTES COUNTY SERVICES AGREEMENT Agreement No. 2011-401 BUSINESS ASSOCIATE AGREEMENT county will make available and/or transfer to Contractor certain Information, in conjunction with goods or services that are being provided by Contractor to County that is confidential and must be afforded special treatment al')d protection. Contractor will have access to and/or receive from County certain Information that can be used or disclosed only in accordance with this Agreement and the HHS Privacy Regulations. To the extent required by 42 U.S.C. 1171 et seq. enacted by the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, Contractor assures County that Contractor will appropriately safeguard protected health information made available to or obtained by Contractor. Contractor further agrees to comply with applicable laws relating to protected health information and with respect to any task or other activity Contractor performs on behalf of County, to the extent County would be required to comply with such requirements. For purposes of this Agreement, the following terms shall apply: A Contractor shall be considered a BUSINESS ASSOCIATE; B. County shall be considered a COVERED ENTITY; C. HHS Privacy Regulations shall mean the Code of Federal Regulations (C.F.R.) at Title 45, Sections 160 and 164; D. Individual shall mean the person who is the subject of the Information, and has the same meaning as the term 'individual' is defined by 45 C.F.R. 164.501; and E. Secretary shall mean the Secretary of the Department of Health and Human Services (HHS) and any other officer or employee of HHS to whom the authority involved has been delegated; F. Information shall mean any health information provided and/or made available by County to Contractor, and has the same meaning as the term 'health information' as defined by 45 C.F.R. 160.102. Contractor agrees it shall: 1. Not use or further disclose such information other than as permitted or required by this Agreement. Contractor shall not, except as necessary for the proper management, administration and performance of its duties under this Agreement, use, reproduce, disclose, or provide to third parties, any confidential document or information relating to the County, its members or to clients of County or its members without the prior written consent or authorization of the County or of the client. If Contractor uses such information for the purposes set forth above, it will only do so jf the disclosure is required by law or Contractor obtains reasonable assurances from the person to whom the information is disclosed that it PAGE 1 OF 2 -EXHIBIT 6 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I will be held confidentially and used or further disclosed only as required by law or for the purpose for which Contractor disclosed it to the person. Contractor shall ensure that its personnel, employees, affiliates and agents maintain the confidentiality of patient health information and business information of County. 2. Not use or further disclose the information in a manner that would violate the reqUirements of applicable law, if done by County; 3. Use appropriate safeguards to prevent use or disclosure of such information other than as provided for by this Agreement; 4. Report to County any use or disclosure of such information not provided for by this Agreement of which Contractor becomes aware; 5. Ensure that any subcontractors or agents to whom Contractor provides protected health information received from County agree to the same restrictions and conditions that apply to Contractor with respect to such information; 6. Make available protected health information in accordance with applicable law, i.e., the Code of Federal Regulations (C.F.R.) at Title 45, Sections 160 and 164; 7. Maintain standard records, pursuant to this Agreement, and to provide such records and other necessary information to the County as may be requested in writing and as permitted by law. Contractor agrees that all records kept in connection with this Agreement are subject to review and audit by the County upon reasonable notice of a minimum of 14 work days from the date of written request by the County. 8. Make Contractor's internal practices, books, and records relating to the use and disclosure of protected health information received from County available to the Secretary of the United States Health & Human Services for purposes of determining County's compliance with applicable law (in all events, Contractor shall immediately notify County upon receipt by Contractor of any such request, and shall provide County with copies of any such materials); 9. Upon termination of this Agreement, Contractor shall promptly return all protected health information received from County. If the return of protected health information is not feaSible, Contractor shall continue the protections required under this Agreement to the protected health information consistent with the requirements of this Attachment and the HIPAA privacy standards. Date: ____ Signature: _____________ Title _______ Contractor: PAGE 2 OF 2 -EXHIBIT6 -DESCHUTES COUNTY SERVICES AGREEMENT No. 2011-401 I DATE (MMIDDlYYYY) ACORD· ~ CERTIFICATE OF LIABILITY INSURANCE OOJ2912011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACTPRODUCER NAME:MARSH RISK &INSURANCE SERVICES 345 CALIFORNIA STREET, SUITE 1300 ' r~gNJn Evil, I r~~.NOI: CALIFORNIA LICENSE NO. 0437153 i:Ollfu,s: ---.__._-:--.__.­SAN FRANCISCO, CA 94104 Attn: SanFrancisco.Certs@marsh.comlf: 212·948·0398 _ INSURER(S).~NG eOVERAGE ..__~__ • NAle. 17370INSURER A: Nautilus Insurance Company072624-CAS-Pl·l1·12 GLALP WC OR INSURED 16535 TELECARE MENTAL HEALTH SERVICES INSURER B: lunch Amelican Insurance Company 40142--­INSURER e : Amelican Zurich Insurance Company 1080 MARINA VILLAGE PARKWAY, SUITE 100 OF OREGON, INC. I I NSURERD-!ALAMEDA, CA 94501 INSURERE: J---~ --~--~----~----~ - INSURERF: COVERAGES CERTIFICATE NUMBER: SEA·002094218-05 REVISION NUMBER' 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ~~f;I~~~ •~'t,%,fy~~F,,1 I f~g}-r®'v~rvl LIMITSLTR POLICY NUMBER A GENERAL LIABILITY X GFP1000063P3 0110112011 0710112012 ~EACH OCCURRENCE $ 1,000,~ ~MERCIAL GENERAL LIABILITY ~AMAGE TO RENTED 100,000PREMISE§ !Ell occurrence] $ • CLAIMS·MADE ~OCCUR MED EXP (Anyone person) $ 5,000 pS~:$l00,OOO PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 I -.­ I~'L AGGREr9 LIMIT APnS PER: PRODUCTS· COM PlOP AGG $ 1,000,000 X POLICY j~g LOC $ B , AUTOMOBILE LIABILITY X BAP378473307 07101/2011 0710112012 COMBINED SINGLE LIMIT 1,000,000_l~llJl.~id!!D!L_ .. .. .L .. ~----.-- ANY AUTO I BODILY INJURY (Per person) $ ALL OWNED ~= SCHEDULED BODIL Y INJURY (Per accident) $AUTOS AUTOS ]ROPERTY,8AMAGE .NON·OWNED $ I.Xl HIRED AUTOS I AUTOS I Per <lQ.C.ident! X Comp $250 IX Coli: $500 $ I I I UMBRELLA LIAB HOCCUR I EACH OCCURRENCE i $ IH EXCESS L1AB CLAIMS-MADE I AGGREGATE $ I I DED I I RETENTION $ $ I C WORKERS COMPENSATION WC829852009 07/01/2011 0710112012 X IT~~$I~I~S I IOJ~' AND EMPLOYERS' LIABILITY YIN 1,000,000ANY PROPRIETOR/PARTNER/EXECUTIVE 0 ~:.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA := (Mandatory in NH) I EL DISEASE EA EMPLOYEE $ tooo,OOO If ~'de'3cribe under I 1,000,000o SCRIPTION OF OPERATIONS below E.l. DISEASE· POLICY LIMIT $ A PROFESSIONAL LIABILITY PFPloo0081P3 07/0112011 0710112012 i~GREGATE 3,000,000 CLAIMS MADE; SIR: $100,000 AGGREGATE 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) peSCHUTES COUNTY, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS ARE ADDITIONAl INSUREDS UNDER THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES SOLELY AS rESPECTS WORK PERFORMED BY OR FOR THE NAMED INSURED IN CONNECTION WITH THE CONTRACT AGREEMENT. CERTIFICATE HOLDER CANCELLATION DESCHUTES COUNTY HEALTH SERVICES 2577 NE COURTNEY DRIVE BEND. OR 97702 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATlON DATE THEREOF, NOTlCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE of Marsh Risk &Insurance Services Ellen Redell Brown ~ © 1988-2010 ACORD CORPORATION. All nghts reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ADDITIONAL INFORMATION -.­T_' __ ,._"_.~.~_._~___~~ PRODUCER MARSH RISK &INSURANCE SERVICES 345 CALIFORNIA STREET, SUITE 1300 CALIFORNIA LICENSE NO. 0437153 SAN FRANCISCO, CA 94104 AtlIl: SanFrancisco.Certs@marsh.com If: 212-948-0398 072624-CAS-PL-11-12 GLALPL INSURED TElECARE MENTAL HEALTH SERVICES OF OREGON, INC. 1080 MARINA VILLAGE PARKWAY, SUITE 100 ALAMEDA, CA 94501 WC OR SEA-002094218-05 ---~-----.------. : INSURERS AFFORDING COVERAGE INSURERG: INSURERH: ..-­ INSURER I: INSURERJ: DATE (MMlDDIYY) 0612912011 iNAIC# TEXT Other Umits EACH OCCURRENCE' 1.000,000 CERTIFICATE HOLDER DESCHUTES COUNTY HEALTH SERVICES 2577 NE COURTNEY DRIVE BEND, OR 97702 ! AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Ellen Redell Brown P > .. ' .;,2.. . ill!,>, i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-AUTOMATIC STATUS WHEN REQUIRED IN AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: HEALTHCARE GENERAL LlABIUTY COVERAGE FORM A. Section 11-Who is An Insured Is amended to Include as an ~ddltlonal insured any person or organ~ation . for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on yourpolioy.) Such person or organization Is an additional insured only with respect 10 lfab18ty fOr "bodily injurY', ·property damage" or ·personal and advertising injury" oaused In whole or In part, by: 1. '(our aots or omissions; orI. < 2. The acts or omissions of those acting on your behalf; . ­ In the pertormance Of your ongoing operations for the additional insured. Aperson's or organization's status as an addiUonal insured under this endorsement ends when your operations for that additional insured are completed. I f ' 'I [ .1 .1 NOTHING CONTAINED HERElN SHALL VARY, ALTER; WAIVE OR eXTEND ANY OF THE TERMS, PROVISIONS, REPRESENTATIONS, CONDmONS OR AGREEMENTS OF THE POLICY OTHER THAN AS STATED ABOVE. < SSM-0061 (7107) IncluQelI COIlyrigh1ed malerial of Insurance S~Office, Inc. wilh its Page 1 011 .1 perml~Jon. ,~ ,:~ 1 ; ,< i :,; !. ; .i ! (~;'::::i ""., i ~:~. i , ; .; II ! I