HomeMy WebLinkAboutDoc 398 - Agrmt - St. Charles - Sage ViewDeschutes County Board of Commissioners
1300 NW Wall St.. Suite 200. Bend. OR 97701-1960
(541) 388-6570 -Fax {541} 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of November 2, 2011
DATE: October 21. 2011
FROM: Lori Hill. Adult Treatment Program Manager
Nancy England. Contract Specialist Phone: 322-7516
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document #2011-398, Agreement between St. Charles Health
System, Inc. and Deschutes County Health Services (DCHS).
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
St. Charles Health System Inc. operates a facility that can serve up to fifteen clients in need of short
term psychiatric care, also referred to as acute psychiatric care services. Acute psychiatric care
services are services delivered to individuals who are suffering from a mental illness. or mental or
emotional disturbance and are posing a danger to the health and safety of the individual or others.
These services are intended to control or reduce the psychiatric symptoms or behaviors in order that
the individual can return to a less restrictive environment.
Since 2005. Deschutes County, on behalf of Crook and Jefferson counties has contracted with St.
Charles to ensure indigent residents of our three counties have access to these services and the Sage
View facility. The resources are subject to funding from the State of Oregon Office of Mental Health
and Addiction Services. Under the terms of this contract, St. Charles agrees to provide acute
psychiatric care services on an in-patient basis. (In-patient meaning that the individual remains at the
facility until transferred to another facility or discharged.) Acute psychiatric care services may include:
twenty-four (24) hour supervision and nursing care; health screening or medical care; psychiatric
assessment; medication management; individual and group therapy; education regarding mental
health and addiction issues; family involvement and transportation services between Sage View and
St. Charles Hospital (Bend) as needed for medical or other services.
In additional to the acute psychiatric care, St. Charles also agrees to provide post-commitment care for
individuals who are civilly committed by a judge. This includes clients who are already admitted and
return to the Sage View facility after a commitment hearing. Post-commitment care includes
professional psychiatrist staff time. psychiatric medications. lab work and medical care.
FISCAL IMPLICATIONS:
Maximum compensation is $458,700 for acute psychiatric care services and $530,700 for post
commitment care services.
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 cen 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 wtth the document, the document will be retumed to
the Department. Please submit documents to the Board Secretary for tracking purposea, and not directly to Legal Counsel, the
County Administrator or the Comml8&loners. In additton to submitting this form wtth your documents, please submit this form
electronically to the Board Secretary.)
Please complete all sections above the OffIcIal Review line.
Date: 'September 20, 2011 ,
Department: IDeschutes County Health Services, Behavioral HealtH
Contractor/Supplier/Consultant Name: 1St. Charles Healthcare Community, Inc.1
Contractor Contact: 1 Robin Henderson I Contractor Phone #: 1 54·1-706-2791
Type of Document: IPersonal Services Contract.1
Goods and/or Services: Secure inpatient acute psychiatric care is provided to indigent
residents of Deschutes, Crook and Jefferson counties at Sage View, a facility and
program of St. Charles Healthcare Community, Inc. (St. Charles)
Background & History: St. Charles operates Sage View as a secure inpatient
psychiatric facility, serving residents of Central Oregon and others in need of acute
psychiatric care. The facility has fifteen (15) beds to serve its clients. Since 2005,
Deschutes County, on behalf of Crook and Jefferson counties, has contracted with St.
Charles to ensure indigent residents of our three counties have access to these
services and this facility. Under the terms of this contract, St. Charles agrees to provide
in-patient psychiatric services to any and all indigent residents of our three (3) counties
who need short term acute stabilization. Acute care services may include: twenty-four
(24) hour supervision and nursing care; health screening or medical care; psychiatric
assessment; medication management; individual and group therapy; psycho-education
regarding mental health and addiction issues; family involvement; case management
and transporation services between Sage View and St. Charles Hospital (Bend) as
needed for medical or other services.
St. Charles also agrees to provide Post-Commitment Care for individuals who are civilly
committed by a judge. This includes clients who are already admitted and return to the
facility after a Civil commitment hearing. This service includes professional staff time
(psychiatrist/MD), psychiatric medications, lab work and medical care. Post
Commitment Care shall be provided until transfer to a long-term care facility at the state
hospital or discharge from the facility.
Agreement Starting Date: Uuly 1, 20111 Ending Date: 1 June 30, 20121
58 700 for acute s chiatric care an
~ Insurance Certificate Received (check box)
Insurance Expiration Date: 1 J~I", I, '2. 0 I '
9/20/2011
Check all that apply:
D RFP, Solicitation or Bid Process
D Informal quotes «$150K)
~ Exempt from RFP, Solicitation or Bid Process (specify -see DCC §2.37)
Funding Source: (Included in current budget? ~ Yes D No
If No, has budget amendment been submitted? 0 Yes 0 No
Departmental Contact: IScott Johnsori Phone #: @22-75021
Title: IHealth Services Diredoij
Department Director APproval:~lI:!2P.kdtv ~~lJhJv
Signature Date
Distribution of Document: Include complete information if document is to be mailed.
OffIcial Review:
County Signature Required (check one): [i] BOCC 0 Department Diredor (if <$25K)
o Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ____.-J)
Legal Review Date~",t.. i~ fot2:5),
Document Number -I2=.:0::...l1....:.1-::-3:.:;9.:..8______
9/2012011
For Rec ordin g Stamp O nl y
DESCHUTES COUNTY SERVICES CONTRACT
CONTRACT NO. 2011-398
This Contract (the "Contract") is made and entered into by and between Deschutes County , a political
subdivision of the State of Oregon , by and through Deschutes County Health Services, Behavioral Health Division ,
hereinafter referred to as "County," and St Charles Healthcare Community, Inc, an Oregon non-profit corporation
(hereinafter referred to as "Hospital"), dO ing business as Sage View, Federal Tax Identification No. 93-0602940 ,
hereinafter referred to as "Contractor."
WHEREAS , County and Hospital (or its predecessor in interest , Cascade Health Services, Inc .) have
caused to be constructed an acute psychiatric treatment facility (hereinafter referred to as "Sage View") for mental
health clients , including indigent individuals residing in Crook , Deschutes and Jefferson Counties and served under
this Contract; and
WHEREAS , the parties agree that a crisis center and facility for acute psychiatric care and treatment of
acute mental health clients and/or patients is the preferred acute care model for mental health care and treatment
in Central Oregon;
WHEREAS , Contractor operates the facilities therein; and
WHEREAS , County is authorized pursuant to ORS 430 .670 to obtain, by contract, the services necessary
to condUct and operate a community mental health and developmental disabilities program ; and
WHEREAS, Contractor has available , or can provide Sage View facilities and staff for the performance of
the services described in this Contract; and
WHEREAS , Contractor has obtained and shall continue to qualify for approval from the Oregon Health
Authority ("OHA") for purposes of providing services under this Contract; now, therefore ,
WHEREAS, County is authorized pursuant to ORS 426.241 and Service Element 24 (State of Oregon
grant -Exhibit 5) to obtain , by contract, the emergency psych iatric care necessary for indigent residents of Crook,
Deschutes and Jefferson counties (collectively, "Counties"); and
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. This Contract is effective July 1 , 2011 and , except as otherwise specifically provided
he rein , shall expire on June 30 , 2012 unless earlier terminated or renewed by agreement of the parties .
2 . Contractor's Services . This Contract will cover services as outlined below for:
A. Acute Psychiatric Care: Both Contractor and County agree to adhere to the principles and
agreements for this Contract as outlined in Exhibit 1. Contractor shall perform the services
described as Acute Psychiatric Care in Exhibit 2 attached hereto and incorporated herein, as
funded by and through the County 's contract with the Oregon Health Authority (OHA). Services
shall be financed in accordance with a schedule conta ined in Exhibit 2 . For the full term of this
PAGE 1 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
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Contract, Contractor agrees to the payment methodology as outlined in Section 8 and Exhibits 1
and 2 to provide service to all indigent clients residing in Crook, Deschutes, and Jefferson
Counties who meet admission criteria as defined in Exhibit 2. Contractor agrees to maintain this
arrangement for the Contract period. Acute Psychiatric Care will include all bed days up to and
including day of commitment if applicable. All days post-commitment will be covered under
payment and services outlined in paragraph 2(b) below. If client is not committed, payment will
include all bed days excluding day of discharge.
B. Post-Commitment Care: Contractor shall perform the services described as Post Commitment
Care in Exhibit 3 attached hereto and incorporated herein, as funded by and through the
County's contract with the Oregon Health Authority (OHA). Services shall be financed in
accordance with a schedule contained in Exhibit 3. For the period of July 1, 2011 -June, 30,
2012, Contractor agrees to the payment methodology outlined in Section 8 and Exhibit 3 to
provide post-commitment service to all indigent clients residing in Central and Eastern Oregon
Counties as defined in Exhibit 3. Any services funded beyond June 30, 2012, if approved, would
be made by separate amendment to this Contract.
3. Regulations and Duties. Contactor shall comply with all applicable provisions of the County Financial
Assistance Contract. including applicable Service Descriptions attached thereto, in place at the time this
Contract is executed and effective July 1, 2011, (Contract #134309, the "Contract") between the Oregon
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Health Authority ("OHA") and Deschutes County, as the same may be amended, replaced and/or renewed
from time to time. Contractor agrees to comply with the rules and regulations of County, applicable
provisions in the Contract between County and the OHA, incorporated herein by reference, as of the
effective date of such regulations, applicable provisions of the Administrative Rules and Procedures of the
OHA, applicable Federal regulations and all provisions of Federal and State statutes, rules and regulations
relating to Contractor's performance of services under this Contract. Any act or duty of County, imposed
upon County by OHA, which, by the nature of this Contract, County determines to be within the scope ofJ this Contract 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. 11 4. Reporting.
I A. Contractor shall document the expenditure of all funds paid to Contractor under this Contract. Unless
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applicable federal law requires Contractor to utilize a different accounting system, Contractor shall
create and maintain all expenditure records in accordance with generally accepted accounting
prinCiples and in sufficient detail to permit County and the Oregon Health Authority to verify how the
funds paid to Contractor under this Contract were expended.
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 Contract. It is understood that due to the limited nature of Contractor's services under this
Contract, 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 Contract.
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 Contract, any and
PAGE 2 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
all written materials in altemate 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 Contract.
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: St. Charles Health System, Inc.
2500 NE Neff Road
Bend, OR 97701
Attn: Karen M. Shephard
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
Contract.
A. All fiscal records shall be maintained pursuant to generally accepted accounting standards, and
other records shall be maintained to the extent necessary to clearly reflect actions taken.
1) Contractor shall retain and keep accessible all books, documents, papers and records that are
directly related to this Contract, 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.
I 2) If an audit, litigation or other action involving this Contract 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
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1 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 Contract, the funds paid
to Contractor hereunder, or any services delivered hereunder for the purpose of conducting audits
J 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 allI
.~ services delivered by Contractor hereunder .
I 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
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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
Contract.
i 3) If Contractor's dwelling is Contractor's place of business, Contractor may, at Contractor's
I expense, make the above records available at a location acceptable to the County.
PAGE 3 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
6. Confidentiality. Contractor shall maintain confidentiality of information obtained pursuant to this Contract
as follows:
A Contractor shall not use, release or disclose any information concerning any employee, client,
applicant or person doing business with the County for any purpose not directly connected with the
administration of County's or the Contractor's responsibilities under this Contract 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
Contract.
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 Contract may be amended in writing in the future to incorporate additional requirements related
to compliance with HIPAA.
H. If Contractor receives or transmits protected health information, Contractor shall enter into a
Business Associate Contract with County, which, if attached hereto, shall become a part of this
Contract.
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 Contract. 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 Contract 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 Contract, 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 Contract or involving the records of Contractor, whichever is longer.
PAGE 4 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
Contractor shall permit County and Department to make site visits upon reasonable notice to monitor the
delivery of services under this Contract
8. Payment of Contract
a. Acute Psychiatric Care
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County shall provide quarterly payments to Contractor as outlined in Exhibit 2 for rendering the
services listed in this Contract. Funds may only be used for the delivery of the service or
services set out in this paragraph unless written permission is granted to use the funds for other
services in accordance with this Contract
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Subject to Annual Payment Reconciliation and adjustment, for the period between and including
July 1,2011 through June 30, 2012, Contractor shall receive a total of $458,700 in four quarterly
payments (Exhibit 2) from County for Acute Psychiatric Care services to all indigent clients
served during those twelve months. This payment arrangement for 2011-12 requires Contractor
to comply with the conditions outlined in Exhibit 1 and 2 for all services described in this
Contract. Reconciliation based on actual utilization of bed days will be made in accordance with
"Annual Payment Reconciliation" in Exhibit 2.
b. Post-Commitment Care
I County shall provide monthly payments to Contractor as outlined in Exhibit 3 for rendering the
services listed in this Contract. Funds may only be used for the delivery of the service or
services set out in this paragraph unless written permission is granted to use the funds for other
services in accordance with this Contract.
Notwithstanding the foregoing, for the period between and including July 1, 2011 through June
30, 2012, Contractor shall receive no more than $530,700 in 12 monthly payments (Exhibit 3) 1 from County for Post-Commitment services to all indigent clients as defined in Exhibit 3 served
during those twelve months. This payment arrangement for 2011-12 requires Contractor adhere i
to the conditions outlined in Exhibit 3 for all services described in this Contract.
1 9. Bed Day Rate. j
A. Acute Psychiatric Care: I
I For the purpose of this Contract for Acute Psychiatric Care and extensions or renewals of this
i Contract, the Contractor and the County have established a Bed Day Rate to assist in
calculating future payments if both parties agree to discontinue the heretofore described method
of calculating compensation payable to Contractor and replace the same with a fee-for-service
payment method. This calculation is based on a 2011-12 bed day rate of $695. This Bed Day J
Rate will be utilized to calculate any 'Annual Reconciliation Based on Actual Bed Day Usage' as
outlined in Exhibit 2.
1 Any change to this bed day rate will be indicated by amendment to this Contract.
By mutual agreement between Contractor and County at time of initial contract for Sage View
Acute Psychiatric Care services, an annual bed day rate increase will not exceed 5% in any
calendar year through December 31, 2024. This provision, as well as the provisions of Section
32, shall survive termination of this Contract.
PAGE 5 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
B. Post-Commitment Care:
For the purpose of this Contract for Post-Commitment Care and extensions or renewals of this
Contract, the Contractor and the County have established a Bed Day Rate to assist in
calculating future payments based on actual usage under this portion of the Contract and future
negotiations with the OHA for continued services. This calculation is based on a 2011-12 bed
day rate of $725. This Bed Day Rate will not affect payment or service levels for the 2011-12
service period.
10. Payments in Future Years beyond June 30, 2011. Not later than April 2012, Contractor and County shall
meet to review the Contract and negotiate the program and reporting requirements, protocols and
payment to be paid by County to Contractor beginning on and immediately after July 1,2012. The parties
may at that time also negotiate payment methods and amounts for one or more years after 2012.
The County shall furnish Contractor with relevant information concerning Department funds anticipated to
be provided for services covered under this Contract, together with budgeted amounts, if any, of the
County General Fund for such services. Contractor shall furnish relevant information concerning
Contractor's costs and overhead related to performance of services covered by this Contract. The parties
shall consider amounts previously paid by County under this Contract and determine whether and to what
extent such payments have fairly compensated Contractor for such services. The parties shall also
consider amounts paid and received by similar providers of acute psychiatric care for indigent mental
health patients. In deciding the appropriate compensation level for future services, the parties shall
consider adjustments in service levels or funding or both.
11. Mediation. If the parties cannot reach agreement in matters other than Section 15 of this Contract, they
shall submit the matter to mediation. The parties shall agree upon a single mediator who is experienced in
the area involving the dispute. If the parties are unable to agree on a mediator, each party shall submit 2-3
names of people acceptable as mediator to the Presiding Judge of Deschutes County, who shall select the
mediator from the list provided. Thereafter, the parties shall participate in the mediation process in good
faith. If mediation fails to resolve the issue then either party may proceed to arbitration.
12. Arbitration. If the parties are unable to resolve the dispute over compensation by mediation, they shall
submit the matter to arbitration as follows: Either party may at any time request final and binding arbitration
of the matter, provided the parties have first tried in good faith to settle the matter by nonbinding mediation.
A party may request arbitration by giving notice to that effect to the other party. The dispute shall be
determined in Deschutes County, Oregon, by three (3) arbitrators, one selected by each party and the two
arbitrators selecting a third arbitrator. The arbitration shall be conducted in accordance with the rules of the
Deschutes County Circuit Court Arbitration Program, except to the extent provided otherwise under
Oregon laws on arbitration and as otherwise provided herein. All arbitrators shall be people having at least
10 years experience with health or behavioral health business transactions. Each party shall submit its
position to the arbitrators, together with evidence thereon, and the arbitrators shall decide the issue and
determine the prevailing party, which decision is final. On the application of either party, the award in the
arbitration may be enforced by the order of judgment of a court of competent jurisdiction.
13. Recovery of Funds. Expenditures of Contractor may be charged to this Contract only if they: (1) are in
payment for services performed under this Contract; (2) conform to applicable State and Federal
regulations and statutes; (3) are in payment of an obligation incurred during the period of this Contract;
and (4) when added to other compensation pursuant to this Contract 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 Contract, or if federal authorities demand the repayment of federal funds
received under this Contract, County may recover all federal funds paid under this Contract, unless a
smaller amount is disallowed or demanded. If Department disallows or requests repayment for any funds
paid under this Contract due to Contractors' acts or omissions, Contractor shall make payment to the
County of the amount disallowed or requested.
PAGE 6 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
In the event that the Department determines that County is responsible for the repayment of any funds
owed to the Department by Contractor, Contractor agrees to make such payment within ten (10) days of
notification by County or the Department of said determination by the Department.
14. 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 it is expended for a mental health service which meets the standards of the OHA.
15. Withholding of Payments. Notwithstanding any other payment provision of this Contract, 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 Contract.
16. Termination. All or part of this Contract 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. If the County
initiates the termination, payment of the usual and customary expenses of termination shall be made to the
Contractor. If the initial provider investment is substantial, this Contract may not be terminated by the
County for convenience.
The County may also terminate all or part of this Contract as 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 thirty (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 Contract.
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
Contract.
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 Contract (or subsequent modifications to
this Contract) within the time specified herein, or any extensions thereof.
E. Upon written or oral notice, if County has evidence that the Contractor has endangered or is
endangering the health and safety of clients, residents, staff, or the public.
F. Failure of the Contractor to comply with the provisions of this Contract and all applicable Federal,
State and local laws and rules which may be cause for termination of this Contract. The
circumstances under which this Contract 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 the Counties' (Deschutes, Crook and
Jefferson) client(s), the Contractor and the County shall jointly conduct an investigation to determine
whether an emergency exists and what corrective action will be necessary. Such an investigation shall be
completed within five (5) working days from the date the County determines that such failure exists.
PAGE 7 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT NO. 2011-398
In those circumstances where a major violation is substantiated, continued performance may be
suspended by the County immediately. In all cases involving a major violation, a written notice of intent to
terminate this Contractor shall be sent to the OHA and the Contractor found to be in violation.
Minor violations usually involve less than substantial compliance with the general or special conditions of
this Contractor. Continued substantial minor violations that threaten adequacy of services may be treated
like a major violation.
Prior to termination for major or minor violations, the Contractor shall be given a reasonable opportunity to
refute the findings. If the problem is not corrected or remedied within thirty (30) days after the County has
given written notice to the Contractor, or in the case the problem cannot be corrected or remedied within
the thirty-day period the Contractor fails to commence and pursue corrective action with reasonable
diligence and good faith, then the County may terminate this Contract or initiate other remedial action.
Termination shall be without prejudice to any obligations or liabilities of either party accrued prior to such
termination.
17. 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. County will continue to be
obligated to pay for authorized services to the date on which termination takes effect.
18. Independent Contractor. Contractor is engaged hereby as an independent contractor, 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 Contract.
B. Contractor shall be solely responsible for and shall have control over the means, methods,
techniques, sequences and procedures of performing the work, and shall be solely responsible
for the errors and omissions of its employees, subcontractors and agents. For goods and
services to be provided under this Contract, Contractor agrees to:
a. perform the work in a good, workmanlike, and timely manner;
b. comply with all applicable legal requirements;
c. take all precautions necessary to protect the safety of all persons at or near Sage View,
including employees and patients of Contractor and County;
d. take full responsibility for wages and entitlements of Contractor's employees assigned
to or furnishing services at Sage View.
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 Contract 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 Contract, a partner or jOint venturer with Contractor in connection
with activities carried on under this Contract, 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
Contract.
19. Contractor and Subcontractors. Contractor agrees to make all provisions of this Contract with the County
applicable to any subcontractor performing work under this Contract. Contactors who perform the work
PAGE 8 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
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.
20. Constraints.
A. The Provisions of ORS 279B.220, 279B.230, and 279B.235, are by this reference incorporate and
made a part of this Contract:
a. Contractor shall pay employees for overtime work performed under this Contract in
accordance and otherwise comply with applicable provisions of ORS 653.010 to 653.261
and the Fair labor Standards Act of 1938 (UFlSA") (29 U.S.C 201 et. seq.).
B. This Contract 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. Unless exempted under the rules, regulations and relevant orders of the Secretary of labor, 41 CFR,
Chapter 60, Contractor agrees to comply with 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), Titles VI and VII of the
Civil Rights Act of 1964 as amended, 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." Contractor will
also comply with all applicable rules, regulations and orders of the Secretary of labor concerning
equal opportunity in employment and the provisions of ORS Chapters 659 and 659A.
D. If the limitation amount specified in this Contract 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.
21. Hold Harmless. Contractor shall indemnify, save and hold harmless and defend the State of Oregon,
Human Resources Department, the County, and their Departments and their officers, employees and
agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and
expenses, of any nature whatsoever, resulting from, arising out of or relating to the operations of
Contractor, including, but not limited to the activities of Contractor, its officers, employees, subcontractors
and agents under this Contract. 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 Contract.
PAGE 9 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
22. Insurance. Prior to the effective date of this Contract, Contractor shall obtain, at Contractor's expense,
and maintain in effect all insurance requirements as outlined in Exhibit 4.
Contractor may satisfy the requirements for liability insurance by obtaining from Hospital a defense,
indemnity and hold harmless agreement, together with evidence of coverage under Hospital's program of
self insurance and umbrella insurance poliCies for the defense and satisfaction of claims. In the event of
unilateral cancellation or restriction by the insurance company of any insurance policy referred to in this
paragraph, Contractor shall immediately notify County verbally and in writing.
23. 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. Where resolution of such disputes is not achieved after consultation with the respective Boards
of Contractor and County, the parties shall proceed with mediation and binding arbitration in accordance
with Sections 10 and 11 of this Contract.
24. Financial Audit. Contractor shall provide County with a copy of each and every audit which it prepares in
order to comply with the applicable audit requirements and responsibilities set forth in the Office of
Management and Budget Circular A-133 entitled "Audits of States, Local Governments and Non-Profit
Organizations."
25. Assignment. Contractor shall not assign this Contract, except to Hospital, without the prior written consent
of County.
26. Renewal. This Contract 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.
27. Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules,
regulations, executive orders and policies.
28. Debt limitation. This Contract 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 Contract.
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 Contract:
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
PAGE 10 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
executive orders are incorporated by reference herein to the extent that they are applicable to
the Contract and required by law to be so incorporated. No federal funds may be used to
provide services in violation of 42 USC 14402.
12) Contractor shall comply with Executive Order 11246, entitled "Equal Employment Opportunity,"
as amended by Executive Order 11375, and as supplemented in Department of Labor
regulations (41 CFR Part 60).
13) If Contract maximum compensation, including amendments, exceeds $100,000 then Contractor
shall comply with all applicable standards, orders, or requirements issued under Section 306 of
the Clean Air Act (42 U.S.C. 1857 (h)), the Federal Water Pollution Control Act as amended
(commonly known as the Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but
not limited to Section 508 (33 U.S.C. 1368). Executive Order 11738, and 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 Department.
16) Contractor may not use the funds paid under this Contract 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 Contract 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 Contract 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 Department, the Medicaid
fraud section of the Oregon Department of Justice and the Secretary of Health and Human
Services;
b. Comply with all applicable disclosure requirements set forth in 42 CFR Part 455, Subpart B;
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.).
27. Non-Discrimination. Contractor agrees that no person shall, on the grounds of race, color, creed, national
origin, sex, marital status, disability, association, or age, suffer discrimination in the performance of this
Contractor when employed by Contractor. Contractor agrees to comply with title VI of the Civil Rights Act
of 1964, with section V of the Rehabilitation Act of 1973 as implemented by 45 CFR Section 84.4, with the
Age Discrimination Act of 1975 as amended, the Age Discrimination Act of 1974 as amended, the Vietnam
Era Veterans' Readjustment Assistance Act of 1975 as amended and with all applicable regulations,
administrative rules and requirements of federal and state civil rights and rehabilitation statues.
Additionally, Contractor shall comply with Title II of the Americans with Disabilities Act of 1990 as
PAGE 11 OF 32 BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
amended (42 USC 12131 et. Seq.), ORS 30.670 to 30.685, ORS 659.425, ORS 659.430, 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 Contract. Unless exempted under 41 C.F.R. 60
1.1 to 60.999.1 (1997), the Contractor agrees to comply with all provisions of Executive Order No. 11,246,
30 F.R. 12319 (1965), as amended by Executive Order No. 11,375,32 F.R. 14303 (1967), reprinted in 42
U.S.C. 2000e (1994) and Executive Order No. 12,086, as supplemented by 41 CFR Part 60, and all
applicable rules, regulations, and orders of the Secretary of Labor concerning equal opportunity in
employment and the provisions of ORS Chapter 659. Contractor shall comply with all federal law
governing operation of Community Mental Health Programs, including without limitation, all federal laws
requiring the reporting of Client abuse. These laws, regulations and executive orders are incorporated by
reference herein to the extent that they are applicable to the Contract and required by law to be so
incorporated.
28. Reductions in Contract Funding.
A. Any funds spent by Contractor for purposes not authorized by this Contract shall either be paid
directly by the Contractor to the County or, if not so paid, at the discretion of County, shall be
deducted from 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
Contract's expiration or after notification by the County, whichever date is earlier, shall be
deducted from future payments from County to the Contractor.
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 related to services rendered without the necessary license or approval will cease on
the date of termination of this Contract (whether in whole or in part) or the date of expiration or
suspension of the license or letter of approval, whichever date is earlier.
C. Any funds awarded to the Contractor pursuant to a fee-for-service payment method under this
Contract that are not obligated and/or spent within the term of this Contract shall be cancelled and
revert to the County.
29. 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 Contract, or for any controversy arising out of this Contract, each party
shall be responsible for its own attorney's fees, expenses, costs and disbursements for said action, suit,
proceeding or appeal.
30. Entire Contract. This Contract constitutes the entire Contract between the parties on the subject matter
hereof. There are no understandings, Contracts, or representations, oral or written, not specified herein
regarding this Contract.
31. Survival. The provisions of paragraphs 3 to 12, 17 to 20, 23 to 27, and 29 and 30, shall survive the
termination or expiration of this Contract.
32. 20-Year Dedicated Use. Notwithstanding any other provision of this Contract, Contractor and
Hospital agree that the Sage View facility will for a period of not less than twenty (20) years be
operated and maintained for the principal purpose of providing a psychiatric treatment program
for mental health patients, including indigent mental health patients who are residents of Crook,
Deschutes and Jefferson Counties. This provision, as well as the provisions of Section 8, shall
survive termination of this Contract.
PAGE 12 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
I
1
DATED this __day of ________, 2011.
Dated this ___ of ________, 2011
TAMMY BANEY, County Commissioner
ANTHONY DeBONE, County Commissioner
ALAN UNGER, County Commissioner
DATEDthis ,21daYOf ~-km~2011.
CONTRACTOR:
PAGE 13 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
EXHIBIT 1
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
SE24 Funding for Local Acute Care Access
Proposed Plan for 2011-12
Principles:
1. Maintain a shared risk management payment method for Acute Psychiatric Care as outlined in Section 8
of main body of the Contract
2. Increase oversight and focus on diversion (when clinically appropriate). Establish process for admission
authorization and utilization management for length of stay that is consistent with fee for service model.
Exact details of process will be determined by mutual agreement of the Directors of Deschutes, Crook
and Jefferson Counties and St. Charles Health System, Inc. or designees.
3. The approach is regional with all three (3) Central Oregon counties committing to this Contract.
4. Each of the three (3) counties will have designated diversion funds to assist with such things as motels,
transportation, and medication as clinically appropriate,
Bed days:
1. Number -660/year
2. Bed Day Rate -$695/day
Contract for Successful Management of Resources within Risk Agreement:
1. Hospital and Community Mental Health Program (CMHP) staff will follow admission authorization
protocol as outlined in "County Acute Care Authorization" in Exhibit 2 for voluntary and involuntary
admissions to Sage View that fall under this Contract.
2. In order to best facilitate the potential for diversion, Hospital staff will contact the responsible CMHP
when admission is being considered and prior to client being given an indication of admission
intent. All admissions, both voluntary and involuntary, must be pre-authorized by the appropriate
CMHP crisis staff.
3. CMHP and Hospital staff will actively work on diversion. CMHP staff will access designated
diversion funds when needed through processed outlined in individual counties.
4. Deschutes Crisis team staff will have daily (Monday-Friday) in-person contact with Sage View to
participate in the review of all Deschutes County admissions and assist in discharge planning.
Crook and Jefferson county staff will have daily contact with Sage View via telephone. The Regional
Utilization Manager (UM) will attend team meetings on a weekly basis. The Regional UM will
provide authorizations for continued stay based on clinical necessity for all Central Oregon
admissions covered under this Contract. (Same process as for Oregon Health Plan Clients)
5. Protocol for initial authorization and utilization management may be modified during the Contract by
written agreement between and among the Manager of Hospital and the three (3) Central Oregon
Directors.
6. For clients anticipated to need a long term stay -an Extended Care Management Unit (ECMU)
referral packet will be completed by SCMC staff immediately after a client is civilly committed by a
judge (i.e. within 1-2 days)
7. County will work with Accountable Behavioral Health Alliance (ABHA) to provide continued training
and consultation in Acceptance Commitment Therapy (ACT) model for both County and Hospital
staff
8. MCAT supervisor will continue to work with local law enforcement to improve con.tact with MCAT
prior to a person being brought to ER -goal will be to divert when possible.
Additional Considerations: In addition to the adjusted payment rate, Contractor agrees to the following
additional considerations:
PAGE 14 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
1. To provide the counties with a financial report showing total revenue and expenses by category
(including salary/benefits, materials and services, capital costs, etc)and the operating deficit for the
facility as well as the bed day rate associated with the Medicare cost report, a financial report will be
provided every 12 months at the Central Oregon Regional Acute Care Committee (CORACC) meeting;
2. To jointly sponsor training(s) and planning to strengthen the system in its use of beneficial interventions
for suicidal clients seeking hospital, crisis or outpatient services;
3. To join with Jefferson, Crook and Deschutes counties in advocating for improvements in the State and
Regional acute care system, with shared advocacy for State reimbursement for the cost of care for
indigent clients on the State wait list for long term care;
4. To advocate and offer support for the development of hold room services and hospital diversion options
at area hospitals; and
5. To not charge Central Oregon counties for transport costs between the Psychiatric Emergency Services
unit at St. Charles Health System, Inc., and Sage View.
PAGE 15 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
EXHIBIT 2
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
SE24 Funding for Local Acute Care Access
Description of Covered Services & Authorization Process for
Acute Psychiatric Care
Preamble
The Central Oregon Acute Care Region consists of Crook, Deschutes and Jefferson counties operating through
Lutheran Community Services Northwest, Deschutes County Health Services Department and Best Care
Treatment Services respectively.
Within available resources, consistent with ORS 426.241 and Service Element 24, and subject to funding from
the Office of Mental Health and Addiction Services, Counties assume the fiduciary accountability and ethical
obligation to meet the acute care mental health service needs of those Central Oregon residents, who lack the
financial resources and I or insurance to cover payment for such mental health services. In an effort to ensure
the judicious use of scarce resources, this Exhibit defines those urgent mental health services and outlines the
processes involved in accessing authorization for those services rendered under this Contract.
Sage View Services:
Contractor agrees to admit all eligible, indigent clients from Crook, Deschutes and Jefferson counties who meet
medical necessity criteria (as defined in this exhibit) as long as Sage View has available bed space. In
recognition that Contractor also provides Psychiatric Emergency Services as outlined in separate contract, it is
.~ agreed that clients will receive treatment at the least restrictive level of care possible.
I
I
Medical Necessity is defined as follows:
o Client has a primary DSM-IV mental health diagnosis AND meets one of more of the following factors
describing the clients condition:
o Client presents as a significant danger as evidenced by person is at imminent risk to self or others
or unable to meet their basic needs due to a major mental illness OR
o Client is at high risk for self destructive acts secondary to severe psychiatric symptoms (i.e.
command hallucinations or persecutory delusions, severe depression); OR
Client is at significant risk of committing violent, aggressive or impulsive acts that can best be
explained as resulting from a severe emotional state or exacerbation of an existing psychiatric
condition; OR
I o Client has acute onset of psychosis, severe thought disorganization or deterioration of a chronic
i
psychotic condition so that the client is unmanageable and unable to cooperate in treatment in a
less restrictive, less intensive setting; OR
I
o Client needs psychiatric medication adjustment that cannot be managed in the community including
monitored administration of medication; OR
o Client presents severe functional impairment resulting from an acute psychiatric condition such that
the member is unable to provide for basic self-care without 24-hour supervision; OR
o The client's condition is such that proposed treatments require 24 hour nursing observation (ie. side
I
! effects of atypical complexity, presence of a medical condition that complicates psychiatric
treatment) which are not appropriate outside of a hospital setting and are not primarily for a
substance abuse or medical condition. OR
o It is considered likely that the client will require restraint or seclusion
o AND in addition to one or more of the criteria outlined above, there are no available less restrictive out
patient alternatives to provide for the safety and supervision of client needs
PAGE 16 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
Contractor will maintain accreditation from the Joint Commission on the Accreditation of Hospital Organizations
as an inpatient facility. Furthermore, they will maintain compliance with the Center for Medicare and Medicaid
Services standards as applicable.
Services available will include but not be limited to:
• 24 -hour supervision and nursing care.
• Any required health screening or medical care (including medications and lab work).
• Multidisciplinary assessment initiated at the time of admission and completed within two (2) days of
admission.
• Service coordination with appropriate CMHP.
• Development of an appropriate treatment plan that addresses service needs, desired outcomes and
strategies to be implemented to resolve the crisis.
• A variety of treatment modalities to meet client needs including: psychiatric assessment; medication
management and supervision; individual and group therapy; psycho-education regarding mental health
and addiction issues; skill development in the areas of self-care, social-emotional adjustment,
behavioral concerns, independent living and community navigation; family involvement; case
management.
• Transportation between Sage View and St Charles Hospital -Bend as needed for medical or other
services
Payment for Acute Psychiatric Care at Sage View (SV)):
Contractor agrees to the payment methodology outlined in this Contract to provide acute psychiatric care at Sage
View to all indigent clients residing in Crook, Deschutes, and Jefferson counties who meet admission criteria, with
the only exception of bed space being unavailable. The payment will cover all charges associated with the
admission of indigent clients for Sage View services, including but not limited to room rate, associated staff
time and professional fees (including psychiatrist J MD), psychiatric medications, lab work and medical care.
This Contract will include all bed days excluding day of discharge.
Contractor shall neither bill nor expect payment for any additional services as part of Sage View service and
payment authorization from any of the three counties, except as outlined below under "Annual Reconciliation
Based on Actual Bed Day Usage". County shall provide quarterly payments to Contractor, for rendering the
services listed in this Contract. Funds may only be used for the delivery of the service or services set out in this
Contract unless written permission is granted to use the funds for other services in accordance with this Contract.
Subject to Annual Payment Reconciliation, for the period between and including July 1, 2011 through June 30,
2012, Contractor shall receive $458,700 for Sage View services in four (4) quarterly payments as outlined below.
The total amount will cover all Sage View services to all Central Oregon indigent clients served during those 12
months.
October 15, 2011 $114,675 April 15, 2012 $114,675
January 15, 2012 $114,675 June 30, 2012 $114,675
Annual Reconciliation Based on Actual Bed Day Usage:
At the close of the fiscal year (June 30, 2012), three provisions related to a financial reconciliation will be
considered to determine the final payment to St Charles Healthcare Community. Annual bed day usage will be
calculated based on fiscal year July 1-June 30.
1. If the total 2011-2012 bed days under this Contract is less than 660:
PAGE 17 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
I
I
The actual number of days under 660 will be valued at the bed day rate for that fiscal year. The
dollar amount of this savings due to a lower level of service will be shared equally (50%) by both
Deschutes County and Contractor. Contractor will refund amount to Deschutes County equal to 50%
value of bed days less than 660.
2. If the total 2011-12 bed days under this Contract is more than 660 and less than 825:
No additional compensation will be expected by either party and the stated payment level will
prevail. . 11' .k
3. If the total 2011-12 bed days used under this Contract equal or exceed 825: ~
County will pay Contractor at the bed day rate for each day at 825 days and above.
If there are any discrepancies in the number of actual bed days covered under this Contract:
Any discrepancies will be referred to the Utilization Management Committee for resolution
utilizing guidelines of this Contract.
If services are provided without authorization as outlined in Exhibit 2:
Any discrepancies will be brought to the Utilization Management Committee for discussion and
resolution.
Process for Obtaining Authorization for Covered Mental Health Services
I
Authorization Process:
In order to track bed day utilization and assure optimum usage of resources, It is agreed that Contractor and
County will adhere to an admission authorization process that is mutually agreed upon between and among
Contractor, the County, BestCare Treatment Services (on behalf of Jefferson County) and Lutheran Community
Services Northwest (on behalf of Crook County).
Contractor will contact the appropriate county when admission Is being considered, and prior to client
being given an Indication of admission Intent, to obtain authorization on a/l patients who meet indigent
status (both voluntary and Involuntary) as outlined by: 1 1) At the time of admission, patient has no third party insurance and has no ability to pay as
defined by federal guidelines; or1
i 2) At the time of admission, patient has exhausted their Medicare and/or Commercial insurance
benefits for mental health; or
I
3) During the course of care, patient has exhausted all ability to pay for services under this
Contract and is receiving involuntary treatment. Contractor agrees to contact appropriate county
with update regarding ·Pended Patients status and county will authorize services depending
upon county continued stay criteria; or
4) During the course of care if Contractor discovers that at the time of admission, the patient had
no third party insurance as reported and there is no other ability to pay for services, Contractor
agrees to contact appropriate county with update regarding *Pended Patients status and county
will decide whether to authorize services depending upon county continued stay criteria.
5) Contractor agrees to utiliZe the same ability-to-pay criteria, as well as make the same efforts to
collect payment as for any other patient admitted for hospital services.
6) Contractor is responsible for providing to County a monthly *Pended Patients and "Posted
Patients list, due on the 15th day of each month. The report will include pended and posted
patients for all 3 counties. i
*Pended Patients: This status Is descriptive of the period of time the Contractor is engaging In dueJ diligence to determine the patient's ability to pay as outlined by Contractor guidelines.
I ··Posted Patients: Patients that have been approved for indigent care through the County.
Report Data from SCMC
1 PAGE 18 OF 32-BeHAVIORAL HEALTH ~ PERSONAL SeRVICES CONTRACT No. 2011-398
.1
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Each person admitted under approved indigent funding, must also meet Contractor's internal requirements (as
stated above in Paragraph 6) for "free care" and go through Contractor's process to make this determination. In
essence the patient is "pended" to indigent funding, contingent upon the outcome of Contractor's due diligence
process for funding under this Contract. The following process outlines the approval process for clients to be
Upended" to indigent contract as well as the finalization of the fist of client bed days that will be actually "paid" or
credited to usage under this Contract.
Upon authorization for admission under indigent funds (pended), the intake worker for SV will notify the
Regional UM Manager (UM) via telephone with the following information: Client Name, OOB, Admit Date,
Funding, Level of Care (LOC), Hold Status ELOS (Estimated Length of Stay). UM will then access Hospital EHR
for any additional information needed specific to authorization ..
This Regional UM will utilize this data to compile the Regional Case List Report.
Contractor will provide a monthly list of the posted patients who also have met Contractor's internal
requirements for "free care" and whose admission will be "paid" or credited under this Contract. These lists will
be provided by the 15th of each month and include "free care" clients from admissions one month prior (i.e. on
3/15 a report would be provided for clients meeting free care criteria between 1/15-2/15) This report will run off
of the admission date (Le. a patient admitted April 30 and discharged May 5 will show up on April list). The
required date by which this list is to be emailed or faxed allows the "lag time" it takes for internal hospital due
diligence for posting cost to the risk based agreements. The report will contain Protected Health Information,
thus must either be faxed or encrypted if sent via e-mail. This report will go to the Regional UM. The required
data elements in this report will be:
1. Patient Name (last, first)
2. Hospital internal record number
3. Admit date
4. Discharge date
5. Follow-up care
6. Location of service PES or SV
1
t
1
Once the Regional UM has the patient list from Contractor, helshe will access Contractor electronic medical
records (TIER andlor CERNER) to ascertain qualitative data required for the Regional Case List. This Case List
will be reviewed at the monthly Central Oregon Regional Acute Care Committee (CORACC) UM group meeting.
The Regional UM will follow established Contractor procedures for access to the Contractor's electronic medical
records.
Modification of Exhibit 2
It is understood and agreed that this Exhibit will be revised periodically. Authority to change this Exhibit shall
rest with the, Deschutes County Health Services and the St. Charles Health System, Inc. Community Directors.
Both parties must agree for the Exhibit to be modified.
PAGE 19 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT 1\10. 2011-398
EXHIBIT 3
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
SE24 Funding for Local Acute Care Access
Post-Commitment Care
Payment for Post-Commitment Care:
Contractor agrees to the payment methodology outlined in this Contract for post-commitment care at Sage View
(SV) or Psychiatric Emergency Services (PES) at S1. Charles Health System, Inc. to all indigent clients residing
in Deschutes, Crook or Jefferson ("Central Oregon") counties as well as clients who reside in Eastern Oregon
counties who are civilly committed by a judge. Eastern Oregon Counties are defined as: Wasco, Sherman, Hood
River, Lake, Wheeler, Morrow, Harney, Grant, Malheur, Baker, Gilliam, Union, Wallowa, and Umatilla. This
includes clients who are already admitted to either SV or PES and return to the facility after civil commitment
hearing, as well as clients who are committed elsewhere in the state and are clinically appropriate for transfer
post-commitment, with the only exception of bed space being unavailable. Central Oregon residents have first
priority for admission, followed by residents of Eastern Oregon counties. This portion of the Contract will cover
all services as of the day post-commitment until transfer to long-term care at the state hospital or other
discharge from the facility.
Residents of other Oregon counties may be served under this contract on a case by case basis and with joint
approval of Director of Behavioral Health Services at Cascade Healthcare Community and Deschutes County
Health Services Director.
The payment will cover all charges associated with the admission of indigent clients for SV or PES services,
including but not limited to room rate, associated staff time and professional fees (including psychiatrist / MD),
psychiatriC medications, lab work and medical care. This contract will include all bed days beginning the first day
post-commitment until transfer to long-term care or other discharge
Contractor shall neither bill nor expect payment for any additional services as part of this Contract. County shall
provide monthly payments to Contractor, for rendering the services listed in this Contract. Funds may only be
used for the delivery of the service or services set out in this Contract unless written permission is granted to
use the funds for other services in accordance with this Contract..
For the period between and including July 1,2011 through June 30, 2012, Contractor shall receive a maximum
compensation of $530,700 for all post-commitment services regardless of whether admission is at SV or PES
unit in twelve (12)) payments as outlined below. This payment is calculated at a bed day rate of $725 for 732
bed days. The total amount will cover all SV/PES services to all post-commitment indigent clients served during
those 12 months.
July 15, 2011 $44,225 January 15, 2012 $44,225
August 15, 2011 $44,225 February 15, 2012 $44,225
September 15, 2011 $44,225 March 15,2012 $44,225
October 15,2011 $44,225 April 15, 2012 $44,225
November 15, 2011 $44,225 May 15, 2012 $44,225
December 15, 2011 $44,225 June 15,2012 $44,225
PAGE 20 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
Reporting Requirements:
Contractor shall provide monthly reports to the County for all usage under this portion of the Contract. Monthly
reports shall include the following:
Client Name
County of Responsibility/Residence
Date of Commitment
Date Extended Care Management Unit (ECMU) application was approved
Date of Discharge
Discharge location (i,e, state hospital or other)
Total bed days for the month
Cumulative bed days
PAGE 21 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
EXHIBIT 4
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
INSURANCE REQUIREMENTS
Contractor shall at all times maintain in force at Contractor's expense, each insurance noted below.
Insurance coverage must apply on a primary or non-contributory basis. All insurance policies, except
Professional Liability, shall be written on an occurrence basis and be in effect for the term of this contract.
Policies written on a "claims made" basis must be approved and authorized by Deschutes County.
Contractor Name: St. Charles Health System Inc.
Workers Compensation insurance in compliance with ORS 656.017, requiring Contractor and all subcontractors
to provide workers' compensation coverage for all subject workers, or provide certification of exempt status under
ORS 656.126(2). Employer's Liability Insurance with coverage limits of not less than $500,000 must be included.
Professional Liability insurance with an occurrence combined single limit of not less than:
Per Occurrence limit Annual Aggregate limit
o $500,000 0 $500,000
~ $1,000,000 0 $1,000,000
o $2,000,000 ~ $2,000,000
Professional Liability insurance covers damages caused by error, omiSSion, or negligent acts related to
professional services provided under this Contract. The policy must provide extended reporting period coverage,
sometimes referred to as "tail coverage" for claims made within two years after this Contract 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 Contract, 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 Contract or, (b) the expiration of all warranty periods provided under the Contract.
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.
~ Required by County 0 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
~ $1,000,000 0 $2,000,000
o $2,000,000 ~ $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.
~ Required by County 0 Not required by County (one box must be checked)
PAGE 22 OF 32 -BEHAVIORAL HEALTH PERSONAL SERVICES CONTRACT No. 2011-398
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 Contract.
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. o Required by County ~ 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 Contract. Contractor's coverage will be primary in the event of loss.
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with
the signed Contract. 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
Contract. The endorsement must be in a format acceptable to Deschutes County . If requested , complete copies of
insurance policies shall be provided to the County .
7 {7
PAGE 23 OF 32 -BEHAVIORAL HEALTH -PERSONAL SERVICES CONTRACT No. 2011-398
EXHIBIT 5
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
Regional Acute Psychiatric Inpatient Services
Service Name: REGIONAL ACUTE PSYCHIATRIC INPATIENT SERVICES
Service ID Code: MHS 24
I. Service Description
Regional Acute Psychiatric Inpatient Services (MHS 24) are inpatient psychiatric services delivered to
individuals who are suffering from an acute mental illness, or other mental or emotional disturbance posing a
danger to the health and safety of the individual or others, The services are primarily delivered on an inpatient
basis and are intended to stabilize, control or ameliorate acute psychiatric dysfunctional symptoms or behaviors
in order to return the individual to a less restrictive environment at the earliest possible time. MHS 24 Services
also include ancillary services such as regional coordination and enhancements to Community Mental Health
Program (CMHP) services that serve to expedite the movement of individuals into and out of facilities where
inpatient psychiatric services are delivered and to divert persons from acute care services.
II. Performance Requirements
MHS 24 Services funded through this Agreement may only be delivered to the following individuals:
A. An individual in need of emergency hold services under ORS 426.232 and ORS 426.233; or
B. An individual committed to Oregon Health Authority (OHA) under ORS 426.130; or
C, An individual voluntarily seeking MHS 24 Services provided that service capacity is available and the
individual satisfies one or more of the following criteria:
1. The individual is at high risk for an emergency hold or civil commitment without voluntary inpatient
psychiatric services; or
2. The individual has a history of psychiatric hospitalization and is beginning to decompensate and for
whom a short period of intensive inpatient psychiatric treatment would reverse the decompensation
process; or
3. The individual is an appropriate candidate for inpatient psychiatric treatment but other inpatient
psychiatric treatment resources are unavailable.
D. Hospital and Providers at Secure Residential Treatment Facilities of MHS 24 Services funded through this
Agreement must comply with OAR 309-031-0200 to 309-031-0255as such rules may be revised from time
to time. Facilities in which a Provider delivers MHS 24 Services funded through this Agreement must:
1. If a hospital, be licensed under ORS 441.015 or certified by the Joint Commission on Accreditation of
Health Care Organization ("JCAHO") for the hospital services; or 134309 Deschutes County Approved
5/9/2011 79 of 220 OHA 11-13 GT0217-11
2. Be approved under applicable portions of OAR 309-033-0500 through 309-033-0560, as such rules may
be revised from time to time, for emergency hold beds.
E. Secured Transportation services under MHS 24 will be approved under OAR 309-033-0432 through 309
033-0440, as such rules may be revised from time to time.
PAGE 24 OF 32 -BEHAVIORAL HEALTH SERVICES CONTRACT No, 2011-398
III. Special Reporting Requirements
A. Reports of JCAHO reviews of the facility where a Provider delivers MHS 24 Services funded through this
Agreement must be submitted to OHA within sixty (60) days after the Providers receipt of such reports or
reviews. Submit reports to:
Oregon Health Authority
Addictions and Mental Health Services Division
Attention: Contracts Administrator
500 Summer Street N.E. E86
Salem, OR 97301-1118
Reports must be prepared using forms and procedures prescribed by OHA.
R Hospital and Providers at Secure Residential Treatment Facilities of MHS 24 Services funded through this
Agreement must submit the following information to OHA electronically through the Oregon Patient and
Resident Care System (OP/RCS) within 12 hours of an individual's admission to and discharge from the
Provider's facility for MHS 24 Services, as outlined in the OP/RCS Manual located at
http://www.oregon.gov/OHNmentalhealth/publications/oprcsloprcs-manual.pdf?ga=t.
C. Contractor must submit an annual accounting report of MHS 24 funds using forms prescribed by OHA by
August 31 for the prior state fiscal year.
IV. Financial Assistance Calculation and Disbursement Procedures
A. Calculation of Financial Assistance: OHA will provide financial assistance for MHS 24 Services identified in
a particular line of the Financial Assistance Award from funds identified on that line in an amount equal to
the amount set forth in that line of the Financial Assistance Award; provided, however, that OHA's obligation
to provide financial assistance for MHS 24 Services under a particular line of the Financial Assistance
Award is conditioned on delivery, during the period specified on that line, of the number of units of MHS 24
Services service capacity specified on that line
B. Disbursement of financial assistance: OHA will disburse the funds awarded for MHS 24 Services in a
particular line of the Financial Assistance Award to County in substantially equal monthly allotments during
the period specified in that line of the Financial Assistance Award, subject to the following:
1. OHA may after 30 days (unless parties agreed otherwise) written notice to County, reduce the monthly
allotments based on under used allotments identified through 134309 Deschutes County Approved
5/9/2011 80 of 220 OHA 11-13 GT0217-11 Oregon PatienUResident Care System (OP/RCS) or through
other method permitted or required by this Service Description or an applicable Specialized Service
Requirement.
2. OHA may, upon written request of County, adjust monthly allotments.
3. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as
necessary, to reflect changes in the funds awarded for MHS 24 Services on that line of the Financial
Assistance Award. 134309 Deschutes County Approved 5/9/2011 81 of 220 OHA 11-13 GT0217-11
Attachment 1 (revised 'Level of Need Determination Data' 1/2010) -Level of Service Intensity
Determination Data
Providers of MHS 22 Services funded through this Agreement must use the CASII as the statewide tool
PAGE 25 OF 32 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2011-398
to assist in the determination for ISA Services for children age six (6) and older and the ECSII for children birth
through age five (5).
Provider shall submit a report to OHA, within sixty (60) calendar days after the end of each calendar quarter of
the Level of Service Intensity Determination Data screenings completed in that quarter.
o 1st Quarter (Jan-Mar) 0 2nd Quarter (Apr-Jun)
o 3rd Quarter (Jul-Sep) 0 4th Quarter (Oct-Dec)
Formatting CASII and ECSII data for submission to OHA:
Data shall be in a comma-delimited format;
Each child shall be represented by a Medicaid ID number and Level of Service Intensity Determination Date;
Complete Data Set: A complete data set will be comprised of a minimum of the following elements:
[ Eight alphanumeric character Medicaid ID number
I Child's date of birth 00/00/0000)
I Child's gender
l Date of referral
i~ Referral Source
r Date of Determination
I Contractor
Scores for CASII Domains I to VI-B (each score must be in the range 1-5) or ECSII Domains I to V.
Composite CASH score or ECSII score.
ISA eligibility YIN (circle one).
Levels of Care recommended {Note: Base the recommended level of care on both CASII or ECSII data and
other data indicative of the child's and family's needs and/or functioning
r Date the child is determined not to be ISA eligible or the last day the child is considered ISA eligible. Field will
be blank if the child continues to be ISA eligible. A blank field will be considered complete. Instructions for
submission and validation of Level of Service Intensity Determination Data shall be provided by OHA as a
separate document. 134309 Deschutes County Approved 5/9/2011 82 of 220 OHA 11-13 GT0217 -11
Attachment 2 (revised 'Integrated Service Array' 1/2010) -Integrated Service Array (ISA) Progress
Review Report
The ISA Progress Review is to be administered for each child found eligible for ISA services upon admission
and discharge to that level of service. A child shall be reviewed no less than annually, should the child remain in
ISA longer than one (1) year. Contractor must submit a Complete Data Set to OHA on those children that were
reviewed during the quarter within Sixty (60) calendar days following the end of the calendar quarter.
Complete Data Set: A complete data set will be comprised of the following elements:
1. Child's last name, first name.
2. Child's date of birth (00/00/0000).
3. Date ISA Progress Review was completed using 00100/0000 format
4. ISA status of child at time of progress review:
"New", first review.
"Open", continuing review.
"Close", final review.
5. Child's current residence:
Biological/adoptive family member.
Other than relative/friend (Not foster care).
Long-term foster care placement.
Temporary foster care placement.
Residential treatment center.
Other (include statement describing type of residence).
6. Number of times child changed residence for any reason within the last 90 days.
PAGE 26 OF 32 BEHAVIORAL HEALTH SERVICES CONTRACT No. 2011-398
a. Indicate the number of times that the child has changed residence, for any reason, in the past 90
calendar days. Do not include planned respite. Do not include Acute Care hospitalizations. Do not
include vacations or recreational stays with friends or relatives that are unrelated to changes in the
child's condition or the Family's circumstances. Do include any planned or unplanned stay with
friends or relatives, if the stay lasted more than seven (7) days and was: (a) precipitated by a
worsening of the child's condition, a change in the Family's circumstances, or increased stress in
the child's environment and; (b) the parent or legal guardian was made aware of and permitted the
stay. (Note: Unplanned stays with others not permitted by the parent or legal guardian should be
regarded as runaways rather than changes of residence). Each time that a child moves out of and
then back to, his or her primary residence is counted as two (2) moves.
b. Parent or legal guardian were made aware of and permitted to stay. Each time that a child moves out of
and back to hislher primary residence, count as two (2) stays. 134309 Deschutes County Approved
5/9/2011 83 of 220 OHA 11-13 GT0217-11
7. Did parent or adult caregiver partiCipate in current and most recent Child and Family Team (CFT) meeting?
(Include those whose primary role with child is that of paid provider of services, i.e. clinical, educational or case
management services.)
8. Caregiver Rating:
a. Social network over the past thirty (30) calendar days:
(1) No family or social network that could help with raising the child.
(2) Some family or friend social network that could help with raising the child.
(3) Some family or friend social network that actively helps with the raising of the child.
(4) Significant family and friend social network that actively helps with raising the child.
(5) NK (Not Known).
b. Child has been producing schoolwork of acceptable quality for his or her ability level over the past
twenty (20) scheduled school days:
(1) Never.
(2) Seldom.
(3) Sometimes.
(4) Frequently.
(5) Very Frequently or Always.
(6) Not applicable (if child has not been in school over past 20 days).
c. Substance abuse over the past thirty (30) days:
O. None.
1. Suspicion of substance abuse.
2. Clear evidence of substance abuse that is interfering with child's ability to function in at least one role
or setting.
3. Clear evidence of substance dependence and 1 or child requires detoxification.
d. Risk of delinquency in consideration of all acts of delinquency (misdemeanors, felonies and all status
offenses except runaways), with or without awareness by legal authorities:
O. No History.
1. None in past thirty (30) days.
2. Some in past thirty (30) days.
3. Several in past thirty (30) days.
e. Risk of self-harm (includes reckless or intentional risk taking behavior that may endanger the child):
O. No history.
1. None in past thirty (30) days.
2. Some in past thirty (30) days.
3. Several in past thirty (30) days.
PAGE 27 OF 32 -PERSONAL SERVICES CONTRACT No. 2011-398
t History of and risk of danger to others:
O. No history.
1. None in past thirty (30) days. 134309 Deschutes County Approved 5/9/2011 84 of 220 OHA 11-13
GT0217-11
2. Some in past thirty (30) days.
g. History and risk of running away:
O. No history.
1. None in past thirty days.
2. Some in past thirty (30) days.
3. Several in past thirty (30) days.
9. Behavioral and Emotional Rating Scale, 2nd Edition (Bers2) Parent/Caregiver Rating Scale, Raw Scores of
Subscales.
Formatting the ISA Progress Review Data for Submission to OHA:
Instructions for submission of the ISA Progress Review Report data shall be provided by OHA as a separate
document.
Modification of Exhibit 5, State Requirements for Mental Health Subcontract
In the event the State of Oregon modifies the terms of SE 24, it is understood that this Contract will be revised
accordingly. Authority to change this Exhibit to comply fully with Deschutes County's State Contract shall rest
with the Director of Behavioral Health Services, St. Charles Medical Center and the Deschutes County Health
Services Director. Both parties must agree for the Exhibit to be modified.
I
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PAGE 28 OF 32 PERSONAL SERVICES CONTRACT No. 2011-398
Exhibit 6
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
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 Contract declares certifies that; Contractor's Work to be performed under this Contract
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
Contract. Contractor is not an "officer," "employee," or "agent" of the County, as those terms are used in
ORS 30.265.
2. Audits.
a. Contractor shall comply, if applicable, with the applicable audit requirements and responsibilities set
forth in the Office of Management and Budget Circular A-133 entitled "Audits of States, Local
Governments and Non-Profit Organizations."
b. Contractor shall also be required to comply with applicable Code of Federal Regulations (CFR)
sections and OMB Circulars governing expenditure of federal funds. State, local and Indian Tribal
Governments and governmental hospitals must follow OMB A-1 02. Non-profits, hospitals, colleges and
universities must follow 2 CFR Part 215. Sub-recipients shall be required to monitor any organization to
which funds are passed for compliance with CFR and OMB requirements.
3. 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 Contract. Contractor further understands that
submission of this certification is a prerequisite, imposed by 31 USC 1352 for entering into this Contract.
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 shaff 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.
PAGE 29 OF 32 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2011-398
4, Contractor understands that, if this Contract involves federally appropriated funds, this certification is a
material representation of facts upon which reliance was placed when this Contract was made or entered
into, submission of this certification is a prerequisite for make or entering into this Contract 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
I
I
j
PAGE 30 OF 32 -BEHAVIORAL HEALTH SERVICES CONTRACT No, 2011-398
EXHIBIT 7
DESCHUTES COUNTY SERVICES CONTRACT
Contract No. 2011-398
Disclosure of Protected Health Information
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) by Contractor to 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").
Use And Disclosure Of PHI.
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
I
• 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.
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
I
PHI in County's possession as is required by the HIPAA Regulations.
Use and Disclosure. COUNTY may not use or disclose PHI except as permitted by this exhibit or
~ other parts of this agreement, or as required by law. i 1
Disclosure Procedure. Unless such disclosure is required by law, COUNTY may not disclose PHI
unless: (a) COUNTY 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 COUNTY of any instances
of which the person is aware of breaches of confidentiality of the PHI.
Other Obligations.
Safeguards. COUNTY will use appropriate safeguards to prevent use or disclosure of PHI otherwise
than as permitted by this exhibit.
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.
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.
Availability. COUNTY shall make PHI in its possession available to the individual who is the subject of
the PHI as required by the HIPAA Regulations.
Amendment. COUNTY shall make available PHI in its possession for amendment of the PHI by the
person identified in the PHI and incorporate any such amendments in accordance with the HIPAA
Regulations.
PAGE 31 OF 32 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2011-398
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.
Accounting Of Disclosures. Although COUNTY does not anticipate making disclosures other than for
the purposes of this agreement, COUNTY will maintain a record 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 to respond to a request by an individual for an
accounting of disclosures in accordance with 45 CFR § 164,528. COUNTY will make such record
available to Contractor on request.
Disclosure To U.S. Department Of Health And Human Services. COUNTY will make its internal
practices, books, and records relating to the use and disclosure of PHI received from Contractor (or
created or received by COUNTY on behalf of Contractor) 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.
Procedure Upon Termination. Upon termination of this Agreement, COUNTY will, if feasible, return or
destroy all PHI that COUNTY maintains in any form, and will retain no copies of such PHI or, if the
parties agree that return or destruction is not feasible, COUNTY 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.
No Third Party Beneficiaries. There are no third party beneficiaries to the agreement or this exhibit.
PAGE 32 OF 32 -BEHAVIORAL HEALTH SERVICES CONTRACT No. 2011-398
~ DATE (MMlDD/YYYlACORD·
~ CERrlFICA TE OF LIABILITY INSURANCE I 09/2812011
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 DOS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE
OR PRODUER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certiflcate 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 endorsementts).
PRODUCER =ACT I Candy Mirabilio
CHIVAROLI & ASSOCIATES INC ~ExtI: I 805.371.3680 I r~ Nol: I 805.371.3684
200 N Westlake Blvd Ste 101
:-:,~ss: I candE!@s:hivaroli.com
Westlake Village, CA 91362 INSURER(S) AFFORDING COVERAGE NAlCI!
INSURER A:. Lexington Insurance Company 19437
INSURED INSURERB:
St. Charles Health System, Inc INSURERC:
2500 NE Neff Rd INSURER 0:
Bend, OR 97701 INSURERE:
INSURERF:
COVERAGES CERTIFICATE NUMBER' REVISION NUMBER'
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 CONotTIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THE INSURED HAS A LIMIT AS INDICATED BELOW EXCESS OF A $500 000 SELF INSURED RETENTION APPLICABLE TO EACH AND EVERY CLAIM.
~: TYPE OF INSURANCE =~~ POLICY NUMBER (~..:o~~ (:~ LIMITS
~ERAL UABILITY
X COMMERCIAL GENERAL lIABILITYltJ CLAIMS MADE 0 OCCUR
A
A
I-
~N'LAGGREGATE LIMIT APPLIES PER:!xl POLICY n::g: n LOC
~,AUTOMOBILE LIABII.ITY
ANY AUTO
r-ALL OWNED
I-AUTOS
HIRED AUTOS
r-SCHEDULED
AUTOS
I-NON-OWNED
I-AUTOS
I-UMBRELLA LIAS HOCCUR
EXCESS LIAS CLAIMS·MADE
OED I I RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERlEXECUTIVEI
OfFICERIMEMBER EXCtUOED?
(lion-,In NH)Wyoo, __
DESCRIPTlON OF OPERATIONS below
Claims-Made
YIN
D
Professional Liability Insurance
NIA
6792944 07/01/2011 07/01/2012
6792944 07/01/2011 07/01/2012
EACH OCCURENCE
, DAMAGE TO ReNTED
PREMISES (Ea occurrencel
i MED EXP (Anyone person)
PERSONAL &AOV INJURY
GENERAL AGGREGATE
$1,000000
$
$
$
$3.000,000
PRODUCTS COMP/OP AGG $
BODILY INJURY (Per person)
BODILY INJURY (Per ao::IdenI)
PROPERTY.PAMAGE
(Per accident)
EACH OCCURENCE
AGGREGATE
$
$
$
$
$
$
I WCSTAT\}. I
TORY LIMITS IO~ $
E.L EACH ACCIDENT $
E.L. DISEASE EA MPLOYEE $
EI.. DISEASE POI.ICY LIMIT $
$1,000,000 Each Claim
$3,000,000 Annual Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attadl ACORD 101, Additional Remarks Schedule. If more apace Is required)
Evidence of Professional and General Liability insurance as respects the HealthyStart Prenatal Program between St. Charles Health System.
Inc, St. Charies Medical Center Foundation and Deschutes County.
It is agreed that Deschutes County. its divisions, officers. agents, employees and volunteers are included as Additional Insureds, but only as
respects liability incurred from the actions of St. Charles Health System. Inc or St. Charles Medical Center Foundation employees in the
performance of their duties under the HealthyStart Prenatal Program agreement effective July 1. 2010.
CERTIFICATE HOLDER CANCELLATION
st. Charles Health System, Inc
2500 HE Neff Road
Bend, OR 97701
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE
EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
ACORD 25 (2010/05)
ENDORSEMENT NO. 16
this endorsement, effective 12:01 AM: July 1, 2011
Forms a part of policy no.: 6192944
Issued to: ST CHARLES HEAlTH SYSTEM, INC.
By: LEXINGTON INSURANCE COMPANY
ADDITIONAL INSUREDS ENDORSEMENT
The Policy is amended as follows:
Section II. WHO IS AN INSURED of the EXCESS HEALTHCARE PROFESSIONAL LIABIUTY COVERAGE
PART is amended by adding the following:
Deschutes County. its divisions, Officers, agents, employees and volunteers are
included as additional insureds. but only as respects any contract or agreement
with you.
but only as respects liability arising out of the conduct of your business.
Section II. WHO IS AN INSURED of the HEAL THeARE UMBRELlA COVERAGE PART is amended by adding
the following:
Deschutes County, its divisions, officers, agents, employees and volunteers are
included as additional insureds, but only as respects any contract or agreement
with you.
but only as respects liabiHty arising out of the conduct of your business.
AI! other terms, conditions and excluSionS of the policy remain unchanged.
Authorized Representative
or countersignature (where required by law)
94481 (5107)
HC0511
wwW.saif.com
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE
CERTIFICATE HOLDER:
DeSCHUTES COUNTY, HEALTH SERVICES
AnN: NANCY ENGLAND, CONTRACT SPECIAUST
1300 NW WALL
BEND, OR 97701
The policy of insurance listed below has been issued to the Insured named below for the
policy period Indicated. The Insurance afforded by the policy described herein is subject to
all the tenns, exduslons and conditions of such policy.
POUCYNO. POLlCY PERIOD ISSUE DATE
417940 07/01/2010 to 01/01/2011 12/29/2010
INSURED: BROKER Of RECORD:
ST CHARlES HEALTH SYSTEM INC
ST CHARLES MEDICAL CENTER
ATTN: REBECCA MORGAN, HUMAN RESOURCES
2500 NE NEFF RD
BEND, OR 97701-6015
UMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each acadent
Bodily Injury by Disease $500,000 each employee
I Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
1 IMPORTANT:
The coverage described above Is In effect as of the issue date of this certificate. It Is subject to change
at any time in the future.
This certificate is issued as a matter of Information only and confers no rights to the certificate
holder. This certlflcate does not amend, extend or alter the coverage afforded by the polices above.
AUTHORIZED REPRESENTATIVEi'r?»-Jf Roq4.iJ-----..
President and CEO
400 High Street SE
Salem, OR 97312
P: 800.285.8525
F: 503.373.8020