HomeMy WebLinkAboutIGA - Mental Health Svcs - Tort Liability InsDeschutes 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 February 27, 2008
Please see directions for completing this document on the next page.
DATE: February 27, 2008
FROM: Sherri Pinner Department: Deschutes County Mental Health (DCMH) Phone #322-7509
TITLE OF AGENDA ITEM:
Consideration and signature of document #2008-054, an intergovernmental agreement with the Oregon
Department of Human Services extending tort liability insurance coverage to Deschutes County Mental
Health (DCMH).
PUBLIC HEARING ON THIS DATE? no.
BACKGROUND AND POLICY IMPLICATIONS:
Oregon Department of Human Services is offering tort liability insurance coverage to psychiatric
security review board providers in the State. The coverage provided would be from the State of
Oregon's self-insurance plan. This requires no change in the operations of DCMH. There is no cost to
Deschutes County for this coverage.
FISCAL IMPLICATIONS:
There are no fiscal implications.
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of document #2008-029.
ATTENDANCE: Sherri Pinner
DISTRIBUTION OF DOCUMENTS:
Fax to April D. Barrett at (503) 378-4324, and fully executed copy to Loretta Gertsch, Mental Health
Department, (541) 322-7565.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
February 6, 2008
Contact Person:
Please complete all sections above the Official Review line.
Lori Hill
Contractor/Supplier/Consultant Name:
Department:
Phone #:
Mental Health Dept.
322-7535
Oregon Department of Human Services
Goods and/or Services: Consideration and signature of document #2008-054, an
intergovernmental agreement, #121520, with the Oregon Department of Human
Services extending tort liability insurance coverage to Deschutes County Mental Health
(DCMH).
Background & History: Oregon Department of Human Services is offering tort
liability insurance coverage to psychiatric security review board providers in the State.
The coverage provided would be from the State of Oregon's self-insurance plan. This
requires no change in the operations of DCMH. There is no cost to Deschutes County
for this coverage.
Agreement Starting Date:
2/27/2008
Annual Value or Total Payment:
Ending Date:
No fiscal implications
® Insurance Certificate Received (check box)
Insurance Expiration Date:
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
❑ Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
N/A County is Contractor
6/30/2009
Funding Source: (Included in current budget? ❑ Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes ❑ No
Departmental Contact:
Title:
Lori Hill
Adult Treatment Program Manager
Department Director Approval:
Phone #:
Signa'
322-7535
2.5.E
Date
2/4/2008
Distribution of Document: Fax to April D. Barrett at (503) 378-4324, and fully
executed copy to Loretta Gertsch, Mental Health Department, (541) 322-7565.
Include complete information if document is to be mailed.
Official Review:
County Signature Required (check one): D BOCC ❑ Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review Date
tae -0541
Document Number
2/4/2008
January 29, 2008
Scott Johnson
Deschutes County
Re: Tort Liability Coverage to Psychiatric Security Review Board Providers
Dear Mr. Johnson,
Pursuant to ORS 278.315, the Department of Human Services may provide tort liability coverage
through the Oregon Department of Administrative Services (ODAS) to any county or private
community care provider that has contracted with the Department to provide supervision, care,
treatment or training of persons under the jurisdiction of the Psychiatric Security Review Board
(PSRB). The funding for this service is from the Office of Mental Health and Addiction
Services (OMHAS). The Department, through the attached agreements, is offering to provide
tort liability coverage to counties and their providers. The coverage provided would be self-
insurance by the State of Oregon to the limits contained in ORS 30.260 to 30.300. Attached are
two contract documents for your consideration:
1. An Intergovernmental Agreement to extend tort liability coverage to the
County; and
2. An amendment form to extend tort liability coverage to the County's
subcontractors providing services to persons under the jurisdiction of the
PSRB.
1. Intergovernmental Agreement between the County and the Department
The Department has identified that your county is receiving funds for and providing
services to persons under the jurisdiction of the PSRB as required in the 2007-2009
Intergovernmental Agreement for the Financing of Community Mental Health,
Developmental Disability and Addiction Services. To take advantage of the tort liability
coverage being offered by the State of Oregon, please review, obtain authorized signatures,
and return the Intergovernmental Agreement for further processing to my office. You will
receive a fully signed agreement by email as soon as all authorized signatures are acquired.
2. Amendment form to add the Department as Third Party
In order to extend tort liability coverage to community care providers (County's
contractors), the Department must be named as a third party in an amendment to the
contract between the County and the private community care provider. To take advantage
of the tort liability coverage being offered by the State of Oregon to providers (County's
subcontractors), please follow the procedures below:
a. Complete the amendment form, stating the amendment number, County
contract number, County name and name of community care provider. This
should be done for each community care provider providing PSRB services.
b. Obtain the authorized signatures of the community care provider and County
representatives on the amendment form.
c. We will need a copy of your fully executed contract with your community
care provider for PSRB services for the current fiscal year for each
amendment. Mark it as Exhibit 1 and insert it into each provider amendment.
Fax the fully signed IGA and Amendment form to:
Department of Human Services
Office of Contracts and Procurement
Attention: April D. Barrett, Contract Specialist
Fax: 503-378-4324
Coverage will not begin until all signatures have been obtained. Please return as
soon as possible.
Thank you for your immediate attention to this matter. If you have any questions or comments
regarding this matter, don't hesitate to call April D. Barrett at (503) 945-5821.
Enclosures: Intergovernmental Agreement with attachments
Amendment form with exhibits and attachments
regon
Theodore R. Kulongoski, Governor
Department of Human Services
Administrative Services
Office of Contracts & Procurement
In compliance with the Americans with Disabilities Act, th3Q0 Summer Street NE, E-03
document is available in alternate formats such as Braille, Salem, OR 97301-1080
large print, audio tape, oral presentation, and electronic (503) 945-5818
format. To request an alternate format call the State of Purchasing Fax (503) 373-7365
Oregon, Department of Human Services, Office of Forms Contracts Fax (503) 373-7889
and Document Management at (503) 373-0333, Fax (503) 373-7690TTY (503) 947-5330
or TTY (503) 947-5330.
INTERGOVERNMENTAL AGREEMENT #121520
)Hs
Or on D artment
TORT LIABILITY COVERAGE AS A PROVIDER FOR °f°n`an�Y"es
PSYCHIATRIC SECURITY REVIEW BOARD
This Agreement is between the State of Oregon acting by and through its
Department of Human Services hereinafter referred to as "Department", and
Deschutes County, hereinafter referred to as "County".
1. Term
This Agreement shall become effective on the date at which all authorized
signatures have been acquired. Unless otherwise terminated or extended, this
Agreement Expires on June 30, 2009 or when the County Intergovernmental
Agreement for the Financing of Mental Health, Developmental Disability and
Addiction Services (IGA for FMHDDAD) is terminated, whichever occurs
earlier.
2. Statutory Authority
Pursuant to ORS 278.315, the Department may provide tort liability coverage
through the Oregon Department of Administrative Services to any county or
private community care provider that has contracted with the Department to
provide supervision, care, treatment, or training of persons under the
jurisdiction of the Psychiatric Security Review Board, hereinafter referred to
as "PSRB".
Pursuant to ORS 278.405, the Oregon Department of Administrative Services
has the authority to direct and manage all risk management and insurance
programs to state government except for employee benefit insurance programs
as otherwise provided in ORS Chapter 243.
121520 PSRB.doc "Assisting People to Become independent, Healthy and Safe"
PSRB (GA 20074009 An Equal Opportunity Employer
Approved December 18, 2007
Page 1
3. Statement of Work and Consideration
The County shall continue to provide Psychiatric Security Review Board
(PSRB) Mental Health Services (MHS 30) in Attachment A as specified in the
2007-2009 Intergovernmental (IGA) for the Financing of Mental Health,
Developmental Disability and Addiction Services (FMHDDAD).
The County must submit a quarterly report of all PSRB clients that are
enrolled in an educational program or that are currently independently
employed or currently receiving supported employment services.
Under this Agreement, the Department obligates itself to provide liability
coverage to the County while delivering PSRB services.
4. The Department has sufficient funds currently available and authorized for
expenditure to finance the costs of this Agreement within the Department's
biennial appropriation or limitation. The County understands and agrees that
the Department's payment of amounts under this Agreement attributable to
work performed after the last day of the current biennium is contingent on the
Department receiving from the Oregon Legislative Assembly appropriations,
limitation, or other expenditure authority sufficient to allow the Department,
in the exercise of its reasonable administrative discretion, to continue to make
payments under this Agreement. In the event the Oregon Legislative
Assembly fails to approve sufficient appropriations, limitations, or other
expenditure authority, the Department may terminate this Agreement without
penalty or liability to Department, effective upon the delivery of written notice
to the County, with no further liability to the County, except that termination
shall not prejudice County's right to tort liability coverage under this
Agreement for any covered liability incurred prior to the date of termination.
5. Termination
A. This Agreement may be terminated by written mutual consent of both
parties, or by either party upon 30 days written notice.
B. The Department may terminate this Agreement effective upon delivery of
written notice to the County, or at such later date as may be established
by the Department, under any of the following conditions:
121520 PSRs.doc
PSRB [GA 2007-2009
Approved December 18, 2007
Page 2
1. The County is deficient in providing the PSRB service as outlined in
the service description (Attachment A) within the time specified
herein or any extension thereof.
2. The Department's 2007-2009 IGA for FMHDDAD is terminated.
C. Termination under this section shall not prejudice County's right to tort
liability coverage under this Agreement for any covered liability incurred
prior to the date of termination.
6. Records Maintenance and Access
The County shall maintain all fiscal records relating to this Agreement in
accordance with generally accepted accounting principles. In addition, the
County shall maintain any other records pertinent to this Agreement in such a
manner as to clearly document on the County's performance hereunder.
County acknowledges and agrees that the Department, the Oregon Secretary
of State's Office, the federal government, and their duly authorized
representative shall have access to such fiscal records and to all other books,
documents, papers, plans and writings of the County that are pertinent to this
Agreement for the purpose of performing examinations and audits, and
making excerpts and transcripts. All such fiscal records, books, documents,
papers, plans, and writings shall be retained by the County and kept accessible
for a minimum of six years, except as required longer by law, following final
payment and termination of this Agreement, or until the conclusion of any
audit, controversy or litigation arising out of or related to this Agreement,
whichever date is later.
7. Compliance with Applicable Law
The County shall comply with all federal, state and local laws and ordinances
applicable to the work under this Agreement. The County, its officers and
employees are not agents of the Department for the purposes of ORS 30.260
to 30.300. The County shall comply with all federal, state and local laws and
ordinances applicable to the service being provided under this Agreement.
Without limiting the generality of the foregoing, County expressly agrees to
comply with: (a) Title VI of the Civil Rights Act of 1964; (b) Section V of the
Rehabilitation Act of 1973; (c) the Americans with Disabilities Act of 1990;
(d) ORS 659A.142, and all regulations and administrative rules established
pursuant to those laws; and (e) all other applicable requirements of federal and
state civil rights and rehabilitation statutes, rules and regulations.
121520 PSRB.doc Page 3
PSRB IGA 2007-2009
Approved December 18, 2007
8. Severability
The parties agree that if any term or provision of this Agreement is declared
by a court of competent jurisdiction to be illegal or in conflict with any law,
the validity of the parties shall be construed and enforced as if the Agreement
did not contain the particular term or provision held to be invalid.
9. Merger Clause
This Agreement and the attachments constitute the entire Agreement between
the parties. No waiver, consent modification, or change of terms of this
Agreement shall bind either party unless in writing and signed by all
signatories to this Agreement. Such waiver, consent modification, or change,
if made, shall be effective only in the specific instance and for the specific
purpose given. There are no understandings, agreements, or representations,
oral or written, not specified herein regarding this Agreement. The County,
by the signature below of its authorized representative, hereby acknowledges
that he or she had read this Agreement, understands it, and agrees to be bound
by its terms and conditions.
Signatures:
Deschutes County:
Authorized County Signature Date
STATE OF OREGON, DEPARTMENT OF HUMAN SERVICES:
Jeremy Emerson, Date
Administrator, Office of Contracts and Procurement
Approved as to Legal Sufficiency:
95/0g
As istant Attorney General Dafe
Oregon Department of Justice
121520 PSRB.doc
PSRB IGA 2007-2009
Approved December 18, 2007
Page 4
Service Name:
SUPERVISION SERVICES FOR PERSONS UNDER THE
JURISDICTION OF THE PSYCHIATRIC SECURITY
REVIEW BOARD
Service ID Code: MHS 30
I. Service Description
Supervision Services For Persons Under the Jurisdiction of the Psychiatric
Security Review Board (MHS 30) are assessment and evaluation services
delivered to individuals residing in the Oregon State Hospital ("OSH"), and
supervision services delivered to individuals while on conditional release from
OSH. MHS 30 Services include:
A. The assessment and evaluation of an individual for conditional release
from OSH or placement on a waiting list for conditional release from
OSH for the court and for the Psychiatric Security Review Board (PSRB)
to determine if the individual can be treated in the community, including
identification of the specific requirements for the community placement
of an individual; and
B. Supervision for individuals while on conditional release from OSH
consistent with the PSRB conditional release order,
C. Coordination with the OSH on transition activities related to conditional
release of an individual.
D. Administrative activities related to the supervision services described
above, including but not limited to:
1. Modification of conditional release orders;
2. Revocations of conditional release, due to violation(s) of conditional
release orders, and readmission to OSH;
3. Response to Law Enforcement Data System notifications as a result
of contact, by the individual receiving MHS 30 Services, with law
enforcement agencies and;
4. Requests for amendments to this Agreement.
121520 PSRB.doc
PSRB ICA 2007-2009
Approved December 18, 2007
Page 5
H. Performance Requirements:
Providers of MHS 30 Services funded through this Agreement must comply
with OAR 309-032-0450 through 309-032-0515, as such rules may be revised
from time to time.
Providers of MHS 30 Services funded through this Agreement must maintain
a Certificate of Approval in accordance with OAR 309-012-0130 through
OAR 309-012-0220, as such rules may be revised from time to time.
III. Special Reporting Requirements:
A. County must submit a copy of the Conditional Release Plan to
Department's Addictions and Mental Health Division ("AMHD") for all
individuals conditionally released from OSH and receiving MHS 30
Services with funds provided under this Agreement.
B. County must submit monthly written reports, no later than the 15th of
each month following the month MHS 30 Services were delivered with
funds provided under this Agreement, to Department's Addictions and
Mental Health Division and to the PSRB specifying: (a) the number of
contacts by type and per month, per each individual on conditional
release; (b) the name of the individuals, residing in OSH, who were
evaluated for potential conditional release; (c) the MHS 30 Services
delivered with funds provided under this Agreement, identified by
individual served; and (d) a line item description of MHS 201 services
delivered and costs incurred in delivering MHS 201 services with funds
provided under this Agreement to individuals receiving MHS 30 Services
with funds provided under this Agreement. Reports must be prepared
using forms and procedures designated by Department.
IV. Financial Assistance Calculation and Disbursement Procedures
Certain financial assistance for delivery of MHS 30 Services may be included in
the Financial Assistance Award while other funds for delivery of MHS 30
Services may be included in the Service Element Prior Authorization. The
procedures for calculating and disbursing financial assistance from MHS 30
funds included in the Financial Assistance Award are set forth in section IV (A)
below.
121520 PSRB.doc
PSRB !GA 2007-2009
Approved December 18, 2007
Page 6
A. Funds Described in the Financial Assistance Award
1. Calculation of Financial Assistance. Department will provide
financial assistance for MHS 30 Services identified in a particular
line of the Financial Assistance Award from funds identified on that
line in an amount equal to the rate set forth in the special condition
identified in that line of the Financial Assistance Award, multiplied
by the number of units of MHS 30 Services delivered under that line
of the Financial Assistance Award during the period specified in that
line, subject to the following:
a. Total Department financial assistance for MHS 30 Services
delivered under a particular line in the Financial Assistance
Award shall not exceed the total funds awarded for MHS 30
Services as specified in that line in the Financial Assistance
Award.
b. Department is not obligated to pay for any MHS 30 Services for
individuals who are not properly reported through Client
Process -Monitoring System (CPMS) (or through other method
permitted or required by this Service Description or an
applicable Specialized Service Requirement) by the date 60
days after the earlier of termination of this Agreement,
termination of Department's obligation to provide financial
assistance for MHS 30 Services, or termination of County's
obligation to include the Program Area, in which MHS 30
Services fall, in its Community Mental Health Program
(CMHP).
c. Once an individual begins receiving MHS 30 and related MHS
201 Services funded through this Agreement, Department will
treat that individual as having received MHS 30 Services
funded through this Agreement during the 90 day period after
services actually end if the services end as a result of revocation
of conditional release or as a result of voluntary admission to
OSH, and the individual's return to MHS 30 Services funded
through this Agreement is anticipated and does in fact occur
within 90 days. If the individual does not return to MHS 30
Services funded through this Agreement within 90 days,
Department may treat that individual as having received MHS
30 Services funded through this Agreement through the date of
the individual's revocation, or voluntary admission to the
hospital.
121520 PSRB.doc
PSRB IGA 2007-2009
Approved December 18, 2007
Page 7
d. Once an individual begins receiving MHS 30 and related MHS
201 Services funded through this Agreement, Department will
treat that individual as having received MHS 30 Services
funded through this Agreement during the 7 -day period after
services actually end if the services end as a result of expiration
of PSRB jurisdiction or early discharge from PSRB jurisdiction.
2. Disbursement of financial assistance: Unless a different
disbursement method is specified in that line of the Financial
Assistance Award, Department will disburse the funds awarded for
MHS 30 Services in a particular line of the Financial Assistance
Award to County in substantially equal monthly allotments during
the period specified in that line of the Financial Assistance Award,
subject to the following:
a. Department may, at its discretion, reduce the monthly
allotments based on under -delivery or non-delivery of services
identified through CPMS (or through other method permitted or
required by this Service Description or an applicable
Specialized Service Requirement).
b. Department may, at its discretion, adjust monthly allotments to
meet cash flow requirements to ensure continued availability of
MHS 30 Services.
c. Department may, at its discretion, adjust monthly allotments to
reflect changes in the funds awarded for MHS 30 Services on
that line of the Financial Assistance Award as a result of
amendment of the Financial Assistance Award.
3. Agreement Settlement. Agreement Settlement will reconcile any
discrepancies that may have occurred during the term of this
Agreement between actual Department disbursements of funds
awarded for MHS 30 Services under a particular line of the
Financial Assistance Award and amounts due for such services
based on the rate set forth in the special condition identified in that
line of the Financial Assistance Award and the actual amount of
services delivered under that line of the Financial Assistance Award
during the period specified in that line of the Financial Assistance
Award, as properly reported in CPMS (or through other method
permitted or required by this Service Description or an applicable
Specialized Service Requirement).
121520 PSRB.doc
PSRB ICA 2007-2009
Approved December 18, 2007
Page 8
Amendment No. N'A to County Contract No. NI{4
between County and
This is an amendment to the County Contract No. (Exhibit 1), to
provide services for persons under the jurisdiction of the Psychiatric Security Review
Board. The contract is between County, hereinafter referred to as "County",
and , hereinafter referred to as "Provider". The purpose of this amendment
is to add the State of Oregon, acting by and through its Department of Human Services,
hereinafter referred to as "Department", as a third party to the contract.
This amendment shall become effective on the date this amendment has been signed by
all authorized parties and, as required, approved by the Department of Justice. This
amendment shall expire on June 30, 2009, unless this contract between the Provider and
the County expires or is terminated earlier.
1. Statutory Authority
Pursuant to ORS 278.315, Department may provide tort liability coverage through
the Oregon Department of Administrative Services to any county or private
community care provider that has contracted with Department to provide
supervision, care, treatment, or training of persons under the jurisdiction of the
Psychiatric Security Review Board, hereinafter referred to as "PSRB".
Pursuant to ORS 278.405, the Oregon Department of Administrative Services has
the authority to direct and manage all risk management and insurance programs to
state government except for employee benefit insurance programs as otherwise
provided in ORS Chapter 243.
2. Department Obligation
As third party to the Contract, Department's obligations under this Contract shall be
limited solely to the provision of tort liability coverage to Provider as specified in
Attachment B — Tort Liability Coverage Clause while delivering Psychiatric
Security Review Board services.
PSRB — Third Party Amendment (Tort Liability) Page 1
Approved 12/18/2007
3. County and Provider Obligation; Compliance
Provider shall assist the County in County's requirement to submit a quarterly report
of all PSRB clients that are enrolled in an educational program or that are currently
independently employed or currently receiving supported employment services.
Provider shall provide services to Department and County that comply with Service
Description for PSRB coded MI -IS 30 (Attachment A), included in the 2007-2009
County Financial Assistance Contract (CFAC). Payment for services shall be made
through County according to the terms of the contract between County and Provider
(Exhibit 1) or subsequent amendments to the contract. County is required to monitor
and assure that the Provider is in compliance with the service delivery as specified in
Exhibit E. 9. of the 2007-2009 CFAC. If County fails to comply and assure service
delivery, Department may unilaterally terminate its involvement and all obligations
under County contract (Exhibit 1) including the tort liability coverage specified in
Attachment B of this amendment.
Upon notification by County to Department that its Provider is deficient in service
delivery, Department may unilaterally terminate its involvement and all obligations
under County contract (Exhibit 1) including the tort liability coverage specified in
Attachment B of this amendment.
4. Merger Clause
This amendment, its attachments, and its exhibits constitute the entire contract
amendment between the three parties. There are no understandings, agreements, or
representations, oral or written, not specified herein regarding this Contract. No
waiver, consent modification, or change of terms of this amendment shall bind either
party unless in writing and signed by all signatories to this amendment. Such
waiver, consent modification, or change, if made, shall be effective only in the
specific instance and for the specific purpose given. There are no understandings,
agreements, or representations, oral or written, not specified herein regarding this
amendment. All parties, by the signature below of its authorized representative,
hereby acknowledges that he or she had read this amendment, understands it, and
agrees to be bound by its terms and conditions.
Provider Data: 1
Name of Provider: CO()} l5 }�►cvlder
Mailing Address: `
PSRB —Third Party Amendment (Tort Liability)
Approved 12/18/2007
Page 2
Federal I.D. No.: or Soc. Security No.:
Signatures:
Provider Date
County's Authorized Signature Date
STATE OF OREGON, Department of Human Services:
Jeremy Emerson, Date
Administrator, Office. of Contracts and Procurement
Approval of the Independent Contractor's Tort Liability Coverage Clause (Attachment B):
By delegation letter date - , on file at DHS Office of Contracts & Procurement
Debra Hembree,
Risk Management Division
Oregon Department of Administrative Services
Form Approved as to Legal Sufficiency:
By e-mail dated
Steven Marlowe,
Assistant Attorney General
, on file at DHS Office of Contracts & Procurement
PSRB — Third Party Amendment (Tort Liability) Page 3
Approved 12/18/2007
Exhibit 1
Insert copy of contract, including amendments,
between County and Provider
PSRB — Third Party Amendment (Tort Liability) Page 4
Approved 12/18/2007
Service Name: SUPERVISION SERVICES FOR PERSONS UNDER THE
JURISDICTION OF THE PSYCHIATRIC SECURITY
REVIEW BOARD
Service ID Code: MHS 30
I. Service Description
Supervision Services For Persons Under the Jurisdiction of the Psychiatric Security
Review Board (MHS 30) are assessment and evaluation services delivered to
individuals residing in the Oregon State Hospital ("OSPf'), and supervision services
delivered to individuals while on conditional release from OSH. MHS 30 Services
include:
A. The assessment and evaluation of an individual for conditional release from
OSH or placement on a waiting list for conditional release from OSH for the
court and for the Psychiatric Security Review Board (PSRB) to determine if the
individual can be treated in the community, including identification of the
specific requirements for the community placement of an individual; and
B. Supervision for individuals while on conditional release from OSH consistent
with the PSRB conditional release order,
C. Coordination with the OSH on transition activities related to conditional release
of an individual.
D. Administrative activities related to the supervision services described above,
including but not limited to:
1. Modification of conditional release orders;
2. Revocations of conditional release, due to violation(s) of conditional
release orders, and readmission to OSH;
3. Response to Law Enforcement Data System notifications as a result of
contact, by the individual receiving MHS 30 Services, with law
enforcement agencies and;
4. Requests for amendments to this Agreement.
PSRB — Third Party Amendment (Tort Liability) Page 5
Approved 12/18/2007
II. Performance Requirements:
Providers of MHS 30 Services funded through this Agreement must comply with
OAR 309-032-0450 through 309-032-0515, as such rules may be revised from time
to time. .
Providers of MHS 30 Services funded through this Agreement must maintain a
Certificate of Approval in accordance with OAR 309-012-0130 through OAR
309-012-0220, as such rules may be revised from time to time.
III. Special Reporting Requirements:
A. County must submit a copy of the Conditional Release Plan to Department's
Addictions and Mental Health Division ("AMHD") for all individuals
conditionally released from OSH and receiving MHS 30 Services with funds
provided under this Agreement.
B. County must submit monthly written reports , no later than the 15`h of each
month following the month MHS 30 Services were delivered with funds
provided under this Agreement, to Department's Addictions and Mental Health
Division and to the PSRB specifying: (a) the number of contacts by type and
per month, per each individual on conditional release; (b) the name of the
individuals, residing in OSH, who were evaluated for potential conditional
release; (c) the MHS 30 Services delivered with funds provided under this
Agreement, identified by individual served; and (d) a line item description of
MHS 201 services delivered and costs incurred in delivering MHS 201 services
with funds provided under this Agreement to individuals receiving MHS 30
Services with funds provided under this Agreement . Reports must be prepared
using forms and procedures designated by Department.
IV. Financial Assistance Calculation and Disbursement Procedures
Certain financial assistance for delivery of MHS 30 Services may be included in the
Financial Assistance Award while other funds for delivery of MHS 30 Services may
be included in the Service Element Prior Authorization. The procedures for calculating
and disbursing financial assistance from MHS 30 funds included in the Financial
Assistance Award are set forth in section IV (A) below.
A. Funds Described in the Financial Assistance Award
1. Calculation of Financial Assistance. Department will provide financial
assistance for MHS 30 Services identified in a particular line of the
Financial Assistance Award from funds identified on that line in an amount
equal to the rate set forth in the special condition identified in that line of
PSRB — Third Party Amendment (Tort Liability) Page 6
Approved 12/18/2007
the Financial Assistance Award, multiplied by the number of units of MHS
30 Services delivered under that line of the Financial Assistance Award
during the period specified in that line, subject to the following:
a. Total Department financial assistance for MHS 30 Services delivered
under a particular line in the Financial Assistance Award shall not
exceed the total funds awarded for MHS 30 Services as specified in
that line in the Financial Assistance Award.
b. Department is not obligated to pay for any MHS 30 Services for
individuals who are not properly reported through Client Process
Monitoring System (CPMS) (or through othermethod permitted or
required by this Service Description or an applicable Specialized
Service Requirement) by the date 60 days after the earlier of
termination of this Agreement, termination of Department's obligation
to provide financial assistance for MHS 30 Services, or termination of
County's obligation to include the Program Area, in which NIRS 30
Services fall, in its Community Mental Health Program (CMIHP).
c. Once an individual begins receiving MRS 30 and related MHS 201
Services funded through this Agreement, Department will treat that
individual as having received MHS 30 Services funded through this
Agreement during the 90 day period after services actually end if the
services end as a result of revocation of conditional release or as a
result of voluntary admission to OSH, and the individual's return to
MHS 30 Services funded through this Agreement is anticipated and
does in fact occur within 90 days. If the individual does not return to
MHS 30 Services funded through this Agreement within 90 days,
Department may treat that individual as having received MHS 30
Services funded through this Agreement through the date of the
individual's revocation, or voluntary admission to the hospital.
d. Once an individual begins receiving MHS 30 and related MHS 201
Services funded through this Agreement, Department will treat that
individual as having received MHS 30 Services funded through this
Agreement during the 7 -day period after services actually end if the
services end as a result of expiration of PSRB jurisdiction or early
discharge from PSRB jurisdiction.
2. Disbursement of financial assistance: Unless a different disbursement
method is specified in that line of the Financial Assistance Award,
PSRB — Third Party Amendment (Tort Liability) Page 7
Approved 12/18/2007
Department will disburse the funds awarded for MHS 30 Services in a
particular line of the Financial Assistance Award to County in substantially
equal monthly allotments during the period specified in that line of the
Financial Assistance Award, subject to the following:
a. Department may, at its discretion, reduce the monthly allotments
based on under -delivery or non-delivery of services identified through
CPMS (or through other method permitted or required by this Service
Description or an applicable Specialized Service Requirement).
b. Department may, at its discretion, adjust monthly allotments to meet
cash flow requirements to ensure continued availability of MHS 30
Services.
c. Department may, at its discretion, adjust monthly allotments to reflect
changes in the funds awarded for MHS 30 Services on that line of the
Financial Assistance Award as a result of amendment of the Financial
Assistance Award.
3. Agreement Settlement. Agreement Settlement will reconcile any
discrepancies that may have occurred during the term of this Agreement
between actual Department disbursements of funds awarded for MHS 30
Services under a particular line of the Financial Assistance Award and
amounts due for such services based on the rate set forth in the special
condition identified in that line of the Financial Assistance Award and the
actual amount of services delivered under that line of the Financial
Assistance Award during the period specified in that line of the Financial
Assistance Award, as properly reported in CPMS (or through other method
permitted or required by this Service Description or an applicable
Specialized Service Requirement).
PSRB — Third Party Amendment (Tort Liability) Page 8
Approved 12/18/2007
7 ( D
Oregon Department
of Human Services
Office of Contracts & Procurement
500 Summer St. NE, E-03
Salem, OR 97301-1080
Phone: (503) 945-5818
Fax: (503) 378-4324
TTY: (503) 947-5330
FAX BACK STATEMENT
Please complete the following statement and return it along with the completed
signature page(s) and the Data Certification page (if applicable) of this contract. If
any changes are made to the document, please return the Contract, in its entirety,
via fax. Thank you.
I
(Name) (Title)
received a copy of Agreement #121520, between the State of Oregon, acting by
and through the Department of Human Services, and Deschutes County, by e-mail
from April D. Barrett on January 28, 2008.
On , I signed the printed form of the Contract without change. A
(Date)
copy of the signature page from this Contract containing my signature
and dated is included with this facsimile transmission.
(Date)
(Signature) (Date)
After all parties have signed, you will receive a copy of the document for your
records. If you have any questions, please call the contract specialist,
April D. Barrett at (503) 945-5821.
Attachment(s)
ATTACHMENT B
TORT LIABILITY COVERAGE CLAUSE
Pursuant to ORS 278.315, Department may provide tort liability coverage through the
Oregon Department of Administrative Services to any county or private community care
provider that has contracted with the Department to provide supervision, care, treatment,
or training of persons under the jurisdiction of the Psychiatric Security Review Board,
hereinafter referred to as "PSRB".
Pursuant to ORS 278.405, the Oregon Department of Administrative Services has the
authority to direct and manage all risk management and insurance programs to state
government except for employee benefit insurance programs as otherwise provided in
ORS Chapter 243.
PSRB — Third Party Amendment (Tort Liability) Page 9
Approved 12/18/2007