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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.oig
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of June 25, 2008
Please see directions for completing this document on the next page.
DATE: June 18, 2008
FROM: Deevy Holcomb Juvenile Community Justice 322-7644
TITLE OF AGENDA ITEM:
Consideration of Board Chair Signature of an Intergovernmental Agreement 125379 (Deschutes County
Doc #2008-352) with the state Department of Human Services regulating the administration of federal
Behavioral Rehabilitation Services for juveniles.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
The Juvenile Community Justice department accesses federal "Behavioral Rehabilitation Services"
(BRS) for economically disadvanged youth under court jurisdiction who are placed out of home in
treatment foster care. These BRS funds help provide a higher level of service for youth and supplement
state grant funds that are used to provide other aspects of treatment foster care services.
Maplestar Oregon, Inc is the provider of treatment foster care services for Deschutes County and has
been certified and is in good standing as a BRS provider by the Oregon Youth Authority (OYA), the
state agency responsible for monitoring BRS related programs. The County has an existing
Memorandum of Agreement with the OYA that specifies the county's roles and responsibilities in
providing BRS services.
Because BRS is a program of the federal Medicaid program, however, all county billing and required
federal match payments are administered through the state's only recognized Medicaid/Medicare
agency, the Department of Human Services (DHS). Of the federal funds received, the county pays the
state back an agreed-upon local match, but it is a cost -neutral process for the county. Anticipated
county revenue for 08/09 is $167,475.
DHS has originated a new Intergovernmental Agreeement reflecting several changes, including
reimbursement rates, match payment processes and certain federal rules regarding eligibile clients
FISCAL IMPLICATIONS:
BRS funds anticipated based on proposed budget for FY 08/09: $167,475
RECOMMENDATION & ACTION REQUESTED:
Board Chair Signature of Intergovernmental Agreement 125379.
ATTENDANCE: Ken Hales and/or Deevy Holcomb
DISTRIBUTION OF DOCUMENTS:
Both originals returned to Deevy Holcomb to be sent to state for signature.
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 b +
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:
Please complete all sections above the Official Review line.
June 17, 2008
Contact Person:
Deevy Holcomb
Contractor/Supplier/Consultant Name:
Department:
Juvenile Community Justice
Phone #:
322-7644
State of Oregon Dept Human Services
Goods and/or Services: Intergovernmental Agreement 125379 (Deschutes County
Doc #2008-352) regulating administration of federal Behavioral Rehabilitation Services
for Deschutes County adjudicated youth.
Background & History: The Juvenile Community Justice department accesses
federal "Behavioral Rehabilitation Services" (BRS) for economically disadvanged youth
under court jurisdiction who are placed out of home in treatment foster care. These BRS
funds help provide a higher level of service for youth and supplement state grant funds
that are used to provide other aspects of treatment foster care services.
Maplestar Oregon, Inc is the provider of treatment foster care services for Deschutes
County and has been certified and is in good standing as a BRS provider by the Oregon
Youth Authority (OYA), the state agency responsible for monitoring BRS related
programs. The County has an existing Memorandum of Agreement with the OYA that
specifies the county's roles and responsibilities in providing BRS services.
Because BRS is a program of the federal Medicaid program, however, all county billing
and required federal match payments are administered through the state's only
recognized Medicaid/Medicare agency, the Department of Human Services (DHS). Of
the federal funds received, the county pays the state back an agreed-upon local match,
but it is a cost -neutral process for the county. Anticipated county revenue for 08/09 is
approximately $167,000.
DHS has originated a new Intergovernmental Agreeement reflecting several changes,
including reimbursement rates, match payment processes and certain federal rules
regarding eligibile clients.
Agreement Starting Date:
July 1, 2008
Annual Value or Total Payment:
II
$167,000
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)
Ending Date:
June 30, 2011
6/18/2008
Funding Source: (Included in current budget? ® Yes 1 1 No
If No, has budget amendment been submitted? I 1 Yes I 1 No
Departmental Contact:
Title:
Deevy Holcomb
Management Analyst
Department Director Approval:
etIr
re
Distribution of Document: Inc
Phone #:
322-7644
4iNg
Date
e complete information if document is to be mailed.
Official Review:
County Signature Required (check one): ❑ BOCC ❑ Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. )
Legal Review
Document Number
Date
6/18/2008
Oregon
Theodore R. Kvtongoski, Governor
Agreement Number 125379
Department of Human Services
Administrative Services
Office of Contracts & Procurement
500 Summer Street NE, E-03
Salem, OR 97301-1080
(503) 945-5818
Fax: (503) 378-4324
TTY: (503) 947-5330
State of Oregon
Intergovernmental Agreement
In compliance with the Americans with Disabilities Act, this
document is available in alternate formats such as Braille, large
print, audiotape, oral presentation and electronic format. To
request an alternate format, please send an e-mail to
DI-IS.Forms@state.or.us state.or.us or contact the Office of Document
Management at (503) 378-3523, and TTY at 503-378-3523.
This Agreement is between the State of Oregon, acting by and through its Department of
Human Services, hereinafter referred to as "DHS," and
Deschutes County
63360 Britta Street, Building 1
Bend, Oregon 97701
Phone number 541-385-1728
Fax number 541-383-0165
Email address: BobL( deschutes.org
hereinafter referred to as "County".
Work to be performed under this Agreement relates principally to the DHS'
Division of Medical Assistance Programs
500 Summer Street NE
Salem, Oregon 97301
Agreement Administrator: Jean Hutchinson
Telephone: 503-945-9420
Fax: 503-373-7689
(DHS
ssisting People to Become Independent, Healthy and Safe"
An Equal Opportunity Employer DC 2 013
1. PURPOSE
County (County or Provider) is enrolled with the Department of Human Services (DHS) for
purposes of providing covered medical assistance services to Medicaid -eligible children and youth.
The purpose of this Agreement is to specify the requirements applicable to the Provider's delivery of
Behavior Rehabilitation Services (BRS). This program has been designed to meet the Federal
Medicaid requirements and to provide individual services to children or youth by providing a
comprehensive assessment and evaluation of the needs of the child or youth. The purpose of BRS
programming is to remediate children's or youth's impairments and encourage and reinforce
children's or youth's appropriate behaviors to restore the child or youth to the best possible
functional level.
2. EFFECTIVE DATE AND DURATION
This Agreement shall become effective on the date this Agreement has been fully executed by
every party and, when required, approved by Department of Justice or on 7/1/2008, whichever
date is later. Unless extended or terminated earlier in accordance with its terms, this Agreement
shall terminate on 6/30/2011. Agreement termination or expiration shall not extinguish or
prejudice either parties' right to enforce this Agreement with respect to any default by the other
party that has not been cured.
3. CONSIDERATION
A. DEPARTMENT shall reimburse COUNTY for billed BRS at the rates included in
Attachment 5 which may be amended from time to time through a written amendment.
B. COUNTY shall reimburse DEPARTMENT for the State financial portion of the BRS as
indicated in Exhibit A, Part 2, Section A., 7. of this Agreement.
4. AGREEMENT DOCUMENTS
a.
This Agreement consists of:
Exhibit A, Part 1:
Exhibit A, Part 2:
Exhibit A, Part 3:
Exhibit A, Part 4:
Exhibit B:
Exhibit C:
Exhibit D:
Exhibit E:
Attachment 1.
Attachment 2.
Attachment 3.
Attachment 4.
Attachment 5.
Definitions (RESERVED)
Statement of Work
Payment and Financial Reporting
Special Terms and Conditions
Standard Terms and Conditions
Insurance Requirements
Required Federal Terms and Conditions
Required Subcontractor Provisions (RESERVED)
Assessment and Evaluation Services
Rehabilitation Services
Intensive Rehabilitation Services
BRS Provider Enrollment Attachment
BRS Rates
This Agreement constitutes the entire agreement between the parties on the subject matter
in it. There are no understandings, agreements or representations, oral or written,
regarding this Agreement that are not specified in it.
125379 rrnh.doe Page 2 of 23
b. In the event of a conflict between two or more of the documents comprising this
Agreement, the language in the document with the highest precedence shall control. The
precedence of each of the documents comprising this Agreement is as follows, listed from
highest precedence to lowest precedence: (a) this Agreement without Exhibits, (b) Exhibit
D, (c) Exhibit A, (d) Attachments 1 through 5, (e) Exhibit B, (f) Exhibit C.
c. For purposes of this Agreement, "Work" means specific work or services to be performed
by County as set forth in Exhibit A.
5. VENDOR OR SUB -RECIPIENT DETERMINATION
In accordance with the State Controller's Oregon Accounting Manual, policy 30.40.00.102, and
DHS procedure "Contractual Governance", DHS' determination is that:
® County is a sub -recipient;
OR
❑ County is a vendor.
Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this
Agreement: 93.778
6. COUNTY DATA AND CERTIFICATION
a. County Tax Identification and Insurance Information. County shall provide County's
federal tax ID number and the additional information set forth below. This information is
requested pursuant to ORS 305.385.
Please print or type the following information.
If County is self-insured for any of the Insurance Requirements specified in Exhibit C of this
Agreement, County may so indicate by writing "Self -Insured" on the appropriate line(s).
Name (exactly as filed with the IRS)
Deschutes County
Address 1300 NW Wall Street Rend, OR 97701
Telephone: (541 388 - 6572
Facsimile: (541 385 - 3909
Proof of Insurance:
Workers Compensation--- Insurance Company Self -Insured
Policy # Expiration Date:
Professional Liability Insurance Company Self -Insured
Policy # Expiration Date:
General Liability Insurance Company
Policy #
Auto Insurance Company N/A
Policy #
Self -Insured
Expiration Date:
Federal Tax I.D.#
Expiration Date:
93 - Coo v ZZ 12-
125379 rmh.doc Page 3 of 23
The above information must be provided prior to Agreement approval. County shall
provide proof of Insurance upon request by DHS or DHS designee. DHS may report the
information set forth above to the Internal Revenue Service (IRS) under the name and
taxpayer identification number provided.
b. Certification. By signature on this Agreement, the undersigned hereby certifies under
penalty of perjury that:
(1) The number shown in Section 5.a, is County's correct taxpayer identification and
all other information provided in Section 5.a. is true and accurate; and
(2) County is not subject to backup withholding because:
(a) County is exempt from backup withholding;
(b) County has not been notified by the IRS that County is subject to backup
withholding as a result of a failure to report all interest or dividends; or
(c) The IRS has notified County that County is no longer subject to backup
withholding.
EACH PARTY, BY EXECUTION OF THIS AGREEMENT, HEREBY ACKNOWLEDGES
THAT IT HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND
BY ITS TERMS AND CONDITIONS.
COUNTY: YOU WILL NOT BE PAID FOR WORK PERFORMED PRIOR TO NECESSARY
STATE APPROVALS
Approved By County
Chair, Board of County Commissioners
Authorized Signature
Approved By DHS
Title Date
Authorized Signature Title Date
Approved for Legal Sufficiency
Electronically approved by Linda Grimms, Senior Assistant Attorney General on June 12, 2008.
Email approval in the Contract file.
DHS Contract Specialist
Signature
Name (printed) Date
125379 rmh.doc Page 4 of 23