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HomeMy WebLinkAboutResolutions - 2016.07.20 - 22436REPORT (MISC. #16169) July 20, 2016 BY: Human Resources Committee, Bob Hoffman, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL AGREEMENT BETWEEN THE COUNTY OF OAKLAND AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY FOR HEALTH EDUCATION PREVENTION SERVICES To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: The Human Resources Committee, having reviewed the above referenced resolution on July 13, 2016, reports with the recommendation that the resolution be adopted. Chairperson, on behalf of the Human Resources Committee, I move the acceptance of the foregoing report. HUMAN RESOURCES COMMITTEE HUMAN RESOURCES COMMITTEE VOTE: Motion carried unanimously on a roll call vote. MISCELLANEOUS RESOLUTION .#16169 July 20, 2016 BY: General Government Committee, Christine Long, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL AGREEMENT BETWEEN THE COUNTY OF OAKLAND AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY FOR HEALTH EDUCATION PREVENTION SERVICES To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS an Interlocal Agreement between the County of Oakland and the Oakland County Community Mental Health Authority (OCCMHA) was approved by the Oakland County Board of Commissioners in 2010 by Miscellaneous Resolution #10236 for Substance Use Disorder Services; and WHEREAS on November 12, 2015 the Interlocal Agreement was amended through Miscellaneous Resolution #15283 to cancel the Substance Use Disorder Access Management services provided by the Oakland County Health Division (OCHD) Prior Authorization and Central Evaluation (PACE) services at the request of OCCMHA; and WHEREAS OCCMHA is requesting to replace the current Interlocal Agreement with a new Interlocal Agreement; and WHEREAS the new Agreement includes total FY 2016 funding in the amount of $461,595 which consists of grant funding in the amount of $441,149 and a local match of $20,446; and WHEREAS this Agreement provides an end date of January 31, 2016 and funding not to exceed $236,685 for PACE services provided from October 1,2015 through January 31, 2016; and WHEREAS this new Agreement continues OCHD Health Education Prevention Services with FY 2016 funding in the amount of $204,464 and a local match of $20,446 comprised primarily of general fund salaries for supervision of the program; and WHEREAS this funding will be used to continue two (2) Special Revenue Full-Time Eligible Public Health Educator III positions (#1060233-00960 and #1060233-07497) within the CHPIS unit of the Health Division; and WHEREAS acceptance of these funds does not obligate the County to any future commitment; and WHEREAS the Agreement is effective upon approval and will remain in effect until terminated by either of the parties; and WHEREAS the positions associated with OCHD PACE services shall be deleted with the approval of this resolution; and WHEREAS this Interlocal Agreement has completed the Grant Review Process according to the Board of Commissioners Grant Procedures and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby approves the Interlocal Agreement between the County of Oakland and the Oakland County Community Mental Health Authority for total FY 2016 funding in the amount of $441,149 and a local match of $20,446 comprised primarily of general fund salaries for supervision of the program. BE IT FURTHER RESOLVED that this resolution effectively ends PACE positions upon approval and continues Health Education Prevention Services positions going forward. BE IT FURTHER RESOLVED to delete the following Oakland County Special Revenue positions associated with the former PACE Unit: 1060261-01919 1060261-06114 1060261-07151 1060261-07152 1060261-07154 1060261-07386 1060261-07387 1060261-07389 1060261-07498 1060261-07500 1060261-07566 1060261-08037 1060261-09026 1060233-09204 Substance Abuse Program Analyst Substance Abuse Program Analyst Treatment Services Supervisor Substance Abuse Program Analyst Office Assistant II Substance Abuse Program Analyst Auxiliary Health Worker Office Assistant II Account Clerk II Substance Abuse Program Analyst Office Assistant II Substance Abuse Program Analyst Substance Abuse Program Analyst Public Health Educator III GENERAL GOVERNMENT COMMITTEE Motion carried unanimously on a roll call vote with Woodward and Quarles absent. BE IT FURTHER RESOLVED to continue two (2) Special Revenue Full-Time Eligible Public Health Educator III positions (#1060233-00960 and #1060233-07497) within the CHPIS unit of the Health Division. BE IT FURTHER RESOLVED that the current and future level of Health Education Prevention Services will be contingent upon the level of funding for this program. BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners is authorized to execute the agreement and to approve any extensions or changes, within fifteen percent (15%) of the original award, which are consistent with the original agreement as approved. Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing resolution. GENERAL GOVERNMENT COMMITTEE GRANT REVIEW SIGN OFF — Health Division GRANT NAME: 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services FUNDING AGENCY: Oakland County Community Mental Health Authority (OCCMHA) DEPARTMENT CONTACT PERSON: Rachel Shymkiw / 452-2151 STATUS: Grant Acceptance DATE: June 29, 2016 Pursuant to Misc. Resolution #13180, please be advised the captioned grant materials have completed internal grant review. Below are the returned comments. The captioned grant materials and grant acceptance package (which should include the Board of Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal Note, and this Sign Off email containing grant review comments) may be requested to be placed on the appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution. DEPARTMENT REVIEW Department of Management and Budget: Approved. — Laurie Van Pelt (6/22/2016) Department of Human Resources: HR Approved (Needs HR Committee) Deletes Positions — Lori Taylor (6/22/2016) Risk Management and Safety: Approved by Risk Management — Robert Erlenbeck (6/22/2016) Corporation Counsel: Approved. — Bradley G. Henn (6/29/2016) From: Van Pelt. Laurie M To: West. Catherine A; Taylor. Lori; Davis, Patricia G; Schultz, Dean ) Cc: Rivmkiw. Rach_el 14; McKay-Chlasson, Lisa; Plsacreta. Antonio S; Md.ernon. Kathleen M Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance Date: Wednesday, June 22, 2016 1:05:46 PM Approved. From West, Catherine A Sent: Wednesday, June 22, 2016 10:35 AM To: Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J Cc: Shymkiw, Rachel M; McKay-Chiasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen M Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor — Dean Schultz — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health gt Human Services/Health Division 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services Oakland County Community Mental Health Authority Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: June 29, 2016 GRANT INFORMATION Date: June 22, 2016 Operating Department: Health St. Human Services/Health Division Department Contact: Rachel Shymkiw Contact Phone: 2-2151 Document Identification Number: REVIEW STATUS: Acceptance — Resolution Required Funding Period: 10/1/2015 through 9/30/2016 Original source of funding: Federal SAMHSA CFDA NO. 93.959 Will you issue a sub award (make payments to outside agencies) or contract (through From: To: Cc: Subject: Date: Taylor. Lori. West. Catherine A; Van Pelt. Laurie Pt; Davis. Patricia G; SchuLl2 Dean J ayjnithy.,BacheLE; F4day_Sliasspaj.L5a; Pisacreta. Antonio a; McLernon. Kathleen M; Russell, Roosevelt F; Mason. Heather L RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance Wednesday, June 22, 2016 1:26:13 PM HR Approved (Needs HR Committee) Deletes Positions From: West, Catherine A Sent: Wednesday, June 22, 2016 10:35 AM To: Van Pelt, Laurie It Taylor, Lori; Davis, Patricia G; Schultz, Dean 3 Cc: Shymkiw, Rachel ft McKay-Chiasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen M Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor — Dean Schultz — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division 2016 Interlocal Agreement— Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services Oakland County Community Mental Health Authority Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: June 29, 2016 GRANT INFORMATION Date: June 22, 2016 Operating Department: Health & Human Services/Health Division Department Contact: Rachel Shymkiw Contact Phone: 2-2151 Document Identification Number: REVIEW STATUS: Acceptance — Resolution Required Funding Period: 10/1/2015 through 9/30/2016 Original source of funding: Federal SAMHSA CFDA NO. 93.959 From: Erlenbeck, gobert C To: West. Catherine A; Van Pelt. Laurie M; Taylor. Lott Davis, Patricia G; Schultz Dean J Cc: 5hyrnkiw, Rachel M; 11cKav-Chiasson, Lisa; Pisacreta, Antonio S; Lemon, Kathleen M Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance Date: Wednesday, June 22, 2016 5:26:54 PM Approved by Risk Management, R.E, 6/22/16. From: Easterling, Theresa Sent: Wednesday, June 22, 2016 1:38 PM To: West, Catherine A; Van Pelt, Laurie Ni; Taylor, Lori; Davis, Patricia G; Schultz, Dean J Cc: Shymkiw, Rachel Ni; McKay-Chlasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen Ni Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance Please be advised that your request for Risk Management's assistance has been assigned to Bob Erlenbeck, (ext. 8-1694). if you have not done so already, please forward all related information, documentation, and correspondence. Also, please include Risk Management's assignment number, RM16-0338, regarding this matter. Thank you. From: West, Catherine A Sent: Wednesday, June 22, 2016 10:35 AM To: Van Pelt, Laurie Ni; Taylor, Lori; Davis, Patricia G; Schultz, Dean 3 Cc: Shymkiw, Rachel Ni; McKay-Chlasson, Lisa; Pisacreta, Antonio S; McLemon, Kathleen M Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor — Dean Schultz — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Serv ices/Health Division 2016 interiocal Agreement Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services Oakland County Community Mental Health Authority Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: June 29, 2016 From: Oenn. Bradley G To: West, CatherineA Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance Date: Wednesday, June 29, 2016 8:47:26 AM Approved. From: West, Catherine A Sent: Wednesday, June 29, 2016 8:46 AM To: Benn, Bradley G Subject: FW: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance From West, Catherine A Sent: Wednesday, June 22, 2016 10:35 AM To: Grant Review Cc: Shymkiw, Rachel M; McKay-Chiasson, Lisa; Pisacreta, Antonio S; McLernon, Kathleen M Subject: GRANT REVIEW: Health & Human Services/Health Division - 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services - Grant Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor Dean Schultz Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division 2016 Interlocal Agreement — Discontinuation of PACE Services and Continuation of Substance Abuse Prevention Health Education Services Oakland County Community Mental Health Authority Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: June 29, 2016 GRANT INFORMATION Date: June 22, 2016 Operating Department: Health & Human Services/Health Division Department Contact: Rachel Shymkiw Contact Phone: 2-2151 OAKLAND COUNTY INTERLOCAL AGREEMENT BETWEEN OAKLAND COUNTY AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY This Agreement ("Agreement") is made and entered into between the County of Oakland, ("County") (DUNS # 136200362), a Michigan Constitutional and Municipal Corporation, a political subdivision of the state of Michigan, and the designated Coordinating Agency per MCL 333.6201 et seq., whose address is 1200 North Telegraph, Pontiac, Michigan 48341 and the OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (hereafter "CMH Authority"), a Michigan Statutory Public Governmental Entity (MCL 330.1100a(12), Federal Employer 1.D. #38-3437521), created pursuant to the Michigan Mental Health Code (P.A. 1974, No. 258, MCL 330.1100, et seq., hereafter "Mental Health Code"), whose address is 2011 Executive Hills Blvd., Auburn Hills, MI 48326. In this Agreement, either the CMH Authority or the County may also be referred to individually as a "Party" or jointly as the "Parties." PURPOSE OF AGREEMENT. The CM11 Authority is seeking to purchase services or provide funds for programs to Oakland County. The Parties agrees, subject to the terms and conditions set forth in this Agreement, to provide funds and/or services as described in Exhibits 1 and Exhibit H. The Parties are authorized to enter into this Agreement pursuant to P.A. 1967, No. 7 (MCL 124.501 et seq.). In consideration of the mutual promises, obligations, representations, and assurances in this Agreement, the Parties agree as follows: 1. DEFINITIONS. In addition to any other defined terms in this Agreement (e.g., "Agreement," "County," "Mental Health Code," "CMH Authority," "Party," or "Parties," etc.), the Parties agree that for all purposes, and as used throughout this Agreement, the following words and expressions used throughout this Agreement, whether used in the singular or plural, within or without quotation marks, or possessive or nonpossessive, shall be defined, and interpreted as follows: 1.1. Agreement Documents mean the following documents, which this Contract includes and incorporates: 1.1.1. Exhibit I: Financial Obligations 1.1.2. Exhibit II: Scope of Services 1.1.3. Exhibit III: Business Associate Agreement, Requirements for Contracts Involving the Health Insurance Portability and Accountability Act, if applicable 1.1.4. Exhibit IV: Attachments C, D, and E. 1.2. Claim(s) means any loss; complaint; demand for relief or damages; lawsuit; cause of action; proceeding; judgment; penalty; costs or other liability of any kind which is imposed on, incmed by, or asserted against the County or for which the County may become legally or contractually obligated to pay or defend against, whether commenced or threatened, including, but not limited to, reimbursement for reasonable attorney fees, mediation, facilitation, arbitration fees, witness fees, court costs, investigation expenses, litigation expenses, or amounts paid in settlement.. 1.3. CMH Authority as defined on the first page of this Agreement, and shall be further defined to include any and all "CMH Agents" as defined herein. 1.4. CMH Authority Agent shall be defined to include, any and all CMH Authority Contractor(s)' employees, officers, directors, board members, concurrent board members, managers, departments, divisions, trustees, volunteers, licensees, concessionaires, subcontractors, vendors, subsidiaries, joint ventures or partners, and/or any such CMH Authority Contractor(s)' successors or predecessors and any such successors' or predecessors' employees (whether such persons act or acted in their personal, representative or official capacities), and/or any and all persons acting by, through, under, or in concert with any CMH Authority Contractor(s) "CMH Authority Agency" shall also include any person who was a CMH Authority Agent any time during the term of this Agreement but, for any reason, is no longer employed, appointed, or serving as a CMH Authority Agent, without limitation, any and all employees, officers, directors, members, managers, departments, and divisions of the CMH Authority (whether such persons act or acted in their personal, representative or official capacities but shall NOT include the County or "Concurrent Board Member" as defined herein. 1.5. Concurrent Board Member shall be defined as any Oakland County Commissioner who is also serving as a member of the Oakland County Community Mental Health Authority Board. 1.6. County As this term may be used in this Agreement, "County" shall be further defmed to include any and all "County Agents," as defined herein. 1.7. County Agent shall be defined as any and all elected officials, appointed officials, directors, board members, council members, commissioners, authorities, other boards, committees, commissions, employees, third-party contractors, departments, divisions, volunteers, representatives, and/or any such persons' successors (weather such persons act or acted in their personal representative or official capacities), and/or "County Agents" shall also include any person who was a County Agent any time during the term of this Agreement but, for any reason, is no longer employed, appointed, or elected and serving as an County Agent, and shall include the any "Concurrent Board Member." 2 1.8. M shall be defined as any calendar day, which shall always begin at 12:00:00 a.m. and end at 11:59:59 p.m. 2. COUNTY SERVICES FOR THE CMH AUTHORITY. Subject to the terms and conditions in this Agreement, and except as otherwise provided by law, the County shall provide those services for the CMH Authority as described in Exhibit II and Exhibit IV attached to this Agreement and hereby incorporated and made part of this Agreement. The Parties intend, agree, and acknowledge that no services, other than those services described in this Agreement, shall or are otherwise required to be provided by the County for or to the CMH Authority. Additional services may be contracted by mutual agreement between the Parties. 3, CMH AUTHORITY PAYMENT OBLIGATION FOR COUNTY SERVICES. 3.1. Subject to the terms and conditions of this Agreement the CIVILI Authority agrees to pay to the County on a monthly basis the dollar amount described in Exhibit I. This amount shall be paid to the County within the thirty days of the CMH Authority receiving the expenditure report from the County, via a wire transfer to a bank account designated by the County. 3.2. The Parties agree that the dollar Amount in Exhibit I is subject to change. The CMH Authority will notify the County via a written notice at least 30 days in advance of any such change, and the notice shall detail the change in the dollar amount. Furthermore, if the dollar amount described in Exhibit I should change either by increase or decrease the level of services provided by the County will change accordingly to match that increase or decrease in funds. At no time will the County be required to perform services for which it will not be paid or reimbursed. 3.3. Notwithstanding any references in the Exhibits to this Agreement, the Parties agree that any and all references to "capitation," "Per Eligible Per Month (PEPM) payments," "shared-risk," "risk" of any sort, or any maximum payment obligation shall be completely void and without any effect in interpreting this Agreement. 3.4. Unless there is a termination as provided for herein, the CMH Authority's obligations set forth in this Section, shall be absolute and unconditional and shall not be affected by the occurrence of either Party's default of any term or condition of this Agreement, nor shall any other occurrence or event relieve, limit, or impair the obligation of the CMH Authority to pay any such amount due to the County. 3.5. In the event that any amount due and owing from the CMH Authority is not paid to the County as otherwise required in this Agreement, the CMH Authority agrees that the County may, at its sole option, recover any and all such amounts determined by the County to be then due and owing by the CMH Authority by and through any combination of reduced payments, set-off, and/or withholding of any CMH Authority funds then in the possession of the County that would otherwise have been paid to the CMH Authority by the County pursuant to the Mental Health Code and/or any prior County funding commitment. 3.6. This Section shall not be interpreted as prohibiting, limiting or preventing the Parties from mutually recognizing and agreeing that any amount invoiced by and/or received 3 or paid to the County in connection with this Agreement was in error and voluntarily agreeing to correct same. 3.7. The Contract Amount per the Exhibit I for the applicable fiscal year represents a Not To Exceed Amount (NTE) and is the maximum financial obligation of the CMH Authority to the County for that fiscal year. If the Contractor projects their expenses will exceed the NTE the County will submit to CMH Authority in writing a request for additional funds as soon as projections indicate a potential overage but no later than September 30th of the current fiscal year. Upon this notification the County and ClVIE1 Authority will discuss potential adjustments to the NTE. 3.8. Cost Settlement 8z Audit: For each fiscal year (October 1 through September 30), cost settlement will be based on a comparison of the Exhibit I categorical amounts, as amended by CMH Authority, to the County's actual, allowable, net expenses incurred and reported for the period. 4. ASSURANCES AND WARRANTIES. 4.1. The CMH Authority agrees to comply with the provisions of any and all laws relating to nondiscrimination and conflict of interest with governmental employees and, specifically, any County Agent. The CMH Authority warrants to avoid any conflict of interest, whether real or perceived. 4.2. Any and all County services set forth in this Agreement are provided on an "as-in" and "as-available" basis, without any warranty of any kind, to the maximum extent permitted by applicable law. The County hereby expressly further disclaims any and all warranties, of any kind, whether express or implied, including, without limitation, any implied warranties of merchantability, fitness for a particular purpose, non- infringement, and/or that any County services under this Agreement will meet any CMH Authority's needs or requirements, will be uninterrupted, timely, secure, error or risk free/or that any deficiencies in any County service. The entire risk arising out of the use of any and all County services herein remains at all times, with the CMH Authority to the maximum extent permitted by law. 5. NO INDEMNIFICATION. 5.1. Each Party shall be responsible for any Claims made against that Party and for the acts of its Employees or Agents. 5.2. In any Claim that may arise from the performance of this Agreement, each Party shall seek its own legal representation and bear the costs associated with such representation including any attorney fees. 5.3. Except as otherwise provided in this Agreement, neither Party shall have any right under any legal principle to be indemnified by the other Party or any of its employees or Agents in connection with any Claim. 5.4, This Agreement does not, and is not intended to, impair, divest, delegate or contravene any constitutional, statutory, and/or other legal right, privilege, power, obligation, duty or immunity of the Parties. Nothing in this Agreement shall be construed as a waiver of governmental immunity for either Party. 6. LIMITS AND EXCLUSIONS ON COUNTY SERVICES. 4 6.1. In no event and under no circumstances in connection with or as a result of this Agreement shall the County be liable to the CMH Authority, or any other person, for any consequential, incidental, direct, indirect, special punitive, or other similar damages whatsoever (including, without limitation, damages for loss of business, profits, business interruption, or any other pecuniary loss or business detriment) arising out of this Agreement for any County services hereunder or any CIVIH Authority use or inability to use any County services, even if the County has been advised of the possibility of such damages. 7. NO IMPLIED WAIVER. Except as otherwise expressly provided for in this Agreement: 7.1. Absent a written waiver, no act, failure, or delay by a Party to pursue or enforce any rights or remedies under this Agreement shall constitute a waiver of those rights with regard to any existing or subsequent breach of this Agreement. 7.2. No waiver of any term, condition, or provision of this Agreement, whether by conduct or otherwise, in one or more instances, shall be deemed or construed as a continuing waiver of any term, condition, or provision of this Agreement. 7.3. No waiver by either Party shall subsequently affect its right to require strict performance of this Agreement. 8. MONITORING. 8.1. The CMH Authority will perform regular monitoring and reporting on the County's performance and the County agrees to cooperate with the monitoring. 8.2. The CMH Authority shall complete on-site reviews and/or audits of the County at least annually and has the right to investigate alleged compliance violations by the County. 8.3. The CMH Authority shall prepare a report summarizing the findings from the on-site review and/or audit and shall forward a copy of the report to the County within 60 days of completion of the review and/or audit. 9. AUDITING. The County agrees that financial records will be available upon request for review or audit by CMH Authority or other appropriate officials. 10. AGREEMENT INTERPRETATION. The Parties agree that performance under this Agreement will be conducted in compliance with all federal, Michigan, and local laws and regulations. This Agreement is made and entered into in the County of Oakland and in the State of Michigan. The language of all parts of this Agreement is intended to and under all circumstances to be construed as a whole according to its fair meaning and not construed strictly for or against any Party. 11. EFFECTIVE DATE AM) DURATION OF THE AGREEMENT. 11.1. The Parties agree that this Agreement, and/or any subsequent amendments thereto, shall not become effective prior to the approval by the Oakland County Board of Commissioners and the CMH Authority. The approval and terms of this Agreement, and/or any possible subsequent amendments thereto, shall be entered in the official minutes and proceedings of the Oakland County Board of Commissioners and the 5 CMH Authority Board and shall also be filed with the office of the Clerk of the County. 11.2. The Parties further agree that this Agreement, and/or any subsequent amendments thereto, shall not become effective prior to the filing of this Agreement, and/or any possible subsequent amendments with the Michigan Secretary of State (MCL 124.510). 11.3. This Agreement shall remain in effect until it is cancelled or terminated by either of the Parties as provided herein. 12. INDEPENDENT CONTRACTOR. The Parties agree that at all times and for all purposes under the terms of this Agreement, the County's and/or any and all County Agents' legal status and relationship to the CMH Authority shall be that of an Independent Contractor. Except as expressly provided herein, each Party will be solely responsible for the acts of its own employees, agents, and servants during the term of this Agreement. No liability, right or benefits arising out of an employer/employee relationship, either express or implied, shall arise or accrue to either Party as a result of this Agreement. 13. TERMINATION OR CANCELLATION OF AGREEMENT. Either Party may terminate and/or cancel this Agreement upon ninety (90) Days written notice to the other Party. The effective date of termination and/or cancellation shall be clearly stated in the written notice. Termination of this Agreement does not release any Party from any obligations that Party has pursuant to any law. 13.1. The Parties agree and acknowledge that either Party's decision to terminate and/or cancel this Agreement, or any one or more individual County Services identified herein, shall not relieve the CMH Authority or any CMH Authority payment obligation for any County Services rendered prior to the effective date of any termination or cancellation of this Agreement. The provisions of this Subsection shall survive the termination, cancellation, and/or expiration of this Agreement. 14. DISCRIMINATION. The Parties shall not discriminate against their employees, agents, applicants for employment, or another person or entities with respect to hire, tenure, terms, conditions, and privileges of employment, or any matter directly or indirectly related to employment in violation of any federal, state or local law. 15. RECORD RETENTION. The Parties agrees to maintain records in accordance with state law. All records relative to this Agreement shall be available at any reasonable time for examination or audit by personnel authorized by CMH Authority or law. 16. CORPORATE COMPLIANCE. The County shall have a Corporate Compliance Plan and/or Policy. The Plan shall advance the prevention of fraud, abuse and waste providing health care and to detect misconduct or wrongdoing. The CMH Authority shall monitor the implementation of the Plan. The County shall investigate any reported allegations of fraud and abuse related to the purchase of services funded through this Agreement. The County shall notify the CMH Authority within 48 hours of becoming aware of any such allegation(s). The County shall also notify the CMH Authority of the outcome of the investigation completed by the County. 6 17. DELEGATION/SUBCONTRACT/ASSIGNMENT. Neither Party shall delegate, subcontract, and/or assign any obligations or rights under this Agreement without the prior written consent of the other Party. 18. FORCE MAJEURE. Each Party shall be excused from any obligations under this Agreement during the time and to the extent that a Party is prevented from performing due to causes beyond the Party's control, including, but not limited to, an act of God, war, fire, strike, labor disputes, civil disturbances, reduction of power source, or any other circumstances beyond the reasonable control of the affected Party. Reasonable notice shall be given to the other party of any such event. 19. SEVERABILITY. If a court of competent jurisdiction finds a term, or condition, of this Agreement to be illegal or invalid, then the term, or condition, shall be deemed severed from this Agreement. All other terms, conditions, and provisions of this Agreement shall remain in full force. 20. CAPTIONS. The section and subsection numbers, captions, and any index to such sections and subsections contained in this Agreement are intended for the convenience of the reader and are not intended to have any substantive meaning. The numbers, captions, and indexes shall not be interpreted or be considered as part of this Agreement. Any use of the singular or plural number, any reference to the male, female, or neuter genders, and any possessive or nonpossessive use in this Agreement shall be deemed the appropriate plurality, gender or possession as the context requires. 21. NOTICES. Notices given under this Agreement shall be in writing and shall be personally delivered, sent by express delivery service, certified mail, or first class U.S. mail postage prepaid, and addressed to the person listed below. Notice will be deemed given on the date when one of the following first occur: (1) the date of actual receipt; (2) the next business day when notice is sent express delivery service or personal delivery; or (3) three days after mailing first class or certified U.S. mail. 21.1. If Notice is sent to the County, it shall be addressed and sent to: 1200 North Telegraph, Pontiac, Michigan 48341. 21.2. If Notice is sent to the CMH Authority, it shall be addressed and sent to: 2011 Executive Hills Blvd., Auburn Hills, MI 48326 21.3. Either Party may change the address and/or individual to which Notice is sent by notifying the other Party in writing of the change. 22. GOVERNING LAW. This Agreement shall be governed, interpreted, and enforced by the laws of the State of Michigan without giving effect to its conflict of law principles. 23. JURISDICTION AND VENUE. Except as otherwise required by law or court rule, any action brought to enforce, interpret, or decide any Claim(s) arising under or related to this Agreement shall be brought in the Sixth Judicial Circuit Court of the State of Michigan, the 50th District Court of the State of Michigan, or the United States District Court for the Eastern District of Michigan, Southern Division, as dictated by the applicable jurisdiction of the court. Except as otherwise required by law or court rule, venue is proper in the courts set forth above. The choice of forum set forth above shall not be deemed to preclude the enforcement of any judgment obtained in such forum or taking action under this Agreement to enforce such judgment in any appropriate jurisdiction. 7 24. AGREEMENT MODIFICATIONS OR AMENDMENTS. Any modifications, amendments, rescissions, waivers, or releases to this Agreement must be in writing and executed by both Parties. The Parties agree that no such modification, rescission, waiver, release or amendment of any provision of this Agreement shall become effective against the County unless signed for by the Oakland County Board of Commissioners. The Parties further agree that this Agreement shall not be changed, supplemented, or amended, in any manner, except as provided for herein, and no other act, verbal representation, document, usage or custom shall be deemed to amend or modify this Agreement in any manner. 25. ENTIRE AGREEMENT. This Agreement sets forth the entire agreement between the Parties along with the Agreement Documents. In entering into this Agreement, CMH Authority acknowledges that it has not relied upon any prior or contemporaneous agreement, representation, warranty, or other statement by the County and/or any County Agent that is not expressly set forth in this Agreement, and that any and all such possible, perceived or prior agreements, representations, understandings, statements, negotiations, understandings and undertakings, whether written or oral, in any way concerning or related to the subject matter of this Agreement are fully and completely superseded by this Agreement. 25.1. If there is a contradicting term or condition in any Exhibit to this Agreement, the Agreement controls. 25.2. It is further agreed that the terms and conditions of this Agreement are contractual and binding and are not mere recitals. The Parties acknowledge that this Agreement contains certain limitations and disclaimers of liability. OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY: BY: DATE: Deputy Executive Director BY: DATE: Chief Financial Officer THE COUNTY OF OAKLAND BY: DATE: Chairperson, Oakland County Board of Commissioners 8 OAKLAND COUNTY INTERLOCAL AGREEMENT BETWEEN OAKLAND COUNTY AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY EXHIBIT I: Financial' and Reporting Obligations PACE Services October 1, 2015 — January 31, 2016 Description Budget FY16 Salaries and Fringes 200,011 Supplies 667 Mileage and Conferences 1,000 Contractual 12,000 Other 3,000 Indirect Costs (14.99%) 20,007 Not To Exceed $236,685 The County shall submit an invoice to the CMH Authority on a monthly basis, which shall itemize all amounts due and or owing by CMH Authority. The monthly invoice must reflect total actual program expenditures by category. The invoices shall be submitted in a form and format agreed upon by the Parties. If the transition of PACE services to OCCMHA does not occur on or before January 31, 2016, the terms, conditions and funding levels shall remain in effect until the transition is complete. Health Education Services October 1. 2015 — Sentember 30. 2016 Description Budget FY16 Travel 3,856 Supplies & Materials 5,832 Contractual 193,472 Other 1,304 OCCMHA Funding 204,464 Local Match 20,446 Total Budget 224,910 1 Some or all of the funds provided by OCCMHA are federal funds. Department of Health and Human Services/Substance Abuse and Mental Health Services Administration (SAMHSA), CFDA NO. 93.959, Block Grant for Prevention and Treatment of Substance Abuse. Grant NO. 13 B1 Ml SAPT, award phase 2015. Title SAPT Block Grant sub-recipient relationship, non-research and development project. 9 The County shall submit an invoice to the CMH Authority on a monthly basis, which shall itemize all amounts due and or owing by CMH Authority. The monthly invoice must reflect total actual program expenditures by category. The invoices shall be submitted in a form and format agreed upon by the Parties. 10 OAKLAND COUNTY INTERLOCAL AGREEMENT BETWEEN OAKLAND COUNTY AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY EXHIBIT II: Scope of Services I. SUPPORTS AND SERVICES: A. The County shall assure for the provision of services for eligible individuals pursuant to the Contract and this Scope of Services. B. Federal Award Project Description: Support projects for the development and implementation of prevention, treatment and rehabilitation activities directed to the diseases of alcohol and drug abuse. C. The County agrees to provide Prior Authorization and Central Evaluation (PACE) services for adults and children with substance use disorders, and co-occurring substance use disorders, and will comply with those terms and conditions in Attachment E. D. The County agrees to provide Health Education services and will comply with the Management by Objective requirements in Attachment C and C-1 and the terms and conditions in Attachment D. II. ADMINISTRATIVE RESPONSIBILITIES A. The County when practicable, and only when authorization has been obtained from the Consumer, shall ensure that coordination of care occurs between the consumer's Primary Care Physician and Medicaid Health Plan. B. Required Staff Training(s): The County understands that various federal and state rules and regulations impose specific training requirements on the Parties. The County agrees that its entire staff will receive all required training(s) as applicable. The County also agrees to document the completion of applicable training in the personnel file of each staff. C. Cultural Competency: The County must assure meaningful service for persons with diverse cultural backgrounds (including, but not limited to religious, ethnical, geographical, geriatric, socioeconomic, and/or disability). The County shall assess 11 the population(s) it serves, collaborating with other community agencies (e.g., Council on Aging) and training staff on any identified cultural issues. D. Relationship with Other Providers (Contractors): The County when practicable shall collaborate with agencies in the community to the benefit of the consumer. Such agencies include but are not limited to hospitals, intermediate school district, local schools, faith based organizations, courts, law enforcement, community corrections, substance abuse, Indian Health Services and Tribal Health Centers, Early On and other early intervention programs that are essential to positive outcomes to our community. E. Advance Directives. The County agrees to comply with federal and state law regarding Advance Directives. F. Customer Services: 1. Orientation: The County will provide orientation to newly enrolled Consumers. Orientation will include information about benefits and services provided by Oakland County's Office of Substance Abuse Services. 2. The County will acknowledge receipt of support and for Federal and State funds from the Michigan Department of Health and Human Services (MDHHS) and/or Oakland County Community Mental Health CMH Authority in any articles or publications that are produced utilizing any such funding. 3. Grievance: The County will have a policy, procedures and a process to document the number and nature of grievances and complaints brought to the County. G. Due Process: The County shall take reasonable steps to inform new Consumers of its Due Process procedures. The County will provide Adequate or Advance Notice whenever there is a proposed or actual denial, termination, suspension or reduction in services requested by or provided to a Consumer. 1. All such notices will be provided in accordance with State and Federal regulations. 2. The County will use notice formats approved by both Parties, and will submit required data elements according to the schedule adapted as set forth in this Contract and/or any applicable State or Federal statute or rule. H. Recipient Rights: 1. The County will, and will require its subcontractors to, at every service site, make readily available to all employees and staff, and if applicable, will post in a conspicuous place and/or make available, the following: a. A summary of all recipient rights guaranteed by the Public Health Code; 12 b. Provide unrestricted access to Rights Complaint forms, Your Rights booklets, and MDCH Request for Administrative Hearing form to recipients and others; c. Post the MDDHS/Office of Recipient Rights (ORR) Reporting Requirements poster for staff; d. Have available for review by any recipient or others, the Medicaid Services Administration {MSA) Manual and Bulletins; I. Service Cost Tables Reporting: The County agrees to cooperate with and participate in CMH Authority's cost integrity process. The County agrees to develop and submit to CMH Authority Service Cost Tables upon request by the CMH Authority. The County agrees that the rates it establishes for all procedures listed in the Service Cost Table are based on actual costs and are representative of current costs incurred and paid by the County. J. Quality Management: I. Quality Improvement (QI) Plan and Status Reports Requirements: The County will submit to the CMH Authority's Quality Management Team (QM) an annual Provider QI Plan which describes the County's ongoing and planned QI activities. The County will submit to the QM Team an annual Status Report for the prior year's QI Plan. The status report will describe the outcomes that were achieved by the County in regards to the QI plan. 2. Satisfaction Surveys: The County will also participate in the administration of the satisfaction surveys as mandated by the Michigan Department of Community Health. 3. Sentinel Events: The County will comply with state laws and regulations regarding Sentinel Events and Other Reportable Critical Incidents which specify actions that the County must take if an incident is identified as a Sentinel Event. The County if required by state law will report events to the CM11 Authority and it will adhere to reporting timeframes for Root Cause Analysis and Action Plans. 4. Credentialing: The County will utilize a credentialing process to validate the qualifications of its direct staff. The process will include evaluating and verifying the appropriate education, licensing, malpractice history, insurance, and service site as applicable. The County must complete primary source verification of staff education and licensure. The County may utilize the National Practitioners Data Bank for this purpose. The American Medical Association or American Osteopathic Association (as applicable) may be utilized to complete primary source verification for physicians. The County will utilize a privileging process which includes a review of specific 13 education, training, and experience to determine the consumer populations and/or service the practitioner will be approved to provide. III. DATA MANAGEMENT: A. As to the extent provided for by law the CMH Authority is the owner of all data related to consumers pursuant to this agreement including all data entered into the County's management information system(s), such as, all eligibility and demographic data, utilization data, claims data, and any other service, administrative or financial information that has passed through the CMH Authority's or the County's operation that resides with the County. Notwithstanding the foregoing, the County is not precluded from maintaining and utilizing the data identified in this section in support of the services provided to the consumer and internal County operations. B. The County shall implement tools to prevent unauthorized access and virus protection to its internal transaction and office system using planning, management, and system monitoring tools. C. The Parties agree that when transmitting information electronically the national ANSI and HIPAA compliant standards shall be utilized D. If the County is transferring data to the CMH Authority electronically, it shall transmit data by the close of the next business month following the month of service for direct care services and within 60 days of the close of the month for subcontracted services. All data for the fiscal year must be received by the 5th working day of December in the format reasonably requested by the CMH Authority. In the event of termination of this Contract and the data is being transferred electronically, the County shall download for and provide to the CMH Authority, at no cost to the CMH Authority, all such CMH Authority data in an electronically accessible format within twenty (20) days following the termination of this Contract. 14 OAKLAND COUNTY INTERLOCAL AGREEMENT BETWEEN OAKLAND COUNTY AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY EXHIBIT III BUSINESS ASSOCIATE AGREEMENT (Health Insurance Portability and Accountability Act Requirements) Exhibit II is a Business Associate Agreement between Contractor ("Business Associate") and the County ("Covered Entity"). This Exhibit is incorporated into the Contract and shall be hereinafter referred to as "Agreement." The purpose of this Agreement is to facilitate compliance with the Privacy and Security Rules and to facilitate compliance with HIPAA and the HITECH Amendment to HIPAA. 1. DEFINITIONS. The following terms have the meanings set forth below for purposes of the Agreement, unless the context clearly indicates another meaning. Terms used but not otherwise defined in this Agreement have the same meaning as those terms in the Privacy Rule. 1.1 Business Associate. "Business Associate" means the Contractor. 1.2 CFR. "CFR" means the Code of Federal Regulations. 1.3 Contract. "Contract" means the document with the Purchasing Contract Number: 1.4 Contractor. "Contractor" means the entity or individual defined in the Contract and listed on the first page of this Contract. 1.5 Covered Entity. "Covered Entity" means the County of Oakland as defined in the Contract. 1.6 Designated Record Set. "Designated Record Set" is defined in 45 CFR 164.501. 1.7 Electronic Health Record. "Electronic Health Record" means an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff. 1.8 HIPAA. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996. 1.9 HITECH Amendment "HITECH Amendment" means the changes to HIPAA made by the Health Information Technology for Economic and Clinical Health Act. 1.10 Individual. "Individual" is defined in 45 CFR 160.103 and includes a person who qualifies as a personal representative in 45 CFR 164.502(g). 1.11 Privacy Rule. "Privacy Rule" means the privacy rule of HIPAA asset-forth in the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E. 1.12 Protected Health Information. "Protected Health Information" or "PHI" is defined in 45 CFR 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. 1.13 Required By Law. "Required By Law" is defined in 45 CFR 164.103. 1.14 Secretary. "Secretary" means the Secretary of the Department of Health and Human Services or his or her designee. 1.15 Security Incident. "Security Incident" is defined in 45 CFR 164.304. 1.16 Security Rule. "Security Rule" means the security standards and implementation specifications at 45 CFR part 160 and part 164, subpart C. 2. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE. Business Associate agrees to perform the obligations and activities described in this Section. 2.1 Business Associate understands that pursuant to the HITECH Amendment, it is subject to the HIPAA Privacy and Security Rules in a similar manner as the rules apply to Covered Entity. As a result, Business Associate shall take all actions necessary to comply with the HIPAA Privacy and Security Rules for business associates as revised by the HITECH Amendment, including, but not limited to, the following: (a) Business Associate shall appoint a HIPAA privacy officer and a HIPAA security officer; (b) Business Associate shall establish policies and procedures to ensure compliance with the Privacy and Security Rules; (c) Business Associate shall train its workforce regarding the Privacy and Security Rules; (d) Business Associate shall enter into a privacy/security agreement with Covered Entity; (e) Business Associate shall enter into privacy/security agreements with its subcontractors that perform functions relating to Covered Entity involving PHI; and (f) Business Associate shall conduct a security risk analysis. 2.2 Business Associate shall not to use or disclose PHI other than as permitted or required by this Agreement or as required by law. 2.3 Business Associate shall use appropriate safeguards to prevent use or disclosure of the PHI. Business Associate shall implement administrative, physical, and technical safeguards (including written policies and procedures) that reasonably and appropriately protect the confidentiality, integrity, and availability of PHI that it creates, receives, maintains, or transmits on behalf of Covered Entity as required by the Security Rule. 2.4 Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of law or this Agreement. 2.5 Business Associate shall report to Covered Entity any known Security Incident or any known use or disclosure of PHI not permitted by this Agreement. 2.6 Effective September 23, 2009 or the date this Agreement is signed, if later, Business Associate shall do the following in connection with the breach notification requirements of the HITECH Amendment: 2.6.1 If Business Associate discovers a breach of unsecured PHI, as those terms are defined by 45 CFR 164.402, Business Associate shall notify Covered Entity without unreasonable delay but no later than ten (10) calendar days after discovery. For this purpose, "discovery" means the first day on which the breach is known to Business Associate or should have been known by exercising reasonable diligence. Business Associate shall be deemed to have knowledge of a breach if the breach is known or should have been known by exercising reasonable diligence, to any person, other than the person committing the breach, who is an employee, officer, subcontractor, or other agent of Business Associate. The notification to Covered Entity shall include the following: (a) identification of each individual whose unsecured PHI has been breached or has reasonably believed to have been breached and (b) any other available information in Business Associate's possession that the Covered Entity is required to include in the individual notice contemplated by 45 CFR 164.404. 2.6.2 Notwithstanding the immediate preceding subsection, Business Associate shall assume the individual notice obligation specified in 45 CFR 164.404 on behalf of Covered Entity where a breach of unsecured PHI was committed by Business Associate or its employee, officer, subcontractor, or other agent of Business Associate or is within the unique knowledge of Business Associate as opposed to Covered Entity. In such case, Business Associate shall prepare the notice and shall provide it to Covered Entity for review and approval at least five (5) calendar days before it is required to be sent to the affected individual(s). Covered Entity shall promptly review the notice and shall not unreasonably withhold its approval. 2.6.3 Where a breach of unsecured PHI involves more than five hundred (500) individuals and was committed by the Business Associate or its employee, officer, subcontractor, or other agent or is within the unique knowledge of Business Associate as opposed to Covered Entity, Business Associate shall provide notice to the media pursuant to 45 CFR 164.406. Business Associate shall prepare the notice and shall provide it to Covered Entity for review and approval at least five (5) calendar days before it is required to be sent to the media. Covered Entity shall promptly review the notice and shall not unreasonably withhold its approval. 2.6.4 Business Associate shall maintain a log of breaches of unsecured PHI with respect to Covered Entity and shall submit the log to Covered Entity within thirty (30) calendar days following the end of each calendar year, so that the Covered Entity may report breaches to the Secretary in accordance with 45 CFR 164.408. This requirement shall take effect with respect to breaches occurring on or after September 23, 2009. 2.7 Business Associate shall ensure that any agent or subcontractor to whom it provides PHI, received from Covered Entity or created or received by Business Associate on behalf of Covered Entity, agrees in writing to the same restrictions and conditions that apply to Business Associate with respect to such information. Business Associate shall ensure that any such agent or subcontractor implements reasonable and appropriate safeguards to protect Covered Entity's PHI. 2.8 Business Associate shall provide reasonable access, at the written request of Covered Entity, to PHI in a Designated Record Set to Covered Entity or, as directed in writing by Covered Entity, to an Individual in order to meet the requirements under 45 CFR 164.524. 2.9 Business Associate shall make any amendment(s) to PHI in a Designated Record Set that the Covered Entity directs in writing or agrees to pursuant to 45 CFR 164.526. 2.10 Following receipt of a written request by Covered Entity, Business Associate shall make internal practices, books, and records reasonably available to the Secretary in order to determine Covered Entity's compliance with the Privacy Rule. The afore mentioned materials include policies and procedures and PHI relating to the use and disclosure of PHI received from Covered Entity or created or received by Business Associate on behalf of Covered Entity. 2.11 Business Associate shall document disclosures of PHI and information related to such disclosures, to permit Covered Entity to respond to a request by an Individual for: (a) an accounting of disclosures of PHI in accordance with 45 CFR 164.528 or (b) effective January 1, 2011 or such later effective date prescribed by regulations issued by the U.S. Department of Health and Human Services, an accounting of disclosures PHI from an Electronic Health Record in accordance with the HITECH Amendment. 2.12 Following receipt of a written request by Covered Entity, Business Associate shall provide to Covered Entity or an Individual information collected in accordance with Section 2 to permit Covered Entity to respond to a request by an Individual for: (a) an accounting of disclosures of PHI in accordance with 45 CFR 164.528 or (b) effective as of January 1, 2011 or such later effective date prescribed by regulations issued by the U.S. Department of Health and Human Services, an accounting of disclosures of Protected Health Information from an Electronic Health Record in accordance with the HITECH Amendment. 3. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE. Business Associate may use and disclose PHI as set forth in this Section. 3.1 Except as otherwise limited in this Agreement, Business Associate may use or disclose PHI to perform functions, activities, or services for or on behalf of Covered Entity as specified in the underlying service agreement between Covered Entity and Business Associate, provided that such use or disclosure shall not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. If no underlying service agreement exists between Covered Entity and Business Associate, Business Associate may use or disclose PHI to perform functions, activities, or services for or on behalf of Covered Entity for the purposes of payment, treatment, or health care operations as those terms are defined in the Privacy Rule, provided that such use or disclosure shall not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. 3.2 Except as otherwise limited in this Agreement, Business Associate may use PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate. 3.3 Except as otherwise limited in this Agreement, Business Associate may disclose PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate, provided that disclosures are Required by Law or Business Associate obtains reasonable assurances in writing from the person to whom the information is disclosed that: (a) the disclosed PHI will remain confidential and will be used or further disclosed only as Required by Law or for the purpose for which it was disclosed to the person and (b) the person notifies the Business Associate of any known instances in which the confidentiality of the information has been breached. 3.4 Except as otherwise limited in this Agreement, Business Associate may use PHI to provide data aggregation services to Covered Entity as permitted by 45 CFR 164.504(e)(2)(i)(B). 3.5 Business Associate may use PHI to report violations of law to appropriate federal and state authorities, consistent with 45 CFR 164.502(j)(1). 4. OBLIGATIONS OF COVERED ENTITY. 4.1 Covered Entity shall notify Business Associate of any limitation(s) of Covered Entity in its notice of privacy practices in accordance with 45 CFR 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of PHI. 4.2 Covered Entity shall notify Business Associate of any changes in or revocation of permission by an Individual to use or disclose PHI, to the extent that such changes may affect Business Associate's use or disclosure of PHI. 4.3 Covered Entity shall use appropriate safeguards to maintain and ensure the confidentiality, privacy and security of PHI transmitted to Business Associate pursuant to this Agreement, the Contract, and the Privacy Rule, until such PHI is received by Business Associate, pursuant to any specifications set forth in any attachment to the Contract. 4.4 Covered Entity shall manage all users of the services including its qualified access, password restrictions, inactivity thneouts, downloads, and its ability to download and otherwise process PHI. 4.5 The Parties acknowledge that Covered Entity owns and controls its data. 4.6 Covered Entity shall provide Business Associate with a copy of its notice of privacy practices produced in accordance with 45 CFR Section 164.520, as well as any subsequent changes or limitation(s) to such notice, to the extent such changes or limitations may effect Business Associate's use or disclosure of PHI. Covered Entity shall provide Business Associate with any changes in or revocation of permission to use or disclose PHI, to the extent the changes or revocation may affect Business Associate's permitted or required uses or disclosures. To the extent that the changes or revocations may affect Business Associate's permitted use or disclosure of PHI, Covered Entity shall notify Business Associate of any restriction on the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR Section 164.522. Covered Entity may effectuate any and all such notices of non-private information via posting on Covered Entity's web site. 5. EFFECT OF TERMINATION. 5.1 Except as provided in Section 5, upon termination of this Agreement or the Contract, for any reason, Business Associate shall return or destroy (at Covered Entity's request) all PHI received from Covered Entity or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to PHI that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of PHI. 5.2 If Business Associate determines that returning or destroying the PHI is infeasible, Business Associate shall provide to Covered Entity written notification of the conditions that make return or destruction infeasible. Upon receipt of written notification that return or destruction of PHI is infeasible, Business Associate shall extend the protections of this Agreement to such PHI and shall limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such PHI, which shall be for a period of at least six (6) years. 6 MISCELLANEOUS. 6.1 This Agreement is effective when the Contract is executed or when Business Associate becomes a Business Associate of Covered Entity and both Parties sign this Agreement, if later. However, certain provisions have special effective dates, as set forth herein or as set forth in HIPAA or the HITECH Amendment. 6.2 Regulatory References. A reference in this Agreement to a section in the Privacy Rule or Security Rule means the section as in effect or as amended. 6.3 Amendment. The Parties agree to take action to amend this Agreement as necessary for Covered Entity to comply with the Privacy and Security requirements of HIPAA. If the Business Associate refuses to sign such an amendment, this Agreement shall automatically terminate. 6.4 Survival. The respective rights and obligations of Business Associate and Covered Entity under this Agreement shall survive the termination of this Agreement and/or the Contract. OAKLAND COUNTY INTERLOCAL AGREEMENT BETWEEN OAKLAND COUNTY AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY EXHIBIT IV: Attachments ATTACHMENT C MBO — GENERAL SUBSTANCE ABUSE PREVENTION OAKLAND COUNTY CONFAUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2015 -2018 Program Name: General Sub Abuse Prevention Agency/Organization: OCHD1 Health Ed Prepared By: Angle GuileKson/Trisha Ozumbo Date Prepared: 2/3/2016 Program Goal: To delay onset/prevent the abuse of ATOD In the Oakland County commuriltf, especiaily among youth Specific Activity and Objective (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total (12months)111 Number of Direct Service 1-burs (outputs) = P Planned / A = Delivered let Qtr. Recipients 2nd Qtr, 3rd Qtr. 4th Qtr. TOTAL A 10 PIIP 10 .111111M.1111 IIP 10 1111 A *1-GENERAL SUBSTANCE ABUSE PREVENTIONt Act as a rwouite on the general topic at substanc a abuse prevention by providing Infonnion and researc h to OCCMHA arid OCHD staff arEithe community at large including (a) IntpAtte educational presentations, materials and stafftraining assistance (TA) to SA na a (b) provide technical ated groups and gencies Including but not limited to coordinate planning & Implementing BASICS Conference (c) provide a minimum of so prevention messages to OCFID for use In social merle. Outcomes: List number and nature of seoic es a 100 I. b 150 IIIIIIIIINIMIIIIIIIIIIIIIIIM MM MI c 2500 = IIII ME= IIII delivered, number of recipients ar4d estimated • reach. MI . 111. = MEM = II Strategy: (list) C, E. N Sub TotaiP Total 0 10 0 10 0 10 0 A = Alternative MIN MI C = Community-Based E = Education N = Information dissemination P = Problem ID & Referral V = Ernironmental A TTACHIVENTC OAKLAND COUNT( COMMUNITY MENTAL HEALTH AU1HORSIY Managenient by Objective Y2015 -2016 Program Narre: Agency/Crganizati on: Prepared Eiyi Program GoaL Genera Sub Abuse Prevention ocHot 1-leathld Arnie GAksoniTritha Zizunto To lid& onset/ oreverit the abu youth Date Prepared 2;3,2016 ATOD in the Oakland County COMTLiti mc.mq Specific ActAty and Cbiective (s). (Number consecutivety and use separate page for each Preverton ActiOty) Esli mated Total Reciponientssi th sti ttUrriDEf of Direct Service Hours (outputs) P 7-- Planned IA = Dekvered r h TOTAL ou and A cinc mri A 42: LI E SKILL S rnfU MT): {a) c00 te r•ccria nt 0 ig k student priplatioria Iva acruols and ether r:rhOrl actritty centers fr LST Cfaasat aril prulca TA la OC HD &tat, 001protarta a MitkffIl to cfg s 4. t t o tir LEir tr Cu -0tatary &idiot atidtke strciai a9c cbkdrea in iti9h.dak scilarii dLNI:rt.t.0 o 5 :,c.i...ated, Outcomes: num ber uf ciaasea recruited and reatala a. to 20 11111M111111111110111 10 11 le, ''' IIIIIIIIIIIIIIIIIIIIIIIII MINI . mmsimimnnim.mmioemii 11111111111111111111111111111.1111111111M11111111111 MIIIIIIIIIIIIIIMIIMIIIIIIIIIIIIIII=IIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIII 11111111111111111111111111101111111111111 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 11111111101111111111111:51111211 mium moo = ;Lek vaiuziit)r, fcr erto serias of ciasata ectd. by s.atmir atienc.i. MEI Strateo li Sub To Total 28 MI 28 111111 26 NM fl A :--- Alternative gal 1111111111111111111111.11111111111111 C Corrmirity-Based E Education N = Informaton disserrination P Problem ID & Referral V Environriertal ATTACHMENT C OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2015 -2016 Program Name: Agency/Organization: Prepared By: Program Goal: General Sub Abuse Prevention Date Prepared: 2/3/2016 OCHD/ Health Ed Angie Gullekson/Trisha Zzumbo To delay onset/ prevent the abuse of ATOD in the Oakland County Community especiatiy among youth Specific Activity and Objective (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total Recipients (12 months) Number of Direct Service Hours (outputs) P = Planned / A = Delkered 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL P AP A P A P A P A #3 UNDERAGE DRINKING (UD) 8. BINGE DRINKING (BD) BY YOUTH & ADULTS: (a) act as a resource and provide technical assistance to OCHD staff and the general community (b) collect and provide to OCCMHA, relewint data on these priority problems by surNeying courts, law enforcement and MI Liquor Control Commission(MLCC), MSP information/data- to assess what is presently occurring in temis of retailer alcohol enforcement checks, tracking community location, number and results of checks accomplished by LE and and the MLCC and data on Minors In Possession by community; (c) target non-coalition community alcohol vendors and MLOC NAolators. Outcomes: (1) list details of 10 10 10 10 40 (a) 50 (b) na (c) 150 services/TA delivered; (2) report summary of data research at 6 month and year-end intervals; {3) complete a year to year comparison (FY12, FY13, FY4) of violations occurring in non-coalition communities who receive vendor education. Strategy: (list) N, V, E Sub Total Total 10 10 10 10 40 A = Alternatiw C = Community-Based E = Education N = Information dissemination P = Problem ID 8, Referral V = Environmental ATTACHMENT C OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2015 -2016 Program Name: Agency/Organization: Prepared By: Program Goal: General Sub Abuse Prevention Date Prepared: 2/3/2016 OCHD/ Health Ed Angie Gullekson/Jennifer Kirby To delay onset/ prevent the abuse of ATOD in the Oakland County Community especially among youth Specific Activity and Objective (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total Recipients (12months)P Number of Direct Service Hours (outputs) P = Planned / A = Deliwred 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL A P A P A P A P A #4 PRESCRIPTION AND OVER-THE COUNTER DRUG ABUSE: (a) Act as a resource offering technical assistance to OCCMHA and OCHD staff, the senior and general community on Rx and OTC misuse and other emerging trends in OC especially opioids and stimulants like Milan (study drugs); (b) provide support and technical assistance in the implementation of any local and State-wide (OROSC dewloped) strategies to prevent the misuse of Rx and OTC medicines; (c) support an awareness campaign on the prevention of the nonmedical use of Rx drugs (d) Support and prokle TA to prescription drug abuse focused community Partnerships/Task Forces/Coalitions with including, but net limited to a focus an older adults (e) Facilitate a minimum of one Photovoice Projects on the prevention of the nonmedical use of Rx drugs Outcomes: (a) report on audiences, (a) 100 14 14 14 14 56 0 (b) 500 , (c) 1000 (d) 1000 types of TA delhered, surveys It administered, emerging trends described; (b) describle local or state-wide strategies Implemented, estimate reach; (c) describe Implementation- press releases, etc., estimated reach; (d) Strategy: (list) C, N, E, V Sub Total Total 14 0 14 0 14 0 14 0 56 A = Alternative 251 C = Community-Based E = Education N = Information dissemination P = Problem ID & Referral V = Environmental ATTACHMENT C-1 MBO - YOUTH TOBACCO USE PREVENTION ATTACHMENT C-1 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2015-2016 Program Name: Youth Tobacco Use Prevention Date Prepared: 2/3/2016 Agency/Organization: OCHD/ Health Ed Prepared By: Melanie Stone/Trisha Zizumbo Program Goal: To delay/ prevent the onset of youth use of tobacco products in the region and coordinate efforts to ensure Oakland County's compliance with the federal Synar Amendment Specific Acthrity and Objective (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total Recipients (12 months) Number of Direct Servte Hours (outputs) P = Planned / A = Delivered let Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL P A P A P A P A P A TEEN TOBACCO USE PREVENTION: #1 Provide education and technical assistance on youth tobacco use and secondhand smoke (a) act as a resource to OCCMHA and OCHD staff and general community by providing: information on tobacco use prevention and emerging trends like anus, e-cigs, hookah, updates on cessation resources, and providing a minimum of 30 tobacco prevention messages to OCHD for use on social media sites (b) provide educational presentations requested on youth tobacco uselpreventioR (c) Promote awareness of Kick Butts Day, World No Tobacco Day, the ALA's Great American SmokeOut in the schools and communities in OC; (d) act as staff to TFOC and provide technical assistance to other local, regional and state planning groups (TFM, SF Michigan Tobacco Coalition, to promote youth tobacco use prevention efforts and support for smoke free environmentsfpolicies; Outcomes: (a) and (b) report on populations served, general types of technical assistance or data delivered and emerging trends; (c) describe participants, implementation- tool kits distributed, press releases disseminated, newsletter articles, media interviews, etc,, estimated reach: (d) describe collaborative efforts, projects initiated or coordinated as a result of meeting participation. a)1000 5 5 5 5 20 b)1000 2.5 2.5 2.5 2.5 10 0100 d)100 5 5 5 5 20 2200 Strategy: (list) E, N, V, C Sub Total Total 13 13 13 13 50 A = Alternative C = Community-Based E = Education N = Information dissemination P = Problem ID & Referral V = Environmental ATTACHMENT C-1 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2016-2016 Program Name: Youth Tobacco Use Prevention Agency/Organization: OCHD/ Health Ed Prepared By: Melanie Stone/Trisha Zizurnbo Date Prepared: 2/312016 Program Goal: To delay/ prevent the onset of youth use of tobacco products in the region and coordinate efforts to ensure Oakland County's compliance with the federal Synar Amendment Specific ActiVAy and Objective (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total Recipients (12 months)P Number of Direct Service Hours (outputs) P = Planned / A = Delivered 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL A P A P AP A PA #2 Synar-Related Activities: (a) train, monitor, collect and assess the results of groups conducting Synar and law enforcement (LE) inspections: (b) maintain a current list of Oakland County tobacco retailers for delivery to OROSC as required; (c) provide an educational program for 2 Synar- related target audiences as determined by needs assessment; (d) coordinate the completion of (d)[1] State required number of Synar inspections, (d)12] a minimum of 400 tobacco retailer education visits, MP] the mailing of a educational letter to all Oakland County tobacco retailers in cooperation with the County Sheriff (le) collect data on youth tobacco use and provide the following to PIHP at the indicated times (e)[1] on-going non-Synar Law Enforcement inspection results, (e)2) Synar Inspection Report as required by OROSC, (0)[3] Ycuth Access to T bacco Activity Report as required, (e)[41 the Annual Action Plan for Synar implementation. Outcomes: Timely submission of deliverables as outlined. a)50 15 15 15 15 60 b)850 2 2 2 2 8 0100 2 2 d1)60 15 15 15 15 60 d2)400 d3)850 e)100 2310 Strategy: (list) C, E, V Sub Total Total 32 32 32 34 130 A = Alternative C = Community-Based E = Education N = Information dissemination P = Problem ID & Referral V = Environmental ATTACHMENT C-1 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2015-2016 Program Name: Youth Tobacco Usr Prevention Agency/Organization: OCHD/ Health Ed Prepared By: Melanie Stone/Trisha Zizumbo Date Prepared: 2/3/2016 Program Goal: To delay/ prevent the onset of youth use of tobacco products and coordinate efforts to ensure Oakland County's compliance with the federal Syrtar Amendment Specific Activity and Objective (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total Recipients (l2 months)P Number of Direct Service Hours (outputs) = P Planned / A = Delivered 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. TOTAL AP A P Ap A p A ActMty #3 Facilltate Tobacco Free Oakland Coalition (TFOC) and the achievement the following TPOC Goals by promoting policy change and other appropriate environmental strategies. a) Eliminating exposure to secondhand smoker public places & schools 0 Preventing youth initiation and access to tobacco products (school and retailer policy changes) c) Increasing and promoting accessible and affordable cessation services especially targeting pregnant women and other disparate populations. cl) Identifying disparities specific to race/ethnicity, socioeconomic status, occupation, geography, gender and sexual orientation for targeted services, Outcomes, Report on policy change attempts and success in resourcing disparate populations. a)200 3 3 3 3 12 b)200 C)1000 d)50 1450 Strategy: (list) E,N,V Sub Total Total 4 0 4 0 4 0 4 0 16 A = Alternative C = Community-Based E = Education N = Information dissemination P = Problem ID & Referral V = Environmental ATTACHMENT C-1 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Management by Objective FY 2016-2016 Program Name: Youth Tobacco Use Prevention Agency/Organization: OCHD/ Health Ed Prepared By: Melanie Stone/Trisha Zizumbo Date Prepared: 2/17/2016 Program Goal: To delay/ prevent the onset of youth substance use through the implementation of activities that reduce/prevent the occurrence of bullying in children and teens and Objective Specific Activity ve (s) (Number consecutively and use separate page for each Prevention Activity) Estimated Total Recipients (12 months) Number of Direct Service Hours (outputs) = = P Planned / A Delivered lst Qtr. 2nd Qtr. 3rd Qtr, 4th Qtr. TOTAL p A P A P A P AP A Activity #4 (a) Complete LifeSkills (LST) online training for elementary level online. (b) Prepare to conduct at least one session of LST with the optional Bullying Module(s) to a Middle School 6-7 grades. (c) Act as a resource and provide support and technical assistance for anti-bullying efforts to groups such as taskforces, partnerships, and coalitions as needed. Provide bullying presentations as needed. (d) utilize media outlets to further anti-bully efforts. a)35 b)100 17 17 7 41 c)100 5 5 5 5 20 d)1000 1145 Strategy: (list) E, N, C, V Sub Total Total 5 22 22 12 61 A = Alternative 257 C Community-Based E = Education N = Information dissemination P = Problem ID & Referral V = Environmental ATTACHMENT D OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES PURCHASE OF SERVICE POLICIES For PREVENTION PROVIDERS FY 2015/2016 CONTENTS I. Budgets IL Billing and Payment III. Amendments and Adjustment to Allocations IV. Data and Reporting V. Staff Credentials and Requirements VI. Cultural Competency and Trauma-Informed Approach to Prevention VII. Charitable Choice Policy and Procedure VILE. Confidentiality IX. Required Statement of Funding Sources and Recipient Rights X. Programmatic and Financial Review ATTACHMENTS D-1 Request for Amendment Form D-2 Mid and End-of-Year Prevention Program Report D-3 Tobacco Activity Report FY 2015/2016 OCCMHA Prevention Program Policies and Procedures I. Budget A. Prevention programs will submit an annual budget for OCCMHA-administered funds that include revenue sources for total substance use disorder prevention programming using the following forms: Prevention Budget/ Billing Summary and Budget/Billing Pages (Attachment A). B. Programs will provide a 10% local match for all OCCMHA funding and submit as part of budget. II. Billing and Payment A. The Prevention Billing Summary Form along with the Prevention Budget Billing Pages are the source document for billing the OCCMHA for actual expenditures related to prevention services provided each month. B. Payment for services will be based on actual expenses incurred for service delivery. The Billing Summary page must include the total amount expended for each category (Supplies & Materials, Travel, Contractual, etc.) for the month, as well as a breakout by funding source (i.e., OCCMHA funds and/or Local Match) The Billing pages must contain the monthly charges by line item in each category as identified in the original budget. C. Bills are due to OCCMHA no later than 10 days after the close of each service month; those received after the 10th will not be processed for payment until the following month. D. Reimbursements will be based on the understanding that a certain level of performance, measured by outputs (face-to-face or direct service hours engaged with the service population) must be met in order to receive full reimbursement of costs up to the contracted amount at the end of the contract year. E. For this agreement, the performance requirement is defined as 100% of the OCCMHA- funded share of total direct service hours. III. Amendments and Adjustments to Allocations A. A program can request an amendment at any time up to the OCCMHA amendment deadline of August 15, 2016. B. A budget amendment with revised budget pages is required when there is a change in a budget category over $2,000 or 15% of the category whichever constitutes the greater amount. The deviation allowance does not authorize new categories or line items within the category. C. Request for Amendment Form (Attachment D-1) must be completed and approved by OCCMHA before requested changes can be implemented. 1. In order to move 15% or $2,000 (whichever is greater) from one budget category to another, it is necessary to complete the Request for Amendment Form, including a detailed explanation of the changes, updated billing summary and billing pages — (fax or email to Cyndi King at 248.975.9768, kingc@ocemha.org or by mail to her attention at 2011 Executive Hills Blvd., Auburn Hills, MI 48326. For questions call 248.758.1977. 2. You will receive a determination of approval, disapproval or pending status along with comments -if further direction-is required within -10 bu-siness days. IV. Data and Reporting A. Prevention contractors must provide evidence-based prevention services (as defined in the Research-based Prevention Protocol of their proposal.) B. A Prevention Management by Objectives Form (Attachment C) describing specific measurable objectives and number of outputs for each is submitted as part of the contract and will be reviewed for compliance during the contract year. C. All OCCMHA-funded program grantees are required to participate in the collection of state-required prevention data elements by utilizing the Michigan Prevention Data System (MPDS) (http://mpds.sudpds.corn), a web-based system- including but not limited to: • the number of direct hours (defined as face to face or output hours); • the collection of strategies employed (Information Dissemination, Education, Community-Based, Environmental, or Alternative); • population code • service population, type and domain • service population demographics • evidence-based practice • funding source. Outputs delivered during the invoiced month must be entered into the Michigan Data Prevention System (MPDS) by the 10th of the month following the service month for on- time reimbursement. D. Reimbursements will be based on the understanding that a certain level of perfoimance, measured by outputs (face-to-face or direct service hours engaged with the service population) must be met in order to receive full reimbursement of costs up to the contracted amount at the end of the contract year. E. OCCMHA grantees must submit a Mid-Year and End-of-Year Prevention Program Report (Attachment D-2) that includes a narrative and tables with data and outcome evaluation results for all programs/services - no later than 10 days following the end of the reporting period (e-mail to altmanla,oceinha.org .) F. OCCMHA grantees must incorporate tobacco prevention activities into their programming. A report of tobacco prevention activities is to be submitted biannually, using the Tobacco Activity Report Form (Attachment D-3) no later than 10 days following the end of Mid and End-of-Year reporting periods (e-mail to altmanWoccrnha.org) G. All forms and reports must be submitted in electronic form. Failure to submit required reports in a timely manner to OCCMHA will result in withholding of payment for services. V. Staff Credentials and Requirements A. During the period covered by this contract, the provider agency that directly employs or contracts with the OCCMHA to provide prevention services is responsible for verifying the ongoing certification status of the employee. This includes verification of the credential(s), monitoring staff development plans, and compliance with continuing education requirements. B. As a condition of the contract, Prevention Professionals (commonly described as Program or Prevention Coordinators, Prevention Specialist, or Consultants i.e., those responsible for the planning, coordination and or oversight of program implementation) must be certified by the Michigan Certification Board for Addiction Professional (MCBAP) as one of the following: • Certified Prevention Specialist M (CPS-M) • Certified Prevention Specialist R (CPS-R) • Certified Prevention Consultant M (CPC-M) • Certified Prevention Consultant R (CPC-R) • Certified Health Educator Specialist (CHES) OR • Must file a certification "Development Plan" with Michigan Certification Board for Addiction Professionals (MCBAP) within 60 days of the contract start date. Information on filing a Plan may be found at www.mcbap.com • Failure to comply with credentialing requirement may result in termination of contract. C. All providers must conduct yearly criminal background checks on all employees (and potential employees) employed in programs funded by the OCCMHA as a condition of employment. VI. Cultural Competency and a Trauma Informed Approach to Prevention A. Providers must submit a cultural competency plan to the OCCMHA addressing the following elements and be able to document same at their annual program review. 1. The program must identify and assess the cultural needs of potential and active clients based on population served. 2. The program must identify how access to services is facilitated for persons with diverse cultural backgrounds and Limited English Proficiency (LEP) and hearing impairment. 3. The program must identify standards for the recruitment and hiring of culturally competent staff members. 4. The program must document cultural competency training for provider staff upon hire and hi-annually (every two years) thereafter for all staff. S. The program must document staff training in a trauma-informed approach to prevention. The training must include: an understanding of the critical nature of trauma in the development of SUD, an understanding of the dimensions of resiliency, building community capacity, and learning strategies to change community conditions to support individuals, families and communities affected by trauma/adverse experiences. VII. Confidentiality The provider will comply with all Federal requirements contained in 42 CFR, Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records, Final Rule, June 9, 1987, as well as any information about alcohol and other drug use obtained by a "program" (42 CFR2.1 (42CFR2.12b). Information may be disclosed in summary, statistical, or other form which does not directly identify particular individuals. VIII. Charitable Choice Policy and Procedure A. The Federal Register (45 CFR part 96) contains federal Charitable Choice SAPT block grant regulations that apply to prevention and treatment providers/programs. The regulations require: (1) that the designation of religious (faith-based) organizations as such be based on the organization's self-identification as religious (or faith-based) and (2) that a program beneficiary receiving services from such an organization who objects to the religious character of a program has a right to notice, referral and alternative services which meet standards of timeliness, capacity, accessibility and equivalency — and ensuring contact to this alternative provider. B. The program is required to comply with all applicable requirements of the Charitable Choice regulations. If the program identifies itself as a religious or faith based organization it must provide the federally mandated model notice to all clients. Providers who are Faith-based must notify participants of their right by providing the following model notice: "No provider of substance abuse services receiving Federal funds from the U.S. Substance Abuse and Mental Health Services Administration, including this organization, may discriminate against you on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to actively participate in a religious practice. If you object to the religious character of this organization, Federal law gives you the right to a referral to another provider of substance abuse services. The referral, and your receipt of alternative services, must occur within a reasonable period of time after you request them. The alternative provider must be accessible to you and have the capacity to provide substance abuse services. The services provided to you by the alternative provider must be of a value not less than the value of the services you would have received from this organization" IX. Required Statement of Funding Sources and Statement of Recipient Rights Prevention programs that maintain records that include both the recipient's name and information regarding his or her substance use or abuse, shall provide the recipient with a summary of recipient rights protected by state or federal laws and promulgated rules. Any program announcement, brochure, or other written communication that describes the program's substance abuse prevention services shall state the following: "Recipients of substance abuse prevention services have rights protected by state and federal laws and promulgated rules". For information contact the OCCMHA Substance Use Disorder Services, Recipient Rights Coordinator, Sherrie Kilpatrick, 2011 Executive Hills Blvd., Auburn Hills, MI 48326 or call 248.858.1210 Providers must assure that any program reports, articles and publications that result from information gathered through the use of state, federal or county funds acknowledge receipt of that support from the OCCMHA and/or the appropriate federal agencies by use of the following statement: "Federal, State, and/or County funding have been provided through the Oakland County Community Mental Health Authority- Substance Use Disorder Services to support the project costs". X. Programmatic and Financial Review OCCMHA grantees are subject to an annual site review as well as annual scheduled program review by the OCCMHA Clinical Analyst. The site review affords OCCMHA an opportunity to experience the staff and program in action, The program review looks at compliance with contractual requirements: progress toward meeting output and outcome goals, process and outcome evaluation, certification and background checks on employees, timeliness and accuracy of billing and reporting, etc. Grantees are also subject to a complete financial review on a bi-annual basis by the OCCMHA Fiscal Analyst. The objectives of the financial review are: 9 To verify the reported expenditures have supporting documentation and were allowable expenses; • To determine whether agency's internal controls are adequate to provide reasonable assurance that funds are managed in compliance with applicable laws and regulations and/or provisions of the contract; • Confirm the budget was consistent with the contract budget; • Review the agency's financial audit to determine if there were any significant audit findings. ..REQUEST FOR AMENDMENT : OAKLAND COUNTY COMMUNITy.:maNTAL HEALTH AUTHORITY Substance Use Disorder Services- " Agency: Amending Budget: Date Requested: Requested by: ATTACHMENT D-1 Purpose of Amendment: Expenditures Current Budget Proposed Budget ncrease/Decrease Travel Supplies/Materials Contractual Other TOTAL EXPENDITURES • Source offuridi. Local Match OCCMHA Funding TOTAL FUNDING 0 Approved 0 Not Approved Fended: Date Comments: Signature Date ATTACHMENT D-2 Agency Name OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Program Report (Mid-Year/End of Year) 0 Mid-Year — Due April 11, 2016 0 End of Year — Due October 10, 2016 Note: the mid-year report should reflect activity from October thru March. The end-of-year report should contain a summation of activity for the entire year. Simply type your responses beneath each question. 1) Describe your service population for the reporting period. Indicate how successful you were in recruiting your target population. It is not necessary to provide exact numbers...however, please describe what risk categories you intended to target and if different from your original plan- describe the actual population served. What impact did this change have on program/service delivery or outcomes? 2) Refer to your MBO (Management By Objective) form and comment on any services that were not provided as planned (explain either why you were not able to complete the activity and/or why you did something different from the original plan.) 3) Describe your program's overall process evaluation method(s) and the results of your evaluation. (In a process evaluation items commonly include recruitment procedures and retention rate; number of participants; participants' risk for substance use; staff processing of program activity; participant comments or results of satisfaction surveys.) Describe any ways in which your process evaluation results will be used to improve the program in the future. 4) Outcome Evaluation: Complete the Attached Outcome Tables for each service/activity listed on your MBO Form. State your measurable indicator(s) and provide supporting data to show if the outcome was achieved. Use as many tables as you need to present results in an organized and logical manner (please number if using multiple tables.) For activities/services that are implemented as series at multiple locations - you may choose to state outcomes by grade, school, city, etc. but you must include a table with an overall result for a particular program. For Alliance of Coalition for Healthy Communities (ACHC) ONLY: In replacement of the Outcome Tables the ACHC is required to submit an MPDS summary of activities report at Mid-Year. The Final Report however, must also include a narrative submission in addition to the MPDS Report in the form of an Annual Report, 5) Provide supporting documentation. • Actual data used to calculate outcome results and a description of how the results were determined • Program flyers or letters used to recruit participants • Outline or brief description of the program or curriculum • A copy of evaluation instruments • Letters of support or news articles generated by the program Call or email Kathleen Altman at altmankAoccmha.oro for assistance in collecting, calculating, analyzing and reporting data. OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Activities FY 2016/2016 Outcomes Table #Exam pie Program Name: Group Designation MBO Activity # Target Population Indicator Statement , Outcome Result's Sat/Unsat CMH Use Only (Example) (Example) (Example) # Econ Hispanic parents who participate in the Love Auburn Hill Elem Group #1 (a) 15% • Disadvantaged middle school students or Arab-Chaldean youth or Hispanic parents & Logic Program (3 hours per week for 8 weeks) will experience (a) 7% increase in positive parenting attitudes and interaction with their children and (b) a 10% increase in knowledge of positive parenting techniques as measured by the Love & Logic Pre Post (b) 12% A Test that accompanies this model program. 4....,K,, Comments: Please Note: for activities/services that are implemented in series at multiple locations — you may choose to state outcomes by grade, school location, city, etc., but please also include a table with an overall result. Use as many tables as you deem necessary to report results. Attach supporting data/spreadsheets to table or at end of report. OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Activities FY 201512016 Outcomes Table #1 Program Name: Group Designation MBO Activity # Population Served Indicator Statement Outcome Results Sat/Unsat CMH Use Only Comments: Please Note: for activities/services that are implemented in series at multiple locations — you may choose to state outcomes by grade, school location, city, etc., but please also include a table with an overall result Use as many tables as you deem necessary to report results. Attach supporting data/spreadsheets to table or at end of report OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services Prevention Activities FY 201512016 Outcomes Table # 2 Program Name: Group Designation MBO Activity # Population Served Indicator Statement Outcome Results Sat/Unsat CMH Use Only Comments: Please Note: for activities/seivices that are implemented in series at multiple locations — you may choose to state outcomes by grade, school location, city, etc., but please also include a table with an overall result. Use as many tables as you deem necessary to report results. Attach supporting data/spreadsheets to table or at end of report ATTACHMENT D-3 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Substance Use Disorder Services PROGRAM TOBACCO ACTIVITY REPORT FY 201512016 0 6 Month 9 Year End Instructions: Please briefly describe any tobacco use prevention activities your group or organization has undertaken in the past six-month reporting period in each of the following strategies- Information Dissemination Specific topic of information Description of population distributed to Estimated Outputs Education Type of format (class, series of classes, video, speaker, skills training, etc.) Description of audience Estimated outputs Community-Based Activity (Describe activity: examples may include assessing community needs regarding tobacco use; accessing services and funding for tobacco use prevention; providing trainings on tobacco use prevention, etc.) Estimated outputs Environmental Strategies (Describe activity; examples include any activity undertaken to change the physical, legal, economic, and social processes of a community that are associated with tobacco use, i.e., establishing tobacco free policies, preventing underage sale of tobacco products to minors, vendor education, changing codes, ordinances, or regulations regarding sale and use.) Estimated outputs ATTACHMENT E OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY PACE SERVICE POLICIES For Access Management System FY 2015/2016 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY PACE SERVICE POLICIES Table of Contents Attachments I. Policy statement IL Eligibility Program III. Requirements Program IV. Service Eligibility: Block Grant V. Service Eligibility: Medicaid and Healthy Michigan Plan VI. Clinical Eligibility: Block Grant, Medicaid and Healthy Michigan Plan VII. Priorities for Admission into Treatment VIII. Waitlist IX. Interim Services X. Access to Care: Medicaid XI. Covered Services: Block Grant, Medicaid, Healthy Michigan Plan and MIChild XII. Authorization: Block Grant, Medicaid and Healthy Michigan Plan XIII. Levels of Care XIV. Utilization Management XV. Client Documentation and Record XVI. Financial Requirements XVII. Program Reviews XVIII. Complaint/Grievance/Appeals Process XIX. Persons Associated with the Corrections System XX. Sanctions ATTACHMENTS E-1 DSM-V Diagnosis Codes E-2 Medical Necessity Criteria E-3 CareNet Initial Authorization Request E-4 CareNet Reauthorization Request E-5 Billing Codes/Modifiers E-6 Rights and Confidentiality E-7 Plan of Action Reauthorization Request E-8 Interagency Consent 8z Authorization to Release Protected Health Information E-9 Client Responsibility Notice E-10 Client Sliding Fee Schedule E-11 Communicable Disease and Interim Services E-I2 CareNet SARF Form E-13 Client Complaint/Grievance Procedure E-I4 Medicaid Fair Hearing Requirements E-15 Trauma Informed System of Care Overview E-16 Recovery Housing Guidelines Substance Use Disorder Treatment Services I. POLICY STATEMENT All Substance Use Disorder Treatment Services provided on behalf of the Oakland County Community Mental Health Authority (OCCMHA) and funded by appropriations from the Michigan Department of Health and Human Services (MDHHS), the Michigan Department of Health and Human Services/Medical Services Administration (Medicaid) shall be administered through Purchase of Service contracts with eligible local programs. Oakland County, through it§ Pnor Authorization Central Evaluation (PACE) Unit, is the provider of Substance Use Disorder (SUD) services for the purpose of this policy. H. ELIGIBILITY: PROGRAM A. The Substance Use Disorder Provider shall be a legal entity with the ability to contract and shall follow all State and Federal laws and regulations. B. Services shall be available Monday-Friday 8:30 a.m. — 5 p.m. An after-hours message shall direct callers to Common Ground Crisis Center or a medical emergency center if immediate service is needed when the agency is closed. The Crisis Center shall contact the on-call PACE Treatment Service Supervisor, based on the 24/7 Substance Use Access Plan. The PACE shall make available a toll free telephone number and shall accept collect calls for the purpose of this contract. C. Screenings PACE shall perform specific services for clients eligible for OCCMHA funding. These services shall include: 1. Determining funding eligibility based on finances, residency and insurance coverage 2. Identifying additional type(s) of funding individuals qualify for and Informing clients of any co-pays associated with treatment services 3. Performing clinical screening to determine service needs, level of treatment needed based on American Society of Addiction Medicine (ASAM) Patient Placement Criteria and medical necessity for services 4. Providing linkage and referrals to the appropriate provider 5. Conducting care management to ensure successful engagement with referrals and follow up services 6. Authorizing services as in accordance to OCCMHA policies HI. REQUIREMENTS: PROGRAM A. Cultural Competency Plan PACE shall have a written Cultural Competency Plan implemented in practice which includes the following: 1. PACE shall identify and assess the cultural needs of potential and active clients based on population served. 2. PACE shall identify how access to services is facilitated for persons with diverse cultural backgrounds and Limited English Proficiency (LEP). 3. PACE shall identify standards for the recruitment and hiring of culturally competent staff members. 4. PACE shall identify how ongoing staff training needs in cultural competency shall be assessed and met and the evidence that staff members receive training. B. Charitable Choice Policy and Procedure I. PACE is responsible for processing request for alternative services. 2. The Federal Register (45 CFR part 96) contains Federal Charitable Choice SAPT block grant regulations that apply to prevention and treatment providers/programs. The regulations require: (1) that the designatioh_of religious (faith-based) organizations as such be based on the organization's self- identification as religious (or faith-based) and (2) that a program beneficiary receiving services from such an organization who objects to the religious character of a program has a right to notice, referral and alternative services which meet standards of timeliness, capacity, accessibility and equivalency — and ensuring contact to this alternative provider. 3. The Program identified by PACE is required to comply with all applicable requirements of the Charitable Choice regulations. If the Program identifies itself as a religious or faith based organization it shall provide the federally mandated model notice to all clients. 4. The model notice is: "No provider of substance abuse services receiving Federal funds from the U.S. Substance Abuse and Mental Health Services Administration, including this organization, may discriminate against you on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to actively participate in a religious practice. If you object to the religious character of this organization, Federal law gives you the right to a referral to another provider for substance abuse services. The referral, and your receipt of alternative services, shall occur within a reasonable period of time after you request them. The alternative provider shall be accessible to you and have the capacity to provide substance abuse services. The services provided to you by the alternative provider shall be of a value not less than the value of the services you would have received from this organization." C. Limited English Proficiency Policy and Procedure PACE shall have a written Limited English Proficiency (LEP) policy and procedure that is in compliance with related Federal and State requirements. The policies and procedures shall contain the following: 1. PACE shall have a procedure for identifying and assessing the language needs of the clients served. 2. PACE shall have a range of oral language assistance options. 3. PACE shall provide notice to LEP persons in their primary language of the right to free language assistance. 4. PACE shall provide appropriate staff training and program monitoring related to LEP policies and procedures. 5. PACE shall have provisions for written materials in language other than English, where a significant number of percentages of the affected population need services or information in a language other than English to communicate effectively. 6. PACE shall have provisions for language interpreters who are trained and competent. 7. PACE shall provide documentation of timely assistance and explanation of "no charge" to the LEP recipient for these services. 8. Provisions regarding the use of family members and/or friends as a language interpreter shall not be required. Should the client choose to use family or friends as an interpreter, both the offering of other resources and the client's choice shall be documented in writing. Availability of client's family and friends as translator/interpreter shall not waive other LEP requirements herein described. D. Communicable Diseases OCCMHA is not involved with and does not financially support any needle exchange programs in Oakland County. 1. PACE shall screen all substance use clients entering treatment for HIV/AIDS, Sexually Transmitted Disease (STD), TB, Hepatitis (Attachment E-11). 2. PACE shall refer all persons receiving substance use disorder services who are infected with TB for medical evaluation using the OCCMHA developed resource list. 3. The Public Health Nurse shall facilitate services with PACE staff. 4. PACE shall provide information about resources, health education, risk reduction activities and referrals for testing and treatment (with follow-up) to clients with high-risk behaviors. E. Welcoming/Engagement 1. PACE shall have a written policy that describes how the agency shall address client engagement, no-shows, cancellations and Against Medical Advice (AMA). 2. PACE shall have a written policy regarding welcoming. 3. The Treatment Program shall notify the PACE Care Manager immediately of clients who do not show for admission. F. Recipient Rights 1. PACE agrees to strictly comply with all recipient rights provisions of the Michigan Department of Public Health Center for Substance Abuse Service Programs in Michigan Part 3, Recipient Rights (Rules 301-307). 2. PACE agrees to take all necessary steps to ensure that clients shall be protected from rights violations while they are receiving services under this contract and shall fully cooperate with any Prepaid Inpatient Health Plan (PHIP), State or Federal agency's investigation into any alleged violation or suspected violation of any client's Recipient Rights. 3. PACE shall make readily available to all employees and clients, the following information: a. Recipient Rights shall be displayed in a public area of all licensed programs that also indicates the names and phone numbers of the PIHP Recipient Rights Consultant and the State Recipient Rights Coordinator. b. Instructions on how to contact and/or access the OCCMHA Recipient Rights Consultant. c. Provide for unrestricted access to rights complaint forms and rights booklets. d. Provide a written or oral description of recipient rights for clients receiving substance use services in a language that is understood by the recipient. e. Have readily available, all applicable State Policies including those set forth in the Michigan Department of Public Health/Center for Substance Abuse Services Administrative Rules for Substance Abuse Service Programs in Michigan; Part 3, Recipient Rights (Rules 301-307). f. Direct complaints to OCCMHA SUD Service Network Team 4. PACE shall notify the Department of Health and Human Services Protective Services Division, as required by law, regarding any alleged or suspected abuse or neglect of any client receiving services. IV. SERVICE ELIGIBILITY: BLOCK GRANT A. An individual with a substance use disorder as defined in P.A. 368, Public Acts of 1978, and Section 6107(3) as amended. B. Immediate family members of a person with a substance use disorder. C. Significant others, which include those involved in a continuing primary relationship with a person who has a substance use disorder, whether or not they are legally related to that individual. D. Individuals who meet the criteria established in A, B, or C above shall also meet the income criteria established in the OCCMHA Reimbursement/Sliding Fee Schedule (Attachment E-10). E. Preference shall be given to individuals who live in Oakland County. Should service requests exceed the monthly prorated treatment slots, two wait lists should be maintained to ensure provision of services to Oakland County residents prior to offering services to residents from other jurisdictions. V. SERVICE ELIGIBILITY: MEDICAID AND HEALTHY MICHIGAN PLAN A. Medicaid, Healthy Michigan Plan and MIChild recipients who are eligible for OCCMHA Medicaid Prepaid Substance Use Services Plan are those Medicaid recipients who reside within Oakland County. B. Current Medicaid, Medicaid spend down and Healthy Michigan Plan eligibility and residency shall be confirmed using the 270/271 System on CareNet. C. The following process shall be followed for clients with Medicaid spend-down: Outpatient Referrals (Methadone, Suboxone, TOP, OP) 1. Clients are responsible for meeting their deductible each month. 2. Remind the client to submit their receipts to MDHEIS so their Medicaid shall activate once the deductible is met. All medical bills including prescriptions can be counted towards the monthly deductible. 3, In the event the client is unable to meet their deductible and cannot cover substance use treatment services, submit a Request for Income Category Fee Waiver form to OCCMHA requesting block grant assistance for the client. The client is responsible for all payments for services rendered. The provider cannot bill block grant without the approval of the waiver form. 4. Authorizations shall be submitted for the client in the event the deductible is met, and Medicaid is billed for part of the month, or in the event a waiver is approved and block grant dollars are used to assist the client. 5. PACE shall explain this expectation to Methadone-referred and Suboxone- referred clients before authorizing services. Residential, Detox, and DIOP Referrals: 1. All Residential, Detox and DIOP referrals are issued through the PACE office. If PACE refers a spend-down client, block grant funding, when needed shall be authorized during the referral process. 2. PACE shall attempt to verify the client's spend-down amount and place it in the "Payor" screen under the notes section. If PACE is unable to obtain the spend-down before placing the client in treatment, the provider is responsible to obtain the amount before billing for services. Without the spend-down amount OCCMHA cannot determine how many days to approve under block grant funding. Lack of a documented spend down amount shall result in the billing being denied. 4. The client's first few days (until the deductible is met) should be billed under block grant. Once the deductible is met and MDHHS activates the Medicaid, the remaining services for the month should be billed under Medicaid, 5. Providers shall submit a receipt to MDHHS showing the client met their deductible. Make sure this process is done each month if the client is in treatment more than one month. 6. Billing for the client's Medicaid cannot be completed until the Medicaid is activated by 1VIDHHS. Check the 270/271 System for updates to the client's status. 7. Providers may contact the PACE supervisor, if they are unable to obtain the client's spend-down activated by MDHHS, or if the spend down amount cannot be verified. VI. CLINICAL ELIGIBILITY: BLOCK GRANT, MEDICAID AND HEALTHY MICHIGAN PLAN A. Clients shall meet use or dependency criteria for one of the substance-related disorders found in the DSM V Table (Attachment E-1). B. All decisions concerning client care are based on clinical eligibility, medical necessity criteria and person-centered planning. C. Decisions concerning client care include admission, level of care, continuation, discharge and other decisions regarding scope, intensity, and duration of care. These decisions are based on Medical Necessity Criteria (Attachment E-2). Medical necessity is defined as a determination that a specific service is medically (clinically) appropriate, necessary to meet a person's symptornology and functional impairments, is the most cost-effective option in the least restrictive environment and is consistent with clinical standards of care. VII. PRIORITIES FOR ADMISSION INTO TREATMENT A. PACE shall give preference for admission into treatment services to clients, regardless of level of care, in the following order: 1. Pregnant Injecting Drug Users (IOU) 2. Pregnant substance users 3. IDUs 4. A parent or caregiver whose child has been removed from the home under the Child Protection Laws of this state or is in danger of being removed from the home under the Child Protection laws of this state because of the parent's substance use 5. All others B. OCCMHA requires that a screening tool be used to gather sufficient information to determine if a person is a potential substance use disorder client, to establish the client's eligibility for public dollars, to verify insurance status and to determine admission priority status, such as IDU and pregnancy status. C. Admission Timelines for Pregnant Women 1. Pregnant women shall be admitted to the treatment program within 24 hours. If the Program has a wait list the client shall be referred to PACE. PACE shall attempt to locate a treatment program that can enroll the client immediately. 2. If a pregnant woman cannot be admitted within 24 hours into a program, the client shall be placed on the pregnant women wait list and PACE shall provide Interim Services within 48 hours. 3. No pregnant woman should be put on a wait list at the program level. D. Admission Timelines for Injecting Drug Users (IDU) 1. Programs serving IDUs shall maintain a wait list of each [DU seeking treatment. 2. Programs shall establish a mechanism for notifying clients on the wait list that a treatment slot is available. 3. If a client cannot be located for admission to treatment after three (3) attempts or if a person refuses treatment, he/she may be taken off the wait list (The wait list should indicate the number of attempts and method for trying to reach the client). VIII. WAIT LIST PACE shall provide for Wait List Management of clients waiting for funded Substance Use Disorder Treatment Services. PACE shall facilitate admissions to treatment services based on federally mandated preferences for treatment admission. IX. INTERIM SERVICES A. Programs and/or PACE shall provide federally mandated Interim Services within 48 hours to: I. IDUs who cannot be admitted into treatment within 14 days 2. Pregnant women who cannot be admitted into treatment immediately B. Interim Services minimally consist of the following: 1. 1DUs a. Counseling and education about HIV and hepatitis b. Completion of TB screening history c. Risks of needle-sharing d. Risks of transmission of HIV and other STDs to sexual partners and infants e. Steps that can be taken to ensure that HIV transmission does not occur f. Referral for HIV and TB services if necessary 2. Pregnant Women a. Services listed above b. Counseling on effects of alcohol, tobacco and other drug use on the fetus c. Referral for prenatal care C. PACE shall provide Interim Services for all eligible clients who are assessed. The Program shall refer all pregnant women and IDU clients who present at the program and - cannot be admitted per above guidelines to the PACE for interim services. D. OCCMHA provides funding for Women Specialty Services. PACE shall refer clients that meet Women Specialty Services criteria to providers identified in the OCCMHA network. X. ACCESS TO CARE: MEDICAID A. Urgent: PREGNANT WOMEN (individual is determined to be at risk of experiencing an emergent situation in the near future if care is not received). 1. Shall be assessed within 24-hours of referral 95% of the time 2. Admission to treatment shall be within 24-hours of assessment 95% of the time 3. Report on number of clients who make intake appointment and do not show 4. Program shall report its performance against these standards quarterly to the OCCMHA B. Non urgent I. Shall be assessed within five calendar days 95% of the time 2. Admission into treatment shall be within seven calendar days 95% of the time 3. Report on number of clients who make intake appointment and do not show 4. Program shall report its performance against these standards quarterly to OCCMHA XL COVERED SERVICES: BLOCK GRANT, MEDICAID, HEALTHY MICHIGAN PLAN AND MICHILD A. Covered Services: I. Initial/Intake Assessment 2. Outpatient (including individual, family and group) 3. Intensive Outpatient PRISM 4. Intensive Outpatient with Domiciliary (NO MIChild) 5. Domicile Outpatient (NO MIChild) 6. Opiate Replacement Therapy including laboratory for Medicaid/Healthy Michigan Nan (NO MIChild) 7. Sub-acute detoxification 8. Residential services 9. Pharmacy, laboratory and inpatient (MIChild ONLY) B. Excluded Services: I. Emergency medical care 2. Emergency transportation 3. Routine transportation 4. Substance use prevention and treatment which occurs routinely in the context of providing primary health care 5. Room and board 6. Pharmacy 7. Laboratory 8. Acute detoxification XII. AUTHORIZATION: 13 OCK GRANT, -MEDICAID AND HEALTHY MICHIGAN PLAN A. Prior Authorization for Intensive Services Services shall be reimbursed according to CPT Codes (Attachment E5). Clients shall need prior authorization from PACE prior to admission to a residential (detoxification, short or long term), domiciliary intensive outpatient program (D1OP), Recovery Housing and Opiate Specific programming. Programs shall refer clients to PACE for screening. Authorizations are valid for 30 days. 1. OCCMHA requires clients to be provided with individualized treatment that includes timely movement into varying levels of care. While OCCMHA encourages the development of diversified treatment packages, it shall be emphasized that predetermined documented client need, shall determine the client's movement through various treatment modalities. 2. Decisions related to authorization for initial and continuing care are based on medical necessity (such as the service is clinically appropriate) necessary to meet a person's symptomology and functional impairments, is the most cost-effective option in the least restrictive environment, and is consistent with clinical standards of care. 3. Providers are required to fax a copy of the two-way release to PACE once the client admits to treatment. PACE shall not release information to the provider until the two-way release is received. 4. Information from the Bin-psycho-social Assessment shall be entered into CareNet by the provider. An initial authorization shall be submitted by the provider and supported with clinical justification. Authorizations should be requested based on the client's treatment plans. 5. Reauthorizations shall be reviewed for clinical necessity. Approval for reauthorizations shall be reviewed within seven business days. 6. Program Admission a. When the client is admitted, proof of Oakland County residency shall be presented to the provider. The client's identification and other documents shall be in the record. The following documents are acceptable: • Picture ID • Medicaid card/Department of Health and Human Services • Utility bill • Voter registration card • Pay stub • Letter from a family or friend confirming residency b. The provider shall contact PACE if services are unable to be provided upon admission. The PACE Care Manager shall coordinate a transition plan with the provider. c. The provider may also contact the PACE Care Manager to assist with continued care planning for clients who successfully complete the program. B. Authorization for Outpatient Services 1. PACE shall complete a SARF form (Attachment E-12) on each client and submit to OCCMHA via CareNet. The ASAM Patient Placement Criteria shall be used in decisions regarding admission, continued stay and discharge/transfer. 2. An individual session is fifty (50) minutes or more in length and one-half (1/2) individual session is thirty (30) minutes in length. Frequency of individual sessions shall be determined by documented clinical need. A full session will, at a minimum, be fifty (50) minutes of direct client contact. The additional ten (10) minutes shall be allocated for paperwork and/or transition between client appointments for scheduled clients. 3. Programs shall fax a copy of their H1PAA/42 CFR compliant two-way Consent for the Release of Confidential Alcohol and Drug Treatment Information Form for the program, OCC1VfHA and PACE to communicate before initial authorization shall be released. Release should remain valid for thirty (30) days post discharge from program. 4. The program has ten (10) days following the date of admission to enter the authorization request in CareNet and submit the two-way release to PACE. If the release of information is received within ten (10) days the initial authorization shall be approved. If the release of information is received on day eleven ( 11) or after, the initial authorization shall be approved starting on the date that the faxed release is received, not on the date of admission. The program shall not be able to bill for services provided prior to the date the faxed release of information was received at the OCCMHA. 5. All units of service (Medicaid, Healthy Michigan Plan, MIChild and Block Grant) shall require authorization. Each level of care shall have its own authorization number. Clients shall be discharged from one level of care before being admitted to another. 6. The program shall submit an INDIVIDUALIZED initial authorization request on the CareNet Initial Authorization Request (Attachment E-3) using the appropriate CPT Code (Attachment E-5). 7. PACE shall review and authorize initial outpatient sessions based on clinical necessity once the Consent for the Release of Confidential Alcohol and Drug Treatment Information form is received. The initial approval for outpatient services is for ninety (90) days. Any requests for additional sessions shall include clinical justification and a specific plan for treatment intervention. Initial authorizations shall be reviewed within seven (7) business days. 8. Outpatient programs may exchange one (1) authorized CPT unit for another. Sessions shall be entered under "individual" and it is expected that the clinician shall exchange them as needed based on the client's treatment plan. 9. Outpatient psychiatric evaluations and medication review units are not exchangeable. C. REAUTHORIZATION REQUIREMENTS 1. When requesting a reauthorization, therapists shall use the CareNet Reauthorization Request Form (Attachment E-4) that clearly documents the reasons continued treatment is necessary (ASAM Patient Placement Criteria), specific goals and objectives on which the continued treatment shall focus, specific time frames for achievement of the goals, and the criteria to be met for treatment termination. 2. The treatment plan on the Reauthorization Request Form shall match the Master Treatment Plan and/or Treatment Plan Reviews from the client's record. 3. OCCMHA/PACE may request additional documentation, clarifications, or may require a PACE assessment if there are clinical concerns. Requests that are outside the guidelines without an explanation shall not be approved. 4. Clients that demonstrate noncompliance with programming via ongoing positive drug screens and/or nonpartieipation in the treatment process; OR are not demonstrating reasonable progress may not be authorized for further OCCMHA funding. 5. Re-authorization requests shall not be approved without an updated toxicology report that includes the primary drug of choice. 6. Re-authorizations shall be entered ten (10) days prior to the expiration of the authorizations. XIII. LEVELS OF CARE Social Detoxification Services are provided in a supervised setting for 23 hours. Trained personnel, including Peer Specialists, shall monitor withdrawal symptoms and provide linkage to treatment services and/or community supports. A. Sub-Acute Detoxification (prior authorization by PACE is required) Detoxification services are defined as medically supervised care provided in a sub-acute residential setting for the purpose of managing the effects of withdrawal from alcohol and/or other drugs. A detoxification program shall be staffed 24-hours per day, seven days per week, by a licensed physician or by the designated representative of a licensed physician. Detox services typically last three to five days. When detoxification cannot be completed within that time, the Medical Director shall determine if acute detox is needed in a hospital setting. Medicaid and Healthy Michigan Plan recipients shall be admitted within seven (7) days of PACE referral. B. Residential - Short Term (prior authorization by PACE is required) Short-term residential care is defined as planned individual and/or group therapeutic and rehabilitative counseling and didactics provided as an intense, organized, daily treatment regimen in a residential setting which includes an overnight stay. These progyams have a trained treatment staff supervised by a professional who is responsible for the quality of clinical care. The provider room and board facility shall maintain a daily census log to document use of the facility by eligible clients. Medicaid and Healthy Michigan Plan recipients shall be admitted within seven (7) days of PACE referral. C. Residential Long Term (prior authorization by PACE is required) Long-term residential care is defined as a professionally supervised program that includes planned individual and/or group therapeutic and rehabilitative counseling, didactics, peer therapy, and rehabilitative care. These services are provided in a residential setting and include an overnight stay. The provider room and board facility shall maintain a daily census log to document use of the facility by eligible clients. D. Intensive Outpatient (prior authorization by PACE is required) Services are provided over a specified time period as determined by program design, clients' needs and individualized treatment plan. Didactic, group, and individual therapy in combination with the individualized treatment needs of the client are provided. Aftercare planning and referral services are provided. A minimum of one (1) individual session per week shall be provided during the intensive outpatient program. E. Intensive Outpatient with Domiciliary (DIOP) (prior authorization by PACE is required) The initial authorization and subsequent reauthorizations shaft be based on medical and clinical necessity. DIOP programming should be a minimum of three (3) clinical contact hours per day, up to seven (7) days per week and should include at least one (1) individual contact weekly as part of the programming. F. Recovery Housing (prior authorization by the AMS Provider is required) The initial authorizations and subsequent authorizations will be based on the client's level of engagement in the recovery process. This process in includes no use of alcohol and illicit substances, involvement in recovery activities and or treatment services. Progress related to recovery goals and individualized need for continued support. Refer to Attachment E-16 for guidelines G. Domiciliary Outpatient (DOP) (prior authorization by the AMS Provider is required) I. The provider shall comply with all applicable Michigan and local laws and ordinances. 2. The provider shall be associated with a licensed OP substance use disorder treatment program. 3. The provider shall maintain a daily census log to document use of the facility by eligible clients. 4. The room and board facility shall be located in a different building than the DOP substance use disorder treatment program. 5. The provider shall document that the client's public assistance or foster care payments do not cover room and board before billing for room and board expenses. The initial authorization and subsequent reauthorizations shall be based on medical and clinical necessity. Clinical services are based on person-centered planning and individual need. H. Outpatient (including Opioid Treatment Programs) Outpatient programming should range from very frequent to infrequent based on medical and clinical necessity, client need, and client motivation and should be individualized based on where the client is at during the course of treatment. 1. More than one group session may be offered in a week, but no more than one session per day unless there has been prior authorization. Group therapy may be up to ninety (90) minutes in length. 2. An individual session is fifty (50) minutes or more in length and one-half individual session is thirty (30) minutes in length. Frequency of individual sessions shall be determined by documented clinical need. A full session will, at a minimum, be fifty (50) minutes of direct client contact. The additional ten (10) minutes shall be allocated for paperwork and/or transition between client appointments for scheduled clients. 3. The program can provide and bill for up to two different service codes in one day. Any additional services shall need prior approval from OCCMHA/PACE. 1. Methadone (prior authorization by PACE is required) New admissions shall require an appointment at PACE. 1. A client under the age of 18 is required to have had at least two documented unsuccessful attempts (to be determined by PACE) at drug-free treatment within a twelve (12) month period to be eligible for maintenance treatment. 2. Clients shall provide current copies of all prescription labels and/or receipts and they shall be included in the client record. 3. The initial authorization for Methadone dosing shall be up to three (3) months. 4. Re-authorizations for Methadone dosing may be up to three (3) months based on medical necessity, unless the client is on a Plan of Action. 5. Re-authorization requests for Methadone dosing shall be determined using the following criteria: a. The client has a clinical diagnosis of Opiate Dependency. b. The client is demonstrating progress on the Goals and Objectives established in the Master Treatment Plan (MTP). c. The client is actively participating in the treatment programming as demonstrated by attendance, therapist report and active involvement in treatment planning. d. The client is submitting clean drug screens for alcohol and all illicit substances. e, The clinic physician is in support of the clients continued treatment with Methadone. 6. Clients not meeting criterion shall be placed on a formal Plan of Action by the provider. (Attachment E-7) 7. The following process for the initial Plan of Action shall be utilized: a. The therapist and or physician are responsible for initiating a plan of action. b. The PACE Care Manager may initiate a plan of action. c. The therapist and client shall have a written plan which shall be included in the reauthorization request. d. The plan shall remain in the client's record at the program. e. The Plan of Action shall provide clear and concise objectives related to the identified problem areas and identify the interventions the client and therapist shall use to address them. f. A signed Release of Information (ROI) Form to all physicians prescribing medications should be included with the Plan of Action if the client agrees. g. The Plan of Action shall be valid for a maximum of thirty (30) days. 8. The Plan of Action shall be reviewed for compliance every thirty (30) days, for a minimum of sixty (60) days, to ensure compliance with the plan. A client shall demonstrate complete compliance with the plan in order to resume normal re- authorization procedures. 9. If the client fails to submit a Plan of Action or fails to comply with his/her Plan of Action, finding for treatment shall be discontinued. The OCCMHA shall send the client a forty-five (45) day Notice of Discontinuation of Funding letter that shall formally notify the agency and client of our intent to discontinue funding due to non-compliance. This shall allow for a safe detoxification or alternate treatment services. 10. Authorization for Methadone dosing beyond two years shall be based on medical necessity and client compliance with and completion of Clinical Treatment Plan goals and objectives. J. Medical Maintenance Only Criteria The following criteria shall be used for clients who may have reached the maximum therapeutic benefit from treatment services. 1. Client who has remained in continuous treatment for at least two (2) years. 2. Client has demonstrated abstinence from illicit substances and from use of prescription drugs for a period of at least six (6) months. 3. No reported or demonstrated use of alcohol (ETOH). 4. Ability to maintain stability in their current living arrangement. 5. Stable and legal source of income. 6. Involvement in productive activities as defined in the client's individual treatment plan. 7. No criminal Or legal involvement in the past year. 8. Adequate social support system. 9. Absence of significant or unstable co-occurring disorders. Authorization Guidelines: 1. Ninety (90) days dosing. 2. One fifteen (15) minute physician contact every sixty (60) days. 3. One sixty (60) minute individual session every sixty (60) days. 4. Treatment Plan Review shall be conducted every sixty (60) days. 5. If additional sessions are needed a reauthorization request supporting clinical necessity shall be submitted. XIV. UTILIZATION MANAGEMENT Utilization Management (UM) is a set of administrative functions that pertain to the assurance of appropriate clinical service delivery. Through the application of written policies and procedures, UM is designed to ensure the following services. 1. Only eligible beneficiaries receive plan benefits 2. All eligible beneficiaries receive all medically necessary plan benefits required to meet their needs 3. Beneficiaries are linked to other services when necessary UM consists of the following components: A. Access and Eligibility Determination - This functional component includes both screening for clinical eligibility and financial eligibility determination. Activities include: 1. Development of access and eligibility policy and procedures 2. Initial contact with potential consumers (when not reported as an encounter) 3. Initial screening (when not reported as an encounter) 4. Collection of consumer-specific information 5. Verification of funding sources including determination of public funding status and first and third part liability 6. Service referral, setting up first appointment if determined eligible. 13. UM Protocols - This component is the development and monitoring of clinical and authorization protocols to be used for determining level of care (LOC) and service selection process. This includes protocols for the following. I. Determination ofMedical Necessity 2. LOC assessments 3. Service intensity or selection criteria 4. Continuing Stay review 5. Services requiring specialist review, best practice guidelines C. Utilization Review (UR) - It should be noted that there may be overlap between UM and UR. This component provides review/monitoring of individual consumer records, specific provider practices and system trends. Review of activities of the provider network is included. It may include the following activities. 1. Review and monitoring to determine appropriate application of guidelines and criteria (LOC, service selection, authorization, best practice) 2. Consumer outcomes 3. Over-utilization or under—utilization 4. Review of outliers 5. Development of procedures for system-level data review 6. Policy and procedures regarding use of review documents 7. Documentation and monitoring of UM/UR activities. D. Core Provider and OSAS Residential Provider Referrals 1. AMS staff shall notify the CPA agency of screening appointment if a Release of Information Form is obtained by the client in advance. 2. CPA shall attend appointment if applicable. 3. AMS shall obtain a ROI Form during the screening and fax to the CPA. 4. CPA shall provide AMS staff with a case summary to assist in the decision making process. 5. AMS staff shall contact the CPA with the disposition on the screening. Residential provider information, including date of admission for treatment service. If residential services are not authorized, rationale shall be provided to the CPA. 6. Information noted in #4 shall be communicated to the CPA within 24 hours of the disposition. 7. If the client decides to leave against medical advice, rule violation, etc. the CPA may contact Pace to assist with making decisions regarding other treatment options. XV. CLIENT DOCUMENTATION AND RECORD A. A Consent and Authorization to Release of Information Form shall be signed by the client (Attachment E-8) with an expiration of no less than thirty (30) days after discharge. B. Verification of current address shall be obtained at admission (such as Driver's license, state ID, utility bill and so forth). C. PACE may require the client to sign Client Responsibility Notice (Attachment E9). 1. If a client has a medical condition that may impact their substance use disorder treatment and/or treatment plan, there should be evidence of coordination of care with the physician. 2. The Medicaid assigned physician should be identified on the form. The client may indicate communication is not authorized. 3. If a client does not have a primary care physician PACE shall refer to a Federally Qualified Health Clinic. D. There shall be evidence that PACE checked Medicaid/Healthy Michigan Plan eligibility via the 270/271 System on CareNet. E. Medicaid and Healthy Michigan Plan clients have access to the Fair Hearing Process. (Attachment E-14) Information regarding the Fair Hearing Process shall be presented at time of admission, with signed documentation in the client record. XVI. FINANCIAL REQUIREMENTS A. Sliding Fee Scale 1. PACE shall at minimum, utilize the sliding fee scale implemented by OCCMHA. (Attachment E-10) 2. The sliding fee scale shall be applied to all persons receiving Block Grant funds. 3. If a person's income falls within the sliding fee scale, clinical need shall be determined through the standard assessment and ASAM criteria. 4. If a financially and clinically eligible person has third-party insurance that insurance shall be utilized to its full extent. 5. If those benefits are exhausted or the person needs services not covered by the third party insurance or if the co-pay or deductible amount is greater than the person's ability to pay, Block Grant funds may be utilized. B. Co-Pays PACE shall assess and determine the co-pays for detoxification, short-term residential, DIOP and long-term residential. PACE Care Managers shall communicate the determined co-pay at the time of the referral. Co-pays should be distributed throughout the duration of their initial authorization. If the client leaves treatment early, the client shall forfeit their entire co-pay to the Provider. XVII. PROGRAM REVIEWS A. PACE shall be reviewed at least annually to ensure compliance with contact requirements. XVIIL COMPLAINT/GRIEVANCE/APPEALS PROCESS A. Clients wishing to express an opinion about care or service provided or to present an issue with a request for remedy may contact the OCCMHA with either an oral or written complaint/grievance. The procedure is documented in (Attachment E-13). B. Medicaid, MIChild, and Healthy Michigan Plan clients have access to the Fair Hearing Process. Information regarding the Fair Hearing Process shall be presented at time of the screening, with signed documentation in the client record. The procedure is documented in (Attachment E-14). XIX. PERSONS ASSOCIATED WITH THE CORRECTIONS SYSTEM A. When the OCCMHA or its PACE receives referrals from the Michigan Department of Corrections (MDOC), PACE shall handle such referrals as per all applicable requirements in this agreement. This woultL include determining financial and clinical eligibility, authorizing care as appropriate, applying admissions preferences, and other steps. MDOC referrals may come from probation or parole agents, or from MDOC Central Office staff. B. In situations where persons have been referred from MDOC and are under their supervision, state-administered funds should be used as the payment of last resort. C. When persons who are on parole or probation seek treatment on a voluntary basis from the OCCMHA, PACE or from a panel provider, these self-referrals shall be handled like any other self-referral to the MIN-MS-funded network. PACE or provider staff may seek to obtain releases to communicate with a person's probation or parole agent but in no instance may this be demanded as a condition for admission or continued stay. D. The OCCMHA may collaborate with MDOC, and with the Office of Community Alternatives (OCA) within MDOC, on the purchase of substance use disorders services and supports. This may include collaborative purchasing from the same providers, and for the same clients. In such situations, OCCMHA shall assure that: 1. All collaborative purchasing is supported by written agreements among the participants. 2. Rates paid to providers, whether by a single purchaser or two or more purchasers, do not exceed provider costs. 3. Rates paid to providers are documented and are developed consistent with applicable OMB Circular 4. No duplication of payment occurs. XX. SANCTIONS Non-compliance with contract requirements may result in the following sanctions: A. Additional reviews from OCCMHA. B. Probation/Corrective Action Plan. ATTACHMENT E-1 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES DSM V Diagnosis Codes In order to be eligible for services, an individual must be found to meet the criteria for one or more selected substance use disorders found in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). These disorders are listed below: Cannabis Related Disorders: 305.20 Cannabis Use Disorder -Mild 304.30 Cannabis Use Disorder - Moderate/Severe 292.89 Cannabis Intoxication 292.0 Cannabis Withdrawal 292.9 Unspecified Cannabis-Related Disorder Hallucinogen Related Disorders: 305.90 Phencyclidine Use Disorder-Mild 304.60 Phencyclidine Use Disorder - Moderate/Severe 305.30 Other Hallucinogen Use Disorder Mild 304.50 Other Hallucinogen Use Disorder - Moderate/Severe 292.89 Phencyclidine Intoxication 292.89 Other Hallucinogen Intoxication 292,89 Hallucinogen Persisting Perception Disorder 292.9 Unspecified Phencyclidine Related Disorder 292.9 Unspecified Hallucinogen Related Disorder Inhalant Related Disorders: 305.90 Inhalant Use Disorder - Mild 304.60 Inhalant Use Disorder - Moderate/Severe 292.89 Inhalant Intoxication 292.9 Unspecified Inhalant Related Disorder Opioid Related Disorder: 305.50 Opioid Use Disorder - Mild 304.00 Opioid Use Disorder - Moderate/Severe 292.89 Opioid Intoxication 292.0 Opioid Withdrawal 292.9 Unspecified Opioid Related Disorder Sedative, Hypnotic, or Anxiolytic (SHA) Related Disorders 305.40 SHA Mild 304.10 SHA Moderate/Severe 292.89 SHA Intoxication 292.0 SHA Withdrawal 292.9 Unspecified SHA Related Disorder Stimulant Related Disorders: Stimulant Use Disorder - 305.70 Amphetamine Type - Mild 305.60 305.70 304,40 304.20 Stimulant Intoxication 292.89 292.89 292,89 Cocaine - Mild Other or Unspecified Stimulant - Mild Amphetamine Type - Moderate/Severe Cocaine - Moderate/Severe Amphetamine or other stimulant, without perceptual disturbances Cocaine, without perceptual disturbances Amphetamine or other stimulant, with perceptual disturbances 292.89 Cocaine, with perceptual disturbances 292.0 Stimulant Withdrawal 292.9 Unspecified Stimulant Related Disorder Alcohol Use Disorders 305.00 303.90 303.00 291.80 291.9 Alcohol Use Disorder—Mild Alcohol Use Disorder — Moderate/Severe Alcohol Intoxication Alcohol Withdrawal Unspeci lied Alcohol-Related Disorder Other (unknown) Substance Related Disorders: 305.90 Other (unknown) Substance Use Disorder — Mild 304.90 Other (unknown) Substance Use Disorder— Moderate/Severe 292.89 Other (unknown) Substance Intoxication 292.0 Other (unknown) Substance Withdrawal 292.9 Unspecified Other (unknown) Substance Related Disorder ATTACHMENT E-2 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Medical Necessity Criteria for Mental Health and Substance Use Disorder Services A. Mental health, developmental disabilities, and substance use disorder services are supports, services, and treatment: • Necessary for screening and assessing the presence of a mental illness, developmental disability or substance use disorder; and/or • Required to identify and evaluate a mental illness, developmental disability or substance use disorder; and/or • Intended to treat, ameliorate, diminish or stabilize the symptoms of mental illness, developmental disability or substance use disorder; and/or • Expected to arrest or delay the progression of a mental illness, developmental disability, or substance use disorder; and/or • Designed to assist the beneficiary to attain or maintain a sufficient level of functioning in order to achieve his goals of community inclusion and participation, independence, recovery, or productivity. B. The determination of a medically necessary support, service or treatment must be: • Based on information provided by the beneficiary, beneficiary's family, and/or other individuals (e.g., friends, personal assistants/aides) who know the beneficiary; and • Based on clinical information from the beneficiary's primary care physician or health care professionals with relevant qualifications who have evaluated the beneficiary; and • For beneficiaries with mental illness or developmental disabilities, based on person-centered planning, and for beneficiaries with substance use disorders, individualized treatment planning; and • Made by appropriately trained mental health, developmental disabilities, or substance abuse professionals with sufficient clinical experience; and • Made within federal and state standards for timeliness; and • Sufficient in amount, scope and duration of the service(s) to reasonably achieve its/their purpose. C. Supports, services, and treatment authorized by OCCMHA must be: • Delivered in accordance with federal and state standards for timeliness in a location that is accessible to the beneficiary; and • Responsive to particular needs of multi-cultural populations and furnished in a culturally relevant manner; and • Responsive to the particular needs of beneficiaries with sensory or mobility impairments and provided with the necessary accommodations; and • Provided in the least restrictive, most integrated setting. Inpatient, licensed residential or other segregated settings shall be used only when less restrictive levels of treatment, service or support have been, for that beneficiary, unsuccessful or cannot be safely provided; and • Delivered consistent with, where they exist, available research findings, health care practice guidelines, best practices and standards of practice issued by professionally recognized organizations or government agencies. D. Using criteria for medical necessity, OCCMEIA may: • Deny services that are: • deemed ineffective for a given condition based upon professionally and scientifically recognized and accepted standards of care; • experimental or investigational in nature; or • for which there exists another appropriate, efficacious, less-restrictive and cost-effective service, setting or support that otherwise satisfies the standards for medically-necessary services; and/or • Employ various methods to determine amount, scope and duration of services, including prior authorization for certain services, concurrent utilization reviews, centralized assessment and referral, gate-keeping arrangements, protocols, and guidelines. Comments: AXIS II OMT I I 115 111..1 14) iro 4.1.11M) Intoxication andiat Withdrawn! Poloyfildi 1CareNat - Initial Authorization Initial Authorization - CIIont totQrnratiail CLIENT NAME CLIENT ID DATE OF BIRTH COUNTY OF RESIDENCE ATTACHMENT E-3 DILUNG TYPE REQUEST DATE PROvinER NAME CONTACT PERSON PROVIDER LICENSE 11 PROVIDER CONFIDENTIAL Pax !,t HOURS AVAILABLE Atiro.igslor Diagnosis AXIS I AXIS I MN Flit eary: Secondwy: Primary: Socrsniimy Primary: Secondary', AXIS III Axis IV AXIS V [ I PROBLEMS VVITI-I PrZlIk4ARY S[J1,1-,C)Ii1 ()ROI IF [ [ OCCLIPATIONAL. PROSLEMS [ ERCRLEMS 'MTH ACCESS TO HEALII I CARE, GAB Snre.. [ ) EROBLEM:i [ED TO SOCIAL DIVIROOME NIT ) NOISING PROM EMS [ 1 PROBLEMs RELAIEE TO THE LEGAL BISTEM [ I EDUCATIONAL PROBLEMS [ ECONOMIC PROBLEMS I IMPER AsA10 PLACEMENT nimeistoirs. cV)eck :AverIty tor aach rtlmenGiDe anti 041y Edo,' mtivn stIr oil I o recith:st to ol.m.111miiiiitimi) As evidericod by; III.2-D 7.1) , ) ( ) Blomodlca) ConflitIons loci Complications i.nirelate4.1 to WI ItrIrruwoll ( ) ( ) I ) ) ( ) PROCEDURE CODE UNITS REQUESTED flqe 2 012 As esidonced EintflunalfRehavion( Conditions and Cool pketiuns weldeorcd by: Traabnent I ) Act.eptanciaillesistaate As avidermod by! ) I ) I ) ) I I 1_ I Relapse/Month-KIM Use rotenlial eeldencod by: Pocovevy E'nvironment A. evidenced by Admission InfonnatSon Acirnissibn Date 1(It )1( )I (U I tIJ Sorvice Category Authorization Datuu Ractussted: - Con-Inv:Ms This clinical authorization does not guarantee payment. Oorarict wi _220 f 55O Nub-4:1;40T Olimbr:4 cs, AXIS I Aoionl$sion DlagnosIS Primary: Secondary: PrInvvy Secondary: ( (PROBLEMS WITH PRIMARY SUPPORT GROUP (OCCUPATIONAL PROBLEMS PROBLEMS WITH ACCESS TO HEALTH CARE PROBLEMS NELATEE TO SOCIAL ENVIRONMENT [ HOUSING PROBLEMS I PROBLEMS RH AIM TO IF-IC LEGAL SYSTEM I EnUcivricriAL PROBLEMS (ECONOMIC PROS LEMS (OTHER A= V I GAP Score: ATTACHMENT E-4 REMuthcirization Reauthorization - Client Information CLIENT NAME CLIENT ID DATE OF BIRTH COUNTY OF RESIDENCE —1 BILUNG TYPE PROVIDER NAME PROVIDER LICENSE # PROVIDER CONFIDENTIAL Fax 0 REQUEST DATE CONTACT PERSON HOURS AVAILABLE A.'3AM PLACE-VIEW-DIMENSIONS (Ploasn ntirook noverity fe.r ere;ht urey Indczte oh]ectiee ink-mealier' related to request For te ,nethorlzatioe) Levetn oF'Frnatment: .5 . er,atio,) I = OutpatIon1 0141 Methadone II , 10P III Resirlentiat IV Hosintal .5 °MI 81 iv Withdrawal 1 Detexitiaatioli Peientiai Client IE tin a bie a allstaln (-rem illicit drug use or alcohol abuse at ( N/A ( )24 Hoare )48 HOW8 72 Hours Gkirrent wIlhdra.vel 0.7es eareNet ReautlioriZation Page 2 of 3 I I Little or no problem in this area I ) inlansification of 1;coblonts al !Ins area Mal should [al affille.9sed i,1 a higher level of care I 1 In on Melnadnno/LAAM ( ) ( I ( I ( ) ( ) ( ) rogriter with take home schedule COrTittIVIlks: Bfomedical Conditions rind Coin pliOn tionS (unrelated to withdrawal ( 1 Currant I chtoniO physioellowtlIcal ilk-losses PM letdifering with treatment I Jo experiencing inlonsifionlloe ef problems Mat sheaf he addressed In a tfillerent least Di G4Fs [ i Client reskIng progress but NOT suflicioni In allow far {I -nosier to a Ims. linertsise level of cold ( I Clive; prowess is sufliciert la oilOw transfer to a lower levet dune [ ) civil iS experiencing Nile or no problems; or progress is soften] fie disc:lump ( / IL ) ( ) ) ( ) ( ) Comments: Emotional / Behavioral Contliliona and CompIicit lions I I I I I I Curierri chronic druolional 1 benuaioral condifordsl arc interfering with houtuattil Ctlent is correnlly being preSOribed rnediCatIOn tor en emotional/Ochre/Wel canilihrei Os experietvan9 intensificailon of problems that should 00 addressorilin a Vinton( Inset of 001 r-.11,,t Inallrriog Ougrm trill NOT 11101001 10 allow for gansirei 100 lower ;spat of esie Cliont's progress is s 1.1i[tiCIII to allow fel transfer to a lower level 010000 Met is ospnrionding hide er prt problems; or progratt is sufficient tor diSohargo ( ) ( ) ( ) I ) ( 1 ) COMMent: TreatmOnt Acceptance i Resistance i Client continues le el4ect to ilealiugni or attends Only to avoid eogolirro coneogtioncos I Client Is non compliant with attendenno, assignments j Client continues to disofay poor !impulse control ] is experiencing intensidentIon of problems shut should he 8(W -rooted in a different Level of cam. ) Client molding progress 001 NOT sufficient to allow for lianslor bulb lower level of coin I Client's p00111e55 K 1011101001 to-Mew for transfer le a lower losel of card / Client Is experiencing little OF no problems: nr progress is sulk:Log for discharge ( ) ( } ( ) ( ) ( ) Comments: Relapse / Continued Use Potential 1Client na5 been unable In achieve oneoistent abstinence ) if ahatinsnl, tient at MO nsl; for iisirly I raiiipse 1 10 experiencing intenaillcalino DI probldius lloll should he analossea in a different 10001 o; care I Chirentnlaking progress hut NOT sufficigni to allow l'or transfer toss lower Noel Cl ears I C doilies tuogress Is sufficient le alow for a gensfot to 0 lower level of csou )Cidird Is experiencing No also protinins; or proriless lo sufficient for discharge Comments: Recover; Environment 1 1 Crodeff Nem r social I vocational I hearicial environment lineopres dna, irddeeeni f 1 Client idands selfritotp, souped group attendance or is sogerficlady invelded in recovery community l ) le expoileilidng irgensifieutian 01 problems Inal should be addressed In a diffe,isiit ievai of cste [ i Client tusking progiose but IsICIT sufficionl ha allow for transfer to a Ichver level Cl care I 1 Client's progress it noffioiera to (Mow for a transfer to a Iconor lol el care I 1 0110111 It oxpurioncing hale or or; pinCrInoln, or progress is sufficient for &suborns ( ) ( ) ( ) I ) ( ) Comments! CURRENT TRE AT fvIENI PLAN Problem ; Admission Date Service Category (7=Net - Reauthorization Page 3 of 3 Goal : Progress; Est. Date of Comp.: Problem : Goal Progress: Est. Date of Comp,: Problem Goal : Progress: Est. Date of Comp.: ls client (.11 current medic:100u? I I I I Nrs Please list: P4ycliotropl I )Merfir,;11 Arfifdrision Mformatier) Authorization Dales Requested: - COMments This clinical authorization does not guarantee payment. Carcret vA,226 ,0 2COU NetGentri ishsrejie I:. Block Grant X X HMP Medicaid X X X X X X X X X X ATTACHMENT E-5 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES FY 14/ 15 Billing Codes / Modifiers CPT Code 90791 90791-HD 90791-HH 90792 90792-HD 90792-HH 90846-H0-HF 90846-HF 90846-HF-HH 90846-HF-HH-HD 90847 90847-HD-HF 90847-HF 90847-HH 90847-HH-HD-HF 90847-HH-HF 90849-HD 90849-HD-HF 90849-HF 90849-HH-HD-HF 90849-HH-HF 97810 99202 Description psychiatric diagnostic evaluation (no medical services) psychiatric diagnostic evaluation (no medical services) psychiatric diagnostic evaluation (no medical services) psychiatric diagnostic evaluation with medical services (or E&M new patient codes) psychiatric diagnostic evaluation with medical services (or E&M new patient codes) psychiatric diagnostic evaluation with medical services (or E&M new patient codes) Family Therapy (Collateral) 60 Minutes Family Therapy (Collateral) 60 Minutes Family Therapy (Collateral) 60 Minutes Family Therapy (Collateral) 60 Minutes Family Psychotherapy (Conjoint) 60 Minutes Family Psychotherapy (Conjoint) 60 Minutes Family Psychotherapy (Conjoint) 60 Minutes Family Psychotherapy (Conjoint) 60 Minutes Family Psychotherapy (Conjoint) 60 Minutes Family Psychotherapy (Conjoint) 60 Minutes Multiple Family Group Psychotherapy Multiple Family Group Psychotherapy Multiple Family Group Psychotherapy Multiple Family Group Psychotherapy Multiple Family Group Psychotherapy Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient Medication Review - Outpatient - New 20 min X 99202-HD 99202-HH Medication Review - Outpatient - New 20 min Medication Review - Outpatient - New 20 min 99213 99213-HD 99213-1-IH 99241 99241-H H H0001 H0004 Behavioral health counseling and therapy, per 15 minutes. Medication Review - Outpatient - Established 15 min Medication Review - Outpatient - Established 15 min Medication Review - Outpatient - Established 15 min 15 min 60 day Physician contact 15 min 60 day Physician contact Assessment X X X H0004-HD H0004-HH Behavioral health counseling and therapy, per 15 minutes. X Behavioral health counseling and therapy, per 15 minutes. X 60 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy X X 90 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy X X Step Forward 90 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy 60 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy X H0005 H0005 HG005 H0005-HD X 90 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy X X 60 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy X X 90 min Alcohol and/or drug services; group counseling by a clinician. Family or group therapy X H0005-HD H0005-HH H0005-HH X X X H0006 H0006 H0006 H0006 H0010 H0010-HD H0010-HH H0015 H0015-HD H0015-H H H0018-HF H0018-HD-H F Alcohol and/or drug services; case management (15 Min) Alcohol and/or drug services; case management (30 Min) Alcohol and/or drug services; case management (60 Min) Alcohol and/or drug services; case management (90 Min) Acute Detoxification Acute Detoxification Acute Detoxification Intensive Outpatient Intensive Outpatient Intensive Outpatient Residential Residential H0018-HH-HF Residential H0018-HH-HD-HF Residential H0019 Halfway House H0019-HD Halfway House H0019-HH Halfway House H0020 Medication (Methadone) H0033 Pharmacologic support (Suboxone) H0025 Family Education (90 Minutes) H0025-1-ID Family Education (90 Minutes) X H0025-HH Family Education (90 Minutes) X H2027 Didactics - 15 minute units Case Management Group Didactics - 15 minute units Didactics - 15 minute units Didactics - 15 minute units Didactics - 15 minute units Didactics - 15 minute units Didactics - 15 minute units Didactics - 15 minute units An hour of outpatient alcohol/other drug treatment services. An hour of outpatient alcohol/other drug treatment services. An hour of outpatient alcohol/other drug treatment services. H2027-CM H2027-HD H2027-HD-FIF H2027-HF H2027-1-IH H2027-HH-HD-HF H2027-HH-HF H2035 H2035-HD H2035-HH X X H2036 H 2036-H D H 2036-H H T1016-HF T1016-HF Alcohol and/or drug treatment program, per diem Alcohol and/or drug treatment program, per diem Alcohol and/or drug treatment program, per diem Case Management Face to Face (15 Min) Case Management Face to Face (30 Min) T1016-HF Case Management Face to Face (60 Min) X X **When billing for a Medicare/Medicaid, Blue Cross/Medicaid or any third party insurance, bill OCCMHA the difference between the third party payment and the OCCMHA rate. ATTACHMENT E-6 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Receipt of Recipient Rights PolicylProcedures and Notice of Confidentiality of Alcohol and Drug Abuse Patient Records I hereby certify that I have been provided with my copy of "Know Your Rights" and have been apprised of my rights as a recipient of services through the Oakland County Health Division — PACE Unit. understand that if I feel my rights as a recipient of services has been violated I will educate myself to the complaint procedure and will pursue my complaint as outlined. I also certify that I have received a copy of "Confidentiality of Alcohol and Drug Abuse Patient Records" regarding notice of Federal rules and regulations on confidentiality of my records, specifically 42 C.F.R. Part 2. In addition, I have also been provided a copy of the Privacy Notice related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), describing the County's use or disclosure of my Protected Health Information for the purpose of diagnosing or providing treatment and care for me, payment or reimbursement for any health care bills for which I am responsible, and to conduct its health care operations. if I am receiving Medicaid funding I acknowledge that I have received a copy of my rights on the Complaint/Grievance Process and Medicaid Fair Hearing. By signing, I acknowledge I have received the above notices and have had the information contained in the notices read / explained to me, and that I understand the content of these notices. Client Signature Date Witness Signature Date Prepared in accordance with Rule 302(4) of the Michigan Department of Community Health Recipient Rights Administrative Rules and Federal Confidentiality Law 42 C.F.R. Part 2. ATTACHMENT E-7 Plan of Action Re-Authorization Request Date: A request for funding re-authorization has been made to the Oakland County Health Division/Office of Substance Abuse Services (OSAS). These indicate that you are in non- compliance with your treatment plan. • You will be given an opportunity to work with your therapist to develop a "plan of action" that addresses the above issues. • You have one week to develop and submit this plan to PACE for review. Once the plan of action is approved, you will be re-authorized for treatment and your progress will continue to be monitored. • If you fail to develop and submit your plan of action within two weeks or you do not comply with the plan of action, your funding will be discontinued. • At that time you will receive a "Discontinuation of Funding" notice which will be final. It is our hope that you will take immediate action to avoid any interruptions of funding related to your treatment. We wish you success in your recovery journey. Sincerely, ATTACHMENT E-8 lirOAKIANM COUNTY MICHIGAN Oakland County Government Interagency Consent and Authorization To Release Protected Health Information I_ grant perm ission_to_(cheek one or more). O Circuit Court-Family Division 0 DERIS/ChilcIren's Village 0 Medical Examiner O Community Corrections III DHHS/Health Division 0 Employment & Training O Community Mental Health 0 Mich. Dept. o ['Human Services-Oakland CI Sheriff's Department [lather (specify) To release information on: Name of Person: DOB or SS# 2. This information may be released to the following (check one or more): O Circuit Court-Family Division 0 DHHS/Children's Village 0 Medical Examiner O Community Corrections 0 DI-ll IS/Health Division 0 Employment & Training CI Community Mental Health 0 Mich. Dept of Human Services-Oakland El Sheriff's Office ['Dither (specify) 3.* What information may be released: 4. For what purpose is the information to be released: 0 To assist in the coordination and/or provision ofservices. 0 Other (specify) 5. I understand that I have a right to receive a copy of this document. 6. I understand that I may withdraw this consent by written notification received by the agency head at any time before information is released. I also understand that disclosure of the above protected health information may be subject to redisclosure by the recipient and, therefore, may no longer be protected. I thither understand that redisclosure of substance abuse-related information by the recipient is prohibited unless authorized by 42 CFR, Part 2. 7. Unless withdrawn in writing, this consent expires as follows: A. Date: B. Event: C. Condition. *NOTE: AIDS-related information (i.e., HIV, ARC, AIDS) and/or psychotherapy notes shall not be released unless specifically listed under Item #3 above. Client/Parent/Guardian Signature (Relationship) Date Witness Signature Date This authorization is consistent with standards established under 42 CPR, Part 2:45 CFR, Parts 16.0 and 164; and Michigan Law. No Oakland County agency may release protected health information without a current valid written authorization in its possession or as otherwise provided by law. DlIFIS 10/24/12 (Revised) Contract 14 - 15 / Attachment E-8 Anthorifation to Release Information 2-Wayfim ATTACHMENT E-9 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Client Responsibility Notice The Oakland County Community Mental Health Authority (OCCMHA) is pleased to inform you that OCCMHA is providing funding assistance for your treatment at: It is important that you understand your responsibilities as they relate to your treatment. You will develop a treatment plan with your therapist and be expected to work towards the goals established in the plan. in order to maintain OCCMHA funding, you are expected to: • participate in your treatment planning • attend scheduled appointments • demonstrate some level of progress in meeting treatment plan goals Failure to comply with these expectations will require a re-evaluation of services and may result in a referral to an alternate level of care. My signature below acknowledges my understanding and agreement. Client Signature Date Witness Signature Date ATTACHMENT E-10 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Reimbursement Rate / Sliding Fee Schedule For Clients Must Bring In Proof Of Income This could include: )> Medicaid card, general assistance papers, check stub, unemployment papers, letter for Social Security, bank statement, W-2 forms, note from homeless shelter, etc. Clients married/co-habituating or are dependent in a household, must provide proof of household income. Adults who have no income, but live with others (roommates, parents, siblings, relatives) will be assessed at: Income Category I. Adults who have an income and live alone: fee based on personal income. Adults who have an income and live with others (roommates, parents, siblings, relatives): Increase personal income fee category by one level. Level 1 2 3 4 5 6 7 Income 0 $19,495 $26,229 $32,959 $39,691 $46,423 $53,155 $19,494 $26,226 $32,958 $39,690 $46,422 $53,154 $59,086 . Clients married or co-habituating or dependent children regardless of age, who live with parent, are supported by parent and claimed for income tax purposes by parent, will have fees assessed upon household income. 1 2 3 4 5 6 7 Income 0 $19,495 $26,229 $32,959 $39,691 $46,423 $53,155 $19,494 $26,226 $32,958 $39,690 _ $46,422 $53,154 $59,086 Family Size 100% 90% 80% 70% 60% 50% 45% 1 *0/68 7/61 14/54 20/48 27/41 34/34 37/31 2 0/68 0/68 7/61 14/54 20/48 27/41 34/34 3 0/68 0/68 0168 7/61 14/54 20/48 27/41 4 or more 0/68 0/68 0/68 0/68 7/61 14/54 20/48 (* Client pays numerator and OCCMHA pays denominator) ATTACHMENT E-11 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Communicable Disease and Interim Services Client Name Possible High Risk Pregnant IDU TB or risk for Other hepatitis STD or risk for HIV/AIDS or risk for Hepatitis C or risk for Other All clients are to be screened for TB, HIV, STD and hepatitis. Clients with high-risk behaviors will be given information about resources available and referral to testing and treatment. IDU clients must receive interim services on: 1. Counseling and education about HIV and hepatitis 2. Completion of TB screening history 3. Risks of needle-sharing 4. Risks of transmission or HIV and other STDs to sexual partners and infants 5. Steps that can be taken to ensure that HIV transmission does not occur 6. Referral for HIV and TB services if indicated Pregnant Women must receive all the above and... 1. Counseling on the effects of alcohol, tobacco and other drug use on the fetus 2. Referral to prenatal care This client was Given counseling and fact sheets on hepatitis/HIV/STDs Was referred to OCHD for TB, HIV, or STD testing and treatment Was referred to Oakland Primary Health Services, Inc. Was referred to Department of Human Services Was referred to personal physician or HMO Was given counseling and brochures on effects of ATOD on fetus Other Care Manager Signature ATTACHMENT E-12 CareNet - SARF Form Adiair-ision Information Client Name Client SSN/ID Date of Dirth Admission Date fienvdcifri.g.6 Age at Admission Is this client Medicaid eligible at the Urns of admission? ) No - 2 ( Yes- Medicaid/ASW Recipient ID Agency Client IOU Service Category Referral to lead of care Referral Source CiA or Non -SA) Demographic Inferniation County of Residence Race Sex { Felirale -2 ( ) Male - 1 I Pregnant at Admission ( ) No- 2 ( ) 'Yes - Arrest History Corrections Related Status Substance Abuse History Drug Code Primary Drug Has this Omit injected drugs in the last 20 days? Diagnosis Diagnostic Impression Additional information Time Waiting for Assessment (days since request made) temisir ris13-0 bek7W Of Me Ceernenk mettoof Route of Admin. ( ) No - 2 ( ) Yes - Indication of Mental Health Issues? Drug Court Client? Katrina Eva cuoe? Is this a Transitional Housing Client? Contact Dates initial Contact Dale First Appointment Offered fimelir ess ( )Merliceiri client, Urgent Status ( No -2 ( ) Yes 1 ( ) No - 2 )Yes 1 ( )No-2( )Yes ( ) No 2 ( )Yes Days from Initial Contact to Admission Dale Days from the ipitial Contact in First Appointment Offered Was client offered an assessment within 24 hours after initial contact? (I Yes, and client :accepted (areNt.1 - SART Form OF 2 ( j Yes, but client declined kite initial appt. ofterad ( ) No ( )Merlicaid client, F,oullrie Status (Non- urgent) Was client offered an assessment within 5 days after initial contact? ( ) Yes, and cllool accepted ( ) Yes, but client declined lois initial appt. offered ( ) No ( jhlo, this is note Medicaid client YesL Did cormimecrequest an appointment outside the-14 calendar day poried?-- ------ If YP.,S Plosi-V.,7, Provide Fx.plan:4tion Comments ....... Referral Referring to Provider ....._...... Miscellaneeos This SARF Appointment Type Program Name MEDICAID GRIEVANCE PROCEDURE (For Medicaid Clients only) I ] A$ a Medicaid recipient, the client has bean notified of the right Co file a request fur tin administrative hearing ifiwlicit a benefit is denied, terminated, suspended, or reduced, As a Medicaid recipient, the client has been given the 'Notice of Privacy" for substance abuse services provided within the Nor ItiCare Pre-Fuld Heallii P1211 (PHI') Network, Clioni has signed ackecwicigement of receipt and understanding of this notification, Carenclv4.22tle 2C011 Nosouot Tochoutgo,3*, o4, ATTACHMENT E-13 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE ABUSE DISORDER SERVICES Client Complaint/Grievance Procedure I. Introduction A complaint is a communication by a client or a client's representative expressing an opinion about care or service provided by the plan, or presenting an issue with a request for remedy that can be resolved informally. Complaints may be oral or written and will be received by the person designated as the OCCMHA's recipient rights coordinator. A grievance is a written request for remedy or reconsideration of an OCCMHA decision submitted by or on behalf of a client regarding: A. availability, delivery or quality of services, including a complaint regarding an adverse determination made pursuant to utilization review; and B. claims payment, handling or reimbursement for services. Grievances will be handled by the regional recipient rights coordinator. The recipient rights coordinator will receive, investigate and resolve complaints and grievances. This person will also assist clients in filing written grievances, as needed. Grievances may be submitted by a client or their selected representative. IV. Internal complaint and grievance resolution process A. Complaint is referred to the recipient rights coordinator. If the recipient rights coordinator is the person who made the initial decision that is the subject of the complaint, an alternate qualified reviewer will be selected. Complaint data form is completed, containing minimally client's name, date of the complaint, and a short summary of each question or problem. A release of information is initiated, if necessary, to enable contacts necessary to conduct an investigation of the complaint. A file is initiated to contain the investigative record and any associated documentation. 2. Sources of information relevant to investigation of the complaint are contacted. 3. Within 15 business days of receiving the complaint, a written response will be provided to the person or agency initiating the complaint. B. Grievance is referred to the recipient rights coordinator. If the recipient rights coordinator is the person who made the initial decision that is the subject of the grievance, an alternate qualified reviewer will be selected. 1. Grievance data form is completed. A file is initiated to contain a copy of the original grievance, the investigative record and associated documentation. 2. Within two business days of receipt, recipient rights coordinator contacts the person/agency submitting the grievance for clarification/additional information regarding the circumstances initiating the grievance. A release of information is initiated to enable appropriate contacts necessary to conduct an investigation of the grievance. 3. Sources of information relevant to investigation of the grievance are contacted. 4. Within 15 business days of receiving the grievance, a written response will be communicated to the person or agency initiating the grievance. a. An appropriate clinical peer will conduct reviews of grievances concerning adverse determinations in the same or similar specialty as would typically manage the case being reviewed. b. Response will contain information regarding subsequent avenues available to the client if he/she is not satisfied with the result. 5. In situations where the standard 15-day time frame would seriously jeopardize the life or health of a client or would jeopardize the client's ability to regain maximum function, an expedited review of a grievance will be provided. a, lin such cases, all necessary information, including the OCCMHA's decision, will be transmitted between the OCCM_HA and appropriate party(s) by telephone, facsimile, or the most expeditious method available. Decisions will be rendered within 24 hours. 6. At time of client/agency notification of the OCCMHA's decision regarding the grievance, information regarding subsequent avenues available to the client/agency will be provided if they are not satisfied with the result. C. The client will have the opportunity to present his/her grievance in person or through a representative to a committee designated by the governing body to handle grievances. ATTACHMENT E-14 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Medicaid Administrative Hearings Requirements Federal law (42 CFR 31.200-250, 431.250-Fair Hearings) provides rights for fair hearings for Medicaid recipients. Medicaid recipients may file a request for an administrative hearing when a benefit is denied, terminated, suspended, or reduced as a result of a utilization review decision made by the OCCMHA or its authorized designee. The Michigan Department of Community Health/Community Health Manual, General Administration Chapter, Legal Section provides the policy and procedures on Administrative Hearings. The Administrative Hearings Policy and Procedure is part of this attachment. Medicaid recipients must be informed of and have simultaneous access to: 1) the recipient rights procedure and 2) the MDCH Administrative Procedure established by federal law and departmental policy. I. Medicaid Administrative Hearing Requirements. A. The OCCMHA must adhere to the Administrative Hearings Policy and Procedures issued by the Department which were effective September 1, 1999. B. All Medicaid recipients must be told and informed in writing of their right to an administrative hearing, if a recipient does not agree with the type or amount of authorized services. When providing the Advance Notice of Action or the Notice of Denial of Service, the Notice of Hearing Rights and the Hearing Request forms must also be provided. Federal law requires that this information be given to or mailed to recipients. Note: Advance Notice of Action, Notice of Denial of Service, Notice of Hearing Rights, and Hearing Request forms are enclosed. Hearing Request forms and pre- addressed envelopes are available from the Administrative Tribunal of MDCH. C. The OCCMHA must identify who from OCCMHA will represent OCCMHA in Administrative Hearings. IVIDCH Responsibilities for the Administrative Hearing Procedure The MDCH will maintain an Administrative Hearing process to assure that Medicaid recipients involved in an OCCMHA managed care plan or their legal representatives have the opportunity to appeal decisions of OCCMHA to deny, terminate, suspend, or reduce, Medicaid-covered services. This process will be administered by the Administrative Tribunal, P.O. Box 30195, Lansing, M1 48906. ADVANCE NOTICE OF ACTION Suspension, Reduction or Termination Date Name Address City, State, Zip Re: Member's Name Member's ID Number Dear Following a review o I' the substance abuse treatment service(s) that you are currently receiving it has been determined that the following service(s) shall be <terminated, suspended, or reduced> effective <date>. The reason for this action is <reason>. The legal basis for this decision is 42CFR440.230/(d) Service(s) Effective Date if you do not agree with this action, you may request a Michigan Department of Community Health Authority/SOD Service Network administrative hearing within 90 days of the date of notice. Hearing requests must be made in writing and signed by you or an authorized person. To request an administrative hearing, complete the "Hearing Request" form, and mail it in the enclosed envelope to: ADMINISTRATIVE TRIBUNAL MICHIGAN DEPARTMENT OF COMMUNITY lEALTH PO Box 30195 LANSING, MI 48909-7695 You will continue to receive the affected substance abuse treatment service(s) in most circumstances until a hearing decision is rendered if your request for an administrative hearing is received within 10 days of receipt of this notice. If you want to know more about how an administrative hearing works, call (517) 335-9384. You may also request a review through the Oakland County Community Mental Health Authority. OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY 2011 EXECUTIVE HILLS BOULEVARD AUBURN Hal.s, MI 48326 248-858-1210 248-858-1633 FAX You may request both an administrative hearing and a local grievance review. The hearing and grievance review processes may occur at the same time. You may contact the Administrative Tribunal or the OCCMHA if you have thither questions. Enclosures: Hearing Request Form & Return Envelope NOTICE OF DENIAL of SERVICES Date Name Address City, State, Zip Re: Member's Name Member's ID Number Dear Following a review of the substance abuse treatment service(s) for which you have applied, it has been determined that the following service(s) shall not be authorized. The reason for this denial is <reason>. The legal basis for this decision is 42CFR440.230/(d) Service(s) Effective Date If you do not agree with this action, you may request a Michigan Department of Community Health Authority administrative hearing within 90 days of the date of notice. Hearing requests must be made in writing and signed by you or an authorized person. To request an administrative hearing, complete the "Hearing Request" form, and mail it in the enclosed envelope to: ADMINISTRATIVE TRIBUNAL MICHIGAN DEPARTMENT OF COMMUNITY HEALTH PO Box 30195 LANSING, MI 48909 7695 If you want to know more about how an administrative hearing works, call (517) 335-9384. You may also request a review through the OCCMHA. OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY 2011 EXECUTIVE HILLS BOULEVARD AUBURN HILLS, MI 48326 248-858-1210 248-858-1633 FAX You may request both an administrative hearing and a local grievance review. The hearing and grievance review processes may occur at the same time. You may contact the Administrative Tribunal or the OCCMHA if you have further questions. Enclosures: Hearing Request Form & Return Envelope NOTICE OF HEARING RIGHTS Substance Use Disorder Authorization Date Name Address City, State, Zip Re: Member's Name Member's ID Number Dear You have been authorized to receive substance abuse treatment services. The Oakland County Community Mental Health Authority is responsible for the authorization of these services. The legal basis for any utilization review decisions is 42CFR440.230 (d). If you do not agree with the scope, duration, or intensity of the services included in this authorization for substance abuse treatment services, you may request a Michigan Department of Community Health Authority administrate hearing before an administrative law judge. The request must be in writing signed by you and your authorized hearing representative, and received by the OCCMHA within 90 days of the date of this authorization. To request an administrative hearing, complete the "Hearing Request" form, and mail it in the enclosed envelope to: ADMINISTRATIVE TRIBUNAL MICHIGAN DEPARTMENT OF COMMUNITY HEAL]] 1 PO Box 30195 LANSING, MI 48909 7695 If you want to know more about how an administrative hearing works, call (517) 335-9384. Enclosures: Hearing Request Form Return Envelope ATTACHMENT E-15 OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY SUBSTANCE USE DISORDER SERVICES Trauma Informed System of Care Overview • Safe, calm and secure environment, with supportive care to ensure the physical and emotional safety of children, youth, and adults • System wide understanding of trauma prevalence, impact and trauma informed care • Cultural Competence • Recovery, consumer-driven and trauma specific services • Engagement in organizational self-assessment of trauma informed care • Screening for trauma exposure and related symptoms for each population • Referral and treatment recommendations will align with Trauma Policy TIP 57 ATTACHMENT E46 RECOVERY HOUSING LEVEL H MONITORED SERVICES Recovery Housing provides a location where individuals in early recovery from a behavioral health disorder are given the time needed to rebuild their lives, while developing the necessary skills to embark on a life of recovery. This temporary arrangement will provide the individual with a safe and secure environment to begin process of reintegration into society, and to build the necessary recovery capital to provide varying degrees of support and structure. Participation is based on individual need and the ability to follow the requirements of the program. Staff Qualifications A. High school diploma or equivalent B. Must possess interpersonal skills • Empathy • Verbal and written communication skills • Listening skills C. Must have a good working knowledge of recovery resources and activities. Training Requirements • Personal Safety • Ethics • Confidentiality • Cultural Competence • Recipient Rights • Communicable Disease/HIV level I • CPR/First Aid/Universal Precautions (recommended) II. Program Services A. Staff will maintain an alcohol-and illicit-drug-free environment. B. Maintain a safe, structured, and supportive environment. C. Set clear rules, policies, and procedures for the house and participating residents D. Establish a screening process for residents. E. Services/structure will be consistent with NARR Level TI Monitored Services Ill. Eligibility Requirements A. Individual meet the criteria for OSAS funding (income, residency, and substance use disorder diagnosis). B. Individual is in need of a highly structured and monitored living environment where recovery support is available. C. Individual has a history of unsuccessful recovery attempts D. Individual has significant negative factors in the areas of family, social, work, or environment that places him/her at-risk for relapse. IV. Admission Requirements A. Individual has completed or does not need medical or sub-acute detoxification. B. Individual does not present with a severe medical or psychiatric condition that would interfere in his/her ability to function in a supervised supportive living environment. C. Individual will engage in treatment services and/or recovery groups/activities. D. Individual demonstrates active motivation for recovery and a desire to work towards self- sufficiency. V. Recovery Housing Placement A. ACCESS Management System Staff will refer and coordinate admission to the home. B. In cases where the Treatment Provider request placement. The provider will contact the AMS Staff. The Provider will enter a note in CareNet with the following information: • Summary of progress and level of engagement • Rationale for placement • Plan for community integration and self-sufficiency, i.e. employment/independent housing etc. C. AMS Staff will review the information and make a recommendation for placement based on the admission requirements/availability. D. AMS staff will assist in arranging admission. E. The Provider will complete an Initial Authorization Form for approval from the A MS. F. Recovery Home Placement is based on first come first serve availability. Waiting list will not be established for this service level. DIOP or DOP maybe an option. The AMS staff will make the determination. G. Recovery Home Staff will keep the AMS Staff apprised of openings. VI. Recovery House Admission Procedure A. Recovery Home Provider will complete the standard information required for admission. In addition to the OSAS required documents. B. Recovery Home Provider will assist the client in developing an individualized recovery plan including Peer and Case Management Services if applicable. VII. Authorizations/Re-Authorization Request A. Clients will be authorized for sixty (60) days. Thirty (30) day extensions will be considered on an individual basis. Extensions will be based on the following criteria: • No behavioral challenges with staff or other residents • Seeking employment or employed • Compliance with house rules and regulations • Engagement in treatment services and /or recovery groups/activities • Progress toward recovery goals as evidenced by measurable improvement in meeting recovery plan goals/recovery process • Other pertinent information B. If services are needed after sixty (60) days an extension maybe requested. The Recovery Home Provider may request a reauthorization for continued stay through AMS ten (10) days prior to the expiration date of the initial authorization. Information noted above for extension request must be included in the reauthorization request. VIII. Records The Recovery Home Provider will maintain adequate program, and fiscal records and files, including source documentation, to support program activities and all expenditures made under the terms of this agreement, as required. A. A daily log for each billable date of service will be kept for each client served. B. OSAS CareNet Forms (i.e. Admission/Discharge, Etc.) will be completed within timeframes noted in Attachment E. Timelines are consistent with outpatient guidelines. C. OSAS required documents including the Provider Consent for services. D. All client specific information will be kept in a secure location and the Recovery Home Provider will adhere to confidentiality requirements. E. Release of Information Forms must be obtained before sharing client information with outside entities. IX. Code/Rate The Code is H2036 The Rate $22.00 per day Standards Criteria Recovery Residence Levels of Support 1i1NARR National Attrance for Recover), ResIdences Level I Peer-Run Level II Monitored Level 11111 Supervised Level IV Service Provider Administration • Democratically run • Manual or policy and procedures • House manager or senior resident • Policy and procedures • Organized hierarchy • Administrative oversight for service providers • Policy and procedures • Licensing varies from state to state • Overseen organizational hierarchy • Clinical and administrative supervision • Policy and procedures • Licensing varies from 1 state to state Services • Drug screening • House meetings • Self-help meetings encouraged • House rules provide structure • Peer-run groups • Drug screening • House meetings • Involvement in self- help and/or treatment services • Life skill development emphasis • Clinical services utilized in outside community • Service hours provided in-house • Clinical services and programming are provided in-house • Life skill development Residence • Generally single family residences • Primarily single family residences • Possibly apartments or other dwelling types • Varies — all types of residential settings • All types — often a step-down phase within care continuum of a treatment center • May be a more institutional in environment Staff • No paid positions within the residence • Perhaps an overseeing officer • At least 1 compensated position • Facility manager • Certified staff or case managers • Credentialed staff FISCAL NOTE (MISC. #16169) July 20, 2016 BY: Finance Committee, Tom Middleton, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL AGREEMENT BETWEEN THE COUNTY OF OAKLAND AND THE OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY FOR HEALTH EDUCATION PREVENTION SERVICES To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above-referenced resolution and finds: 1. Public Act 500 of 2012 amended Public Act 258 of 1974, MCL 330.1287(5) changing the designated substance abuse coordinating agency from the Oakland County Health & Human Services Department (DHHS)/Health Division to the Oakland County Mental Health Authority (OCCMHA). 2. An Interlocal Agreement was approved through Miscellaneous Resolution #15283 on November 12, 2015 to cancel the Substance Use Disorder Access Management services provided by the Oakland County Health Division (OCHD) Prior Authorization and Central Evaluation (PACE) services at the request of OCCMHA. 3. The current resolution recognizes entering into a new Interlocal Agreement between the Oakland County Department of Health and Human Services/Health Division and the OCCMHA which provides an end date of January 31, 2016 and funding not to exceed $236,685 for PACE services provided from October 1, 2015 through January 31, 2016 as well as continues OCHD Health Education Prevention Services with FY 2016 funding in the amount of $204,464 and a local match of $20,446 comprised primarily of general fund salaries for supervision of the program for total FY 2016 funding in the amount of $461,595. 4. With the discontinuation of PACE services one (1) Special Revenue (SR) Treatment Services Supervisor position (#1060261 —07151); one (1) SR Auxiliary Health Worker position (#1060261 —07387); one (1) SR Public Health Educator 111 position (#1060261 -09204); one (1) SR Account Clerk II position (#1060261 — 07498); three (3) SR Office Assistant II positions (#1060261 07154, 07389, 07566); seven (7) SR Substance Abuse Program Analyst positions (#1060233 — 07152, 07386 and #1060261 — 01919, 06114, 07500, 08037, 09026) will be deleted effective immediately. 5. With the continuation of OCHD Health Education Prevention Services two (2) SR Public Health Educator II! positions (#1060261 — 00960 and 07497) will remain through September 30, 2016. 6. The future level of service, including personnel, will be contingent upon the level of funding available through future contract awards. A budget amendment for services after September 30, 2016 will be made upon future contract acceptance. 7. The FY 2016 - FY 2019 budgets are amended as follows to reflect services through September 30,2016: HEALTH MDPH OSAS FUND (#28249) GR0000000203 / Budget Reference 2016 activity: GLB analysis: GLB Revenues 1060261-134795-610313 Federal Operating Grants 1060261-134800-610313 Federal Operating Grants Total Revenues Expenditures 1060261-134795-702010 Salaries FY2016 FY2017 — FY2019 ($ 5,155) ($ 209,619) ( 622,3421 ( 859,027) S 627,497) ( 103,412) FINANCE COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Woodward and Quarles absent. 1060261-134795-722740 Fringe Benefits 0 ( 73,886) 1060261-134795-730926 Indirect Costs 0 ( 15,666) 1060261-134795-731213 Membership Dues 0 450) 1060261-134795-731346 Personal Mileage 0 ( 3,673) 1060261-134795-731388 Printing 3,904) ( 5,000) 1060261-134795-732018 Travel and Conference 0 ( 1,327) 1060261-134795-750245 Incentives 1060261-134795-750294 Material and Supplies 1060261-134795-750392 _Metered Postage 1060261-134795-750399 Office Supplies 1060261-134795-750567 Training Educational Supplies 1060261-134795-770631 Building Space 1060261-134800-702010 Salaries 1060261-134800-722740 Fringe Benefits 1060261-134800-730926 Indirect Costs 1060261-134800-731346 Personal Mileage 1060261-134800-731388 Printing 1060261-134800-730373 Contracted Services 1060261-134800-731997 Transportation of Clients 1060261-134800-732018 Travel and Conference 1060261-134800-750294 Material and Supplies 1060261-134800-750392 Metered Postage 1060261-134800-750399 Office Supplies 1060261-134800-750567 Training-Educational Supplies 1060261-134800-774637 Info Tech Managed Print Svcs 1060261-134800-774677 Insurance Fund 1060261-134800-778675 Telephone Communications Total Expenditures 100) 300) 200) 400) 500) 1,500) 450) 600) 2,500) 0 904) 346,561) 473,305) 224,457) 297,725) 52,707) 71,706) 0 467) 800 700) 3,308 0 0 100) 1,217) 1,750) 442 225) 0 2,100) 792 700) 0 1,200) 1,220 300) 0 2,000) 3,963) ( 6,750) 627,497) ( 1068646) Resolution #16169 July 20, 2016 Moved by Hoffman supported by Zack the resolutions (with fiscal notes attached) on the Consent Agenda be adopted (with accompanying reports being accepted). AYES: Dwyer, Fleming, Gershenson, Gosselin, Hoffman, Kochenderfer, KowaII, Long, Middleton, Quarles, Scott, Taub, Weipert, Woodward, Zack, Bowman, Crawford. (17) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent Agenda were adopted (with accompanying reports being accepted). MOW APPROVE THIS RESOLUTION CHIEF DEPUTY COUNTY EXECUTIVE ACTING PURSUANT TO MCL 45,559A (7) STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on July 20, 2016, with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 20th day of July, 2016. Lisa Brown, Oakland County