SHJ26-008 VALLEY HEALTH MOU - PARTIALLY EXECUTED

Home Browse Search

CLINICAL OPERATIONS MOU • Corrections to clinical records follow professional and legal standards; neither party will require alteration of an accurate clinical record. • KCJ receives operational and de -identified aggregate reports. Where reasonably available from existing systems, aggregate measures may include service timeliness, telehealth utilization, referral status or closure, discharge or reentry referrals, and behavioral -health medication -management continuity. Neither party must create a new reporting system or perform material custom analytics without a separately approved scope and price. Access to identifiable records requires a lawful purpose and minimum -necessary basis under the BAA, Part 2, chapter 70.02 RCW, privilege, and other applicable law. 7. PRIVACY AND COMMUNICATION The parties will execute the BAA and applicable Part 2 terms before exchanging PHI or SUD records. Clinical information will be communicated through approved secure channels. Communications with courts, prosecutors, defense counsel, family, or outside providers require the authorization, court order, treatment exception, or other legal basis applicable to the information. 8. INSURANCE VERIFICATION AND BILLING • KCJ provides available coverage information at referral and promptly supplies updates. Contractor performs reasonable verification but does not guarantee payer eligibility or payment. • Contractor bills an active third -party payer first only when the client, service, setting, provider, and claim are lawfully payable and Contractor is authorized to bill. • If insurance is inactive or cannot be verified at the visit, incarceration or payer policy prevents payment, or a claim is denied for a reason other than Contractor billing error, KCJ reimburses Contractor at the Medicaid -equivalent rate. Contractor need not await a denial when eligibility records establish that no payer is available. • Contractor will not bill or balance -bill the incarcerated client. No service may be billed to both a payer and KCJ beyond any lawful residual amount; later payer recovery will be credited or refunded to KCJ. • Invoices will identify service date, category, code, modifier, units, provider type, HCA schedule/effective date, insurance status or payer disposition, and amount. KCJ will pay undisputed amounts within thirty days and identify disputes within fifteen days. Undisputed amounts not paid when due accrue interest as provided by chapter 39.76 RCW, consistent with the service agreement. 9. MEDICAID -EQUIVALENT RATE METHOD Mental health uses the HCA Mental Health and Psychology Services Fee Schedule. SUD uses the HCA Substance Use Disorder Fee Schedule and applicable SERI requirements. Behavioral -health practitioner and medication - management services use the HCA Physician -Related Services/Health Care Professional Services Fee Schedule. The schedule effective on the service date controls for the correctly documented code, modifier, unit, provider type, age, place of service, and facility designation. Where no HCA rate exists, the parties must approve a written rate before service. Preapproved business mileage is reimbursed at the Washington Office of Financial Management privately owned vehicle rate effective on the travel date ($0.725 per mile effective January 1, 2026). Travel time and other expenses are not separately payable unless approved in writing before travel. 10. TECHNOLOGY AND FUNDING COOPERATION Subject to available funding, applicable approvals, and a mutually approved written implementation plan, the parties may use secure telehealth, electronic referral, behavioral -health medication follow-up, and transition - support technology to improve access to the contracted services. Before deployment, the implementation plan will address ownership, approved location, space, power, connectivity, system access, privacy, security, accessibility, clinical safety, support, custody, incident reporting, and removal. Grant funds will not duplicate technology the County already provides under the service agreement. Upon reasonable request, the County may provide factual confirmation of the service relationship, identified operational need, intended location, and approved workflows for a funding application. This does not require the County to sponsor or endorse an application, provide matching funds, guarantee an award, purchase equipment, administer a grant, accept grant -compliance duties, or incur costs not separately approved in writing. 11. INCIDENTS, COMPLAINTS, AND ESCALATION • Immediate clinical or safety threats follow KCJ emergency procedures first, followed by prompt notice to Contractor leadership. KITTITAS COUNTY / VALLEY HEALTH AND COUNSELING I Page 2