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Home My WebLink AboutPSA CHCWPROFESSIONAL SERVICES AGREEMENT FOR PROVISION OF SERVICES This Agreement is made and entered into effect f 'J WI between Kittitas County Sheriffs Office and Community Health of Central W ashing o (hereinafter referred to as CHCW) WHEREAS, Kittitas County Sheriffs Office owns and operates the Kittitas County Corrections Center , WHEREAS, CHCW, through its physicians and practitioners, is engaged in the practice of medicine, as an independent contracting entity and offers services to the general public, including hospitals, clinics and individual persons and is qualified to provide Substance Use Disorder Treatment (SUD) to patients within the care of the Kittitas County Corrections Center. In consideration of the mutual covenants, conditions and promises contained herein, Kittitas County Sheriffs Office and CHCW hereby agree as follows: Kittitas County Corrections Center and CHCW share a common goal of early entry into medicine assisted treatment of opioid disorders and will work collaboratively to monitor the number of patients beginning substance use disorder treatment. 1. Services to be Provided by CHCW. 1.1 CHCW will provide medical treatment for SUD to person(s) incarcerated in Kittitas County Corrections Center as deemed appropriate by CHCW providers. 1.2 CHCW will triage inmates on the waiting list to get in as many patients as reasonable possible knowing that we may not be able to serve all patients requesting services. 1.3 Upon visit, prescriptions will be sent to the pharmacy of Kittitas County Correction Center's choice. 1.4 Next appointment reminders will be given to jail personnel. 1.5 Medical services shall reflect the exercise of the standard of care of a reasonably prudent health care provider in the same profession. 2. Non-Exclusive Services. CHCW shall provide SUD treatment to incarcerated patients in the care of the Kittitas County Corrections Center on a non-exclusive basis. 3. Qualifications. All providers providing SUD under this Agreement shall maintain, on an unrestricted basis: A. Li censure as a physician or other health care provider in the State of Washington; B. Federal DEA number for physicians; C. Certification by the American Board of Family Medicine; CHCW and each Practitioner agree to notify Kittitas County Corrections Center promptly in writing of any sanction, restriction, suspension, probation, termination or other change in any of the above qualifications. 4. Responsibilities of Kittitas County Corrections Center. 4.1 Transportation and supervision of incarcerated patients to and from the medical clinic located at 521 E. Mountain View Ave, Ellensburg, WA 98926. 4.2 Administration of medication as instructed by provider to patient. 5. Insurance. The terms of this section shall survive termination or expiration of this Agreement to cover claims arising during the term of this agreement and any applicable limitation term. CHCW shall maintain professional liability insurance for each physician or other provider providing services under the terms of this Agreement with minimum liability of limits of one million dollars ($1,000 ,000) per occurrence and three million dollars ($3,000,000) in the aggregate. 6. Billing. CHCW will make attempts to bill patient's insurance at time of service. CHCW will submit patient responsible medical claims, at least monthly, to Kittitas County Corrections Center for professional services rendered by CHCW staff for incarcerated inmates at the Jail. Billed charges shall be equal to L&I (Washington State Department of Labor & Industries) fee schedule. Payment for the services is expected within 45 days ofreceiving the claim(s) from CHCW. The Claim information will contain the inmates name, services rendered, and rendering provider of services (Medical or Mental Health Provider). Kittitas County Corrections Center will be required to provide CHCW a W-9 upon the agreement's effective data. 7. Term and Termination of Agreement. 7.1 This agreement will be in effect until either party chooses to terminate or request an amendment to the terms . 7 .2 Termination. Either party may terminate this Agreement at any time with our without cause and without penalty or premium upon ninety (90) days prior written notice. This Agreement shall terminate immediately (a) if necessary in Kittitas County Corrections Center's or CHCW's reasonable judgment, to protect patient health or safety, or (b) in the event CHCW or its Practitioners providing services on behalf of CHCW under the terms of this Agreement is excluded from participating in the Medicare and/or Medicaid programs. In the event of termination of this Agreement, Kittitas County Corrections Center and its Practitioners shall cooperate with and shall not interfere in the transfer of responsibilities of CHCW and its Practitioners to a successor entity or physician(s). 8. Miscellaneous . 8.1 Non-Discrimination. All decisions by CHCW that govern its employment practices, including the selection of physicians or providers assigned to Kittitas County Corrections Center under the terms of this Agreement, shall be made on the basis of qualifications, ability and performance, without regard to an individual's race, color religion, national origin, sexual orientation, age, sex, marital status, veteran status, or disability. All employment related decisions shall be made in accordance with all applicable laws prohibiting discrimination in employment. 8 .2 Binding Effect. All obligations and prohibitions imposed on CHCW or its Practitioners pursuant to this Agreement are equally applicable to each and every physician or provider providing services under this Agreement, and CHCW shall ensure that each such physician or provider agrees to be so bound. The CHCW CEO is hereby designated to act as its representative and he is hereby authorized to bind CHCW and its Practitioners with respect to all matters relating to the rights and duties of CHCW and its Practitioners pursuant to the terms of this Agreement. FOR: COMMUNITY HEALTH OF CBNTRA J FOR: KITTITAS COUNTY SHERIFF'S OFFICE Date G~U. Sheriff Gene Dana Kittitas County Sheriff g-/ ?.! ./7 ~ \ 7 Date I r ADOPTED this ifA-day of S UJlz:,nJt ffOl9. BOARD OF COUNTY COMMISSIONERS Kl a:.a.~"9-'f-tt+f'.i-:-1. ASHINGTON Kittitas County Review Form Grants & Contract Agreement Today's Date I Agenda Date August 22, 2019 September 3, 2019 Fund/Department 30 / Sheriff Contract/Grant Information Contract /Grant Agency: Community Health of Central Washington (CHCW) -SUD Services Period Begin Date: August 19, 2019 Period End Date: until terminated by either party Total Grant/Contract Amount: Grant/Contract Number: SH19-016 Contract/Grant Summary: This Agreement is between Kittitas County Sheriffs Office and Community Health of Central Washington (CHCW) to provide Substance Use Disorder (SUD) treatment for person(s) incarcerated at Kittitas County Corrections Center. CHCW will make attempts to bill patient's insurance, and then bill the patient's responsible share of the bill to KCCC. KCCC will bear the up-front cost of services, but will bill each patient's inmate trust account to recover as much of the cost as possible . Financial Information Total Amount$ Variable State Funds $0 Federal Funds $0 Percentage County Funds 100% Matching Funds $0 CFDA# NA In-Kind $0 Explain Is Equipment being purchased? NO Who owns equipment? NA New Personnel being hired? NO Contact HR hiring -reporting requirements -N/ A Future impacts or liability to Kittitas County: Contractor will maintain professional liability insurance as required by contract. Budget Information Budget Amendment Needed? Yes D attach budget form No[J Why not -Already budgeted New Division Created? NO Revenue Code NA Expense Code 001-300954113 Pass Through Information Agency to Pass Through NA Amount to Pass Through $0 Sub-Contract Approved Date: Grant/Contract Review Page 1 Prosecutor Review I Has the Prosecutor reviewed this agreement? I Yestxl No 0cAMAS#46599 County Departments Impacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted l I Signature: V, Department: She I Date: 'i? /,p~ /.;Wt</ _ I T ' Assignment of Tracking Information Auditor's Office Human Resource ... Prosecutor's Office ~ J / fj/,z. ri-/1' ) Who Signed the grant application / f I ( I Reviewer l Date Grant/Contract Review Page 2