HomeMy WebLinkAboutSH21-018 - CWU MAT EVALUATOR PARTIALLY EXECUTED15062
INTERLOCAL AGREEMENT
BETWEEN
THE STATE OF WASHINGTON
CENTRAL WASHINGTON UNIVERSITY
AND
KITTITAS COUNTY
THIS AGREEMENT is made and entered into by and between Central Washington
University,hereinafter referred to as "University"and Kittitas County,hereinafter referred to
as "County,"pursuant to the authority granted by Chapter 39.34 RCW.
The County has received a federal grant from the Department of Justice (DOJ),
Bureau of Justice Assistance (BJA)to develop and implement an evidence-based
medication assisted treatment program (MAT Program).Consistent with the University's
instructional,scholarship,public service,and research objectives,and consistent with its
status as a non-profit,tax-exempt,educational institution,the University will provide
professional services to the County to assist with the evaluation of this MAT Program.
IT IS THE PURPOSE OF THIS AGREEMENT for the University to arrange for
Assistant Professor,Dr.Roger Schaefer,to act as the Program Evaluator of the County's
MAT program to perform the duties as described herein.
THEREFORE,IT IS MUTUALLY AGREED THAT:
STATEMENT OF WORK
As the designated Program Evaluator,Dr.Roger Schaefer shall do all things necessary for
or incidental to the performance of the duties of Program Evaluator as set forth in the Scope
of Work,Attachment "A",which is attached hereto and incorporated herein.
PERIOD OF PERFORMANCE
Subject to its other provisions,the period of performance of this Agreement shall commence
on May 15,2021 and be completed on September 30,2023 unless terminated sooner or
extended,as provided herein.
PAYMENT
Compensation for the work provided in accordance with this Agreement has been
established under the terms of RCW 39.34.The parties have determined that the cost of
accomplishing the work herein will not exceed $6,250 annually,for a not-to-exceed total of
$18,750 over the term of this Agreement.Payment for satisfactory performance of the work
shall not exceed this amount unless the parties mutually agree to a higher amount.
Compensation for services shall be based on the following rates and in accordance with the
following terms,or as set forth in accordance with the budget in Attachment "B"which isattachedheretoandincorporatedherein.
BILLING PROCEDURE
The University shall submit invoices accompanied by a general ledger report no more oftenthanmonthly.Payment to the University for approved and completed work will be made bycheckbytheCountywithin30daysofreceiptoftheinvoice.Upon expiration of theAgreement,any claim for payment not already made shall be submitted within 30 days aftertheexpirationdateortheendofthefiscalyear,whichever is earlier.
RECORDS MAINTENANCE
The parties to this Agreement shall each maintain books,records,documents and otherevidencewhichsufficientlyandproperlyreflectalldirectandindirectcostsexpendedbyeitherpartyintheperformanceoftheservicesdescribedherein.These records shall besubjecttoinspection,review or audit by personnel of both parties,other personnel dulyauthorizedbyeitherparty,the Office of the State Auditor,and federal officials so authorizedbylaw.All books,records,documents,and other material relevant to this Agreement will beretainedforsixyearsafterexpirationandtheOfficeoftheStateAuditor,federal auditors,and any persons duly authorized by the parties shall have full access and the right toexamineanyofthesematerialsduringthisperiod.
Records and other documents,in any medium,furnished by one party to this agreement totheotherparty,will remain the property of the furnishing party,unless othenvise agreed.The receiving party will not disclose or make available this material to any third partieswithoutfirstgivingnoticetothefurnishingpartyandgivingitareasonableopportunitytorespond.Each party will utilize reasonable security procedures and protections to assurethatrecordsanddocumentsprovidedbytheotherpartyarenoterroneouslydisclosedtothirdparties.
RIGHTS IN DATA
Unless otherwise provided,data which originates from this Agreement shall be co-owned bytheUniversityandtheCounty.County acknowledges that data collected during thisevaluationmaybeusedbyDr.Schaefer to author peer review publications.All data usedforsuchlegitimateacademicpurposesshallbeprocessedinamannerthatcompletelydeidentifiesthedataandisconsistentwiththeBusinessAssociateAgreementattachedheretoasExhibit"D"and incorporated by reference.Data shall include,but not be limited to,reports,documents,pamphiets,advertisements,books magazines,surveys,studies,computer programs,films,tapes,and/or sound reproductions.Ownership includes the righttocopyright,patent,register,and the ability to transfer these rights.
INDEPENDENT CAPACITY
The employees or agents of each party who are engaged in the pedormance of thisAgreementshallcontinuetobeemployeesoragentsofthatpanyandshallnotbeconsideredforanypurposetobeemployeesoragentsoftheotherparty.
INDEMNIFICATION
Each party to this Agreement shall be responsible for its own acts or omissions and forthoseofitsofficers,employees,and agents.Neither party shall be responsible for the acts
or omissions of persons or entities not a party to this Agreement.
AGREEMENT CHANGES,MODIFICATIONS AND AMENDMENTS
This Agreement may be changed,modified,or amended by written agreement executed
by both parties.
TERMINATION
Either party may terminate this Agreement upon 30 days'prior written notification to theotherparty.If this Agreement is so terminated,the parties shall be liable only forperformancerenderedorcostsincurredinaccordancewiththetermsofthisAgreementpriortotheeffectivedateoftermination.
TERMINATION FOR CAUSE
If for any cause,either party does not fulfill in a timely and proper manner its obligationsunderthisAgreement,or if either party violates any of these terms and conditions,theaggrievedpartywillgivetheotherpartywrittennoticeofsuchfailureorviolation.Theresponsiblepartywillbegiventheopportunitytocorrecttheviolationorfailurewithin15workingdays.If failure or violation is not corrected,this Agreement may be terminatedimmediatelybywrittennoticeoftheaggrievedpartytotheother.
FORCE MAJEURE
Either pany may cancel this Agreement without obligation or liability to the other party in theeventthatitbecomesimpossibleorimpracticableforthatpartytoperformitsobligationshereunderbyreasonofforcemajeurebeyondthatparty's reasonable control,including butnotlimitedtofire,flood,earthquake,pandemic,or other acts of God,war,invasion,hostilities,rebellion,insurrection,or prohibitory or injunctive orders of any competent judicialorothergovernmentalauthority,civil or military.In the event of such cancellation,the partiesshallbeliableonlyforperformancerenderedorcostsincurredinaccordancewiththetermsofthisAgreementpriortotheeffectivedateoftermination.
DISPUTES
in the event that a dispute arises under this Agreement,it shall be determined by a DisputeBoardinthefollowingmanner:Each party to this Agreement shall appoint one member totheDisputeBoard.The members so appointed shall jointly appoint an additional member to
the Dispute Board.The Dispute Board shall review the facts,agreement terms andapplicablestatutesandrulesandmakeadeterminationofthedispute.The determinationoftheDisputeBoardshallbefinalandbindingonthepartieshereto.As an alternative tothisprocess,either of the parties may request intentention by the Governor,as provided byRCW43.17.330,in which event the Governor's process will control.
GOVERNANCE
This Agreement is entered into pursuant to and under the authority granted by the laws ofthestateofWashingtonandanyapplicablefederallaws.The provisions of this Agreement
shall be construed to conform to those laws.
In the event of an inconsistency in the terms of this Agreement,or between its terms and
any applicable statute or rule,the inconsistency shall be resolved by giving precedence inthefollowingorder:
a.Applicable state and federal statutes and rules;
b.Statement of Work,Attachment "A";
c.Budget,Attachment "B";
d.Project Narrative,Attachment "C";and
e.Any other provisions of the agreement,including materials incorporated by
reference.
ASSIGNMENT
The work to be provided under this Agreement,and any claim arising there under,is notassignableordelegablebyeitherpartyinwholeorinpart,without the express prior writtenconsentoftheotherparty,which consent shall not be unreasonably withheld.
WAIVER
A failure by either party to exercise its rights under this Agreement shall not preclude thatpartyfromsubsequentexerciseofsuchrightsandshallnotconstituteawaiverofanyotherrightsunderthisAgreementunlessstatedtobesuchinawritingsignedbyanauthorized
representative of the party and attached to the original Agreement.
SEVERABILITY
If any provision of this Agreement or any provision of any document incorporated byreferenceshallbeheldinvalid,such invalidity shall not affect the other provisions of thisAgreementwhichcanbegiveneffectwithouttheinvalidprovision,if such remainder
conforms to the requirements of applicable law and the fundamental purpose of thisagreement,and to this end the provisions of this Agreement are declared to be severable.
CONTRACT MANAGEMENT
The program manager for each of the parties shall be responsible for and shall be the
contact person for all communications and billings regarding the performance of thisAgreement.
The Program Manager for University:Roger Schaefer,Ph.D.,Assistant Professor,Law
and Justice,Central Washington University,400 E University Way,Ellensburg WA
98926 (509)963-3529,Roger.Schaefer@cwu.edu.
The Program Manager for County:Edward L.Buntin,Corrections Lieutenant #J30,Kittitas County Sheriff's Office,(509)962-7527,edward.buntin@co.kittitas.wa.us.
ALL WRITINGS CONTAINED HEREIN
This Agreement contains all the terms and conditions agreed upon by the parties.No otherunderstandings,oral or otherwise,regarding the subject matter of this Agreement shall bedeemedtoexistortobindanyofthepartieshereto.
IN WITNESS WHEREOF,the parties have executed this Agreement.
Central Washington University Kittitas County
5/18/2021
Signature Signature"'
g Kevin Archer,Dean,College of Clayton Myers,SheriffGraduateStudies&Research
RATIFIED this day of 2021.
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY,WASHINGTON
Chair
Vice-Chair
Commissioner
ATTEST:R ED AS TO FORM:
Douglas R.MitcheÍÍ,D uty Prosecuting Attorney
O Clerk of the Board-Julie Kjorsvik
O Deputy Clerk of the Board-Mandy Buchholz
Attachment "A"-Scope of Work
The Kittitas County Jail has been awarded grant funds to developand implement a medication assistedtreatmentprogram.The grant narrative outlines specific aspects of the proposed program including thedutiesofaprogramevaluator.The grant narrative does not specify an evaluator,however,it doesoutlinewhataspectsoftheprogramneedtobeevaluated.
The evaluation parameters are discussed on pages 15 through 18 in the grant narrative,a copy of which
is attached hereto as Attachment "C".Below is a summary of the expected evaluator duties andresponsibilities.
In accordance to the expectations associated with federal grant monies,the program made possiblethroughBJAfundswillbesubjecttoaformalevaluation.The program evaluation will be conducted in amannerthatisfullyalignedwiththestandardsandbestpracticesutilizedby,and within the realm ofsocialscienceevaluation.Further,the program evaluation will adhere to the guidelines,expectation,andparametersdefinedbytheCentralWashingtonUniversityInstitutionalReviewBoard(IRB)and HumanSubjectsReviewCouncil(HRSC).Per the grant narrative,the evaluation will examine both the processandtheoutcomesoftheMATprogram;and will employ a mixed methods research design.
The specific tasks are outlined below.
1)Design and implement an evaluation study that examines the following:Intake assessment andbaselinedata;treatment progress metrics;implementation procedures and integrity;stakeholder perceptions;correctional outcomes;and challenges and barriers.
2)Communicate with Kittitas County Sheriff's Office,jail and program administrators,treatmentproviders,custody staff,and BJA facilitators.
3)5ubmit the necessary applications and engage in the proper review process for approvalformtheCentralWashingtonUniversityInstitutionalReviewBoard(IRB)and Human Subjects ReviewCouncil(HSRC).In the event that another IRB/HSRC has granted approval,the proper reciprocityproceduresmustbefollowedtoensurethatDr.Schaefer of fully aligned with expectation ofCentralWashingtonUniversity.
4)Maintain rigorous ethical,methodological,and scientific standards throughout the entirety ofevaluationprocess--both during and after the completion of the grant funded MAT program.
5)Oversee data collection,acquisition,and analysis.These tasks include but are not limited tosurveycreationandvalidation;conducting interviews and focus groups,direct observation,record data analysis,instrurnentation (item inclusion),and necessary follow-up.
6)Overseeing/co-authoringa final report based on the analysis of all data collected throughout theprogramevaluationprocess.This final report will be subrnitted as a deliverableto the DOJ/BJA.Co-authors for this report will include but is not limited to Dr.Roger Schaefer (programevaluator);Ueutenant Ed Buntin (grant administrator);SuperintendentSteve Panattoni.
7)Upon the completion and submission of the final report,Dr.Schaefer will work with KittitasCountyJailadministratorsandstafftodevelopaplantofullutilizethefindingsoftheevaluation
-completing the evidence-based cycle.
Attachment "B"-Budget
$4,699 Schaefer salary
$1,551 Schaefer benefits
$6,250 Total Cost per Year
Attachment "C"
Program Narrative:Kittitas County Jail MAT Program
Statement of the Problem
Kittitas County Sheriff's Office requests consideration for funding through the Bureau of
Justice Assistance's (BJA)Comprehensive Opioid,Stimulant,and Substance Abuse Program
(COSSAP)under Category 1,Subcategory le as a rural county with a population of fewer than
100,000.If funded,Kittitas County Sheriff's Office proposes to expand and enhance evidence-
based medication-assisted treatment (MAT),as well as recovery support services within the
Kittitas County Jail.Kittitas County Sheriff's Office serves those incarcerated,which includes
American Indians/Alaskan Natives,Veterans,pregnant and post-partum women,and
uninsured/underinsured populations.This information will be tracked and reported throughout
the process.
Kittitas County Sheriff's Office currently contracts with Whatcom County jail,U.S
Immigration and Customs Enforcement (ICE),Washington Department of Corrections (DOC),
and the U.S Marshals Service,of whom all house inmates regularly inside our jail.With this
grant,Kittitas County Sheriff's Office will procure a contract with a MAT provider in
Washington state.Due to shortage of treatment providers in Kittitas County and the number of
inmates housed under contract,Kittitas County Sheriff's Office is seeking a MAT partner that
can provide services within the jail,the county,and major cities across the state of Washington.
A partner with an extensive reach will ensure a smooth transition from jail MAT to community
treatment regardless of the inmate's home location.
Kittitas County Sheriffs Office currently participates in the state of Washington's
Division of Behavioral Health and Recovery (DBHR)Hub and Spoke Project.The Hub and
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Spoke model connect a network of community providers around a central hub,curently located
in Yakima,Washington,offering a MAT component to all patients seeking treatment.Kittitas
County Jail participates in this program as a Spoke,providing treatment referrals to the state-
funded Hub entity.While participation in this program has created an avenue for access where
one did not previously exist the Hub entity can only provide minimal services in the Jail on a
part-time basis.Currently the program serves approximately 12-19 inmates on a part-time basis,
but a full-time program is needed to adequately address the needs of the estimated 30%of
inmates (28+inmates based on the average daily population)in need of treatment.A full-time
Nurse Care Manager (NCM)and peer support specialist on-site would allow for adequate
coverage of MAT treatment,care coordination,and community referrals to support services.
Kittitas County Jail is located in Ellensburg,Washington.As of July 2019,Kittitas
County has an estimated population of 47,9351.A comparison of demographics between our
larger community and the jail population we intend to serve is illustrated in the Table 1 below.
Table 1.Kittitas County and Jail Population Demographics
County Population Jail Average Daily Population
Total 47,935 95
White non-Hispanic 83.8%69.82%
Hispanic or Latino 8.9%17.59%
Asian 2.3%0.39%
Mrican American 1.2%3.85%
American Indian 1.3%1.69%
i U.S Census Bureau.(20 IS).Quickfacts:Kittitas County.In U.S Census Bureau .Retrieved from
https://www.census.gov/quickfacts/fact/table/kittitascountywashington/BZA010217
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In Kittitas County injury and poisoning are among the leading causes of hospitalization
among adults ages 25-64,not including hospitalizations for pregnancy and childbirth.These rates
are concerning as they are all significantly higher than the state rates2.Drug overdose deaths are
a largely preventable cause of premature death in a population.Prescription drug abuse-
particularly opiates-has reached epidemic levels within the United States.3 The indicator for drug
misuse in a population is the number of drug poisoning deaths per 100,000 population.There
were 11 total deaths due to drug overdose in Kittitas County (combined years 2014-16)including
all prescription and intravenous drug use."Tlie niortality rate due to all drug overdoses is 8 per
100,000.In 2016,the inortality rate for opiate overdose is less than 1.6 per 100,000.6 Kittitas
County has the fifth lowest rate of death due to drug poisoning in the statet While the county
appears to be addressing the opioid epidemic successfully,it is important to note that
incarcerated individuals are disproportionately affected by substance use disorder compared to
the general population.At point of intake,over 30%of newly incarcerated individuals reported
experiencing a substance use disorder to a corrections department staff member.The actual
representation may be higher when disclosure is moved to a medical setting.
Program-specific Priority Area -A lack of accessibility to treatment providers and facilities
2Washington State Department of Health,Center for Health Statistics.WA Hospital Discharge Data,Comprehensive Hospitalization Abstract
Reporting System (CHARS)1987-2015.Cornmunity Health Assessment Tool (CHAT),August,2016.
*Centers for Disease Contral and Prevention.Increases in drug and opioid overdose deaths -United States,2000-20]4.Morbidity and Mortality
Weekly Report (MMWR)64{50)(Centers for Disease Control and Prevention).2016:1378-82.Available at:
https://www.cdc.govimmwr/preview/mmwrhtmilmm6450a3.htm (Accessed February 3,2018}
*University of Wisconsin Population Health Institute.County Health Rankings and Roadmaps.2018.Available
at:http://www.countyhealthrankings.orglapp/washington/20L8/rankings/kittitasicounty/factorsloverall/snapshot(Accessedlanuary22,2018).
*Washington State Department of Health,Center for Health Statistics.Washington State Drug Overdose Quarterly Report:Drug Overdose
Deaths 2017 First Three Quarters and 2016 Maps.Community Health Assessment Tool (CHAT),February I2,2018.(Accessed March 3 l,2018)
University of Wisconsin Population Health Institule.County Health Rankings and Roadmaps.2018.Available
at:http://www.countyhealthrankings.org/app/washington/2018/rankings/kittitas/county/factors/overallisnapshot (Accessed January 22,2018).
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Kittitas County is currently experiencing a shortage of providers for primary,mental,and
dental healthcare.The ratio of Kittitas County residents to primary care physicians is 1570:1.
This is higher than the state's ratio of 1190:1.2 The ratio of residents to mental health providers
is 710:1.That is more than twice as many residents per mental health provider as the state ratio
of 360:1."The ratio of residents to dentists is 2,700:1.Again,this is nearly twice the state ratio of
1250:l.
Due to the shortage of primary and mental health care providers,residents are unable to
receive the necessary medical attention to treat substance abuse disorders.According to the NIH,
individuals who use illicit drugs are more likely to commit crimes,and it is common for many
offenses,including violent crimes,to be committed by individuals who had used drugs or alcohol
prior to conunitting the crime,or who were using at the time of the offense.'°Once in the Kittitas
County Jail,due to limited budgets and staff,unfortunately inmates can only receive minimum
care for their addictions.To address the provider shortage and other rural challenges Kittitas
County Sheriff's Office proposes to expand and enhance evidence-based treatment as well as
recovery support services within the Kittitas County Jail and it has been determined to a
contractor should be used to deliver services to best serve the inmates at Kittitas County Jail.By
identifying a provider group that can provide both jail full-time on-site MAT services and
establish a local presence the proposed project will impact the inmates upon release and the
greater commuinty.
2University of Wisconsin Population Health fastitute.County Heahh Rankings and Roadmaps.2018.Available
at:http://www.countyhealthrankings.orglapp/washington/2018/rankings/kittilas/county/factorslaverallisnapshot (Accessed January 22,20]8),*University of Wisconsin Population Health Institute.County Health Rankings and Roadmaps.20I8.Available
at:http://www.countyhealthrankíngs.org/app/washington/2018/rankings/kittilas/county/factorsloverallisnapshot (Accessed January 22,2018)."University of Wisconsin Population Health Institute.County Health Rankings and Roadmaps.2018.Available
at:http://www.countyhealthrankings.orglapp/washington/2018/rankings/kittitas/county/factorsloverallisnapshot (Accessed January 22,2018).10 NIDA.(2014,April 18)Prmeiples ofDrug Abuse Treatment for Criminal Justice Populations -A Research-Based Guide.Retrieved from
https://www.drugabuse.gov/pubheations/principles-drug-abuse-treatment-crirninal-justice-populations-research-based-guideon2020,May 17
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OJP Policy Priority Areas -Poverty,Rural Community,and Qualified Opportunity Zones
Kittitas County ranked second worst in the state for income inequality.*The US Census
Bureau determines who is in poverty by comparing a set of money income thresholds (lowest
amount of income an individual can survive on)to overall family size and composition.
Figure 1.Kittitas County Poverty &Housing Costs"
O 25¾
-mtas county,wA (n.1ss)
Washington (13.26%)
United 5tates 15A7%}
50%
-xntitas county,wA (as.ssal
washington (35.08%)
United States (33 93%)
This measure does not vary by geographic area but is adjusted for inflation.In Kittitas
County,22%of residents are living in household with income below the federal poverty line.13
In Kittitas County,approximately 39%of households have housing costs that amount to over
30%percent of the household's income.Kittitas County ranks third worst in the state for this
measure.'"
"University of Wisconsin Population Health Institute.County Health Rankings and Roadmaps.2018.Avalable
at:http://www.countyhealthrankings.org/app/washington/2018/rankings/kittitas/county/factorsloverallisnapshot (Accessed January 22,2018)."Kittitas County Public Health Department.(2018,April).The Health ofKittilas County A profile afhealth,well-being and quality of life in outcommunity.In Kittitas Countv.Retrieved from https://www co.kittitas.wa us/health/reports*Community Commons.Community Health Indicator Report.www.communitycommons.org.2018,Available at;
https;//assessment.communitycommons.org/CHNA/SelectArea.aspx?reporttype=libraryCHNA"Community Commons.Community Health Indicator Report.www.communitycommons.org.2018.Available at,
https://assessmenLeommunitycommons.org/CHNA/SelectArea.aspx?reporttype=libraryCHNA
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The Kittitas County is a designated rural as defined by the Federal Office of Rural Health
Policy and considered outside an urbanized area as defined by CMS -Rural Health Clinics
Progran 6.Figure 2 below displays the location of Kittitas County Jail in relation to the
county's two census tract Qualified Opportunity Zones (53037975500 and 53037975600)t6
Figure 2.Kittitas County -Quahfied Opportunity Zones
Retrieved from:CDFI Information Mapping System"
CI MS
¯
Eit&as Co-y Ceneciens
2011-2015 UC Census Tract 53037975500
NMTC Quaified Yes
Qualified Opponunity Zone:Yes
Populanon 4 417
Median income (½\:9 07
Poverty Rat.(¾y y 90 -¯¯¯¯
Unemployment Rats (¾]:7 70
Metro Designation:Man-r.I :r:>po tan
Tract Unemployment to National Unem¢oyment
2011-2010 UC Census Tract 53037975800
NMTC Qualified:Tes
Qualified Opponunity Zone:Yes \Population i 997
Median Income (%|:54 N
Poverty Rate (5.}.P *
Unemployment Rate(%F 9 10
MetroDesignation:Nou.aro are
Tract Unemployment to Nationa3 Unem¢oyment
Natio:0 98
Due to shortage of treatment providers in Kittitas County and the number of inmates
housed under contract,Kittitas County Sheriff's Office is seeking a MAT partner that can
provide services within the jail,the county,and major cities across the state of Washington.A
partner with a commitment to serving the Ellensburg,WA area and an extensive reach will
ensure a smooth transition from the Jail MAT Program to community treatment regardless of the
I"Am I Rural?-Report.(2020,April 24).In Rura/Health Infommtion Hub (RHIhub).Retrieved from https:Hwww.ruralliealthinfo.org/am-i-rural/report?!at=46.997L3&lng=-120.54940&addr=205%20W%20Sth%20Ave%2C%20Ellensburg%2C%20WA%2098926&exact=I
*Intema1Revenue Service.(2018,July9).Designated Qualified Opportunity Zones under Intemal Revenue Code §140DZ-2 Notice 2018-48.
In /RS.Retrieved fiom https://www.irs.gov/pub/irs-drop/n-18-48.pdf"Community Development Financial Institutions Fund.Retrieved April 24,2020,fromhttps://www.cims.cdfifund.gov/preparation/?config=config nmtc,xml
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inmate's home location.This conunitment to increasing MAT access to the greater community,
in addition to the inmates at the Kittitas County Jail,will impact both of Kittitas County's
Qualified Opportunity Zones.
Drug treatment has been shown to be both less expensive and more effective at reducing
recidivism,drug abuse,and crime compared to prison".Dr.Nora D Volkow,the director of the
National Institute on Drug Abuse,stated "Detox alone in jail or prison is not treatment.Without
proven treatment and therapeutic follow-up in a community setting,addicted offenders are at a
high risk of relapse despite a long period of forced sobriety.""By instituting evidence-based
treatment in the jail setting,along with a clear path for care coordination post-release,the
proposed program should have a positive impact on the public safety20 of the area surrounding
the Kittitas County Jail.
Program Design and Implementation
With the size and complexity of the Kittitas County Jail in mind,as well as best practice
guidelines published by SAMHSA and other organizations for cutting operational costs in jails
related to inmates going through withdrawal,reducing overdose rates post-release,and lowering
the rate of recidivism the following minimum qualifications will be used to identify a partner to
provide onsite medication-assisted treatment for inmates with substance use disorder.The
Kittitas County Jail has researched available MAT organization and reviewed programs offered
in other jail programs in the State of Washington.The Kittitas County Jail is confident an
organization with all minimum qualifications can be procured for this project.
3"National Admissions to Substance Abuse Treatment Services,2005.Treatment Episode Data Set (TEDS)Highlights-2005;Harrison,Paige M.
and Allen J.Beck.2006.Prisoners in 2005.Washington,DC:Bureau of Justice Statistics
*National Institute on Drug Abuse.NIDA announces recommendations to treat drug abusers,save money.and reduce crime.Press release July
24.2006.Online at:http://drugabuse.gov/newsroom/06/NR7-24html
*Naturajan,Nila,et al."Substance Abuse Treatment and Public Safety."Justice Policy Institute .,Jan.2008,
www.justicepolicy.orglimages/upload/08_01_rep_drugtx ac-ps.pdf.
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Minimum Qualifications:
•5+years providing MAT to patients in an Office Based Opioid Treatment (OBOT)setting.
•Staff experience with correctional medicine and correctional healthcare partners.
•l+year of experience providing MAT to inmates in correctional facilities.
•Experience providing 24/7 on call consultation to jails and medical oversight to providers,
nurses,and medical assistants conducting MAT related activities inside of the jail.
•Ability to accept new patients at outpatient clinics within 72 hours of release.
•A currently established or commitment to establish an outpatient clinic in Ellensburg,WA.
•Presumptive and defmitive internal laboratory operations to rapidly diagnose and treat opioid
use disorder (OUD),alcohol use disorder (AUD),mental health disorders,Hepatitis C,and
sexually transmitted infections (STI).
•Accepts Medicaid,Medicare,and private insurance in addition to self-pay at clinics.
•Must have significant X-DEA/Buprenorphine Waiver capacity.
•Evidence of corporate financial stability and experience with rapid operational expansion.
•Actively networked with connnunity-based organizations state-wide.
Screening
Current Kittitas County Sheriff's Office staff collect urine samples from individuals entering
the jail per standard intake protocol.Currently inmates are referred to the Hub and Spoke
treatment as resources allow.Under the proposed project,all inmates will be screened for a
possible OUD concern would be referred to the MAT partner organization.The MAT partner
organization staff will begin with a general assessment for all substance use disorders (SUDs)
utilizing NIDA validated screening tools (NIDA quick screen,NIDA Modified ASSIST).If
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opioids are a primary substance of abuse,both the DSM 5 Criteria for the Diagnosis of Opioid
Use Disorder and the Clinical Opioid Withdrawal Scale will be utilized.Assessment for other
SUDs and withdrawals will also occur during initial screening.For example,if alcohol is
identified as a substance of abuse,the DSM S Criteria for the Diagnosis of Alcohol Use Disorder
and the Clinical Institute Withdrawal Assessment for Alcohol will be used.A combination of
screening/assessment instruments as well as the individual characteristics of each patient will be
used to identify appropriate and willing candidates for MAT.The screening flow is demonstrated
in Figure 3 below.
Figure 3.Inmate flow
GAIN-SS
jfo¯king/Triage
-,,•Urinedrugscreen
Screening for SUD history
I Substance Use
Disorder (SUD}
Screened in for en SUD not
i Alcohol Use Benzodiazepine Oploid Agonist arnandable to i
No SUDDisorderUseDisorderTherapyMedication-
(OAT)Assessment Assisted Treatment
Clinical institute Clinical Opiate !Cleared for Cleared for iWithdrawalMedicallyWlanagedWithdrawalScaleclassificationfor--chassificationfor
(C
eA}Sment Withdrawal (COWS)Score |housing housing
Me drMaareged Medical cla a i for
housing
Medical
While local MAT program medication options may include buprenorphine HCL,Naltrexone
HCL,and Vivitrol IM,the Jail MAT program will only offer Buprenorphine HCL at this time.
Onsite Services
Intake:A full-time onsite Nurse Care Manager (NCM)will assist each imnate who has been
pre-screened using an evidence-based screening tool provided by the MAT partner organization,
and identified as a candidate for MAT by the jail correctional or medical staff,to complete new
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patient paperwork.Forms include a Consent to Treat and a Consent to Release Information,
allowing patient data to be shared between the jail and the MAT partner organization.
Induction:A licensed,X-DEA waivered provider and NCM will operate from inside the jail
to conduct a medical exam of each inmate who has completed the new patient paperwork.If the
provider diagnoses the inmate with substance use disorder and confirms the imnate is a candidate
for MAT,the provider will prescribe an appropriate dose of medication and the NCM will handle
documentation,registration,and induction dosing.In addition to inducting new patients,the
provider will review patient charts weekly and refill or adjust prescriptions as appropriate.
Dosing:The NCM will prepare medication doses,administer balloon dosing (3 times per
week)or daily dosing if medically appropriate,directly to all inmates on the MAT program,and
maintain accurate electronic medical record (EMR)documentation.The dosing schedule will be
detennined by command staff in collaboration with the MAT partner organization during the
implementation planning phase.
Care Coordination:The Peer Support Specialist will coordinate scheduling of ongoing care
for inmates at the MAT partner organization's local clinic,starting immediately post-release.
Care coordination includes appointment scheduling,documentation,financial counseling,
referrals to services,and communication with the patient to ensure smooth transition from onsite
services to outpatient services.
Staff Training:The MAT partner organization will deliver initial and refresher training to all
command and corrections staff on opioid use disorder,withdrawal symptoms,medication
information,dosing protocols,and the role of behavioral counseling.Scheduling and the final
content of training seminars will be determined by command staff during the implementation
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planning phase.Medical staff will be on call for phone-based clinical consultation as needed for
any questions or issues related to MAT that come up after hours for medical or correctional staff.
Post-Release Coordination and Services
MAT partner organization prescribing staff and the NCM will meet with individuals
currently incarcerated and establish a provider/patient relationship.Once the individual is
released from jail,he/she will have had their first appointment or will attend their first
appointment,scheduled with the MAT partner organization.If there is any time lapse between
release and appointment,the individual will receive reminder call.
An appointment will be already scheduled at the MAT partner organization in Ellensburg and
transportation waiting for these individuals,as needed,upon release from custody.The MAT
partner organization will also aid in the application process for insurance for the uninsured so
that care and the individual's medication can be paid for after their release from the Kittitas
County Jail.The MAT partner organization will need to ensure flexibility in their scheduling as
well and will be able to accommodate changes in release dates.
Ongoing medication-assisted treatment and appropriate lab testing with a licensed addiction
medicine provider and medical staff at the MAT partner organization's Ellensburg clinic
location.Addiction to all substances,including opioids,methamphetamines,alcohol,marijuana,
and tobacco is treated along with prescribing of medications where appropriate,including
Suboxone®/buprenorphine,Vivitrol®/naltrexone,disulfiram,acamprosate,gabapentin,
carbamazepine,and pregabalin.Costs are to be covered by insurance,including Medicaid.
42 CFR part 2 Compliant
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Kittitas County Sheriff's Office has developed 42 CFR part 2 compliant consent forms that
encompass all requirements set forth by the Legal Information Institute and the Legal Action
Center.All staff are fully trained in the utilization of consent forms prior to start of work.
Ongoing training is provided annually,or sooner,as rules change.The elements of each consent
are fully understood.We utilize two types of consent forms:Consent to Treat and Consent to
Release Information.Each consent form has the Prohibition on Redisclosure statement.All
participants will be fully informed of their right to sign,revoke,and/or limit the consent form.
These forms will be maintained within participant file and date/event of expiration will be
monitored.The initiating site will maintain the original consent form and a copy will be provided
to the referent.No participant information will be disclosed without a valid consent form being
completed,unless otherwise allowed by law (medical emergency,mandatory duty to report,
etc.).
Under 42 CFR Part 2,Subparts 34 and 35 disclosures may also be made to other correctional
facilities and to judicial agencies when participation in a program is a condition of their release
or parole.All elements of these subparts will be followed and documented within the participant
file.
Capabilities and Competencies
Our initial concerns focus primarily on being able to appropriately staff the jail with qualified
and culturally informed personnet A MAT partner organization will need to have developed a
list of appropriate candidates for the positions needed with the ability to have a full staff no later
than 12/01/2020 and will be able to provide services by 12/31/2020.
Kittitas County Sheriff's Office will seek a MAT partner organization that consists of
medical providers carrying certifications in Addiction and Emergency Medicine,Internal,
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OB/GYN,and Family Medicine,among other specialties.The potential MAT partner
organization will also need to employ social workers,caseworkers,counselors,and mental health
practitioners.This diverse staff will lead to a holistic approach driving positive outcomes,
including family stability,stable housing,improved overall health,and reduced rates of
recidivism.
Kittitas County Sheriff's Office Project Lead:
Kittitas County Sheriff's Office has identified Lieutenant Edward Buntin as the Project
Lead.Lieutenant Buntin will oversee the budget,project contracts,correctional staff,and other
grant duties.As project lead,Lieutenant Buntin will work closely as the point of contact with
Kittitas County leadership,BJA grant staff,MAT partner organization,and his local conununity
to make sure the scope and direction of the project is completed.
Lieutenant Buntin was hired with the Sheriff's Office in January 2005.He has worked as
a Control Room Operator,Corrections Officer,Corporal,Sergeant and has been the Lieutenant
since 2015.Lieutenant Buntin graduated from the Washington State Corrections Officer
Academy in 2005 and continues to attend regular education events and in 2018 received a
Middle Management Certification from the Washington State Criminal Justice Training Center.
Lieutenant Buntin is responsible for the planning,organization,and directing of the
activities for corrections staff to insure the lawful and proper care of inmates.In his duties,
Lieutenant Buntin maintains effective working relationships with administrative personnel,
public agencies,and the general public to accomplish work under the guidance of State and
Federal laws and regulations,Sheriff s Office and County polices,regulations and procedures.
Other duties include inventory control,training for staff,overseeing civilian law enforcement
clerks,volunteer (Ministry,Narcotics Anonymous,Alcoholics Anonymous,etc.)programs,
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civilian cooks,performance evaluations,disciplinary actions and performances,policy,
purchasing,complaints,grants,and more.
Program Evaluator
The Program Evaluator is responsible for managing all program evaluation activities and serves
as the liaison to BJA project evaluators.The Program Evaluator will work with the Kittitas
County Sheriff's Office Project Lead and the MAT partner organization Program Coordinator to
develop,implement,and oversee the BJA program evaluation.
Program Coordinator (MAT Partner Organization):
The Program Coordinator will serve as an administrative professional specialized in
managing,coordinating,implementing,and evaluating the MAT Partner Organization's medical
services.Responsibilities will include,but are not limited to,ensuring implementation of policies
and practices,facilitating positive relations within the grant program team and external parties,
providing relevant project information updates,communicating between Kittitas County
Sheriff's Office and the MAT Partner Organization,and creating presentations,summaries,and
reports to ensure communication and program transparency for stakeholders.
Medical Staff (MAT Partner Organization)
Mid-Level Provider
A provider with one of the following credentials:medical doctor (MD/DO),physician
assistant (PA-Cs),or nurse practitioners (ARNP,CRNP).The provider will need to have
received up to 24 hours of training and received their DEA waiver to prescribe buprenorphine.
Established connections with agencies,such as the American Society of Addiction Medicine
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(ASAM),and continued education regarding the most up-to-date,evidence-base treatment
available is preferred.
Nurse Care Manager (NCM)
The NCM's responsibility will be to overseeing health,wellness,and medical processes
for patients undergoing treatment at the Kittitas County Jail.The NCM will also provide
screening,triage,crisis intervention,medical services,case coordination,and education and
referral services.The NCM shall utilize best practices to engage and help motivate patients to
commit to treatment and to assist patients to identify and problem-solve individual and systemic
barriers to treatment.
Peer Support Specialist
The Peer Support Specialist will provide support for those who are going through
treatment or are new to recovery utilizing their life experiences and recovery.The Peer Support
Specialist will interface with patients individually and with the members'care team.The Peer
Support Specialist will work patients to prepare for their transition into the community including,
but not limited to,coordinating transportation,providing referrals to community organizations,
scheduling treatment follow-up,and applying for health insurance.
Plan for Collecting the Data Required for this Solicitation's Performance Measures
Kittitas County Sheriff's Office believes strong program evaluation can help identify the
best investments as well as determine how to establish and sustain them as evidence-based best
practice.Due to this commitment to the utilization of evidence-based practice,Kittitas County
Sheriff s Office is proposing the inclusion of a formal program evaluation.
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The Program Evaluator would be in continuous contact with all providers to gather the
required infonnation including completing surveys.Open lines of communication are to be
established between the jail site,the MAT off-site clinic,and federal program staff to ensure
appropriate steps are being taken to conduct evaluation.
Evaluation Development 21
The Program Evaluator will work with all program partners to ensure communication and
completion of evaluation components.Figure 4 displays an overview for the development of the
program's evaluation plan,while Figure 5 highlights the standards to be used during the
development.
Figure 4.Steps to Evaluation Develo ent
Figure 5.Evaluation Standards
Accuracy
Ensuring that an evaluation will
reveal and convey technically
/adequate information about the
features that determine worth or
merit of the program being
evaluated,
Propriety UtilitvEnsuringthatan"
evaluation will be Evaluation Ensuring that an
conducted legally,Standards evaluation will serve the
ethically and with due information needs of
regard for the welfare of intended users.
those involved.\Feasibility
a CDC guideline citation:Program Performance Ensuring that an evaluation i Evaluation.In Center for Disease
Control and Prevention.Retrieved May 4,2020,fr*will be realistic.prudent
diplomatic and frugat
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The evaluation of this program will involve a mixed method approach consisting of
participant interviews,MAT retention rates,and process metrics.The main themes of the
evaluation will focus on the impact to program participants and Kittitas County's treatment and
recovery population.The logic model below,Figure 6,displays the relationship of the program's
resources,participants,activities,anticipated products along with the programs intended effects
highlightedin the short term,intermediate,and long-term outcomes/impacts portion.
Figure 6.Evaluation Logic Model
Short term lissam.dian tang-tenn
Partne<väth
57.tf
MAT Partner
comniunity services Implementation
TB-e Organization Trainstaff debriefsammag
a p tncreaseutJIirational DecreaserecidMsm
P=I Is Kittt.iscounty Protocoddevelopment Programprotocols
Decreaselucidenceof
OUDtreatnient Decraseincidental
individuals in recovery
Cmreca Facáty
Eommunity
Medicaiservices EvaldaLiocrepon IRCreasecap¥ltyfor
IncreaseparlEnt
stakeholders Frograrn monitoring Flequired contract retention in MAT
Caucty and State andimprovement deliverables increaseDpropertion of services.Reducestigmarelated
Lo-tDua Evaluatienteam
conductprogram Gustainabilityaction transitioningte improveservices tosubstanceuse
Eqcvwt BureauofrosMee evaluation pian community treatment
Assistance
5ustainabilityexercise
Situation/Pmgram:
Pmject Evaluation Plan for Kitt|ta5County Co<rettians
A cdtical need to provida this service exists.temmurdty readiness and political atmosphere.
disorder
During the first month of the contract period,the Program Evaluator will collaborate with the
Kittitas County Sheriff s Office and BJA program staff to develop a formal evaluation protocol.
The formal evaluation protocol will define metrics and methodology of data collection.Potential
data collection tools include,but are not limited to:
L Kittitas County Correctional Data
17 of 20
2.Treatment Information
3.Survey tool to assess the quality of treatment and self-reported changes in OUD
knowledge,confidence,and readiness for transition into the community.
4.Community transition and treatment retention rates.
5.Process notes such as annual summary reports,quarterly program monitoring meeting
notes,or contract deliverables to identify the successes and challenges of delivering the
program along with opportunities for improvement.
The Program Evaluation will communicate information regarding all aspects of the program
evaluation to staff to ensure clear expectations for the final program evaluation report.The
Program Evaluator will provide Kittitas County Sheriff's Office,the MAT partner,and BJA staff
with ample opportunity to provide insight and feedback to the report's methodology,format,and
focus.
Data Collection
The NCM and Peer Support Specialist will complete the intake assessment to establish
baseline data.Periodic benchmark data collection,via interviews or surveys,will be conducted if
all required data cannot be collected from partners.Table 2 provides a potential outline for
evaluation metrics and data collection.
Table 2.Potential Data Collection
Potential Program Metrics
•Percent of individuals screened for OUD
•Percent of Individuals diagnosed with OUD
•Percent of Individuals offered MAT
•Percent of Individuals who initiate MAT
•Average Length of Stay
•Percent of individuals who remain on MAT at the time of release to the community
•Percent of Individuals who have an appointment scheduled with a community MAT
provider when released
•Percent of Buprenorphine recipients given a bridging supply or prescription.
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•Percent of individuals insured at the time of release.
•Decrease number of disciplinary reports
•Decrease incidence of contraband drug confiscation
IndividualLevel Data
Data Element Description Source
Detention Type Pre-trial,sentenced Kittitas County Jail
Demographics Age,gender,race/ethnicity Kittitas County Jail
Date of detention Entry mm/dd/yyyy Kittitas County Jail
Result of OUD Screening positive/negative Kittitas County Jail
Result of OUD Assessment OUD diagnosis yes/no MAT Partner Organization
Result of MAT Assessment MAT recommended (yes/no)MAT Partner Organization
Receiving MAT at time of yes/no and type of MAT MAT Partner Organization
arrest
Date initiated MAT mm/dd/yyyy MAT Partner Organization
Form of MAT initiated Methadone,MAT Partner Organization
buprenorphine/naloxone,
buprenorphine,XR-NTX
Dose of MAT at time of Methadone MAT Partner Organization
discharge from treatment or (mg)/buprenorphine/naloxone
detention release (mg)
Date of discharge from mm/dd/yyyy MAT Partner Organization
treatment
Reason for discharge from Released from MAT Partner Organization
treatment incarceration/facility
transfer/patient request/medically
advised (describe)/non-medically
advised/death (cause)/other
(describe)
Date of detention release mm/ddlyyyy Kittitas County Jail
Location to which released Other correctional Kittitas County Jail
facility/community
Legal status at release Pretrial/post-trial Kittitas County Jail
If released to community,Pretrial:bond/citation,post-trial:Kittitas County Jail
form of release "time served"/charges dismissed
Referral to community MAT yes/no MAT Partner Organization
provider made prior to release
Appointment with Yes (mm/dd/yyyy)/no MAT Partner Organization
community MAT provider
made prior to release
Insurance Status at the time Medicaid/Medicaideligible and MAT Partner Organization
of Release uninsured privately
insured/Medicare/Medicaid
ineligible and uninsured
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Date seen by community mm/dd/yyyy MAT Partner Organization
MAT provider
Date first post-release MAT mm/ddlyyyy MAT Partner Organization
prescrivtion filled.
Correctional system level data
(Measured among entire correctional facility population duri sg identified time period)
Data Element Description Source
Deaths due to suicide #Kittitas County Jail
Deaths due to opioid #Kittitas County Jail
overdose
incidence of contraband Non-prescribed Kittitas County Jail
drugs confiscated within buprenorphine/illicitopioids/all
facility illicit drugs
Assaults #assaults on Kittitas County Jail
stafflinmates/visitors
Disciplinary reports #,type Kittitas County Jail
Annual Recidivism rate Rate of people who are released Kittitas County Jail
and re-offend within a given
year,by type of re-offense (new
offense/aarole violation)
Community level data
(Measured among correctional facilig catchment area over the identijled time period)
Data Element Description Source
Annual deaths due to opioid #deaths,by gender State and Local Public
overdose among total Health
population
Annual deaths due to opioid #total post-release overdose State and Local Public
overdose among individuals deaths/post-releaseMAT Health
released from correctional participant deaths
setting within 12 months
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BUSINESS ASSOCIATE ADDENDUM
EXHIBIT "D"TO THE CONTRACT TO WHICH IT IS ATTACHED
This Addendum is incorporated into the contract to which this document is attached between
Kittitas County Washington on behalf of the Office or Department thereof ("Covered Entity")
and the other party or parties thereto ("Business Associate").The singular shall include the plural
and the plural the singular as required by the context.
The Business Associate acknowledges and agrees that Protected Health Infortnation (PHI)in any
format,including electronic PHI (ePHI),can be used,shared,created,retained or transferred
only within the parameters of this document and the Department of Health and Human Services
Privacy Regulations,Code of Federal Regulations,("CFR"),Title 45,Sections 160 and 164,or
as required by law.
CFR Title 45,Sections 160 and 164 and any applicable Washington statutory law ("RCW")or
Administrative Code ("WAC")provision (Federal and State statutory or regulatory standards
applicable to this addendum are collectively referred to as "law")are by way of reference,an
integral part of this Addendum as if incorporated in full.Business Associate is charged with the
knowledge of and agrees to abide by the terms and conditions of law.To the extent that any
applicable provision of RCW or WAC provides for or mandates any standard differing from
those of Federal law,the standard more restrictive of disclosure shall control subject to federal
preemption;this applies throughout this Addendum without regard to any further explicit
reference to RCW or WAC provisions.
This Addendum is effective upon signing of this attachment or the contract to which it is
attached,whichever is prior in time.
L PURPOSE
The Covered Entity needs to make available and/or disclose to the Business Associate certain
PHI for rnanagement,administration,and legal responsibilities during the normal course of
business between the parties as referenced in the contract or other agreement to which this
document is attached and incorporated by reference.This document is intended to define and
incorporate but not limit the obligations of the Business Associate with regard to its use and
protection of that PHI,
IL RESPONSIBILITIESOF BUSINESS ASSOCIATE
The Business Associate hereby agrees to do the following:
A.Use and Disclosure:Use and/or disclose PHI only as permitted or required by this
Addendum,Health Insurance Portability and Accountability Act (HIPAA),and the
Health Information Technology for Economic and Clinical Health Act (Division A,Title
XIII of the American Recovery and Reinvestment Act of 2009,Pub.Law 111-5,2009
HR 1)("HITECH").The Business Associate shall use and disclose PHI only if such use
or disclosure,respectively,is in compliance with each applicable requirement of 45 CFR
§l64.504(e)or other law.The Business Associate is directly responsible for full
B.A.A.Attachment Page 1 of5
compliance with the privacy provisions of law that apply to the Business Associate to the
same extent as the Covered Entity.
B.Scurity:Implement administrative,physical,and technical safeguards that reasonably
and appropriately protect the confidentiality,integrity,and availability of the PHI that it
creates,receives,maintains,or transmits on behalf of the Covered Entity as required by
law.The Business Associate is directly responsible for compliance with the security
provisions of HIPAA and H1TECH to the same extent as the Covered Entity.
C.Improper Disclosures:Report all unauthorized or otherwise improper disclosures of PHI,
or security incident,to the Covered Entity within two (2)days of the Business
Associate's knowledge of such event.
D.Notice of Breach:Within two (2)business days of the discovery of a breach as defined at
45 CFR §164.402 notify the Covered Entity of any breach of unsecured PHL Notification
shall by the most rapid means reasonably possible,such as telephonic notice made
directly to an appropriate person within the covered entity and not including a voice mail
or similar messagc.Written notification shall follow within that two (2)period by fax and
be confirmed by direct contact with the intended recipient,and include the identification
of each individual whose unsecured PHI has been,or is reasonably believed by the
Business Associate to have been,accessed,acquired,or disclosed during such breach;a
brief description of what happened,including the date of the breach and the date of the
discovery of the breach,if known;a description of the types of unsecured PHI that were
involved in the breach (such as whether full name,social security number,date of birth,
home address,account number,diagnosis,disability code,or other types of information
were involved);any steps individuals should take to protect themselves from potential
harm resulting from the breach;a brief description of what the Business Associate is
doing to investigate the breach,to mitigate harm to individuals,and to protect against any
further breaches;the contact procedures of the Business Associate for individuals to ask
questions or learn additional information,which shall include a toll free number,an e-
mail address,Web site,or postal address;and any other information required to be
provided to the individual by the Covered Entity pursuant to 45 CFR §l 64.404,as
amended.A breach shall be treated as discovered in accordance with the terms of 45 CFR
§164.410.The information shall be updated promptly and provided to the Covered Entity
as requested by the Covered Entity.
E.Mitigation:Mitigate,to the extent practicable,any harmful effect that is known to
Business Associate of a use or disclosure of PHl by Business Associate in violation of the
requirements of this Addendum or the law.
F.Agents:Ensure that any agent,including all of its employees,representatives,and
subcontractors,to whom it provides PHI received fiom,or created or received by
Business Associate on behalf of Covered Entity agrees to the same restrictions and
B.A.A.Attachment Page 2 of 5
conditions that apply through this Addendum to Business Associate with respect to such
information.
G.Right of Access:
1.From time to time upon reasonableadvance notice,or upon a reasonable
determination by Covered Entity that Business Associate has potentially or actually
breached this Addendum,make internal practices,books,and records relating to the
use and disclosure of PHI received from,or created or received by Business Associate
on behalf of Covered Entity available to the Covered Entity,or at the request of the
Covered Entity to the Secretary of Department of Health and Human Services,for the
purpose of determining compliance with HIPAA,HITECH,and/or this Addendum.
2.From time to time upon reasonable advance notice,or upon a reasonable
determination by Covered Entity that Business Associate has potentially or actually
breached this Addendum,to permit Covered Entity to respond to a request by an
Individual for an accounting of disclosures of PHI in accordance with 45 CFR
§164.528,or to permit Covered Entity to respond to a request by an Individual for
access to PHI in accordance with 45 CFR §164.524.
H.Documentation of Disclosures:Document such disclosures of PHI and information
related to such disclosures as would be required for Covered Entity to respond to a
request by an Individual for an accounting of disclosures of PHI in accordance with 45
CFR §164.528.Should an individual make a request to Covered Entity for an accounting
of disclosures of his or her PHI pursuant to 45 CFR §164.528,Business Associate agrees
to promptly provide an accounting,as specified under 42 U.S.C.§17935(c)(1)and 45
CFR §164.528,of disclosures of PHI that have been made by the Business Associate
acting on behalf of the Covered Entity.The accounting shall be provided by the Business
Associate to the Covered Entity or to the individual,as directed by the Covered Entity.
I.Amendments:Make any amendments to PHI that the Covered Entity directs or agrees to
pursuant to 45 CFR §164.526 at the request of Covered Entity,within five (5)business
days of written request by Covered Entity.
J.Other:To the extent the Business Associate is to carry out one or more of the covered
entities obligations under Subpart E of 45 CFR 164,comply with the requirements of
Subpart E that apply to the covered entity in the performance of such obligations.
HL PERMITTED USES AND DISCLOSURES BY RUSINESS ASSOCIATE
A.Except as otherwise limited in this Addendum or by law,Business Associate may use
Protected Health Information for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business Associate.
The Business Associate shall limit its use and disclosure of,and requests for,PHI to the
minimum necessary as determined in accordance with 42 U.S.C.§17935(b)(l),
B.A.A.Attachment Page 3 of 5
B.Except as otherwise limited in this Addendum or by law,Business Associate may use
PHI to provide Data Aggregation services to Covered Entity as permitted by 45 CFR §
164.504.(e)(2)(i)(B).
IV.TERM AND TERMINATION
A.Term:This Addendum shall become effective on the Effective Date and shall continue in
effect until all obligations of the parties have been met,unless terminated as provided
herein or by mutual agreement of the parties
B.Termination for Cause:Upon Covered Entity's knowledge of a material breach by
Business Associate,Covered Entity may provide an opportunity for Business Associate
to cure the breach or end the violation and terminate this Addendum if Business
Associate does not cure the breach or end the violation within five (5)business days of
receipt of written notice by the Covered Entity,or immediately terminate this Addendum
if Business Associate has breached a material term of this Addendum and cure is not
possible.
C.Other Termination:This Addendum may be terminated by Covered Entity without cause
upon thirty (30)days prior written notice to the other party,which notice shall specify the
date of termination.
D.Effect of Termination:Except as provided in paragraph B.of this Section,upon
termination of this Addendum,for any reason,Business Associate shall return or destroy
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 the PHI,Destruction must be by means that meet or exceed the standards of law.
In the event that Business Associate determines that returning or destroying the PHI is
not feasible,Business Associate shall extend the protections of this Addendum to such
PHI and limit further disclosures of such PHI to those purposes that make return or
destruction infeasible,for so long as Business Associate maintains such PHI.Business
Associate must provide written notice of the conditions that make return or destruction
not feasible;if Covered Entity does not concur in that assessment,Business Associate
shall return or destroy the PHI within five (5)business days.
V.MISCELLANEOUS
A.Defense and Indemnification:Business Associate shall defend,indemnify and hold
harmless Covered Entity from and against all claims,liabilities,judgments,fines,
assessments,penalties,awards or other expenses,of any nature whatsoever,including
without limitation attorneys'fees,expert witness fees,and costs of investigation,
litigation,or dispute resolution,relating to or arising out of any breach of this Addendum
by Business Associate,its employees,officers,agents,or sub-contractors.This provision
B.A.A.Attachment Page 4 of5
is supplemental to and to be interpreted and applied in a manner consistent with,any
indemnification provision of the agreement to which this Addendum is attached.
B.Reimbursement for Costs Incurred Due to Breach:Business Associate shall reimburse
Covered Entity,without limitation,for all costs of investigation,dispute resolution,
notification of individuals,the media,and the government,and expenses incurred in
responding to any audits or other investigation relating to or arising out of a breach of
unsecured PHI by the Business Associate,including mitigation.
C.Regulatory References:A reference in this Addendum to a Section in the Department of
Health and Human Services Privacy Regulations,CFR,Title 45,Sections 160 and 164
means the Section as in effect or as amended,and for which compliance is required.
D.Amendment:Changes in the law are automatically incorporated herein without need for
explicit amendment.The Parties agree this this Addendum may be amended from time to
time if otherwise necessary for Covered Entity to comply with the requirements of the
Department of Health and Human Services Privacy Regulations,CFR,Title 45,Sections
160 and 164 and other provisions of law.
E.Notices:Whenever Covered Entity or Business Associate is required to give notice to the
other party,notice shall be in writing,posted in the US Mail,and deemed delivered after
three (3)business days except as described in II D.,above.
F.Survival:The obligations of the Business Associate shall survive the tennination of this
Addendum.
G.Interpretation:Any ambiguity in this Addendum shall be resolved in favor of a meaning
that permits Covered Entity to comply with the Department of Health and Human
Services Privacy Regulations,CFR,Title 45,Sections 160 and 164 and other provisions
of law.Any provision of the Underlying Agreement that is directly contradictory to one
or more terms of this Addendum is superseded by the terms of this Addendum to the
extent necessary for the parties'compliance with HIPAA.
B.A.A.Attachment Page 5 of 5