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					                                                KLAMATH COUNTY

                                         REQUEST FOR PROPOSALS



         OUTPATIENT AND RESIDENTIAL ALCOHOL AND DRUG TREATMENT
                               PROGRAMS




Date Issued: April 21, 2009

Issued By:         Klamath County Finance Department
                   305 Main Street, Room 230
                   Klamath Falls, Oregon 97601

                   (541) 883-4299

Closing Date: May 28, 2009




    FAXED OR ELECTRONIC DATA INTERCHANGE PROPOSALS WILL NOT BE
                             ACCEPTED




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                                              TABLE OF CONTENTS




Notice                                  ........................................................................ 3

Introduction                            ........................................................................ 4

Program Synopses                        ........................................................................ 5

General Conditions and Instructions .......................................................... 9

Schedule of Events                      ...................................................................... 12

Proposal Requirements                   ...................................................................... 13

         Attachment A: Attestment Forms ............................................... 15

         Attachment B: Proposal Cover Sheet, Proposal Questions and
                       Evaluation Criteria, and Project Budget Worksheet
                       For 2009 A&D Outpatient and Residential
                       Proposals (Content of Proposals) .......................... 19

         Attachment C: Proposal Evaluation Report ................................... 36

         Attachment D: Proposed Contract for Services ............................. 49

                   Exhibit I:      Description of Service, Performance Requirements
                                   And Payment Method ........................................ 62
                   Exhibit II:     Remedies Short of Termination ......................... 79
                   Exhibit III:    Reporting and Other Documentation Matrix ...... 84
                   Exhibit IV:     Klamath County Mental Health Fee Schedule ... 85
                   Exhibit V:      The monthly A&D Residential Service Reporting
                                   Form .................................................................. 87




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                                       REQUEST FOR PROPOSALS


The Klamath County Board of Commissioners and the Klamath County Mental Health
Department invite proposals from qualified providers for Outpatient and Residential
Alcohol and Drug Treatment Programs.

The Request for Proposals (RFP) document may be obtained from the undersigned at
305 Main Street, Room 230, Klamath Falls, Oregon 97601 or by calling (541) 883-4299
Monday through Friday 8:00 a.m. - 5:00 p.m. The RFP is also available on the web at
www.co.klamath.or.us/Contracts/index.html. Any proposer downloading the RFP
packet from the web will be responsible to check with the Contract/Grant Specialist for
any addenda issued for this project.

Questions pertaining to this solicitation should be directed to Bonnie Grant, Contract
Specialist, 305 Main St., Room 230, Klamath Falls, OR 97601 or by calling (541) 883-
4299. Questions pertaining to program services should be directed to Colette Fleck,
Behavioral Health Program Administrator, 3314 Vandenberg Road, Klamath Falls, OR
97603 or by calling (541) 882-7291.

Sealed proposals marked “Outpatient and Residential Alcohol and Drug Treatment
Programs” will be received by Bonnie Grant, Contract/Grant Specialist at 305 Main
Street, Room 230, Klamath Falls, Oregon 97601 until 2:00 p.m., May 28, 2009 and
publicly opened thereafter and the name of the proposer(s) will be noted for the record.
No proposal shall be considered if received later than 2:00 p.m., May 28, 2009.

Proposer(s) will be required to complete a certificate of non-discrimination pursuant to
ORS 279A.110(4), a certificate of compliance with Oregon tax laws pursuant to ORS
305.380 - 305.385, and a bidder residency statement pursuant to ORS 279A.120(1).

Klamath County may reject any proposal not in compliance with all prescribed public
bidding procedures and requirements, and may for good cause reject any or all
proposals upon a finding of the agency it is in the public interest to do so. Klamath
County reserves the right to rescind the award of any contract at any time before the
execution of said contract by all parties without any liability against the County. All
proposals are subject to Oregon Law bid procedures.




Bonnie Grant
Contract/Grant Specialist




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                                         REQUEST FOR PROPOSALS

To provide Outpatient and Residential Alcohol and Drug Treatment Programs for
the period July 1, 2009 through June 30, 2010, with possible extensions through June
30, 2013.


INTRODUCTION

    A. Klamath County, as the Local Mental Health Authority, is responsible for
       planning, implementing and monitoring addiction treatment services for the
       County. In keeping with the intent of the “Klamath County Implementation Plan
       for Mental Health and Addictions”, Klamath County Department of Mental Health
       seeks to contract with qualified providers for an array of Chemical Dependency
       Treatment services that employ evidence based practices. In order to assure
       consumer choice, the County issues this Request for Proposals (RFP) with the
       intent to award multiple contracts for the provision of the Outpatient services
       listed below, up to three contracts for Adult Outpatient, up to two contracts for
       Youth Outpatient, one contract for Life Skills and Aftercare for Drug Court
       Participants, one contract for Adult Residential Treatment Services and one for
       Locally Funded Special Projects for Outpatient Alcohol and Drug Treatment for
       Minorities. Proposers may elect to submit proposals for one or more of the
       programs listed below. In order to qualify for funding, proposers must meet the
       Qualification of Providers listed under each program description below for which
       they will be submitting a proposal. Funding amounts are contingent on revenues
       and/or allocations from the State and may change if allocations are reduced.
       Klamath County may only contract with either government entities or private non-
       profit organizations for services funded under these service elements.




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                                        Program Synopses
A. Outpatient Alcohol and Drug Treatment for Adults (AD 66)
Adult men and women who are in need of treatment services on a regularly scheduled
basis so they can achieve or maintain abstinence or related recovery goals. Services
include assessment, individual, group, and family counseling, case management,
mentoring, and long-term support for relapse prevention. A complete definition of
outpatient client criteria can be found in ASAM PPC-2R.
     The target population is Klamath County residents who are indigent.
     Funds cannot be used to deliver outpatient services to any individual enrolled in
       the Oregon Health Plan (OHP) for chemical dependency benefits.
     It is the intent to issue from 1 to 3 contracts for these services.
     A full description of these services may be found in Exhibit I of the Proposed
        Contract for Services at Attachment D of this RFP.

       Qualification of Providers: Must have a valid Letter of Approval from the State
of Oregon, Department of Human Services Addictions and Mental Health Division, to
provide Outpatient Chemical Dependency Treatment to Adults. Must have capacity to
submit and receive electronic information in regard to Client Process Monitoring System
data.

         Maximum funding available: $110,707.00
        Services will be paid on a modified fee-for-service basis with reimbursement at either the lesser
         of billed charges or the KCMH fee schedule.
        If a client is enrolled in the Oregon Health Plan (OHP) or has other insurance, Proposer will be
         expected to bill OHP (or any other insurance carrier, if applicable) for any part of these services
         covered by the OHP or other insurance. If a client is eligible for the OHP or other insurance
         coverage, but has not enrolled, the Proposer will assist the client in applying for that coverage.
         Funding for services provided under these contracts cannot be used for individuals eligible for or
         enrolled in the Oregon Health Plan.
        Service duplication adversely impacts the cost effectiveness of contracted services. To minimize
         duplications, clients served under any Klamath County contract may not support a claim for
         reimbursement for the same services under any other Klamath County contract.




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B.     Outpatient Alcohol and Drug Treatment for Adolescents (AD 66)
Youth ages 12 through 17 years of age, or those persons who are determined by the
program to be developmentally and clinically appropriate for Youth services, who are in
need of treatment services on a regularly scheduled basis so they can achieve or
maintain abstinence or related recovery goals.         Services include: assessment;
individual, group, and family counseling; case management; mentoring; and long-term
support for relapse prevention. A complete definition of outpatient client criteria can be
found in ASAM PPC-2R.

     The target population is Klamath County residents who are indigent.
     Funds cannot be used to deliver outpatient services to any individual enrolled in
      the OHP for chemical dependency benefits.
     It is the intent to issue from 1 to 2 contracts for this service.
     A full description of these services may be found in Exhibit I of the Proposed
      Contract for Services at Attachment D of this RFP.

      Qualification of Providers: Must have a valid adolescent-specific Letter of
Approval from the State of Oregon, Department of Human Services Addictions and
Mental Health Division to provide outpatient chemical dependency treatment for youth.
Must have capacity to submit and receive electronic information in regard to Client
Process Monitoring System data.

         Maximum funding available: $37,778.00
      Services will be paid on a modified fee-for-service basis with reimbursement at either the lesser
        of billed charges or the KCMH fee schedule.
      If a client is enrolled in the Oregon Health Plan (OHP) or has other insurance, Proposer will be
        expected to bill OHP (or any other insurance carrier, if applicable) for any part of these services
        covered by the OHP or other insurance. If a client is eligible for the OHP or other insurance
        coverage, but has not enrolled, the Proposer will assist the client in applying for that coverage.
        Funding for services provided under these contracts cannot be used for individuals eligible for or
        enrolled in the Oregon Health Plan.
      Service duplication adversely impacts the cost effectiveness of contracted services. To minimize
         duplications, clients served under any Klamath County contract may not support a claim for
         reimbursement for the same services under any other Klamath County contract.




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C.     Outpatient Alcohol and Drug Treatment for Adults (AD 66), Life Skills and
       Aftercare for Drug Court Participants
The intent of this program is to assist Drug Court clients who move to Phase II of the
drug court program develop the skills necessary to transition into a positive, drug and
alcohol free lifestyle. Services such as parenting, family counseling, anger
management, life skills including budgeting, employment seeking skills and nutrition, as
well as long-term support for relapse prevention are to be included in the program.
Services may be provided in both group and individual settings and should be
individualized to focus on the needs of these clients as they transition to recovery. A
complete definition of outpatient client criteria can be found in ASAM PPC-2R.

      The target population is Klamath County residents who are participating in Drug
       Court in either CJC slots or regular Drug Court slots.
      Funds cannot be used to deliver outpatient services to any individual enrolled in
       the OHP for chemical dependency benefits.
      It is the intent to issue 1 contract for these services.
      A full description of these services may be found in Exhibit I of the Proposed
        Contract for Services at Attachment D of this RFP.

       Qualification of Providers: Must have a valid Letter of Approval from the State
of Oregon, Department of Human Services Addictions and Mental Health Division, to
provide Outpatient Chemical Dependency Treatment to Adults. Must have capacity to
submit and receive electronic information in regard to Client Process Monitoring System
data.

         Maximum funding available: $41,392.00
        Services will be paid on a modified fee-for-service basis with reimbursement at either the lesser
         of billed charges or the KCMH fee schedule.
        Service duplication adversely impacts the cost effectiveness of contracted services. To minimize
         duplications, clients served under any Klamath County contract may not support a claim for
         reimbursement for the same services under any other Klamath County contract.




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D.      Residential Alcohol and Drug Treatment for Adults (A&D 61 & A&D 67)
Persons 18 years and older who have a primary dependency on alcohol and drugs, are
unable to live independently in the community, cannot maintain even a short period of
abstinence and are in need of 24-hour supervision, treatment and care. A complete
definition of residential treatment client criteria can be found in ASAM PPC-2R.

     It is the intent to issue 1 contract for these services.
      Additional Requirements:
     100 % utilization of 18 treatment beds.
     State requires 60% of residential bed availability to be used for Medicaid clients.
      Explanation: The Medicaid eligibility requirement will be settled on an average
      statewide basis. If the statewide Medicaid percentage falls below 60%, prorated
      settlement will be made from those Counties who failed to meet the 60%
      threshold. If Klamath County fails to meet the 60% threshold, reconciliation will
      be made at the provider level.
     Client Engagement: In 50% of A/D treatment episodes, the client is engaged
      (remains in treatment for at least 15 days).
     Successful Completion: in 60% of Adult A/D residential treatment episodes, the
      client meets ASAM PPC-2R discharge criteria, completes at least two-thirds of
      their treatment plan goals, and demonstrates 30 days of abstinence.
     For State-funded residential treatment beds, priority client admission is:
      o First priority to pregnant women, then to,
      o Intravenous drug abusers, then to
      o Persons referred by the State Department of Human Services and to
           individuals who are receiving Medicaid, then to
      o Individual referred from within the region as such region is designated by the
           State Department of Human Services after consultation with County and
           relevant providers.
      o Services may be delivered to individuals referred from any county within the
           region and no priority to preference shall be given to individuals referred from
           any particular county with the region based on the referring county.

       Qualification of Providers: Must have a valid Letter of Approval from the State
of Oregon, Department of Human Services Addictions and Mental Health Division, to
provide Residential Chemical Dependency Treatment to Adults. Must have capacity to
submit and receive electronic information in regard to Client Process Monitoring System
data.

         Maximum funding available for 18 beds:
              Treatment: $550,237.00
              Capacity: $131,400.00
        Treatment services will be reconciled monthly.
        Service duplication adversely impacts the cost effectiveness of contracted services. To minimize
         duplications, clients served under any Klamath County contract may not support a claim for
         reimbursement for the same services under any other Klamath County contract.




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E. Locally Funded Special Projects for Outpatient Alcohol and Drug Treatment for
    Minorities (A&D 66)
The intent of this program is to provide outreach and treatment to minorities and/or
underserved populations of any age so that access to A&D treatment services is
improved. Services include case finding, outreach activities and education, assessment,
individual, group, and family counseling, case management, mentoring and long term
support for relapse prevention, delivered in culturally appropriate, relevant ways for the
population served. A complete definition of outpatient client criteria can be found in
ASAM PPC-2R.

        The target population is Klamath County Residents (Adults or Youth) who are
         indigent, members of minority and/or underserved populations, who may find
         difficulty in accessing treatment services due barriers such as remote location,
         homelessness, lack of transportation, language difficulties or other cultural or
         physical barriers.
        Funds cannot be used to deliver outpatient services to any individual enrolled in
         the OHP for chemical dependency benefits.
        It is the intent to issue 1 contract for these services.
        Full scope of services will be dependent on specifics proposed by the proposer.

       Qualification of Providers: Must have a valid Letter of Approval from the State
of Oregon, Department of Human Services Addictions and Mental Health Division, to
provide Outpatient Chemical Dependency Treatment to the population served. Must
have capacity to submit and receive electronic information in regard to Client Process
Monitoring System data.

         Maximum funding available: $ 14,000.00
        Services will be paid on a modified fee-for-service basis with reimbursement at either the lesser
         of billed charges or the KCMH fee schedule.
        Service duplication adversely impacts the cost effectiveness of contracted services. To minimize
         duplications, clients served under any Klamath County contract may not support a claim for
         reimbursement for the same services under any other Klamath County contract.

Funding for these services comes from Federal and State sources, which carries
requirements for allocation, performance, expenditures and monitoring which shall be
presented in the body of this RFP and its Exhibits and Attachments. Specific services
that may be provided are stated in Exhibit I of the Proposed Contract for Services at
Attachment D of this RFP.

GENERAL CONDITIONS AND INSTRUCTIONS

This solicitation and any subsequent award of contract are subject to the following
conditions. These conditions hereby constitute a portion of the solicitation documents
and some items shall be made part of any resulting contract.

1.       All proposals must be submitted in typewritten form on standard 8 ½ X 11" paper.

2.       One original and seven (7) copies of the proposal must be submitted to:

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                             Bonnie Grant, Contract/Grant Specialist
                             Klamath County Finance Department
                             305 Main Street, Room 230
                             Klamath Falls, Oregon 97601

3.       Sealed proposals in an opaque envelope marked “Outpatient and Residential
         Alcohol and Drug Treatment Programs” must be received by 2:00 p.m., May
         28, 2009. Any proposals received later than the stated date and time shall be
         rejected and returned to the proposer unopened. Proposals shall be opened
         immediately thereafter. Only the name of the proposer(s) will be read aloud at
         that time. Facsimile proposals or other electronically transferred proposals are
         not acceptable. All proposals received shall be firm and binding and irrevocable
         for a period of 60 days following opening of the proposals.

4.       Pursuant to OAR 137-047-0630 and ORS 279B.060, solicitation files are not
         required to be open for public inspection until after the notice of intent to award a
         contract is issued. After that time, solicitation files shall be made available for
         public inspection, except to the extent that the proposer has designated trade
         secrets or other proprietary data to be kept confidential, in accordance with ORS
         279B.055(5)(c). Any such designated material shall accompany the proposal but
         shall be readily separable from it. Proposals and the contracting record shall be
         available for public review during usual business hours by contacting the
         Contract/Grant Specialist.

5.       Should a proposer or prospective proposer seek to appeal or protest an award
         resulting from this RFP, such protest must be made within seven (7) calendar
         days of the intent to award notice by the Klamath County Board of
         Commissioners. The notice of protest of the award shall be submitted in writing
         to the Klamath County Finance Department, Attn: Contract/Grant Specialist, 305
         Main Street, Room 230, Klamath Falls, OR 97601. The protesting proposer can
         claim to be adversely affected or aggrieved only if the proposer is eligible for
         award of the contract as the responsible proposer submitting the best responsive
         proposal and is next in line for award as defined in OAR 137-047-0261(6).
         Protests shall be reviewed and forwarded to the Local Contract Review Board
         (LCRB) (the Klamath County Board of Commissioners) for resolution. The LCRB
         reserves the right to settle or resolve the written protest as specified in the
         above-stated OAR.

6.       Submission of a proposal in response to this RFP signifies the proposer’s
         willingness to enter into a contract for services with Klamath County and is in
         agreement with the conditions set forth in the Proposed Contract for Services
         included in this RFP as Attachment D. Proposer further signifies willingness and
         ability to meet appropriate requirements of the Financial Assistance Agreement
         between the State of Oregon and Klamath County incorporated into the
         Proposed Contract for Services. A copy of this Agreement may be obtained from
         Klamath County Mental Health, 3314 Vandenberg Road, Klamath Falls, OR
         97603 or (541) 882-7291. Proposers are invited to submit comments regarding
         the Proposed Contract for Services.
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7.       Proposers are to understand that final funding of services is dependent upon
         funds made available.

8.       It is the intention of the County to execute contracts for the period July 1, 2009
         through June 30, 2010. There is a possibility that the contracts may be extended
         for up to three additional one-year periods based on availability of funding.

9.       Failure to submit any requested information may serve as grounds for
         disqualification of the proposal. Applications must include all required
         documentation to be considered. Any applications not including all required
         documentation will be rejected.

10.      Questions pertaining to the terms and conditions of the RFP shall be submitted in
         writing no later than 4:00 p.m. on April 28, 2009. Should comments be received
         or questions be raised by potential proposers, or situations arise which require
         any revision of the terms or conditions of this solicitation, an Addenda will be
         submitted to all known recipients of the RFP by way of fax and a mailed copy, or
         an extension will be given to the proposal closing date. Any proposer
         downloading the RFP packet from the web will be responsible to check with the
         Contract/Grant Specialist for any addenda issued for this project. Proposers
         shall be required to acknowledge the receipt and consideration of such
         Addenda on their submitted proposal.

         Questions concerning RFP content and scope of work should be directed to:
             Colette Fleck, Behavioral Health Program Administrator
             Klamath County Mental Health
             3314 Vandenberg Road
             Klamath Falls, OR 97603
             (541) 882-7291

         Questions pertaining to the solicitation process should be directed to:
             Bonnie Grant, Contract/Grant Specialist
             Klamath County Finance Office
             305 Main Street, Room 230
             Klamath Falls, OR 97601
             (541) 883-4299




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11.      Schedule of Events:
         Date of issuance of RFP ........................................................ April 21, 2009
         Deadline for requesting changes or clarifications, 4:00 p.m.
                              . ............................................................. April 28, 2009
         Proposal due date, 2:00 p.m................................................... May 28, 2009
         Completion of evaluation period (approximately)..................... June 9, 2009
         Acceptance of Proposals by Board of County Commissioners
               (approximately) ........................................................... June 16, 2009
         Deadline for submitting protest of award (approximately) ...... June 22, 2009
         Date of Announcement of Contract Award (approximately) June 23, 2009

12.      Klamath County reserves the right to (a) amend any part of this RFP, including
         exhibits and attachments; (b) to extend the deadline for submitting proposals; (c)
         to waiver minor irregularities, informalities, or failures to conform to the RFP; (d)
         to reject for good cause and without liability therefore, any and all proposals and,
         (e) upon a finding that doing so is in the public interest, Klamath County reserves
         the right to rescind the award of any contract at any time before the execution of
         said contract by all parties without any liability against the County. All proposals
         are subject to Oregon Law bid procedures.

13.      Klamath County is not liable for any cost incurred by the proposer responding to
         this RFP. Proposer is responsible for all costs associated with preparing and
         submitting the RFP response.

14.      Award of a contract resulting from this solicitation shall be based upon a finding
         in the public interest by the Board of County Commissioners. Criteria used to
         identify the proposals that best meet the County’s need will include, but may not
         be limited to cost, quality, experience, expertise, reliability of proposed providers,
         approval of service provisions, continuity of care, ability to pass a criminal history
         background check from the Office of Mental Health and Addictions Services and
         conformance to RFP requirements. A committee appointed by the Director of
         Klamath County Mental Health Department shall review proposals. This Review
         Committee using Attachment C, “Proposal Evaluation Report”, shall review and
         rank proposals on the stated criteria. Klamath County seeks a varying number of
         contracts as stated in the Program Synopses tables above. The highest ranking
         scored proposals for each program, which also meet the minimum scores stated
         in the Proposal Questions and Evaluation Criteria at Attachment B, will be
         recommended to the Director of Klamath County Mental Health, who will then
         make recommendations to the Board of County Commissioners for funding
         approval and final decision on contract award.

15.      Proposers are to understand that final funding of services are dependent upon
         funds made available and proposals accepted for contracts.

16.      Klamath County reserves the right to exercise its options of negotiations with
         proposers in the development of final contracts. This may include both service
         and allocated funds.

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17.      The proposer hereby represents that this proposal is made without connection
         with any person, firm or corporation making a proposal for the same project, and
         is in all respects fair and without collusion or fraud.

18.      By signing and returning the Proposal (Offer) the Proposer (Offeror)
         acknowledges they have read and understand the terms and conditions in the
         Solicitation Document and accept and agree to be bound by the terms and
         conditions of the Solicitation Document.

19.      The contract documents pertinent to this project shall be comprised of the fully
         executed contractual agreement, the proposal, the specifications for the project,
         and any addenda subsequently issued to those documents.

PROPOSAL REQUIREMENTS

1.       Proposals shall contain narrative descriptions as indicated in Attachment B
         “Content of Proposal(s)” for each of the areas listed. When information will be
         duplicative a reference may be made to a prior section. Each narrative
         description should not exceed the number of pages stated in the Content of
         Proposal for that program.

2.       Proposers shall certify on the Attestment Form at Attachment A that the agency
         holds a current Letter of Approval from the State of Oregon Department of
         Human Services Addictions and Mental Health Division for proposed services or
         has a license to practice in the State of Oregon, that they will meet insurance
         requirements, and all services being proposed shall be provided by individuals
         and agencies meeting the criteria stated in the solicitation documents for each
         service area. Proposers who do not meet these requirements must do so within
         a reasonable time after selection and the effective date of the contract. This
         Attestment Form must be returned as a part of the proposal.

3.       Attachment A, Proposer Residency Statement, Certificate of Non-Discrimination,
         and Oregon Tax Laws must be returned as a part of the proposal.

4.       The provider selected must ensure HIPPA, and 42 CFR Part 2, compliance.

5.       Minimum Score: Proposers must attain a minimum score as indicated in the
         Proposal Questions and Evaluation Criteria at Attachment B for each program
         proposed in order to be considered.

6.       Proposers shall provide a copy of their most recent site review report from the
         State of Oregon Addictions and Mental Health Division, or from the County site
         review, whichever is most recent for the program(s) proposed.

7.       Proposers shall submit copies of current Letters of Approval from the State of
         Oregon, Department of Human Services Addictions and Mental Health Division
         (AMH), which apply to the specific program(s) for which they are submitting
         proposals.
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8.       Proposers must submit a copy of their service fee schedule, sliding scale fee
         schedule and most recent financial statements, including, but not limited to an
         income statement, balance sheet and statement of cash flow, as well as a
         complete budget showing revenue and expenditures for all current and proposed
         programs. Proposers are to complete and submit the Project Budget Worksheet
         for 2009 A&D Treatment Proposals included as part of this RFP for each
         program proposed.




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                                                  ATTACHMENT A

                                              ATTESTMENT FORMS


The Attached Attestment of Liability Insurance Coverage, Letter of Approval, Electronic
Submission of Data, Bidder/Proposer Residency Statement, Certification of Non-
discrimination and the Certificate of Compliance with ORS 305.380 - 305.385, must be
completed and returned with the proposal.




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                                                    ATTESTMENT



1.       The undersigned Proposer hereby attests that all requirements for liability
         insurance coverage and certification stated in the solicitation shall be met should
         a contract be offered by the County for providing services.

2.       Should a contract be offered by the County for providing services, the
         undersigned Proposer also hereby attests that, to the best of their knowledge,
         any person performing direct or indirect consumer services has a letter of
         approval from the Department of Human Services Addictions and Mental Health
         Division in accordance with OAR 415-051-0000 through 415-051-0165 and OAR
         415-012-0000 through 415-012-0090 or has the ability to obtain such approval.

3.       Should a contract be offered by the County for providing services, the
         undersigned Proposer also hereby attests that their organization has the capacity
         for electronic reporting in accordance with the Client Process Monitoring System
         and will work with County and comply with other electronic reporting as may be
         required.


         **************************************************************************************
         THIS FORM IS TO BE SIGNED AND RETURNED WITH THE PROPOSAL.
         **************************************************************************************



___________________________________                                    ____________________
         Signature                                                         Date Signed



___________________________________                                     ____________________
     Agency Name (if applicable)                                          Federal I.D. Number




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                   16
                                                KLAMATH COUNTY

                                  PROPOSER RESIDENCY STATEMENT

Pursuant to ORS 279A.120(1), Oregon’s Reciprocal Preference Law, public contracting
agencies shall, for the purposes of determining the lowest responsible bidder and the
awarding of a contract, add a percent increase on the bid of a non-resident bidder equal
to the percent, if any, of the preference given to that bidder in the state in which the
bidder resides.

As defined in ORS 279A.120(1), “Resident Bidder/Proposer” means a bidder/proposer
that has paid unemployment taxes or income taxes in this state in the twelve calendar
months immediately preceding submission of the bid, has a business address in this
state, and has stated in the bid whether the bidder is a “Resident Bidder/Proposer”. A
“Nonresident Bidder/Proposer” means a bidder/proposer who does not meet the
definition of a “Resident Bidder/Proposer” as stated above.

1.       CHECK ONE:                    Bidder/Proposer IS or IS NOT a “Resident Bidder or
                                       Proposer” as set forth above.

2.       If a Resident Bidder/Proposer, enter your Oregon business address:

         ________________________________________________________________

         ________________________________________________________________

3.       If a Nonresident Bidder/Proposer, enter State of residency:

         ________________________________________________________________

Bidder/Proposer hereby certifies that the information provided above is true and
accurate.

Signature:________________________________________ Date:________________

Printed or Typed Name:__________________________________________________

Title: _________________________________________________________________

Firm:__________________________________________________________________

Telephone:_____________________________________________________________




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                               17
                                                KLAMATH COUNTY

                                CERTIFICATE OF NON-DISCRIMINATION


Pursuant to ORS 279A.110(4), discrimination in subcontracting is prohibited. Any
contractor who contracts with a public contracting agency shall not discriminate against
minority, women or emerging small business enterprises in the awarding of subcontract.

By signature of the authorized representative of the bidder/proposer, the
bidder/proposer hereby certifies to Klamath County that the bidder/proposer has not
discriminated against minority, women or emerging small business enterprises in
obtaining any subcontracts; and, further, that if awarded the contract for which this
bid/proposal is submitted, shall not so discriminate.


Dated:__________________

Signature:_____________________________________________________________

Printed or Typed
Name:________________________________________________________________

Name of
Firm:_________________________________________________________________




                CERTIFICATE OF COMPLIANCE WITH ORS 305.380 - 305.385


The undersigned as a provider or potential provider of goods, services or real estate
space to Klamath County hereby certifies under penalty of perjury that to the best of my
knowledge, the undersigned is not in violation of any Oregon tax laws described in ORS
305.380(4).

Dated:___________________

Signature:_____________________________________________________________

Printed or Typed Name:__________________________________________________

Name of Firm:__________________________________________________________




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                         18
                                                  ATTACHMENT B



Proposal Cover Sheet

Proposal Questions and Evaluation Criteria for:
   A. Outpatient Alcohol and Drug Treatment for Adults (AD 66)
   B. Outpatient Alcohol and Drug Treatment for Youth (AD 66)
   C. Life Skills and Aftercare for Drug Court Participants (AD 66)
   D. Alcohol and Drug Residential Treatment for Adults (AD 61 & 67)
   E. Locally Funded Project for Minorities or Underserved Populations (AD 66)

Project Budget Worksheet for 2009 A&D Outpatient and Residential Proposals

Complete a Proposal Cover Sheet and Proposal Application forms for each program for
which you are submitting a proposal. You may apply for more than one program. Each
program will be considered and scored separately.




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                  19
                                                      Proposal Cover Sheet


                                                 For Mental Health Use Only:

                                                                                   Yes No      NA
Attestment Forms (Attachment A)(Only 1 set needed per proposer)                    _____ _____ _____
Minimum Score                                                                      _____ _____ _____
Site Review Report                                                                 _____ _____ _____
Proposer in Substantial Compliance or Has Attached Work Plan,
 if applicable                                                                     _____ _____ _____
Proposer Fee Schedule                                                              _____ _____ _____
Proposer Sliding Scale Fee Schedule                                                _____ _____ _____
Qualified Provider (Letter of Approval)                                            _____ _____ _____
Electronic Submission of Data                                                      _____ _____ _____

                                                                         Proposal Score: ________


Proposal Category – Select One:

              Outpatient Alcohol and Drug Treatment for Adults (AD 66)

              Outpatient Alcohol and Drug Treatment for Youth (AD 66)

              Life Skills and Aftercare Treatment for Drug Court Participants (AD 66)

              Alcohol and Drug Residential Treatment for Adults and Residential Capacity
              (AD 61 & AD 67)

              Locally Funded Project for Minorities or Underserved Populations (AD 66)

Provider Name:                                                     Address:


Phone:                                                             E-Mail:

Fax:

Amount of Funds Requested:                                                   Approximate # to be served:




Signature of Agency Director: ____________________________________ Date: _______________


              PLEASE COPY AND USE THIS FORM FOR EACH PROGRAM PROPOSED
       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                     20
                     PROPOSAL QUESTIONS AND EVALUATION CRITERIA

                 A. Outpatient Alcohol & Drug Treatment Services for Adults

                                              Total Points Possible 215

Describe the Outpatient treatment services your agency will be providing to
                                                                                           Possible
Adults by answering the following questions. Do not exceed 10 pages for the                Points
narrative portion for this proposal.
1. Provide an overview of your proposed services, including areas of                       25
particular expertise. The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s)
that serves as the basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment
model(s) and standardized clinical practices you will be using for the
population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but
plan to put in place within the next two years, indicate your plan for
implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the
population(s) being served. Proposer addresses the importance of integrating
employment, pro-social activities, natural support systems into the clients’ treatment
and recovery process.
2. Describe your referral and intake process including:                                    25
• Strategies for facilitating client access and engagement in treatment;
• Stabilization maintenance strategies for clients waiting to get into treatment,
• Systems in place to communicate with referents.

Evaluation Criteria: Proposers response addresses the potential barriers to treatment
for the target population(s) to be served and details suggest experience with the target
population. Response includes strategies for overcoming the identified barriers. A
single point of contact with designated back-up for referral questions, status reports,
and problem solving is discussed. Engagement methodologies are discussed. Wait list
stabilization services are offered and details regarding these services are provided.
3. Describe your treatment planning process:                                               25

Evaluation Criteria: Response discusses how the clinical needs and strengths of each
client are integrated into a treatment plan. As the plan is developed, Proposer includes
family and/or significant others. The role of other support service providers and
human service providers is clearly and concisely described. Employment, pro-social
activities and natural support systems are all topics discussed as part of the treatment
planning process.
4. Describe your treatment services and how these services are                           25
structured to address recovery. Include in your response:
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                 21
 • The typical weekly schedule of treatment and support services to be
provided.
• The number of hours of therapeutic services available to clients per week;
broken out for individual counseling, family counseling, group treatment, and
structured recreational/pro-social activities.
• For each group treatment service describe its purpose, content, and the
criteria that will be used to determine if the client mastered the knowledge and
skills targeted.
• Specify what relapse prevention services will be provided.
• Identify the evidence-base service/practice that you propose to implement and
the source of your information.
• The process and criteria that will be used to guide service placement and
movement within and through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is
appropriate to the needs of the target population(s). Services are available for the
family and/or significant others to further enhance the treatment process. Strength
based and cognitive/behavioral approaches are used. A variation in service intensity is
employed based on client needs and progress in treatment. A competence-based
movement is used to guide the client through the treatment services. Delivered
services specifically target employment readiness, positive social activities and natural
support system.
5. Describe the continuing care services your program will provide                          25
following the clients’ discharge from outpatient treatment. Identify what
services will be provided through referral to other agencies and
providers.

Evaluation Criteria: Proposer’s response provides continuing care services. The
nature and frequency of services are fully described. The criteria used to adjust
continued service is discussed, as are relapse intervention strategies and options.
Proposer clearly makes the case that the proposed continuing care program is
appropriate for the target Population, and evidence of success is provided, if available.

6. Describe your staffing plan, including staff supervision and                             20
development. Include in your description:
• The FTE by position, typical salary range offered by your organization, and the
average caseload for each direct service position. This information may be
shown in chart format – which will not count against your page count.
• For each position or category of positions, identify the staff credentials and
competencies (knowledge and skills) that will be required to effectively serve
the target population(s), fully implement the program and competently deliver
the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve
the target population(s) and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the
proposed service to the target population(s). Proposer demonstrates skill and
experience delivering the services by their description of the staffing requirements and
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                  22
skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver
the proposed services are in place and have been used successfully before.
7. Describe how your agency will assist in forming a strong collaboration                 25
with the referral source and others involved in providing
treatment/support services to the client (e.g., criminal justice agencies,
other A/D treatment centers and other community providers) in order to
ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining
close, collaborative working relationships with referral sources and other service
providers involved with the client.
8. Describe the proposed quality assurance activities for these services,                 20
including defining the process of record review, complaints, consumer
satisfaction and progress in achieving performance outcomes. Include in
your response the strategies that will be utilized to assure fidelity to the
treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately
address requirements. Quality assurance will ensure the provision of safe and
clinically appropriate services to clients. Strategies for ensuring the program’s
contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement
process is continuous and embedded in the organization’s culture. QA strategies exist
calling for direct observation and evaluation of clinical practice and service delivery
as a fundamental part of staff supervision or there exists a reasonable plan for
implementing such strategies, including a process of record review, complaints,
consumer satisfaction and progress in achieving performance outcomes. Proposer has
fidelity measures and clinical supervision in place to assure adherence to treatment
modalities.
9. Does the last site review state that the Proposer is in substantial                    25
compliance with applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable
OARs and ORSs to maintain licensure to provide the services proposed under a
Contract awarded as a result of this RFP. If Proposer is not in full compliance or has
a temporary Letter of Approval, Proposer must be able to substantiate how they will be
able to obtain substantial compliance before entering into a Contract for services as a
result of this RFP. If Proposer received any findings as a result of the site review,
Proposer must attach a copy of the work plan to substantiate how the findings will be
mitigated.
Total Points Possible                                                                     215
Minimum Score Required to be Considered                                                   150




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                23
                     PROPOSAL QUESTIONS AND EVALUATION CRITERIA

                 B. Outpatient Alcohol & Drug Treatment Services for Youth

                                            Total Points Possible 215

Describe the Outpatient treatment services your agency will be providing to
                                                                                           Possible
Youth by answering the following questions. Do not exceed 10 pages for the                 Points
narrative portion for this proposal.
1. Provide an overview of your proposed services, including areas of                       25
particular expertise. The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s)
that serves as the basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment
model(s) and standardized clinical practices you will be using for the
population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but
plan to put in place within the next two years, indicate your plan for
implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the
population(s) being served. Proposer addresses the importance of integrating
employment, pro-social activities, natural support systems into the clients’ treatment
and recovery process.
2. Describe your referral and intake process including:                                    25
• Strategies for facilitating client access and engagement in treatment;
• Stabilization maintenance strategies for clients waiting to get into treatment,
• Systems in place to communicate with referents

Evaluation Criteria: Proposers response addresses the potential barriers to treatment
for the target population(s) to be served and details suggest experience with the target
population. Response includes strategies for overcoming the identified barriers. A
single point of contact with designated back-up for referral questions, status reports,
and problem solving is discussed. Engagement methodologies are discussed. Wait list
stabilization services are offered and details regarding these services are provided.
3.Describe your treatment planning process:                                                25

Evaluation Criteria: Response discusses how the clinical needs and strengths of each
client are integrated into a treatment plan. As the plan is developed, Proposer includes
family and/or significant others. The role of other support service providers and
human service providers is clearly and concisely described. Employment, pro-social
activities and natural support systems are all topics discussed as part of the treatment
planning process.
 4. Describe your treatment services and how these services are                          25
structured to address recovery. Include in your response:
• The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week;
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                 24
broken out for individual counseling, family counseling, group treatment, and
structured recreational/pro-social activities.
• For each group treatment service describe its purpose, content, and the
criteria that will be used to determine if the client mastered the knowledge and
skills targeted.
• Specify what relapse prevention services will be provided.
• Identify the evidence-base service/practice that you propose to implement
  and the source of your information.
• The process and criteria that will be used to guide service placement and
  movement within and through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is
appropriate to the needs of the target population(s). Services are available for the
family and/or significant others to further enhance the treatment process. Strength
based and cognitive/behavioral approaches are used. A variation in service intensity is
employed based on client needs and progress in treatment. A competence-based
movement is used to guide the client through the treatment services. Delivered services
specifically target education, positive social activities and natural support systems.

 5. Describe the continuing care services your program will provide                         25
following the clients’ discharge from outpatient treatment. Identify what
services will be provided through referral to other agencies and
providers.

Evaluation Criteria: Proposer’s response provides continuing care services. The
nature and frequency of services are fully described. The criteria used to adjust
continued service is discussed, as are relapse intervention strategies and options.
Proposer clearly makes the case that the proposed continuing care program is
appropriate for the target Population, and evidence of success is provided, if available.
6. Describe your staffing plan, including staff supervision and                             20
development. Include in your description:
• The FTE by position, typical salary range offered by your organization, and the
average caseload for each direct service position. This information may be
shown in chart format – which will not count against your page count.
• For each position or category of positions, identify the staff credentials and
competencies (knowledge and skills) that will be required to effectively serve
the target population(s), fully implement the program and competently deliver
the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve
the target population(s) and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the
proposed service to the target population(s). Proposer demonstrates skill and
experience delivering the services by their description of the staffing requirements and
skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver
the proposed services are in place and have been used successfully before.

D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                  25
7. Describe how your agency will assist in forming a strong collaboration                 25
with the referral source and others involved in providing
treatment/support services to the client (e.g., Juvenile justice agencies,
Child Welfare, other A/D treatment centers and other community
providers) in order to ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining
close, collaborative working relationships with referral sources and other service
providers involved with the client.
8. Describe the proposed quality assurance activities for these services,                 20
including defining the process of record review, complaints, consumer
satisfaction and progress in achieving performance outcomes. Include in
your response the strategies that will be utilized to assure fidelity to the
treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately
address requirements. Quality assurance will ensure the provision of safe and
clinically appropriate services to clients. Strategies for ensuring the program’s
contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement
process is continuous and embedded in the organization’s culture. QA strategies exist
calling for direct observation and evaluation of clinical practice and service delivery
as a fundamental part of staff supervision or there exists a reasonable plan for
implementing such strategies, including a process of record review, complaints,
consumer satisfaction and progress in achieving performance outcomes. Proposer has
fidelity measures and clinical supervision in place to assure adherence to treatment
modalities.
9. Does the last site review state that the Proposer is in substantial                    25
compliance with applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable
OARs and ORSs to maintain licensure to provide the services proposed under a
Contract awarded as a result of this RFP. If Proposer is not in full compliance or has
a temporary Letter of Approval, Proposer must be able to substantiate how they will be
able to obtain substantial compliance before entering into a Contract for services as a
result of this RFP. If Proposer received any findings as a result of the site review,
Proposer must attach a copy of the work plan to substantiate how the findings will be
mitigated.
Total Points Possible                                                                     215
Minimum Score Required to be Considered                                                   150




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                26
                     PROPOSAL QUESTIONS AND EVALUATION CRITERIA

            C. Life Skills and Aftercare Treatment for Drug Court Participants

                                            Total Points Possible 140

Describe the life skills and treatment services your agency will be providing to
                                                                                          Possible
Adults by answering the following questions. Do not exceed 8 pages for the                Points
narrative portion for this proposal.
1. Provide an overview of your proposed services, including your                          25
proposed curriculum areas of particular expertise. The overview needs
to include:
• The treatment philosophy, program model, and the theoretical frame work(s)
that serves as the basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment
model(s) and standardized clinical practices you will be using for the
population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but
plan to put in place within the next two years, indicate your plan for
implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the
population(s) being served. Proposer addresses the importance of integrating
employment, pro-social activities, skills training, natural support systems into the
clients’ treatment and recovery process.
 2. Describe your treatment services, life skills training services and              25
aftercare services and how these services will be structured to support
recovery. Include in your response:
• The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week;
broken out for individual counseling, family counseling, skills training, group
treatment, and structured recreational/pro-social activities.
• For each group treatment service and life skills training group describe its
purpose, content, and the criteria that will be used to determine if the client
mastered the knowledge and skills targeted.
• Specify what relapse prevention services will be provided.
• Identify the evidence-base service/practice that you propose to implement and
the source of your information.
• The process and criteria that will be used to guide service placement and
movement within and through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is
appropriate to the needs of the target population(s). Services are available for the
family and/or significant others to further enhance the treatment process. Strength
based and cognitive/behavioral approaches are used. A variation in service intensity is
employed based on client needs and progress in treatment. A competence-based
movement is used to guide the client through the treatment services. Delivered services
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                27
specifically target employment readiness, positive social activities and natural support
system.
3. Describe your staffing plan, including staff supervision and                            20
development. Include in your description:
• The FTE by position, typical salary range offered by your organization, and the
average caseload for each direct service position. This information may be
shown in chart format – which will not count against your page count.
• For each position or category of positions, identify the staff credentials and
competencies (knowledge and skills) that will be required to effectively serve
the target population(s), fully implement the program and competently deliver
the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve
the target population(s) and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the
proposed service to the target population(s). Proposer demonstrates skill and
experience delivering the services by their description of the staffing requirements and
skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver
the proposed services are in place and have been used successfully before.
4. Describe how your agency will assist in forming a strong collaboration                  25
with the drug court team and other treatment agencies in order to ensure
the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining
close, collaborative working relationships with the drug court team and other
treatment entities involved with the client.
5. Describe the proposed quality assurance activities for these services,                  20
including defining the process of record review, complaints, consumer
satisfaction and progress in achieving performance outcomes. Include in
your response the strategies that will be utilized to assure fidelity to the
treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately
address requirements. Quality assurance will ensure the provision of safe and
clinically appropriate services to clients. Strategies for ensuring the program’s
contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement
process is continuous and embedded in the organization’s culture. QA strategies exist
calling for direct observation and evaluation of clinical practice and service delivery
as a fundamental part of staff supervision or there exists a reasonable plan for
implementing such strategies, including a process of record review, complaints,
consumer satisfaction and progress in achieving performance outcomes. Proposer has
fidelity measures and clinical supervision in place to assure adherence to treatment
modalities.
6. Does the last site review state that the Proposer is in substantial                     25
compliance with applicable OARs and ORSs?

D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                 28
Evaluation Criteria: Proposer must be in substantial compliance with applicable
OARs and ORSs to maintain licensure to provide the services proposed under a
Contract awarded as a result of this RFP. If Proposer is not in full compliance or has
a temporary Letter of Approval, Proposer must be able to substantiate how they will be
able to obtain substantial compliance before entering into a Contract for services as a
result of this RFP. If Proposer received any findings as a result of the site review,
Proposer must attach a copy of the work plan to substantiate how the findings will be
mitigated.
Total Points Possible                                                                     140
Minimum Score Required to be Considered                                                    98




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                             29
                     PROPOSAL QUESTIONS AND EVALUATION CRITERIA

                         D Residential Alcohol & Drug Services for Adults

                                            Total Points Possible 165

Describe the treatment services your agency will be providing for Adults by
                                                                                        Possible
answering the following questions. Do not exceed 10 pages for the narrative             Points
portion for this proposal.
1. Provide an overview of your proposed services, including areas of                    25
particular expertise. The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s)
that serves as the basis for your treatment approach(es).
•    Any research or evidence of the effectiveness of the proposed treatment
model(s) and standardized clinical practices you will be using for the
population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but
plan to put in place within the next two years, indicate your plan for
implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the
population(s) being served. Proposer addresses the importance of integrating
employment, pro-social activities, natural support systems, and post-release housing
into the clients’ treatment and recovery process.
2.Describe your treatment planning process:                                             25

Evaluation Criteria: Response discusses how the clinical needs and strengths of each
client are integrated into a treatment plan. As the plan is developed, Proposer includes
family and/or significant others. The role of other support service providers and
human service providers is clearly and concisely described. Employment, pro-social
activities, and natural support systems and discharge criteria are all topics discussed
as part of the treatment planning process.
 3. Describe your treatment services and how these services are                          25
structured to address recovery. Include in your response:
• The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week;
broken out for individual counseling, family counseling, group treatment, and
structured recreational/pro-social activities.
• For each group treatment service describe its purpose, content, and the
criteria that will be used to determine if the client mastered the knowledge and
skills targeted.
• Specify what relapse prevention services will be provided.
• The process and criteria that will be used to guide service placement and
movement within and through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is
appropriate to the needs of the target population(s). Services are available for the
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                               30
family and/or significant others to further enhance the treatment process. Strength
based and cognitive/behavioral approaches are used. A variation in service intensity is
employed based on client needs and progress in treatment. A competence-based
movement is used to guide the client through the treatment services. Delivered
services specifically target employment readiness, positive social activities, natural
support systems.
4. Describe your staffing plan, including staff supervision and                            20
development. Include in your description:
• The FTE by position, typical salary range offered by your organization, and the
average caseload for each direct service position. This information may be
shown in chart format – which will not count against your page count.
• For each position or category of positions, identify the staff credentials and
competencies (knowledge and skills) that will be required to effectively serve
the target population(s), fully implement the program and competently deliver
the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve
the target population(s) and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the
proposed service to the target population(s). Proposer demonstrates skill and
experience delivering the services by their description of the staffing requirements and
skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver
the proposed services are in place and have been used successfully before.
5. Describe how your agency will assist in forming a strong collaboration                  25
with the referral source and others involved in providing
treatment/support services to the client (e.g., criminal justice agencies,
other A/D treatment centers and other community providers) in order to
ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining
close, collaborative working relationships with referral sources and other service
providers involved with the client.
6. Describe the proposed quality assurance activities for these services,                  20
including defining the process of record review, complaints, consumer
satisfaction and progress in achieving performance outcomes. Include in
your response the strategies that will be utilized to assure fidelity to the
treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately
address requirements. Quality assurance will ensure the provision of safe and
clinically appropriate services to clients. Strategies for ensuring the program’s
contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement
process is continuous and embedded in the organization’s culture. QA strategies exist
calling for direct observation and evaluation of clinical practice and service delivery
as a fundamental part of staff supervision or there exists a reasonable plan for
implementing such strategies, including a process of record review, complaints,
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                 31
consumer satisfaction and progress in achieving performance outcomes. Proposer has
fidelity measures and clinical supervision in place to assure adherence to treatment
modalities.
7. Does the last site review state that the Proposer is in substantial                    25
compliance with applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable
OARs and ORSs to maintain licensure to provide the services proposed under a
Contract awarded as a result of this RFP. If Proposer is not in full compliance or has
a temporary Letter of Approval, Proposer must be able to substantiate how they will be
able to obtain substantial compliance before entering into a Contract for services as a
result of this RFP. If Proposer received any findings as a result of the site review,
Proposer must attach a copy of the work plan to substantiate how the findings will be
mitigated.
Total Points Possible                                                                     165
Minimum Score Required to be Considered                                                   116




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                32
                     PROPOSAL QUESTIONS AND EVALUATION CRITERIA

        E. LOCALLY FUNDED PROJECT FOR MINORITIES OR UNDERSERVED
                              POPULATIONS

                               Total Points Possible 145
Describe the services your agency will be providing by answering the following
                                                                                            Possible
questions. Do not exceed 8 pages for the narrative portion for this proposal.               Points
1. Provide an overview of your proposed services, including areas of                        25
particular expertise. The overview needs to include:
• The target population your project intends to reach.
• Explanation of the need for special outreach to the target population.
• Program model, intended goals of the project.

Evaluation Criteria: Proposers response defines the specific population to be served.
The need for services, barriers to access and strategies to remove barriers are clearly
defined. Clear and realistic goals are outlined.
2. Describe your outreach process.                                                          25
• Strategies for reaching the target population
• Stabilization maintenance strategies for clients waiting to get into treatment
• Systems in place to communicate with referents

Evaluation Criteria: Proposers response addresses the potential barriers to treatment
for the target population(s) to be served and details suggest experience with the target
population. Response includes clear strategies for reaching the target population.
Response includes strategies for overcoming the identified barriers. A single point of
contact with designated back-up for referral questions, status reports, and problem
solving is discussed. Engagement methodologies are discussed. Wait list stabilization
services are offered and details regarding these services are provided.
3. Describe your treatment planning process:                                                25

Evaluation Criteria: Response discusses how the clinical needs and strengths of each
client are integrated into a treatment plan. As the plan is developed, Proposer includes
family and/or significant others. The role of other support service providers and
human service providers is clearly and concisely described. Employment, education,
pro-social activities and natural support systems are all topics discussed as part of the
treatment planning process.

4. Describe your staffing plan, including staff supervision and                             20
development. Include in your description:
• The FTE by position, typical salary range offered by your organization, and the
average caseload for each direct service position. This information may be
shown in chart format – which will not count against your page count.
• For each position or category of positions, identify the staff credentials and
competencies (knowledge and skills) that will be required to effectively serve
the target population(s), fully implement the program and competently deliver
the specified services.
D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                  33
• Your plan for ensuring staff are properly trained and able to effectively serve
the target population(s) and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the
proposed service to the target population(s). Proposer demonstrates skill and
experience delivering the services by their description of the staffing requirements and
skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver
the proposed services are in place and have been used successfully before.
5. Describe how your agency will assist in forming a strong collaboration                  25
with the referral source and others involved in providing
treatment/support services to the client (e.g., DHS agencies, Tribal
organizations, criminal justice agencies, other A/D treatment centers,
mental health organizations, physical health providers and other
community providers) in order to ensure the best possible results for
clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining
close, collaborative working relationships with referral sources and other service
providers involved with the client.
6. Does the last site review state that the Proposer is in substantial                     25
compliance with applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable
OARs and ORSs to maintain licensure to provide the services proposed under a
Contract awarded as a result of this RFP. If Proposer is not in full compliance or has
a temporary Letter of Approval, Proposer must be able to substantiate how they will be
able to obtain substantial compliance before entering into a Contract for services as a
result of this RFP. If Proposer received any findings as a result of the site review,
Proposer must attach a copy of the work plan to substantiate how the findings will be
mitigated.
Total Points Possible                                                                      145
Minimum Score Required to be Considered                                                    102




D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                 34
        Project Budget Worksheet for 2009 A&D Outpatient and Residential Proposals
                        Submit one Worksheet for each program proposed
Proposer: ____________________________________________________________________
Program Title: ________________________________________________________________


  Budget Category                        FTE              Klamath County   Other Funding      Program
                                                             Funding          Sources          Budget
Personnel:
  List Direct Service
Positions by Job Title:




Administrative (Combined
FTE and costs)
Travel/Conference/Training
Contractual Services
Equipment
Supplies
Rent/Utilities
Other




                                                            Total Amount    Total Other    Total Costs for
                                                             Requested       Funding          Program

                                                          $ ____________ $ ____________ $ ____________


Prepared by: _______________________________ Title:______________________________

Signature of Program Contact: ___________________________________________________



       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                              35
                                                         ATTACHMENT C

                          PROPOSAL EVALUATION REPORT
              A. Outpatient Alcohol & Drug Treatment Services for Adults
Name of Proposer:

Proposal Name:


Signature of Reviewer: ________________________________________ Date:____________

                                                                                                                    Max       Score
                                                                                                                    Points
                                            Content of Proposal
 1. Provide an overview of your proposed services, including areas of particular expertise.                         25
The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s) that serves as the
basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment model(s) and standardized
clinical practices you will be using for the population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but plan to put in place
within the next two years, indicate your plan for implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the population(s) being
served. Proposer addresses the importance of integrating employment, pro-social activities, natural support
systems into the clients’ treatment and recovery process.

COMMENTS:



 2. Describe your referral and intake process including:                                                            25
• Strategies for facilitating client access and engagement in treatment;
• Stabilization maintenance strategies for clients waiting to get into treatment,
• Systems in place to communicate with referents

Evaluation Criteria: Proposers response addresses the potential barriers to treatment for the target
population(s) to be served and details suggest experience with the target population. Response includes
strategies for overcoming the identified barriers. A single point of contact with designated back-up for referral
questions, status reports, and problem solving is discussed. Engagement methodologies are discussed. Wait
list stabilization services are offered and details regarding these services are provided.

COMMENTS:



3.Describe your treatment planning process:                                                                         25
Evaluation Criteria: Response discusses how the clinical needs and strengths of each client are integrated
into a treatment plan. As the plan is developed, Proposer includes family and/or significant others. The role of
other support service providers and human service providers is clearly and concisely described. Employment,
pro-social activities and natural support systems are all topics discussed as part of the treatment planning
process.
COMMENTS:



       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                       36
4. Describe your treatment services and how these services are structured to address                               25
recovery. Include in your response:

• The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week; broken out for individual
counseling, family counseling, group treatment, and structured recreational/pro-social activities.
• For each group treatment service describe its purpose, content, and the criteria that will be used to
determine if the client mastered the knowledge and skills targeted.
• Specify what relapse prevention services will be provided.
• Identify the evidence-base service/practice that you propose to implement and the source of your
information.
• The process and criteria that will be used to guide service placement and movement within and
through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is appropriate to the needs
of the target population(s). Services are available for the family and/or significant others to further enhance
the treatment process. Strength based and cognitive/behavioral approaches are used. A variation in service
intensity is employed based on client needs and progress in treatment. A competence-based movement is used
to guide the client through the treatment services. Delivered services specifically target employment readiness,
positive social activities and natural support system.

COMMENTS:



 5. Describe the continuing care services your program will provide following the clients’                         25
discharge from outpatient treatment. Identify what services will be provided through referral
to other agencies and providers.

Evaluation Criteria: Proposer’s response provides continuing care services. The nature and frequency of
services are fully described. The criteria used to adjust continued service is discussed, as are relapse
intervention strategies and options. Proposer clearly makes the case that the proposed continuing care
program is appropriate for the target Population, and evidence of success is provided, if available.

COMMENTS:



6. Describe your staffing plan, including staff supervision and development. Include in your                       20
description:
• The FTE by position, typical salary range offered by your organization, and the average caseload for
each direct service position. This information may be shown in chart format – which will not count
against your page count.
• For each position or category of positions, identify the staff credentials and competencies
(knowledge and skills) that will be required to effectively serve the target population(s), fully
implement the program and competently deliver the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve the target population(s)
and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the proposed service to the
target population(s). Proposer demonstrates skill and experience delivering the services by their description of
the staffing requirements and skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver the proposed services are
in place and have been used successfully before.
COMMENTS:


       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                  37
                                                                                                                     25
7. Describe how your agency will assist in forming a strong collaboration with the referral
source and others involved in providing treatment/support services to the client (e.g.,
criminal justice agencies, other A/D treatment centers and other community providers) in
order to ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining close, collaborative
working relationships with referral sources and other service providers involved with the client.
COMMENTS:



8. Describe the proposed quality assurance activities for these services, including defining                         20
the process of record review, complaints, consumer satisfaction and progress in achieving
performance outcomes. Include in your response the strategies that will be utilized to assure
fidelity to the treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately address requirements.
Quality assurance will ensure the provision of safe and clinically appropriate services to clients. Strategies for
ensuring the program’s contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement process is continuous and
embedded in the organization’s culture. QA strategies exist calling for direct observation and evaluation of
clinical practice and service delivery as a fundamental part of staff supervision or there exists a reasonable
plan for implementing such strategies, including a process of record review, complaints, consumer satisfaction
and progress in achieving performance outcomes. Proposer has fidelity measures and clinical supervision in
place to assure adherence to treatment modalities.
COMMENTS:



9. Does the last site review state that the Proposer is in substantial compliance with                               25
applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable OARs and ORSs to maintain
licensure to provide the services proposed under a Contract awarded as a result of this RFP. If Proposer is not
in full compliance or has a temporary Letter of Approval, Proposer must be able to substantiate how they will
be able to obtain substantial compliance before entering into a Contract for services as a result of this RFP. If
Proposer received any findings as a result of the site review, Proposer must attach a copy of the work plan to
substantiate how the findings will be mitigated.
Total Points                                                                                                         215




       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                     38
                         PROPOSAL EVALUATION REPORT
              B. Outpatient Alcohol & Drug Treatment Services for Youth
Name of Proposer:

Proposal Name:


Signature of Reviewer: ________________________________________ Date:____________

                                                                                                                    Max       Score
                                                                                                                    Points
                                            Content of Proposal
                                                                                                                    25
1. Provide an overview of your proposed services, including areas of particular expertise.
The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s) that serves as the
basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment model(s) and standardized
clinical practices you will be using for the population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but plan to put in place
within the next two years, indicate your plan for implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the population(s) being
served. Proposer addresses the importance of integrating employment, pro-social activities, natural support
systems into the clients’ treatment and recovery process.
COMMENTS:



2. Describe your referral and intake process including:                                                             25
• Strategies for facilitating client access and engagement in treatment;
• Stabilization maintenance strategies for clients waiting to get into treatment,
• Systems in place to communicate with referents

Evaluation Criteria: Proposers response addresses the potential barriers to treatment for the target
population(s) to be served and details suggest experience with the target population. Response includes
strategies for overcoming the identified barriers. A single point of contact with designated back-up for referral
questions, status reports, and problem solving is discussed. Engagement methodologies are discussed. Wait
list stabilization services are offered and details regarding these services are provided.
3. Describe your treatment planning process:                                                                        25
Evaluation Criteria: Response discusses how the clinical needs and strengths of each client are integrated
into a treatment plan. As the plan is developed, Proposer includes family and/or significant others. The role of
other support service providers and human service providers is clearly and concisely described. Employment,
pro-social activities and natural support systems are all topics discussed as part of the treatment planning
process.
COMMENTS:




       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                       39
 4. Describe your treatment services and how these services are structured to address                              25
recovery. Include in your response:

• The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week; broken out for individual
counseling, family counseling, group treatment, and structured recreational/pro-social activities.
• For each group treatment service describe its purpose, content, and the criteria that will be used to
determine if the client mastered the knowledge and skills targeted.
• Specify what relapse prevention services will be provided.
• Identify the evidence-base service/practice that you propose to implement and the source of your
information.
• The process and criteria that will be used to guide service placement and movement within and
through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is appropriate to the needs
of the target population(s). Services are available for the family and/or significant others to further enhance
the treatment process. Strength based and cognitive/behavioral approaches are used. A variation in service
intensity is employed based on client needs and progress in treatment. A competence-based movement is used
to guide the client through the treatment services. Delivered services specifically target education, positive
social activities and natural support system.

COMMENTS:


 5. Describe the continuing care services your program will provide following the clients’                         25
discharge from outpatient treatment. Identify what services will be provided through referral
to other agencies and providers.

Evaluation Criteria: Proposer’s response provides continuing care services. The nature and frequency of
services are fully described. The criteria used to adjust continued service is discussed, as are relapse
intervention strategies and options. Proposer clearly makes the case that the proposed continuing care
program is appropriate for the target Population, and evidence of success is provided, if available.
COMMENTS:


6. Describe your staffing plan, including staff supervision and development. Include in your                       20
description:
• The FTE by position, typical salary range offered by your organization, and the average caseload for
each direct service position. This information may be shown in chart format – which will not count
against your page count.
• For each position or category of positions, identify the staff credentials and competencies
(knowledge and skills) that will be required to effectively serve the target population(s), fully
implement the program and competently deliver the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve the target population(s)
and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the proposed service to the
target population(s). Proposer demonstrates skill and experience delivering the services by their description of
the staffing requirements and skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver the proposed services are
In place and have been used successfully before.
COMMENTS:




       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                  40
7. Describe how your agency will assist in forming a strong collaboration with the referral                          25
source and others involved in providing treatment/support services to the client (e.g.,
Juvenile justice agencies, Child Welfare, other A/D treatment centers and other community
providers) in order to ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining close, collaborative
working relationships with referral sources and other service providers involved with the client.
COMMENTS:


8. Describe the proposed quality assurance activities for these services, including defining                         20
the process of record review, complaints, consumer satisfaction and progress in achieving
performance outcomes. Include in your response the strategies that will be utilized to assure
fidelity to the treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately address requirements.
Quality assurance will ensure the provision of safe and clinically appropriate services to clients. Strategies for
ensuring the program’s contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement process is continuous and
embedded in the organization’s culture. QA strategies exist calling for direct observation and evaluation of
clinical practice and service delivery as a fundamental part of staff supervision or there exists a reasonable
plan for implementing such strategies, including a process of record review, complaints, consumer satisfaction
and progress in achieving performance outcomes. Proposer has fidelity measures and clinical supervision in
place to assure adherence to treatment modalities.
COMMENTS:


9. Does the last site review state that the Proposer is in substantial compliance with                               25
applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable OARs and ORSs to maintain
licensure to provide the services proposed under a Contract awarded as a result of this RFP. If Proposer is not
in full compliance or has a temporary Letter of Approval, Proposer must be able to substantiate how they will
be able to obtain substantial compliance before entering into a Contract for services as a result of this RFP. If
Proposer received any findings as a result of the site review, Proposer must attach a copy of the work plan to
substantiate how the findings will be mitigated.
Total Points Possible                                                                                                215




       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                     41
                           PROPOSAL EVALUATION REPORT
              C. Life Skills and Aftercare Treatment for Drug Court Participants
Name of Proposer:

Proposal Name:


Signature of Reviewer: ________________________________________ Date:____________

                                                                                                                   Max       Score
                                                                                                                   Points
                                            Content of Proposal
                                                                                                                   25
1. Provide an overview of your proposed services, including your proposed curriculum areas
of particular expertise. The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s) that serves as the
basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment model(s) and standardized
clinical practices you will be using for the population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but plan to put in place
within the next two years, indicate your plan for implementing these changes.
Evaluation Criteria: Proposer employs evidence-based practices appropriate to the population(s) being
served. Proposer addresses the importance of integrating employment, pro-social activities, skills training,
natural support systems into the clients’ treatment and recovery process.
COMMENTS:




2. Describe your treatment services, life skills training services and aftercare services, and                     25
how these services are structured to address recovery. Include in your response:
• The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week; broken out for individual
counseling, family counseling, skills training, group treatment, and structured recreational/pro-social
activities.
• For each group treatment service and life skills training group describe its purpose, content, and the
criteria that will be used to determine if the client mastered the knowledge and skills targeted.
• Specify what relapse prevention services will be provided.
• Identify the evidence-base service/practice that you propose to implement and the source of your
information.
• The process and criteria that will be used to guide service placement and movement within and
through the program.
Evaluation Criteria: Response convincingly shows the range of proposed services is appropriate to the needs
of the target population(s). Services are available for the family and/or significant others to further enhance
the treatment process. Strength based and cognitive/behavioral approaches are used. A variation in service
intensity is employed based on client needs and progress in treatment. A competence-based movement is used
to guide the client through the treatment services. Delivered services specifically target employment readiness,
positive social activities and natural support system.
COMMENTS:




       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                      42
3. Describe your staffing plan, including staff supervision and development. Include in your                         20
description:
• The FTE by position, typical salary range offered by your organization, and the average caseload for
each direct service position. This information may be shown in chart format – which will not count
against your page count.
• For each position or category of positions, identify the staff credentials and competencies
(knowledge and skills) that will be required to effectively serve the target population(s), fully
implement the program and competently deliver the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve the target population(s)
and deliver the services being proposed.
Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the proposed service to the
target population(s). Proposer demonstrates skill and experience delivering the services by their description of
the staffing requirements and skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver the proposed services are
in place and have been used successfully before.
COMMENTS:



4. Describe how your agency will assist in forming a strong collaboration with the drug court                        25
team and other treatment agencies in order to ensure the best possible results for clients.
Evaluation Criteria: Proposer discusses strategies for establishing and maintaining close, collaborative
working relationships with the drug court team and other treatment entities involved with the client.
COMMENTS:



5. Describe the proposed quality assurance activities for these services, including defining                         20
the process of record review, complaints, consumer satisfaction and progress in achieving
performance outcomes. Include in your response the strategies that will be utilized to assure
fidelity to the treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately address requirements.
Quality assurance will ensure the provision of safe and clinically appropriate services to clients. Strategies for
ensuring the program’s contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement process is continuous and
embedded in the organization’s culture. QA strategies exist calling for direct observation and evaluation of
clinical practice and service delivery as a fundamental part of staff supervision or there exists a reasonable
plan for implementing such strategies, including a process of record review, complaints, consumer satisfaction
and progress in achieving performance outcomes. Proposer has fidelity measures and clinical supervision in
place to assure adherence to treatment modalities.
COMMENTS:



6. Does the last site review state that the Proposer is in substantial compliance with                               25
applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable OARs and ORSs to maintain
licensure to provide the services proposed under a Contract awarded as a result of this RFP. If Proposer is not
in full compliance or has a temporary Letter of Approval, Proposer must be able to substantiate how they will
be able to obtain substantial compliance before entering into a Contract for services as a result of this RFP. If
Proposer received any findings as a result of the site review, Proposer must attach a copy of the work plan to
substantiate how the findings will be mitigated.
Total Points Possible                                                                                                140

       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                     43
                        PROPOSAL EVALUATION REPORT
            D. RESIDENTIAL ALCOHOL AND DRUG SERVICES FOR ADULTS
Name of Proposer:

Proposal Name:


Signature of Reviewer: ________________________________________ Date:____________

                                                                                                                      Max       Score
                                                                                                                      Points
                                            Content of Proposal
                                                                                                                      25
1. Provide an overview of your proposed services, including areas of particular expertise.
The overview needs to include:
• The treatment philosophy, program model, and the theoretical frame work(s) that serves as the
basis for your treatment approach(es).
• Any research or evidence of the effectiveness of the proposed treatment model(s) and standardized
clinical practices you will be using for the population(s) you will be serving.
• If there are treatment models or practices that you are not currently using but plan to put in place
within the next two years, indicate your plan for implementing these changes.

Evaluation Criteria: Proposer employs evidence-based practices appropriate to the population(s) being
served. Proposer addresses the importance of integrating employment, pro-social activities, natural support
systems, and post-release housing into the clients’ treatment and recovery process.
COMMENTS:



2.Describe your treatment planning process:                                                                           25
Evaluation Criteria: Response discusses how the clinical needs and strengths of each client are integrated
into a treatment plan. As the plan is developed, Proposer includes family and/or significant others. The role of
other support service providers and human service providers is clearly and concisely described. Employment,
pro-social activities, natural support systems, and discharge criteria are all topics discussed as part of the
treatment planning process.
COMMENTS:



 3. Describe your treatment services and how these services are structured to address                                 25
recovery. Include in your response:
•The typical weekly schedule of treatment and support services to be provided.
• The number of hours of therapeutic services available to clients per week; broken out for individual
counseling, family counseling, group treatment, and structured recreational/pro-social activities.
• For each group treatment service describe its purpose, content, and the criteria that will be used to
determine if the client mastered the knowledge and skills targeted.
• Specify what relapse prevention services will be provided.
• The process and criteria that will be used to guide service placement and movement within and
through the program.

Evaluation Criteria: Response convincingly shows the range of proposed services is appropriate to the needs
of the target population(s). Services are available for the family and/or significant others to further enhance the
treatment process. Strength based and cognitive/behavioral approaches are used. A variation in service
intensity is employed based on client needs and progress in treatment. A competence-based movement is used
to guide the client through the treatment services. Delivered services specifically target employment

       D:\Docstoc\Working\pdf\f4310045-297f-4a98-9edb-5b4ab0d492d2.doc                                                         44
readiness, positive social activities, natural support systems.

COMMENTS:


4. Describe your staffing plan, including staff supervision and development. Include in your                         20
description:
• The FTE by position, typical salary range offered by your organization, and the average caseload for
each direct service position. This information may be shown in chart format – which will not count
against your page count.
• For each position or category of positions, identify the staff credentials and competencies
(knowledge and skills) that will be required to effectively serve the target population(s), fully
implement the program and competently deliver the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve the target population(s)
and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the proposed service to the
target population(s). Proposer demonstrates skill and experience delivering the services by their description of
the staffing requirements and skill levels necessary to deliver quality service. Effective staff training and
development strategies to assure staff have/retain the knowledge and skills to deliver the proposed services are
In place and have been used successfully before.
COMMENTS:


5. Describe how your agency will assist in forming a strong collaboration with the referral                          25
source and others involved in providing treatment/support services to the client (e.g.,
criminal justice agencies, other A/D treatment centers and other community providers) in
order to ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining close, collaborative
working relationships with referral sources and other service providers involved with the client.
COMMENTS:


6. Describe the proposed quality assurance activities for these services, including defining                         20
the process of record review, complaints, consumer satisfaction and progress in achieving
performance outcomes. Include in your response the strategies that will be utilized to assure
fidelity to the treatment practices and service models you are proposing.

Evaluation Criteria: Proposed QA strategies are comprehensive and will adequately address requirements.
Quality assurance will ensure the provision of safe and clinically appropriate services to clients. Strategies for
ensuring the program’s contract service standards are being met including progress reporting and service
collaboration requirements. There is evidence that the service quality improvement process is continuous and
embedded in the organization’s culture. QA strategies exist calling for direct observation and evaluation of
clinical practice and service delivery as a fundamental part of staff supervision or there exists a reasonable
plan for implementing such strategies, including a process of record review, complaints, consumer satisfaction
and progress in achieving performance outcomes. Proposer has fidelity measures and clinical supervision in
place to assure adherence to treatment modalities.
COMMENTS:


7. Does the last site review state that the Proposer is in substantial compliance with                               25
applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable OARs and ORSs to maintain
licensure to provide the services proposed under a Contract awarded as a result of this RFP. If Proposer is not
in full compliance or has a temporary Letter of Approval, Proposer must be able to substantiate how they will

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be able to obtain substantial compliance before entering into a Contract for services as a result of this RFP. If
Proposer received any findings as a result of the site review, Proposer must attach a copy of the work plan to
substantiate how the findings will be mitigated.
Total Points Possible                                                                                               165




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                          PROPOSAL EVALUATION REPORT
          E. Locally Funded Project for Minorities or Underserved Populations
Name of Proposer:

Proposal Name:


Signature of Reviewer: ________________________________________ Date:____________

                                                                                                     Max      Score
                                                                                                     Points
                                        Content of Proposal
                                                                                                     25
1. Provide an overview of your proposed services, including areas of particular
expertise. The overview needs to include:
• The target population your project intends to reach.
• Explanation of the need for special outreach to the target population.
• Program model, intended goals of the project.

Evaluation Criteria: Proposers response defines the specific population to be served. The
need for services, barriers to access and strategies to remove barriers are clearly defined.
Clear and realistic goals are outlined.
Comments:


2. Describe your outreach process.                                                                   25
• Strategies for reaching the target population
• Stabilization maintenance strategies for clients waiting to get into treatment
• Systems in place to communicate with referents

Evaluation Criteria: Proposers response addresses the potential barriers to treatment for the
target population(s) to be served and details suggest experience with the target population.
Response includes clear strategies for reaching the target population. Response includes
strategies for overcoming the identified barriers. A single point of contact with designated back-
up for referral questions, status reports, and problem solving is discussed. Engagement
methodologies are discussed. Wait list stabilization services are offered and details regarding
these services are provided.
Comments:


3.Describe your treatment planning process:                                                          25
Evaluation Criteria: Response discusses how the clinical needs and strengths of each client
are integrated into a treatment plan. As the plan is developed, Proposer includes family and/or
significant others. The role of other support service providers and human service providers is
clearly and concisely described. Employment, education, pro-social activities and natural
support systems are all topics discussed as part of the treatment planning process.
Comments:


4. Describe your staffing plan, including staff supervision and development. Include in              20
your description:
• The FTE by position, typical salary range offered by your organization, and the average
caseload for each direct service position. This information may be shown in chart format –
which will not count against your page count.
• For each position or category of positions, identify the staff credentials and competencies

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(knowledge and skills) that will be required to effectively serve the target population(s), fully
implement the program and competently deliver the specified services.
• Your plan for ensuring staff are properly trained and able to effectively serve the target
population(s) and deliver the services being proposed.

Evaluation Criteria: Staffing plan is adequate to effectively implement and deliver the
proposed service to the target population(s). Proposer demonstrates skill and experience
delivering the services by their description of the staffing requirements and skill levels
necessary to deliver quality service. Effective staff training and development strategies to
assure staff have/retain the knowledge and skills to deliver the proposed services are in place
and have been used successfully before.
Comments:


5. Describe how your agency will assist in forming a strong collaboration with the                             25
referral source and others involved in providing treatment/support services to the client
(e.g., DHS agencies, Tribal organizations, criminal justice agencies, other A/D treatment
centers, mental health organizations, physical health providers and other community
providers) in order to ensure the best possible results for clients.

Evaluation Criteria: Proposer discusses strategies for establishing and maintaining close,
collaborative working relationships with referral sources and other service providers involved
with the client.
Comments:


6. Does the last site review state that the Proposer is in substantial compliance with                         25
applicable OARs and ORSs?

Evaluation Criteria: Proposer must be in substantial compliance with applicable OARs and ORSs to
maintain licensure to provide the services proposed under a Contract awarded as a result of this RFP. If
Proposer is not in full compliance or has a temporary Letter of Approval, Proposer must be able to
substantiate how they will be able to obtain substantial compliance before entering into a Contract for
services as a result of this RFP. If Proposer received any findings as a result of the site review, Proposer
must attach a copy of the work plan to substantiate how the findings will be mitigated.
Total Points Possible                                                                                          145




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                                                  ATTACHMENT D

                               PROPOSED CONTRACT FOR SERVICES




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                                               PROPOSED
                                          CONTRACT FOR SERVICES


PARTIES:                     KLAMATH COUNTY (“County”); and,

                                                                  (“Contractor”)


DATE:                        ______________________, 2009


1.       Services to be Provided: Contractor shall provide or cause to be provided as
         an independent contractor and not as an agent of the County,
         ________________________________, as set forth in Exhibit I “Services to be
         Provided, Performance Requirements and Payment Method”, attached to and
         hereby made a part of this Contract. All services shall be performed in
         accordance with the established standards and requirements stated therein.

2.       Term of the Contract: This Contract shall be in effect from July 1, 2009, through
         June 30, 2010 or until terminated pursuant to the “Termination” section of this
         Contract. This Contract may be renewed upon mutual written agreement
         between the parties according to the same terms contained herein or as modified
         for up to three additional one-year periods contingent upon receipt of funds.
         Renewal will be based, in part, on subcontractor meeting minimum contract
         requirements.

3.       Compensation: Contractor shall be compensated for services to be provided
         under the Contract as set forth in Exhibit I, “Services to be Provided,
         Performance Requirements and Payment Method”. Failure of the Contractor to
         submit the required program or audit reports to Klamath County Mental Health, or
         to resolve financial, program, or audit issues, will result in the suspension of
         payments or other sanctions as outlined in Exhibit II, Remedies Short of
         Termination, and/or termination of the Contract.

4.       Incorporation of Intergovernmental Agreement (IGA) for the Financing of
         Community Mental Health, Developmental Disability and Addiction
         Services between the State of Oregon and Klamath County:

         4.1.      The Intergovernmental Agreement (IGA) for the Financing of Community
                   Mental Health, Developmental Disability and Addictions Services between
                   the State of Oregon and Klamath County is hereby incorporated into this
                   Contract by way of reference. Contractor shall comply with all pertinent
                   requirements of that Intergovernmental Agreement. A copy of this
                   document may be obtained from Klamath County Mental Health, 3314
                   Vandenberg Road, Klamath Falls, Oregon, 97603.

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         4.2.      Contractor agrees that amendments or other modifications pertinent to the
                   Intergovernmental Agreement, services and compensation provided under
                   the Agreement shall thereby be made part of this Contract.

5.       Contract Administrator: The Director of the Klamath County Mental Health
         Department shall administer this Contract as the delegate of the Klamath County
         Board of Commissioners.

6.       Status: Contractor is hereby engaged as an independent contractor as defined
         in ORS 670.600 and will be so deemed for purposes of the following:

         6.1.      Contractor shall be solely responsible for payment of any Federal or State
                   taxes as required as a result of this Contract.

         6.2.      Contractor hereby specifically waives any right that it may have or claim
                   for indemnification from the County for the Contractor, its heirs,
                   successors or assigns pursuant to the Oregon Tort Claims Act, ORS
                   30.260, et seq.

         6.3.      This Contract is not intended to entitle Contractor to any benefits generally
                   granted to County employees.           Without limitation, but by way of
                   illustration, the benefits which are not intended to be extended by this
                   Contract to Contractor are overtime pay, vacation, holiday and sick leave
                   and other leaves with pay; tenure; medical and dental coverage; life and
                   disability insurance; or Social Security, Worker’s Compensation,
                   unemployment compensation or retirement benefits.

         6.4.      Contractor, subcontractors, if any, and all employers working under this
                   Contract are subject employers under the Oregon Worker’s Compensation
                   Law and shall comply with ORS 656.017, which requires them to provide
                   worker's compensation coverage for all their subject workers. Contractor
                   hereby covenants that it will bind its subcontractors to comply with this
                   statutory provision. Contractor shall provide the County proof of worker's
                   compensation coverage prior to commencement of any services provided
                   in connection to this Contract.

7.       Quality of Service: Contractor has represented, and by entering into this
         Contract now represents, that all personnel assigned to the work under this
         Contract are fully qualified to perform the work to which they will be assigned in a
         competent and professional manner, and if required to be licensed or registered
         by the State of Oregon, are so licensed or registered. Contractor shall perform
         the services herein described as an independent contractor in accordance with
         its own methods, the terms of the Contract and applicable laws and regulations
         and shall be responsible for the professional quality, technical accuracy and the
         coordination of all services furnished by the Contractor under this Contract.
         Contractor shall, without additional compensation, correct or revise any error or
         deficiencies in the work products or services. Neither the County’s review,
         approval or acceptance of, nor payment for, any of the services required under
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         this Contract shall be construed to operate as a waiver of any rights under this
         Contract or of any cause of action arising out of the performance of this Contract,
         and the Contractor shall be and remain liable to County in accordance with
         applicable laws for all damages to County caused by Contractor’s negligent
         performance of any services furnished under the Contract.

8.        Constraints:

         8.1.      The provisions of this Contract are contingent upon the appropriation of
                   funds by the State of Oregon. If funds are not appropriated, or
                   appropriations are subsequently amended by any party, the provisions of
                   this Contract thereupon become voidable or subject to amendment at the
                   option of the County.

         8.2.      Contractor must submit a copy of the following to the Contract
                   Administrator within six months of the completion of each Contractor’s
                   fiscal year for the duration of this Contract: annual business financial
                   statements, including, but not limited to a) an income statement, b)
                   balance sheet, as well as c) a complete budget showing revenue and
                   expenditures for all current and proposed programs. In addition,
                   Contractor will submit to County, two weeks prior to the Contractor’s new
                   fiscal year, the approved annual budget for programs of services provided
                   under this Contract.

         8.3.      Contractor agrees to participate in the repayment of any overpayment or
                   any State of Oregon or Federal government disallowed or unauthorized
                   expenditure of Contract funds to the full extent of Contractor’s
                   responsibility for those expenditures.

         8.4.      Contractor may expend funds paid to Contractor under this Contract in
                   accordance with federal OMB Circular A-87 as that circular is applicable
                   on allowable costs.

         8.5.      Contractor, if a non-profit organization and a sub-recipient of federal funds
                   passed through the County, must meet the audit requirements of OMB
                   Circular A-133 “Audits of States, Local Governments, and Non-Profit
                   Organization”, which applies the federal Single Audit Act Amendment of
                   1996, Public Law 104-156.

         8.6.      The County, the Oregon Department of Human Services, the Secretary of
                   State’s Office of the State of Oregon, the Federal Government, and their
                   duly authorized representatives shall have access and shall be entitled to
                   perform site reviews, audit, examine and make excerpts, copies and
                   transcriptions of the books, documents, papers and records of Contractor
                   or any subcontractor under this Contract or applicable subcontract to the
                   extent that such books, documents, papers or records are related to the
                   performance of this Contract. The Contractor shall maintain such books,
                   documents, papers or records that are directly related to this Contract for
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                   a period of not less than three (3) years from the date of final payment
                   under this Contract and by any subcontractor for a period of not less than
                   three (3) years from the date of final payment under subcontract and all
                   pending matters are closed unless an audit, litigation or other action
                   involving the records is started before the end of the three (3) year period,
                   whichever is later, pertaining to either the Contractor or its subcontractor.

         8.7.      This Contract is expressly subject to the debt limitation of Oregon counties
                   set forth in Article XI, Section 10 of the Oregon Constitution, and is
                   contingent upon funds being appropriated therefore.

         8.8.      Contractor agrees to defend, indemnify and save County, the State of
                   Oregon, the Office of Addictions and Mental Health and their agents and
                   employees harmless from any and all losses, claims, actions, costs,
                   expenses, judgments, subrogation or other damages resulting from injury
                   to any person (including injury resulting in death), or damage (including
                   loss or destruction) to property, arising or resulting from the fault,
                   negligence, wrongful act or wrongful omission of Contractor or its agents
                   or employees.

         8.9.      Contractor shall document the expenditures it makes in connection with
                   providing the services under this Contract. Unless applicable federal law
                   requires Contractor to utilize a different accounting system, Contractor
                   shall create and maintain all expenditure records in accordance with
                   generally accepted accounting principles and in sufficient detail to permit
                   County and the Oregon Department of Human Services to verify how the
                   funds paid to the Contractor under this Contract were expended.

         8.10. Neither party shall be held responsible for delay or failure in performance
               of this Contract when such delay or failure is due to causes beyond the
               control and without the fault or negligence of the party. Such causes may
               include, but are not restricted to, fire, flood, epidemic, acts of God,
               unusually severe weather, labor strikes, or legal acts of public authorities,
               which cannot be reasonably forecast or provided against. Either party
               may terminate this Contract after reasonably determining that such delay
               or failure will prevent continued performance of the Contract and upon
               giving written notice to the other party of cause, its effect upon Contract
               performance, and effective date of Contract termination.

         8.11. In connection with the delivery of services, Contractor shall:

                   8.11.1. Make available to a client, without charge to the client, upon the
                           client’s, the County’s or the Department of Human Service’s
                           request, any and all written materials in alternate, if appropriate,
                           formats as required by Oregon Department of Human Services
                           administrative rules or by Oregon Department of Human Services
                           written policies made available to Contractor.

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                   8.11.2. Make available to a client, without charge to the client, upon the
                           client’s, County’s or the Oregon Department of Human Services’
                           request, any and all written materials in the prevalent non-English
                           languages in the area served by the Contractor.

                   8.11.3. Make available to a client, without charge to the client, upon the
                           client’s, County’s or the Oregon Department of Human Services’
                           request, oral interpretation services in all non-English languages
                           in the area served by Contractor.

                   8.11.4. Make available to a client with hearing impairments, without
                           charge to the client, upon the client’s County’s or the Oregon
                           Department of Human Services’ request, sign language
                           interpretation services and telephone communications access
                           services.

                   For purposes of the foregoing, “written materials” includes, without
                   limitation, all work product and contracts related to this Contract.

9.       Compliance with Law:

         9.1.      Contractor and Contractor through its agents, officers and employees shall
                   observe and comply with all present and future laws, orders, regulations,
                   rules, ordinances and requirements of Federal, State and County
                   governments with respect to activities performed pursuant to this Contract.
                   Without limiting the generality of the foregoing, Contractor acknowledges
                   that a contractor of alcohol and drug treatment and addiction services may
                   not use the funds paid under this Contract for the following:

                   9.1.1 To provide inpatient hospital services.

                   9.1.2. To make cash payments to intended recipients of health services.

                   9.1.3. To purchase or improve land, to purchase, construct or
                          permanently improve (other than minor remodeling) any building or
                          other facility or to purchase major medical equipment.

                   9.1.4. To satisfy any requirement for expenditure of non-federal funds as
                          a condition for receipt of federal funds (whether the federal funds
                          are received under this Contract or otherwise).

                   9.1.5. With respect to federal Substance Abuse Prevention and Treatment
                          Block Grant moneys only, to purchase services from any person or
                          entity other than a public or non-profit entity.

                   9.1.6. To carry out any program prohibited by section 245(b) of the Health
                          Omnibus Programs Extension Act of 1988 (codified at 42 USC
                          300ee(5)).
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         9.2.      Contractor shall comply with all applicable requirements of the Americans
                   with Disabilities Act of 1990 and ORS 659A.142 in regard to employment
                   and access to services.

         9.3.      Contractor shall comply with the requirements of the Rehabilitation Act of
                   1973 which provides that no qualified handicapped persons shall, on the
                   basis of the handicap, be excluded from, be denied the benefits of, or
                   otherwise be subjected to discrimination under any program or activity
                   which receives or benefits from funds under this Contract.

         9.4.      Contractor shall comply with the requirements of the Civil Rights Act of
                   1964, including the following provisions:

                   9.4.1. No person in the United States shall, on the grounds of race, color
                          or national origin be excluded from participation in, be denied the
                          benefits of, or be subjected to discrimination under any program or
                          activity receiving this assistance.

                   9.4.2. It shall be an unlawful employment practice for an employer to fail
                          or refuse to hire or to discharge any individual or to otherwise
                          discriminate against any individual with respect to compensation,
                          terms, conditions, or privileges of employment, segregate, or
                          otherwise adversely affect his status as an employee, because of
                          such individual’s race, color, sex, religion, or national origin.

         9.5.      The Contractor shall provide worker’s compensation coverage for all
                   persons employed to perform work pursuant to the Contract in full
                   compliance with ORS Chapter 656.          Prior to commencing any work
                   pursuant to the Contract, the Contractor shall certify to the County that
                   Contractor is either a carrier-insured employer or a self-insured employer
                   as provided for by ORS 656.407. If the Contractor is a carrier-insured
                   employer, Contractor shall provide the County with a certificate of worker’s
                   compensation insurance. If the Contractor is a self-insured employer, the
                   Contractor shall provide the County with certification from the Worker’s
                   Compensation Division as evidence of the Contractor’s status.

         9.6.      The Contractor shall comply with all pertinent provisions of ORS Chapters
                   200, 279A, 279B, 279C, and 659 pertaining to nondiscrimination in hiring
                   and subcontracting practices.

         9.7.      The Contractor shall take affirmative steps to assure that small, minority
                   and women-owned businesses and firms located in labor surplus areas
                   are used when possible as sources of supplies, equipment, construction,
                   services and labor when subcontracts are utilized in the performance of
                   this Contract.



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         9.8.      Pursuant to ORS 279B.025, the Contractor shall use recyclable products
                   to maximum extent economically feasible in the performance of the work
                   of this Contract.

         9.9.      Pursuant to ORS 279B.220, the Contractor shall:

                   9.9.1. Make payment promptly, as due, to all persons supplying to the
                          Contractor labor or material for the performance of the work
                          provided for in this Contract.

                   9.9.2. Pay all contributions or amounts due the Oregon Industrial Accident
                          Fund from the Contractor or any subcontractor incurred in the
                          performance of this Contract.

                   9.9.3. Not permit any lien or claim to be filed or prosecuted against the
                          County/State of Oregon on account of labor or material furnished.

                   9.9.4. Pay to the Oregon Department of Revenue all sums withheld from
                          employees pursuant to ORS 316.167.

         9.10. Pursuant to ORS 279B.235, Contractor shall pay employees for overtime
               work performed under this contract in accordance with ORS 653.010 to
               653.261 and the Fair Labor Standards Act of 1938 (29 U.C.C. 201 et
               seq.).

         9.11. Pursuant to ORS 279B.230, the Contractor shall promptly, as due, make
               payment to any person, co-partnership, association or corporation
               furnishing medical, surgical and hospital care or needed care and
               attention, incident to sickness or injury, to employees of Contractor, of all
               sums which Contractor agrees to pay for such services and all monies and
               sums which the Contractor collected or deducted from the wages of the
               employees pursuant to any law, contract or agreement for the purpose of
               providing or paying for such service.

         9.12. Contractor understands that Contractor may be prosecuted under
               applicable federal and state criminal and civil laws for submitting false
               claims, concealing material facts, misrepresentation, falsifying data
               system input, other acts of misrepresentation, or conspiracy to engage
               therein.

10.      Insurance:

         10.1. Contractor shall obtain and at all times during the duration of this Contract
               keep in effect comprehensive liability insurance and property damage
               insurance covering the contracted activities. Said insurance shall, at a
               minimum, provide for:


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                   10.1.1. $500,000 to any claimant for any number of claims for damage to
                           or destruction of property, including consequential damages,
                           arising out of a single accident or occurrence.

                   10.1.2. $1,000,000 to any claimant as general and special damages for
                           all other claims arising out of a single accident or occurrence,
                           unless those damages exceed $1,000,000, in which case the
                           claimant may recover additional special damages, but in no event
                           shall the total award of special damages exceed $1,000,000.

                   10.1.3. $2,000,000 for any number of claims arising out of a single
                           accident or occurrence.

                   10.1.4. Automobile liability insurance with a combined single limit per
                           occurrence of not less than $500,000.

         10.2. Contractor shall provide compliant Certificates of Insurance to the County
               prior to the commencement of any services by Contractor under this
               Contract. These Certificates shall contain provision that coverages
               afforded under the policies cannot be canceled and restrictive
               modifications cannot be made until at least thirty (30) days prior written
               notice has been given to the County. A certificate which states merely
               that the carrier “will endeavor to mail written notice” is unacceptable.

         10.3. Contractor shall include Klamath County, the State of Oregon, the Office
               of Addictions and Mental Health Services and its officers, agents and
               employees as named additional insured on policies issued for this
               Contract, or shall furnish an additional insured endorsement naming the
               same as additional insured to Contractor’s existing public liability and
               property damage insurance, for Contractor’s activities pursuant to the
               performance of this Contract.

         10.4. Contractor shall ensure that the County is provided with a renewal
               certificate at least fifteen (15) days prior to the expiration date of the
               coverage in the event that the original certificate expires prior to the
               scheduled termination of the Contract.

11.      Contract Monitoring:

         11.1. These contracts will be monitored through a number of means, including:

                   11.1.1. Site Reviews: KCMH staff may schedule on-site visits to review
                           agency compliance with the contract. Site visits are usually
                           scheduled with contracted providers, but may be conducted
                           without notice.
                   11.1.2. Technical Assistance: KCMH staff may offer training and/or
                           assistance to programs.

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                   11.1.3. Evaluations/Program Performance: Program performance may be
                            evaluated through other quality assurance/evaluation processes,
                            including:
                            11.1.3.1. Performance reviews for achieving client service
                                       outcomes;
                            11.1.3.2. Contracted provider self-assessments;
                            11.1.3.3. Client satisfaction surveys and complaint resolution
                                       processes;
                            11.1.3.4. Compliance reviews for reporting requirements,
                                       including use of the County’s data collection systems;
                            11.1.3.5. Referral source satisfaction surveys;
                            11.1.3.6. Census validation audits; and,
                   11.1.4. Fiscal Compliance Reviews: County fiscal compliance reviews
                           may be conducted to ensure that financial records, systems and
                           procedures conform to Generally Accepted Accounting Principles
                           and are in compliance with all County and State audit and
                           accounting requirements.

12.      Assignments, Subcontracts: Contractor shall not assign or subcontract this
         Contract, or any part thereof, without the written consent of the County, and any
         attempted assignment or subcontract in violation hereof shall be void.

13.      Default, Remedies: Time is of the essence of this Contract. Either party shall be
         deemed to be in default if such party fails to perform any of its obligations under
         this Contract. In the event of default, the party that is not in default shall have the
         right to terminate this Contract immediately and pursue whatever legal, or
         equitable, remedies are available. All remedies shall be cumulative.

14.      No Waiver: No term or provision hereof shall be deemed waived and no breach
         excused, unless such waiver or consent shall be in writing and signed by the
         party claimed to have waived or consented. Any consent by either party to, or
         waiver of, a breach by the other, whether expressed or implied, shall not
         constitute a consent to, waiver of, or excuse for any other different or subsequent
         breach.

15.      Conflict Resolution: With respect to resolving issues in relation to this Contract,
         the Contractor may submit its concerns in writing to the Contract Administrator.
         The Contract Administrator shall submit such written materials and any other
         written materials the Contract Administrator believes are relevant to the Local
         Contract Review Board, which is the Klamath County Board of Commissioners
         (BOCC) for its review. The Contractor is entitled to a hearing before the BOCC
         at which it has a right to appear and present its concerns for decision by the
         BOCC.

16.      Amendment: This Contract and amendments to this Contract shall be in writing
         and will not be effective until approved by the Klamath County Board of
         Commissioners and the Contractor.

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17.      Client Service Eligibility for Outpatient Services Provided: Individuals
         receiving outpatient services funded under this Contract must not have other
         resources to pay for services and must meet the criteria as indigent. The
         definition of indigent, for purposes of this Contract, are defined as those
         individuals who are at or below 133% of the Federal Poverty Level as indicated
         at http://aspe.hhs.gov/poverty/09poverty.shtml

18.      Client Service Eligibility for Residential Services Provided: Individuals
         receiving residential services funded under this Contract shall be either OHP
         eligible individuals or indigent as defined in paragraph 17. above.

19.      Termination:

         19.1. The County shall reserve the right to terminate this Contract with twenty-
               four (24) hours notice should the County find the Contractor has failed to
               provide for the health and safety of individuals served under this Contract
               in keeping with the contractual conditions or relevant law, rule or
               regulation; or has performed in a manner determined to have violated the
               civil rights of, or otherwise caused harm to, any individual served under
               this Contract.

         19.2. This Contract may be terminated by either party by giving written notice to
               the other party at least sixty (60) days prior to the termination date. If
               termination is initiated by Contractor, the County and the Department of
               Human Services (DHS) have a right to full disclosure of Contractor’s
               records required by this Contract and the Intergovernmental Agreement.
               Contractor shall promptly provide such disclosure to County and DHS
               upon demand.

         19.3. The County reserves the right to terminate this Contract upon ten (10)
               days notice should the Contractor fail to comply with the provisions of the
               Insurance Section of this Contract.

         19.4. If Contractor’s license, registration or certificate required by law or
               regulation to be held by Contractor or Contractor’s subcontractors or
               participating providers to provide covered services under this Contract is
               for any reason denied, revoked or not renewed, County will terminate this
               Contract upon delivery of written notice to Contractor.

20.      Severability: The parties agree that if any term or provision of this Contract is
         declared by a court of competent jurisdiction to be illegal or in conflict with any
         law, the validity of the remaining terms and provisions shall not be affected, and
         the rights and obligations of the parties shall be construed and enforced as if the
         Contract did not contain the particular term or provision held to be invalid.

21.      Notices: Any notice required to be given pursuant to this Contract shall be in
         writing and may be given by personal delivery or by registered or certified mail,

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         addressed to County or Contractor at the address set forth below, or to either
         party in any other manner prescribed by law:
///

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                                                  Alcohol and Drug __________________ Services
                                               Contract Between Klamath County and ***************
                                                Term: Effective July 1, 2009 through June 30, 2010


                   COUNTY:                                             CONTRACTOR:

         Klamath County                                                *******************
         Mental Health Department
         3314 Vandenberg Road
         Klamath Falls, OR 97601
         (541) 882-7291
         (541) 883-4213 (Fax)


KLAMATH COUNTY                                                         ***********************
BOARD OF COMMISSIONERS



                                                                  ______________________________
Chairman                                                          Signature
Board of Commissioners


                                                                  ______________________________
Commissioner                                                      Printed Name, Title



                                                                  ______________________________
Commissioner                                                      Federal I.D. No.



APPROVED AS TO FORM AND                                           AS DEPARTMENT HEAD, I
LEGAL SUFFICIENCY:                                                RECOMMEND APPROVAL:



                                                                  ______________________________
W. Daniel Bunch                                                   Ann Lynn, BA
County Counsel                                                    Director




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                                                        EXHIBIT I


               DESCRIPTION OF SERVICE, PERFORMANCE REQUIREMENTS
                              AND PAYMENT METHOD



         A. Outpatient Alcohol and Drug Treatment for Adults (AD 66)
         B. Outpatient Alcohol and Drug Treatment for Youth (AD 66)
         C. Life Skills and Aftercare Treatment Services for Drug Court Participants (AD
            66)
         D. Residential Treatment Services for Adults (AD 61 & AD 67)
         E. Locally Funded Project for Minorities or Underserved Populations (AD 66)
         F. Contractor’s Proposal




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                                      EXHIBIT I.
          A. Outpatient Alcohol and Drug Treatment for Adults (AD 66)

I.         Service Description:

Contractor agrees to provide Outpatient Alcohol and Drug Treatment to Adult men and
women who are in need of treatment services on a regularly scheduled basis, so they
can achieve or maintain abstinence or related recovery goals. Services include
assessment, individual, group, and family counseling, case management, mentoring,
and long-term support for relapse prevention. A complete definition of outpatient client
criteria can be found in ASAM PPC-2R.

II.       Performance Requirements:

         Services are to be delivered to Adult (18 years of age or older) Klamath County
          residents who are indigent.
         Funds cannot be used to deliver outpatient services to any individual enrolled in
          the OHP for chemical dependency benefits.
         Contractor must comply with all applicable sections of OAR 415-051-0000
          through 415-051-0165, Standards for Outpatient and Residential A&D Treatment
          Programs). Services are described in part below. For the full text of OAR 415-
          051-000 through 415-051-0165 can be accessed at
          http://www.sos.state.or.us/archives/rules/OARS_400/OAR_415/415_051.html

OAR 415-051-0030
Client Diagnostic Assessment
        (1) Written Procedure: The alcohol and drug abuse treatment program shall
        develop and implement a written procedure for assessing each client's treatment
        needs based on the ASAM PPC-2R.
        (2) Assessment to Include: The diagnostic assessment shall be documented in
        the permanent client record. It shall consist of both the elements described in the
        ASAM PPC-2R and documentation of the client's self-identified cultural
        background, including level of acculturation, knowledge of own culture, primary
        language, spiritual or religious interests, and cultural attitudes toward alcohol
        and other drug use.

OAR 415-051-0035
Treatment Services, General
      (1) Services to be Provided: The alcohol and other drug abuse treatment
      program shall provide to each client those clinically appropriate services and
      activities needed to address the problems identified from the diagnostic
      assessment and document the activity in the client record.
      (2) Other Services: The program, to the extent of community resources available
      and as clinically indicated, shall provide clients with information and referral to
      other services, including smoking cessation services.

OAR 415-051-0037
Treatment Planning and Documentation of Treatment Progress
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          (1) Placement, Continued Stay, Discharge Criteria: The alcohol and other drug
          abuse treatment program shall develop treatment plans, progress notes, and
          discharge plans consistent with the ASAM PPC-2R.
          (2) Treatment Plan: Individualized treatment planning shall occur and be
          documented in the client record no later than 30 days from admission to an
          outpatient treatment program and no later than 14 days from admission to a
          residential treatment program. The treatment plan shall:
          (a) Describe the primary client-centered issue or issues as determined by the
          assessment;
          (b) Focus on one or more treatment plan objectives that are consistent with the
          client's abilities and strengths and are established to address the primary
          obstacles to recovery;
          (c) Define the treatment approach, which shall include services and activities to
          be utilized to achieve the individualized objectives;
          (d) Document the participation of significant others in the planning process and
          treatment where appropriate; and
          (e) Document the client's participation in developing the content of the treatment
          plan and any subsequent modifications with, at a minimum, the client's
          signature.
          (3) Documentation of Progress: The treatment staff shall document in the
          permanent record the client's progress toward achieving the individualized
          objectives in the client's treatment plan and any current obstacles to recovery.
          (4) Treatment Plan Review: The permanent client record shall document that the
          treatment plan is reviewed and modified continuously as needed and as clinically
          appropriate and that the modifications are consistent with the ASAM PPC-2R.
          (5) Treatment Summary: No later than 30 days after the last service contact, the
          program shall document in the permanent client record a summary describing
          the reason for discharge and the client's progress toward treatment objectives
          consistent with the ASAM PPC-2R.
          (6) Discharge Plan: Upon successful completion or planned interruption of the
          treatment services, the treatment staff and client shall jointly develop a discharge
          plan. The discharge plan shall include a relapse prevention plan that has been
          jointly developed by the counselor and client and signed by the client.
          [Publications: Publications referenced are available from the agency.]

III.     General Billing Requirements and Compensation

If a client is eligible for Oregon Health Plan (OHP) or other insurance, Contractor will
assist the client in applying for that coverage.

Funding under this Contract may not be used to provide treatment for clients who are
OHP eligible, who have other chemical dependency coverage or who are not indigent.

Service duplication adversely impacts the cost effectiveness of contracted services. To
minimize duplications, clients served under any Klamath County contract may not
support a claim for reimbursement for the same services under any other Klamath
County contract.



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Based on a sliding scale starting at zero, Proposers shall have a client fee system to
support the costs of these services. However, in no circumstance shall a client’s inability
to pay become a barrier to treatment for those individuals served with funding provided
through this Contract.

Monthly County payments for Contractor services are contingent on the dollar amounts
and services authorized in the Intergovernmental Agreement for the Financing of
Community Mental Health, Developmental Disability and Addiction Services between
the Office of Addictions and Mental Health Services and Klamath County.

Contractor shall bill County on the CMS 1500 form at the rate established in this section
for all individuals receiving services under this Contract and will use standard billing
procedures i.e., service codes CPT/HCPCs, place of service, unit of service, etc.
Contractor will use the client’s CPMS number in Block 1a of the CMS 1500 form.

Contractor shall be required to bill and receive payment from third party resources for
individuals with such resources.

Monthly payments for contractor services are disbursed through the normal County
accounts payable process. Billings to be paid must be received in accordance with time
lines as described earlier in this section. Payments for services will be rendered as
follows. Contract and reimbursement rates are subject to the availability of funds:

( 1 ) Reimbursement will be made according to the Klamath County Mental Health
Fee Schedule attached at Exhibit IV; however such reimbursement shall be the lesser
of billed charges or the Klamath County Mental Health Fee Schedule. Billed charges
must reflect the CONTRACTOR’s current fee schedule. Contractor will be paid a
maximum of $__________ per contract year (as negotiated) based on the services
stated in the Contractor’s proposal attached to, and made a part of, this Contract.
Payment in the amount of $__________ per month (as negotiated) will be made
prospectively based on historical billings or as negotiated and reconciled monthly.
Contract compliance will be reviewed at intervals during the contract year. KCMH
reserves the right to adjust payment downward if minimum average billing target is not
met.

(2)      Reconciliation will be done monthly.

County is not obligated to provide payment for any services for individuals who are not
properly reported through CPMS.

IV. Special Reporting Requirements

Contractor will submit enrollment and discharge Client Process Monitoring System
(CPMS) forms for each client to the State Department of Human Services Addictions
and Mental Health (AMH) Division or designee. Contractor will comply with all relevant
CPMS reporting timelines and standards.

Comply with County Quality Assurance reviews, County/State on-site visits/reviews and
recommendations resulting from such reviews.
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               B. Outpatient Alcohol and Drug Treatment for Youth (AD66)

I.        Service Description:

Contractor agrees to provide Alcohol and Drug Treatment services to Youth ages 12
through 17 years of age, or those persons who are determined by the program to be
developmentally and clinically appropriate for Youth services, who are in need of
treatment services on a regularly scheduled basis so they can achieve or maintain
abstinence or related recovery goals. Services include: assessment; individual, group,
and family counseling; case management; mentoring; and long-term support for relapse
prevention. A complete definition of outpatient client criteria can be found in ASAM
PPC-2R.

II.       Performance Requirements:

         The target population is Klamath County residents who are indigent.
         Funds cannot be used to deliver outpatient services to any individual enrolled in
          the OHP for chemical dependency benefits.
         Any client enrolled in the Oregon Health Plan shall not be billed for services
          covered by the Oregon Health Plan.
         Service duplication adversely impacts the cost effectiveness of contracted
          services. To minimize duplications, clients served under any Klamath County
          contract may not support a claim for reimbursement for the same services under
          any other Klamath County contract.
         Contractor must comply with all applicable sections of OAR 415-051-0000
          through 415-051-0165 (Standards for Outpatient and Residential A&D
          Treatment), and in particular 415-051-0100, Adolescent Treatment Services

In addition to the general standards for alcohol and other drug abuse treatment
programs under OAR 415-051-0000 through 415-051-0060 and 415-051-0165 the
programs approved to provide adolescent treatment services or those with adolescent
designated treatment funding shall meet the following standards:
(1) Participation of Family/Agencies: Treatment planning/case management services
shall include participation of parents, other family members, schools, children's services
agencies, and juvenile corrections, as appropriate.
(2) Treatment Services: Treatment services should include:
          (a) Family treatment;
          (b) Recreation and leisure time skills training;
          (c) Academic education services or referral;
          (d) Smoking cessation treatment; and
          (e) Gender-specific treatment.
(3) Continuing Care: Continuing care services shall be of appropriate duration and
designed to maximize recovery opportunities. The services shall include:
          (a) Reintegration services and coordination with family and schools;
          (b) Support groups and/or other peer support groups provided at school sites;
          (c) Youth dominated self-help groups where available;
          (d) Referral to emancipation services when appropriate; and
          (e) Referral to physical or sexual abuse treatment when appropriate.
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(4) Staff Qualifications: Staff shall have formal training in adolescent development and
family counseling and demonstrate competence in the gender-specific alcohol and other
drug abuse treatment of adolescents and their families.

III.     General Billing Requirements and Compensation

If a client is eligible for Oregon Health Plan (OHP) or other insurance, Contractor will
assist the client in applying for that coverage.

Funding under this Contract may not be used to provide treatment for clients who are
OHP eligible, who have other chemical dependency coverage or who are not indigent.

Service duplication adversely impacts the cost effectiveness of contracted services. To
minimize duplications, clients served under any Klamath County contract may not
support a claim for reimbursement for the same services under any other Klamath
County contract.

Based on a sliding scale starting at zero, Proposers shall have a client fee system to
support the costs of these services. However, in no circumstance shall a client’s inability
to pay become a barrier to treatment for those individuals served with funding provided
through this Contract.

Monthly County payments for Contractor services are contingent on the dollar amounts
and services authorized in the Intergovernmental Agreement for the Financing of
Community Mental Health, Developmental Disability and Addiction Services between
the Office of Addictions and Mental Health Services and Klamath County.

Contractor shall bill County on the CMS 1500 form at the rate established in this section
for all individuals receiving services under this Contract and will use standard billing
procedures i.e., service codes CPT/HCPCs, place of service, unit of service, etc.
Contractor will use the client’s CPMS number in Block 1a of the CMS 1500 form.

Contractor shall be required to bill and receive payment from third party resources for
individuals with such resources.

Monthly payments for contractor services are disbursed through the normal County
accounts payable process. Billings to be paid must be received in accordance with time
lines as described earlier in this section. Payments for services will be rendered as
follows. Contract and reimbursement rates are subject to the availability of funds:

( 1 ) Reimbursement will be made according to the Klamath County Mental Health
Fee Schedule attached at Exhibit IV; however such reimbursement shall be the lesser
of billed charges or the Klamath County Mental Health Fee Schedule. Billed charges
must reflect the CONTRACTOR’s current fee schedule. Contractor will be paid a
maximum of $__________ per contract year (as negotiated) based on the services
stated in the Contractor’s proposal attached to, and made a part of, this Contract.
Payment in the amount of $__________ per month (as negotiated) will be made
prospectively based on historical billings and reconciled monthly. Contract compliance

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will be reviewed at intervals during the contract year. KCMH reserves the right to
adjust payment downward if minimum average billing target is not met.

(2)      Reconciliation will be done monthly.

County is not obligated to provide payment for any services for individuals who are not
properly reported through CPMS.

IV. Special Reporting Requirements

Contractor will submit enrollment and discharge Client Process Monitoring System
(CPMS) forms for each client to the State Department of Human Services Addictions
and Mental Health (AMH) Division or designee. Contractor will comply with all relevant
CPMS reporting timelines and standards.

Comply with County Quality Assurance reviews, County/State on-site visits/reviews and
recommendations resulting from such reviews.




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       C. Outpatient Alcohol and Drug Treatment for Adults (AD 66), Life Skills and
                             Aftercare for Drug Court Clients

I.         Service Description:

The intent of this program is to assist Drug Court clients who move to Phase II of the
drug court program develop the skills necessary to transition into a positive, drug and
alcohol free lifestyle. Services such as parenting, family counseling, anger
management, life skills including budgeting, employment seeking skills and nutrition, as
well as long-term support for relapse prevention are to be included in the program.
Services may be provided in both group and individual settings and should be
individualized to focus on the needs of these clients as they transition to recovery. A
complete definition of outpatient client criteria can be found in ASAM PPC-2R.

II.        Performance Requirements:

          The target population is Klamath County residents who are participating in Drug
           Court in either CJC slots or regular Drug Court slots.
          Funds cannot be used to deliver outpatient services to any individual enrolled in
           the OHP for chemical dependency benefits.
          Services are to be delivered to Adult (18 years of age or older) Klamath County
           residents who are indigent.
          Contractor must comply with all applicable sections of OAR 415-051-0000
           through 415-051-0165 Standards for Outpatient and Residential A&D Treatment
           Programs). For the full text of OAR 415-051-000 through 415-051-0165 can be
           accessed at
           http://www.sos.state.or.us/archives/rules/OARS_400/OAR_415/415_051.html
          Service duplication adversely impacts the cost effectiveness of contracted
           services. To minimize duplications, clients served under any Klamath County
           contract may not support a claim for reimbursement for the same services under
           any other Klamath County contract.

III.       General Billing Requirements and Compensation

If a client is eligible for Oregon Health Plan (OHP) or other insurance, Contractor will
assist the client in applying for that coverage.

Funding under this Contract may not be used to provide treatment for clients who are
OHP eligible, who have other chemical dependency coverage or who are not indigent.

Service duplication adversely impacts the cost effectiveness of contracted services. To
minimize duplications, clients served under any Klamath County contract may not
support a claim for reimbursement for the same services under any other Klamath
County contract.

Based on a sliding scale starting at zero, Proposers shall have a client fee system to
support the costs of these services. However, in no circumstance shall a client’s inability

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to pay become a barrier to treatment for those individuals served with funding provided
through this Contract.

Monthly County payments for Contractor services are contingent on the dollar amounts
and services authorized in the Intergovernmental Agreement for the Financing of
Community Mental Health, Developmental Disability and Addiction Services between
the Office of Addictions and Mental Health Services and Klamath County.

Contractor shall bill County on the CMS 1500 form at the rate established in this section
for all individuals receiving services under this Contract and will use standard billing
procedures i.e., service codes CPT/HCPCs, place of service, unit of service, etc.
Contractor will use the client’s CPMS number in Block 1a of the CMS 1500 form.

Contractor shall be required to bill and receive payment from third party resources for
individuals with such resources.

Monthly payments for contractor services are disbursed through the normal County
accounts payable process. Billings to be paid must be received in accordance with time
lines as described earlier in this section. Payments for services will be rendered as
follows. Contract and reimbursement rates are subject to the availability of funds:

( 1 ) Reimbursement will be made according to the Klamath County Mental Health
Fee Schedule attached at Exhibit IV; however such reimbursement shall be the lesser
of billed charges or the Klamath County Mental Health Fee Schedule. Billed charges
must reflect the CONTRACTOR’s current fee schedule. Contractor will be paid a
maximum of $__________ per contract year (as negotiated) based on the services
stated in the Contractor’s proposal attached to, and made a part of, this Contract.
Payment in the amount of $__________ per month (as negotiated) will be made
prospectively based on historical billings or as negotiated and reconciled monthly.
Contract compliance will be reviewed at intervals during the contract year. KCMH
reserves the right to adjust payment downward if minimum average billing target is not
met.

(2)      Reconciliation will be done monthly.

County is not obligated to provide payment for any services for individuals who are not
properly reported through CPMS.

IV. Special Reporting Requirements

Contractor will submit enrollment and discharge Client Process Monitoring System
(CPMS) forms for each client to the State Department of Human Services Addictions
and Mental Health (AMH) Division or designee. Contractor will comply with all relevant
CPMS reporting timelines and standards.

Comply with County Quality Assurance reviews, County/State on-site visits/reviews and
recommendations resulting from such reviews.



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                    D. Adult Alcohol and Drug Residential Services (AD 61)

I. Service Description:

This is a contract to provide 18 contracted beds for Adult Alcohol and Drug Residential
Treatment Services (A&D 61) which are services delivered to individuals 18 years of
age or older who have a primary dependency on alcohol or drugs, are unable to live
independently in the community, cannot maintain even a short period of abstinence and
are in need of 24-hour supervision, treatment and care. The purpose of A&D 61
Services is to support, stabilize and rehabilitate alcohol and drug dependent individuals
to permit them to return to independent community living. A&D 61 Services provide a
structured environment for an individual on a 24-hour basis consistent with Level III of
the chemical dependency placement, continued stay and discharge criteria set forth in
OAR 415-051-0000 through 415-051-0155, as such rules may be revised from time to
time, are appropriate to the individual’s needs and include structured counseling,
educational services, recreation services, self help group participation services and
aftercare planning to support the gains made in treatment. A&D 61 Services address
the needs of diverse population groups within the community.

II. Performance Requirements:

Providers of A&D 61 Services funded through this Contract must comply with OAR 415-
051-0000 through 415-051-0155, as such rules may be revised from time to time.
Providers of A&D 61 Services funded through this Contract must also have a current
license issued by the Department of Human Services (the Department) in accordance
with OAR 415-012-0000 through 415-012-0090.

Contractor must give priority access to such services first 1) to individuals referred from
the Department of Human Services and 2) to individuals who are receiving Medicaid
and 3) then to individuals referred by Drug Courts from within the region as such region
is designated by the Department after consultation with County and relevant providers.
A&D 61 Services funded through this Contract may be delivered to individuals referred
from any County within the region and no priority or preference shall be given to
individuals referred from any particular County with the region based on the referring
County. Except as provided below, at least 60% of the A&D 61 Services funded through
this Contract must be delivered to individuals receiving Medicaid. The remaining A&D
61 Services funded through this Contract may be delivered to individuals who need
State support to finance their treatment, and who may or may not be eligible for
Medicaid.

Special Federal Requirements Applicable to Addictions Services:

       Pregnant Women:
       • Within the priority categories, if any, set forth in a particular Service Description,
         give preference in admission to pregnant women in need of treatment who seek,
         or are referred for, and would benefit from such services.
       • Perform outreach to inform pregnant women of the availability of treatment
         services targeted to them and the fact that pregnant women receive preference
         in admission to these programs.
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       • If Contractor has insufficient capacity to provide treatment services to a pregnant
         woman, refer the woman to another provider with capacity or if no available
         treatment capacity can be located, refer the woman to Klamath County Mental
         Health for referral to another provider in the State.

       Intravenous Drug Abusers:
       • Within the priority categories, if any, set forth in a particular Service Description
         and subject to the preference for pregnant women described above, give
         preference in admission to intravenous drug abusers.
       • If Contractor reaches 90 percent of its capacity to admit intravenous drug
         abusers, Contractor must attempt to refer an intravenous drug abuser seeking
         admission, to another provider and provide notice of such referral or attempted
         referral to County who will notify DHS’s Addiction and Mental Health Division.
       • If Contractor receives a request for admission to treatment from an intravenous
         drug abuser, Contractor must, unless it succeeds in referring the individual to
         another provider with treatment capacity under the circumstances described
         above, admit the individual to treatment not later than:
         •      14 days after the request for Admission to Contractor is made, or
         •      120 days after the date of such request if no provider has the capacity to
         admit the individual on the date of such request and, if interim services are made
         available not less than 48 hours after such request.
       • For purposes of paragraphs above, “Interim Services” means:
         •      Services for reducing the adverse health effects of such abuse, for
         promoting the health of the individual, and for reducing the risk of transmission of
         disease, including counseling and education about HIV and tuberculosis, the
         risks of needle sharing, the risks of transmission of disease to sexual partners
         and infants, and steps that can be taken to ensure that HIB and tuberculosis
         transmission does not occur
         •      Referral for HIV or TB treatment services, where necessary, and
         •      Referral for prenatal care if appropriate until the individual is admitted to a
         provider’s services.
         •      If Contractor treats recent intravenous drug abusers (those who have
         injected drugs within the past year) in more than one-third of its capacity,
         Contractor shall carry out outreach activities to encourage individual intravenous
         drug abusers in need of such treatment to undergo treatment, and shall
         document such activities.

       Infectious Diseases:
       • Complete a risk assessment for infectious diseases including Human
         Immunodeficiency Virus (HIV) and tuberculosis, as well as sexually transmitted
         diseases, based on protocols established by DHS, for every individual seeking
         services from Contractor, and
       • Routinely make tuberculosis services available to each individual receiving
         services for alcohol/drug abuse either directly or through other arrangements with
         public or non-profit entities and, if Contractor denies an individual admission on
         the basis of lack of capacity, refer the individual to another provider of
         tuberculosis services.
       • “Tuberculosis services” means:
         •      Counseling the individual with respect to tuberculosis
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         •       Testing to determine whether the individual has contracted such disease
         and testing to determine the form of treatment for the disease that is appropriate
         for the individual, and
         •       Appropriate treatment services.

       DHS Referrals:
       • Contractor must, within the priorities of categories, if any, set forth in a particular
         service description and subject to the preference for pregnant women and
         intravenous drug abusers described above, give preference in A&D service
         delivery to persons referred by DHS.

       Barriers to Treatment: Where there is a barrier to delivery of an A&D service due to
       culture, gender, language, illiteracy, or disability, Contractor shall develop support
       services available to address or overcome the barrier, including:
       • Providing, if needed, hearing impaired or foreign language interpreters
       • Providing translation of written materials to appropriate language or method of
         communication
       • Providing devices that assist in minimizing the impact of the barrier
       • Not charging clients for the costs of measures, such as interpreters, that are
         required to provide nondiscriminatory treatment.

       Misrepresentation: Contractor shall not knowingly or willfully make or cause to be
       made any false statement or representation of a material fact in connection with
       the furnishing of items or services for which payments are made under this
       Contract.

       Oregon Residency: A&D services funded through this Contract may only be
       provided to residents of Oregon. Residents of Oregon are individuals who live in
       Oregon. There is no minimum amount of time an individual must live in Oregon to
       qualify as a resident so long as the individual intends to remain in Oregon. A child’s
       residence is not dependent on the residence of his or her parents. A child living in
       Oregon may meet the residency requirement if the caretaker relative with whom
       the child is living is an Oregon resident.

       Tobacco Use: If Contractor has A&D services treatment capacity that has been
       designated for children, adolescents, pregnant women, and women with
       dependent children, Contractor must implement a policy to eliminate smoking and
       other use of tobacco at the facilities where the services are delivered on the
       grounds of such facilities.

       Client Authorization: Contractor must comply with 42 CFR Part 2 when delivering
       an addiction service that includes disclosure of client information for the purposes
       of eligibility determination or CPAs, PPAs, or SEPA adjustments, if appropriate.
       Contractor must obtain client authorization for disclosure of billing information, to
       the extent and in the manner required by 42 CFR Part 2, before a disbursement
       claim is submitted with respect to delivery of an addiction service to that individual.

Providers of A&D 61 Services funded through this Contract must participate in client
outcome studies conducted by the Department.
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Unless otherwise specified in this Contract, Contractor shall create and maintain a client
record for each client who receives services under this Contract and in accordance with
OAR 415-051-0000 through 415-051-0155. The client record must include, but is not
limited to:
•      Client identification
•      Problem assessment
•      Treatment, training and/or care plan
•      Medical information when appropriate; and
•      Progress notes including service termination and current assessment or
evaluation instrument as designated by the Oregon Department of Human Services in
administrative rules.

Unless State Archivist OARs (OAR 166) require a longer retention period, client records
must be retained for a minimum of seven years from termination of this Contract.

III. Additional Requirements:
      100 % utilization of treatment beds.
      State requires 60% of residential bed availability be used for Medicaid clients.
       Explanation: The Medicaid eligibility requirement will be settled on an average
       statewide basis. If the statewide Medicaid percentage falls below 60%, prorated
       settlement will be made from those Counties who failed to meet the 60%
       threshold. If Klamath County fails to meet the 60% threshold, reconciliation will
       be made at the provider level.
      Client Engagement: In 50% of A/D treatment episodes, the client is engaged
       (remains in treatment for at least 15 days).
      Successful Completion: in 60% of Adult A/D residential treatment episodes, the
       client meets ASAM PPC-2R discharge criteria, completes at least two-thirds of
       their treatment plan goals, and demonstrates 30 days of abstinence.

IV. Special Reporting Requirements:

Contractor will submit enrollment and discharge Client Process Monitoring System
(CPMS) forms for each client to the State Department of Human Services Addictions
and Mental Health (AMH) Division or designee. Contractor will comply with all relevant
CPMS reporting timelines and standards.

Comply with County Quality Assurance reviews, County/State on-site visits/reviews and
recommendations resulting from such reviews.

Contractor must submit a copy of the Monthly A&D Residential Service Reporting Form
to the Contract Administrator at Klamath County Mental Health, Attn: Colette Fleck,
3314 Vandenberg Road, Klamath Falls, OR 97603 no later than 15 days following the
reporting month.

V.    Compensation/Payments:

Reporting using The Monthly A&D Residential Service Reporting Form will determine
monthly reimbursement and reconciliation, if necessary, based on a bed day rate which
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includes payment for services described in A&D 67, Adult Alcohol and Drug Residential
Capacity Services.

Service duplication adversely impacts the cost effectiveness of contracted services. To
minimize duplications, clients served under any Klamath County contract may not
support a claim for reimbursement for the same services under any other Klamath
County contract.

Payments for contract services are disbursed through the normal Klamath County
Accounts Payable process.

Monthly County payments for Contractor services are contingent on the dollar amounts
and services authorized in the Intergovernmental Agreement for the Financing of
Community Mental Health, Developmental Disability and Addiction Services between
the Office of Addictions and Mental Health Services and Klamath County.

County is not obligated to provide payment for any services for individuals who are not
properly reported through CPMS.

Contractor will be paid a maximum of $__________ per contract year (as negotiated)
based on the services stated in the Contractor’s proposal attached to, and made a part
of, this Contract. Payment in the amount of $__________ per month (as negotiated)
will be made prospectively based on historical billings or as negotiated and reconciled
monthly. Contract compliance will be reviewed at intervals during the contract year.
KCMH reserves the right to adjust payment downward if minimum average client target
is not met.

Reconciliation will be done monthly.




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             D. Adult Alcohol and Drug Residential Capacity Services (AD 67)

I.       Service Description:

This contract is also to provide Alcohol and Drug Residential Capacity Services (A&D
67) which are 24-hour residential services delivered to individuals who are enrolled in
A&D 61 services. A&D 67 Services provide a structured environment for an individual
on a 24-hour basis consistent with Level III of the chemical dependency, continued stay
and discharge criteria set forth in OAR 415-051-0000 through 415-051-0155, as such
rules may be revised from time to time, are appropriate to the individual’s needs and
include housing and food services.

II.      Performance Requirements:

Providers of A&D 67 Services funded through this Contract must comply with OAR 415-
051-0000 through 415-051-0155, as such rules may be revised from time to time.
Providers of A&D 67 Services funded through this Contract must also have a current
license issued by the Department of Human Services (the Department) in accordance
with OAR 415-012-0000 through 415-012-0090.

Providers of A&D 67 Services funded through this Contract must participate in client
outcome studies conducted by the Department.

III.     Special Reporting Requirements:

There are no special reporting requirements.

IV.      Compensation/Payments:

Payment is made based on services performed in A&D 61.




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           E. Locally Funded Project for Minorities or Underserved Populations

I.         Service Description:

Contractor agrees to provide outreach and treatment to minorities and/or underserved
populations (target population to be specified in proposal) of any age so that access to
A&D treatment services is improved. Services include case finding, outreach activities
and education, assessment, individual, group, and family counseling, case
management, mentoring and long term support for relapse prevention, delivered in
culturally appropriate, relevant ways for the population served. A complete definition of
outpatient client criteria can be found in ASAM PPC-2R.

II.        Performance Requirements:

          The target population is Klamath County Residents (Adults or Youth) who are
           indigent, members of minority and/or underserved populations, who may find
           difficulty in accessing treatment services due barriers such as remote location,
           homelessness, lack of transportation, language difficulties or other cultural or
           physical barriers.
          Funds cannot be used to deliver outpatient services to any individual enrolled in
           the OHP for chemical dependency benefits.
          Full scope of services will be dependent on specifics proposed by the proposer.
          Service duplication adversely impacts the cost effectiveness of contracted
           services. To minimize duplications, clients served under any Klamath County
           contract may not support a claim for reimbursement for the same services under
           any other Klamath County contract.

III.       General Billing Requirements and Compensation:

If a client is eligible for Oregon Health Plan (OHP) or other insurance, Contractor will
assist the client in applying for that coverage.

Funding under this Contract may not be used to provide treatment for clients who are
OHP eligible, who have other chemical dependency coverage or who are not indigent.

Service duplication adversely impacts the cost effectiveness of contracted services. To
minimize duplications, clients served under any Klamath County contract may not
support a claim for reimbursement for the same services under any other Klamath
County contract.

Based on a sliding scale starting at zero, Proposers shall have a client fee system to
support the costs of these services. However, in no circumstance shall a client’s inability
to pay become a barrier to treatment for those individuals served with funding provided
through this Contract.

Monthly County payments for Contractor services are contingent on the dollar amounts
and services authorized in the Intergovernmental Agreement for the Financing of

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Community Mental Health, Developmental Disability and Addiction Services between
the Office of Addictions and Mental Health Services and Klamath County.

Contractor shall bill County on the CMS 1500 form at the rate established in this section
for all individuals receiving services under this Contract and will use standard billing
procedures i.e., service codes CPT/HCPCs, place of service, unit of service, etc.
Contractor will use the client’s CPMS number in Block 1a of the CMS 1500 form.

Contractor shall be required to bill and receive payment from third party resources for
individuals with such resources.

Monthly payments for contractor services are disbursed through the normal County
accounts payable process. Billings to be paid must be received in accordance with time
lines as described earlier in this section. Payments for services will be rendered as
follows. Contract and reimbursement rates are subject to the availability of funds:

( 1 ) Reimbursement will be made according to the Klamath County Mental Health
Fee Schedule attached at Exhibit IV; however such reimbursement shall be the lesser
of billed charges or the Klamath County Mental Health Fee Schedule. Billed charges
must reflect the CONTRACTOR’s current fee schedule. Contractor will be paid a
maximum of $__________ per contract year (as negotiated) based on the services
stated in the Contractor’s proposal attached to, and made a part of, this Contract.
Payment in the amount of $__________ per month (as negotiated) will be made
prospectively based on historical billings or as negotiated and reconciled monthly.
Contract compliance will be reviewed at intervals during the contract year. KCMH
reserves the right to adjust payment downward if minimum average billing target is not
met.

(2)      Reconciliation will be done monthly.

County is not obligated to provide payment for any services for individuals who are not
properly reported through CPMS.

IV. Special Reporting Requirements:

Contractor will submit enrollment and discharge Client Process Monitoring System
(CPMS) forms for each client to the State Department of Human Services Addictions
and Mental Health (AMH) Division or designee. Contractor will comply with all relevant
CPMS reporting timelines and standards.

Comply with County Quality Assurance reviews, County/State on-site visits/reviews and
recommendations resulting from such reviews.




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                                             EXHIBIT II
                                  REMEDIES SHORT OF TERMINATION

Contractor may be subject to intermediate sanctions, other than termination of contract,
for failure to comply with the terms and conditions of this Contract as stated below.

Whenever County, in its sole judgment, determines that Contractor is out of compliance
with this Contract, County may, at its discretion, take Remedial Action as outlined
below. County shall issue a Notice of Intended Remedial Action which provides, in non-
Emergency Situations, at least thirty (30) calendar days notice prior to the effective date
of the Remedial Action, and in Emergency Situations, at least seven (7) calendar days
notice prior to the effective date of the Remedial Action. Contractor may request an
administrative review concerning the Notice of Intended Remedial Action and may also
request suspension of the Remedial Action until a decision is reached through the
administrative review process. To receive suspension of the intended Remedial Action,
Contractor must request an administrative review before the effective date of the
intended Remedial Action and include a request to suspend the intended Remedial
Action. If the intended Remedial Action is suspended and a decision is reached in favor
of County, County may impose the Remedial Action retroactively to effective date stated
in the Notice of Intended Remedial Action.

I. Sanctions

Sanctions should provide for a range of options of varying severity depending on the
seriousness and nature of the contract violation. Options include financial withholds, or
other sanctions designated to remedy contract violations. Conditions that may result in
sanctions include, but are not limited to:

         A. Failure to substantially provide clinically necessary services that are required
            to be provided to individuals under this Contract,

         B. failure to maintain an internal quality improvement program as described in
            OAR 415-051-0015.

         C. failure to comply with the operation and financial reporting requirements of
            this Contract,

         D. failure to comply with Fraud and Abuse requirements as described in this
            Contract,

         E. failure to comply with CPMS submission requirements as described in this
            Contract,

         F. Contractor acts to discriminate among individuals to be served under this
            Contract on the basis of their mental health status or need for mental health
            services, and




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         G. misrepresentation or falsification of information that Contractor provides to a
            client, potential client, provider, Oregon Department of Human Services, or
            County.

         H. Failure to maintain substantial compliance with OAR 415-051-0000 through
            415-051-0165.

II. Corrective Action Plan

County may require corrective action in the event that conditions exist which indicate
that the Contractor is not in compliance with the provisions of this Contract. County will
issue the Contractor a Notice of Intended Remedial Action. Contractor shall comply
with any requirements, placed upon the Contractor by County, to bring the identified
areas into compliance with this Contract as soon as is practical and no later than sixty
(60) calendar days after a Notice of Intended Remedial Action is received.

A written plan to correct deficiencies cited and a time frame for completion of the plan
must be submitted to County by the Contractor within 10 (ten) calendar days after
receipt of Notice of Intended Remedial Action. The plan shall be subject to approval by
County, which may accept it as submitted, accept it with specified modifications, or
reject it. County may extend or reduce the time frame for corrective action depending
on the nature of the deficiency and shall be entitled to exercise any other right or
remedy available to it.

         A. Contractor shall submit a written Corrective Action Plan for approval by
            County within 10 (ten) calendar days after receipt of Notice of Intended
            Remedial Action. The Contractor’s plan must include:

                   1. Identification of all areas of non-compliance;
                   2. description of specific activities to be undertaken to achieve
                      compliance;
                   3. a completion date for each activity and the date by which full
                      compliance will be achieved;
                   4. identification of persons responsible for completing each activity; and
                   5. a plan for monitoring to assure future compliance.

         B. County shall review and monitor Contractor’s Corrective Action Plan and shall
            respond in writing with either recommendations for revisions or modifications,
            or approval of plan as submitted.

         C. If Contractor’s plan requires revisions, Contractor shall have 10 calendar days
            from the date the plan is returned by County to make the revisions and
            resubmit the plan.

         D. If Contractor is unable or unwilling to develop a Corrective Action Plan within
            the time frames indicated, County may choose to initiate one of the Remedies
            Short of Termination outlined below.

III. Remedies Short of Termination
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In the event County intends to exercise one of the following Remedies Short of
Termination, County shall provide the Contractor with the opportunity to implement
corrective action in accordance with the following procedures:

         A. County will issue a Notice of Intended Remedial Action notifying contractor of
            its failure to comply with the requirements of this Contract. In cases of
            emergency, Notice of Immediate Action will be provided as soon as
            practicable.

         B. The Notice of Intended Action will provide Contractor with at least 30 calendar
            days notice prior to the effective date of the intended Remedial Action.
            Contractor shall develop an acceptable corrective action plan for correcting
            the deficiencies.

         C. If the Contractor has not submitted an acceptable corrective action plan, or
            has not implemented this plan within a reasonable time, County will provide
            the Contractor with notice that County is proceeding with one of the following
            intermediate Remedies Short of Termination.

              1. Adjustment in Payment

              In the event that the Contractor substantially fails to submit required data or
              reports accurately and within the time frames specified in this Contract,
              County shall withhold two percent (2%) of the next monthly payment. For
              each month thereafter that Contractor fails to comply with the requirements of
              this Contract an additional one percent (1%) will be withheld, to a maximum of
              twenty-five percent (25%). During the term of the sanction, all other terms and
              conditions of this Contract still apply.

              2. Other

              Any other sanctions, at the County’s discretion, reasonably designed to
              remedy and/or compel future compliance with the Contract.

         D. Circumstances of non-compliance which could compromise the health, safety,
            or rights of members would be considered emergency cases and Notice of
            Immediate Action shall be provided to Contractor.

         E. County shall provide Addictions & Mental Health Division (AMH) written
            notice within 30 calendar days that a sanction has been issued which details
            the kind of sanction and the reason for the County’s decision to impose or
            remove the sanction.

         F. In determining the type of sanction imposed and the duration of the sanction,
            County will consider the following factors:

                 1. Any prior violations by the Contractor which relate to the compliance with
                    this Contract;
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                 2. the gravity of the violation, including the actual and potential threat to
                     health, safety, and rights of members; and
                 3. the financial benefits, if any, realized (or anticipated to be realized) as a
                     result of the violation, such as costs avoided as a result of not having
                     complied with the terms of this Contract.

         G. Any sanctions imposed by County shall continue until Contractor successfully
            demonstrates to County correction of identified areas of non-compliance.

IV. Operational

If County determines that Contractor is substantially out of compliance with the terms of
this Contract either through monitoring or audit activities, County shall do the following:

            A. Issue a Notice of Intended Remedial Action

            Contractor will be notified by certified mail of the County’s intent to initiate
            Remedial Action at least 30 calendar days prior to the effective date of the
            action in non-emergency situations. In emergency situations, Contractor shall
            be given notice at least 7 calendar days prior to the effective date of the
            Remedial Action. The notice shall identify:

              1. The factual basis used to determine the alleged violations of this Contract;
              2. reference to the section(s) of this Contract alleged to have been violated
                 by the Contractor;
              3. explanation of actions expected by the Contractor;
              4. explanation of actions County intends to take; and
              5. Contractor’s right to file a request for an administrative review of the
                 decision.

         B. A copy of the Notice of Intended Remedial Action shall be forwarded to
            AMH.

         C. Review and Approval of Corrective Action Plan

              If County requires Contractor to submit a Corrective Action Plan, the County
              will review, approve, and monitor progress towards compliance with the
              requirements of this Contract.

         D. If the Contractor fails to meet the specified performance requirements of a
            corrective action plan, County may impose a sanction on the Contractor.
            When this decision is made, County shall do the following:

                  1. The County will consult and verify Contractor non-compliance with
                     contractual requirements with a representative from Addictions and
                     Mental Health Division. Factors to consider when recommending a
                     corrective action or sanctions are:



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                      a. prior violations by Contractor as an indicator of ongoing or systemic
                         problems;
                      b. the gravity of the current area of non-compliance, including the actual
                         and potential threat to health, safety, and rights of members; and
                      c. any potential or realized cost avoidance as a result of Contractor’s
                         non-compliance.

              2. The County will send notification to the Addictions and Mental Health
                 Division of the sanction and corrective action plan and attach all
                 documentation supporting the sanction.

              3. Upon approval the County will prepare the Notice of Intended Action for
                 the Contract Administrator’s signature. A copy of the letter will be sent to
                 AMH.

Notify the Contractor in writing of the basis for the sanction, the type and duration of the
sanction, and the Contractor’s right to file a request for an administrative review of the
sanction decision. Contractor may request this review in writing within 21 calendar days
of the date of the sanction notice.

If, after a reasonable period of time, County determines that Contractor will not or
cannot comply with the provisions of the Contract, County will provide Contractor with a
90 day termination notice, per the Termination Section of the Contract.




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                                        Exhibit III
                  Reporting and Other Documentation Requirements Matrix



                                                                                  Due Date
     Reports & Other Documentation
                                                                                 For Report
           Approved Annual Budget                          2 weeks prior to Contractor’s new fiscal year
                                                           At initial Contract signature and within 15 days
             Certificate of Approval
                                                           after receipt of new certificate
                                                           Prior to Contract signature and 15 days prior to
            Certificate of Insurance
                                                           expiration
                                                           7 days after opening chart and 30 days after
                        CPMS
                                                           closing chart
                                                           15th day of the following month that services were
            Billing Data (CMS 1500)                        provided or 15 days after receipt of third party
                                                           payment
 Financial Audit & Letter to Management                    6 months after end of Contractor’s fiscal year
    Monthly A&D Residential Service                        15th business day of the following month that
 Reporting Form (Residential Services                      services were provided
                  only)




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                                            EXHIBIT IV
                             Klamath County Mental Health Fee Schedule




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                                                     Klamath County Mental Health Chemical Dependency
                                                         Procedure Codes and Reimbursement Rates
CPT/ HCPC       POS          Daily        Frequency Limitations                       Upper               Description
                             Max                                                      Payment
                             Unit/                                                    Limit ***
                             Svc


Outpatient Services
H0001         13,12          1               1 assessment per 12 mos.                    $170.98          Alcohol and/or Drug Assessment
              57,99
H0002 t       13,12                                                                       $21.37          Behavioral health screening to determine eligibility for admission
              57,99                                                                                       to treatment program, per 15 mins.
H0004 t       13,12          8                            24/mo                           $21.37          Behavioral Health counseling and therapy, per 15 mins.
              57,99
H0005         13,12          2                             8/wk                           $42.77          Alcohol and/or Drug Services; group counseling by a clinician.
              57,99
H0006 t       13,12                                                                       $21.37          Case management of patient needing services relating to alcohol or
              57,99                                                                                       drug abuse/dependence, provides assistance and care coordination
                                                                                                          based on the needs of the individual. The case manager assesses the
                                                                                                          needs of the patien, assists in the development of recovery plans to
                                                                                                          benefit the patien,as well as the implementation of the plans.
                                                                                                          Reviews and evaluates the patient’s progress in relation to the plan,
                                                                                                          per 15 mins.
H0048-HF        13,12        1                         4 UA’s/mo                          $11.48          Alcohol and/or Other Drug Testing; collection and handling only,
                57,99                                                                                     specimens other than blood.
T1006           13,12        1                             6/mo                          $128.24          Alcohol and/or other substance abuse services, family/couple
                57,99                                                                                     counseling
T1013-HF        13,12                                                                      $7.69          Sign language or oral interpretation services, per 15 mins.
                57,99
90849-HF        13,12        1                            4/mo.                           $42.77          Multiple-family group.
                57,99
     “T” indicates service may be provided telephonically
     Modifiers                                          Place of Service
     HF – Substance Abuse                               03 – School, a facility whose primary purpose is education   57 - Non-Residential Substance Abuse Treatment Facility (OP)
     HG – Opiate Addiction Treatment Program            11 – Office Location                                         49 – Independent Clinic: Services provided in OTP
     (Modifiers may only be used for specific codes,    12 – Home Location                                           99 – Other Place of Service, other place of service not identified.
     Identified in this document)                       Use “G” as type of service for “AC” Providers.               55– Residential Substa

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                                                   Exhibit V
                               The Monthly A&D Residential Service Reporting Form

                                                           (To be negotiated)




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