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HomeMy WebLinkAbout06/02/2003 Item 048 MOHAVE COUNTY REQUEST FOR BOARD ACTION FORM From: MOHAVE COUNTY DEPARTMENT OF PUBLIC HEAL TH FORMAL ACTION ❑ CONSENT X Date: April 29, 2003 RESOLUTION ❑ OTHER ❑ BOS Meeting Date: June 2, 2003 INFORMATION ONLY ❑ SUMMARIZE THE ISSUE & DESIRED ACTION CLEARLY /ATTACH BACKUP MATERIAL: The Mohave County Dept of Public Health., Nursing Division is requesting that the BOS approve the Ryan White title 1 2003/2004 agreement and budget in the amount of $52,461. This agreement is for the period for March 1, 2003 -June 30, 2003. There are no county matching funds required. Recommended Motion: Approve the Ryan White title 1200' /2004 agreement and budget Reviewed and Ap roved By: County Att 1 1] Human Resources Finance County ger Board Action Taken: Approved a R nested No Action Taken ❑ Disapproved ❑ Continued t * x ❑ Approved with the following changes: Acknowledged receipt and referred to Filing Information and Retrieval Filed Bid lied Agreement BOS Resolution Filed Yearly Correspondence Filed Petition Filed Dedication Filed Land Sold Filed Land Acquired Filed Franchise I.D. Resolution Filed Improvement District Filed Other Date Routed: Additional Information: xC: You are reminded that items for the agenda, along with complete backup, must be in the County Manager's Office 10 days prior to Board Meeting. Item No. <i:!. .. AGREEMENT BETWEEN CLARK COUNTY HEALTH DISTRICT AND MOHAVE COUNTY DEPARTMENT OF HEALTH & SOCIAL SERVICES MARCH 2003 This Agreement is entered into by and between CLARK COUNTY HEALTH DISTRICT (hereinafter referred to as "DISTRICT") and MOHAVE COUNTY DEPARTMENT OF HEALTH & SOCIAL SERVICES (hereinafter referred to as "PROVIDER"). WHEREAS, DISTRICT is the public health entity for Clark County, Nevada organized pursuant to Nevada Revised Statues Chapter 439 et sequentia; and WHEREAS, DISTRICT is the recipient of Title I funds pursuant to the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 as amended in 1996 and 2000, Public Act 104-146, Catalogue of Federal Domestic Assistance Number 93.914 (hereinafter referred to as the "CARE ACT") and is responsible for the administration of said funds within the Las Vegas, Nevada standard metropolitan statistical area defined by the US Census Bureau, which metropolitan area has been designated by the Health Resources and Services Administration of the US Department of Health and Human Services (hereinafter referred to as "HRSA") as an Eligible Metropolitan Area (EMA) for CARE ACT funding; and WHEREAS, the Las Vegas EMA Ryan White Title I Planning Council (hereinafter referred to as "COUNCIL") was created by and functions pursuant to the requirements of the CARE ACT to provide comprehensive planning for the health care of people living with HIV/AIDS in Clark and Nye Counties, Nevada and Mohave County, Arizona; and WHEREAS, PROVIDER has submitted a detailed proposal in response to the DISTRICT'S Request for Proposals (RFP) dated September 27,2002 and Amendment One dated October 14,2002 under the CARE ACT Program as structured and allocated by said COUNCIL; NOW, THEREFORE, the parties hereto covenant and agree as follows with respect to said CARE ACT program requirements and funds: 1. AGREEMENT TERM: This Agreement shall take effect upon full execution and expires on . June 30, 2003. The project period of this Agreement shall be March 1, 2003 through June 30, 2003. Depending upon the availability of additional funding, this Agreement and project period may be extended for up to one-year ending February 29, 2004 upon execution of an amendment by the parties hereto. , Mohave County Department of Health & Social Services 2. SCOPE OF WORK: PROVIDER shall perform in a professional and diligent manner the specific activities described in Exhibit A, Scope of Work and Budget, attached hereto and incorporated by reference and made a part of this Agreement as though fully set forth herein. PROVIDER shall comply with Standards, Outcomes and Protocols as developed by the COUNCIL. 3. ADDITIONAL INCORPORATED DOCUMENTS AND OBLIGATIONS: PROVIDER understands and further agrees that in order to receive payment under this Agreement it shall: (1) perform all the activities and provide all the services specified in Exhibit A, (2) submit reports in accordance with report due dates specified in Exhibit 8, Deliverables, (3) follow case management guidelines, specified in Exhibit C "Nevada Standards of Practice and Guidelines for HIV-Related Case Management" or any revision thereof implemented by DISTRICT, (4) utilize the Nevada Care Information Management System to manage eligible client data, (5) attend mandatory conferences and trainings and provide sufficient personnel to conduct trainings, as required by DISTRICT. All Exhibits are incorporated by reference and made a part of this Agreement as though fully set forth herein. PROVIDER understands and further agrees that funding made available by DISTRICT under this Agreement shall be used exclusively by PROVIDER to perform the activities and provide the specific services set forth in Exhibit A. These activities and services shall originate at PROVIDER'S main office located at: P. O. Box 7000 318 N. 5th Street Kingman, AZ 86402-7000 Project Director is Patty Mead and Finance Officer is John Timko. PROVIDER shall submit to DISTRICT an updated roster of its Board of Directors and copies of Minutes of Board Meetings conducted during the term of this Agreement and project period within 10 working days of each meeting thereof. PROVIDER understands and further agrees in order to maintain referral relationships it shall participate in the Las Vegas EMA Continuum of Care where services are organized to respond to the individual or family's changing needs in a holistic, coordinated, timely and uninterrupted manner thereby reducing fragmentation of care. PROVIDER shall submit to DISTRICT copies of current Memorandums of Understanding with other providers within the continuum of care PROVIDER shall maintain referrals to the Centralized Services Office for registration into the centralized system. 2 - Mohave County Department of Health & Social Services PROVIDER understands and further agrees that it shall participate in access improvement and shall collaborate with CARE ACT funded and other agencies when deemed necessary to provide efficient and effective services to the HIV infectedlaffected population. PROVIDER shall also insure compliance with National Standards for Culturally and Linguistically Appropriate Services in Health Care as defined by US Department of Health and Human Services, Office of Minority Health. PROVIDER shall also submit copies to DISTRICT of all forms of written correspondence andlor documents pertaining to Ryan White CARE Act Title I Services including but not limited to press releases, formal business letters and notices to the general public issued or released by PROVIDER. PROVIDER shall also account for and report funds expended andlor services provided from other funding sources, specifically for the Ryan White Title I program including but not limited to in-kind contributions, volunteer services, cash match and monetary contributions and donations. See Attachment 1, Quarterly Maintenance of Effort Report and Exhibit B. PROVIDER shall also conduct a price analysis of not less than two quotes for any purchases exceeding $1000 and provide documentation of such analysis. PROVIDER shall use the lowest responsive quote. 4. TERMINATION: This Agreement may be terminated without cause by either party giving written notice by personal service or Certified Mail to the other party at least thirty (30) days prior to the effective date of such termination. Upon the effective date of any termination, any and all rights and obligations of each party hereto shall be deemed at an end and canceled, except as previously accrued or vested. 5. COMPENSATION: PROVIDER shall be compensated monthly for services performed under this Agreement. Total compensation paid by DISTRICT hereunder shall not exceed $52,461 and is conditioned upon receipt of appropriate billing documents as described below. The Financial Status Report/Request for Reimbursement, Attachment 2, submitted to DISTRICT shall include billings to DISTRICT on a monthly basis and in accordance with Exhibit 0, Payment Schedule which is incorporated by reference and made a part of this Agreement as though fully set forth herein. Billings received late, shall be processed in a subsequent payment period. All incomplete and/or inaccurate billings will be returned to PROVIDER for correction and re-submission. Payments 3 , Mohave County Department of Health & Social Services shall be made by DISTRICT in accordance with the payment schedule and not more than (30) calendar days after receipt and approval of an accurate and complete billing form. Payments will be on actual services provided and supporting documentation requirements in accordance with the budgets in Exhibit A and the forms in Attachment 2. PROVIDER may be required by DISTRICT to modify its process by which services are billed and negotiate with DISTRICT units of service, payment rates and total monthly payments during this Agreement period. Funding for the specific services provided as set forth in Exhibit A of this Agreement is made available under the CARE ACT. PROVIDER understands and further agrees that this Agreement is valid and enforceable only if sufficient CARE ACT funds are made available to DISTRICT by HRSA. Payment for all services provided under this Agreement is expressly contingent upon the availability of such CARE ACT funds. This Agreement may be suspended or terminated effective immediately by DISTRICT at any time in the event of reduction, suspension, discontinuation, or other unavailability of these funds. As directed by COUNCIL based on changing service priorities or changing client demand for services, DISTRICT reserves the right to reallocate funding during the Agreement period so that services to be provided and the corresponding maximum payment amount may be decreased or increased at the discretion of DISTRICT. PROVIDER shall obtain written approval from DISTRICT prior to making: 1) fund or budget line item transfer within a service category exceeding 10% of the total award amount, 2) major programmatic changes in the scope of the project or changes in key personnel specified in this Agreement and 3) fund or budget transfers from one service category to another. PROVIDER shall obtain prior written approval from DISTRICT to subcontract any services. Should DISTRICT disallow any portion of the draw down, the request shall be processed for the reduced amount and PROVIDER will be notified in writing of the reason for such disallowance. Grievances concerning such disallowance shall be addressed in writing to the Director of Administrative Services as specified in Section 12. GENERAL PROVISIONS of this Agreement. PROVIDER understands and further agrees that DISTRICT shall not be obligated to honor any claim for payment submitted more than six (6) months after services were provided or submitted more than thirty (30) days after the expiration or termination of this Agreement. DISTRICT shall not honor any request for payment for services provided by volunteers at no cost to the PROVIDER. DISTRICT shall not honor any request for payment for services provided outside of Clark and Nye Counties, Nevada and Mohave County, Arizona unless prior written authorization has been obtained from DISTRICT. 4 .' Mohave County Department of Health & Social Services DISTRICT shall be held harmless for any unforeseen, or unavoidable delays beyond the control of DISTRICT that may affect the timely processing of payments. 6. OPERATION: A. Personnel: PROVIDER understands and further agrees that while performing CARE ACT activities, employees while funded with CARE ACT funds provided under this Agreement, shall provide no services, nor engage in activities other than those specifically set forth in Exhibit A. Personnel "after the fact" time and effort reporting for employees serving in Ryan White funded positions shall be documented (reference Section 6 of this Agreement) by submitting a certified PERSONNEL ACTIVITY EXPENDITURES REPORT (see Attachment 2, Page 5) AND time sheets or certified payroll register for all positions, whether fully or partially funded with CARE ACT funds. PROVIDER shall ensure that no employees or volunteers of the PROVIDER shall in any way have an actual or perceived interest and will not acquire any interest, direct or indirect, financial or otherwise, which would result or have the appearance of resulting in personal, organizational, or professional gain which would conflict in any manner or degree with the performance of the services outlined in Exhibit A. PROVIDER shall maintain and preserve current job descriptions as well as curriculum vitae, resumes, copies of certificates, licenses, and other pertinent credentials of all employees serving in positions funded under this Agreement for a minimum of three (3) years subsequent to the expiration date of this Agreement. B. Equipment Purchases: Funds may be used to purchase medical equipment if the equipment is used primarily for services relating to care of patients with HIV/AIDS and if the equipment purchase has been approved in writing by the DISTRICT. Computer hardware and software applications may not be purchased without prior written approval from DISTRICT which will insure compatibility with the Nevada CARE Information Management system. Title to any and all equipment procured through the expenditure of CARE ACT funds will vest upon acquisition with DISTRICT. Upon termination of Agreement, DISTRICT shall determine the disposition of all such equipment. Property records shall be maintained by PROVIDER, including a description of the property, serial or ID number, source of property, title holder, acquisition date, and cost of property, percentage of CARE ACT funds used to procure the property, its location, use and condition. 5 0, Mohave County Department of Health & Social Services PROVIDER shall develop and institute a system of control to ensure safeguards against theft, damage or other loss of equipment purchased with CARE ACT funds. Any loss, theft or damage shall be immediately reported to the DISTRICT and be promptly investigated. PROVIDER shall conduct a physical inventory of all such equipment annually as identified in Exhibit B and prior to the expiration or termination of this Agreement. 7. RESTRICTIONS ON EXPENDITURES: PROVIDER understands and further agrees that it shall account for the use of Ryan White Title I funding by insuring all expenditures are reasonable and necessary, and are subject to the following: A. CARE ACT funds shall not be used to purchase or improve land, or to purchase, construct, or make permanent improvement to any building except for minor remodeling. B. CARE ACT funds shall not be used to make direct payments to recipients of services except as may be authorized under the Direct Emergency Financial Assistance category of service. C. CARE ACT funds shall not be used to supplant or replace current state or local HIV-related funding. PROVIDER shall maintain on file documentation assuring that services rendered under this Agreement will use CARE ACT funding as a "dollars of last resort" and that the client has no other source of funding to secure such services. D. CARE ACT funds are to be used for HIV/AIDS related services only. Research, epidemiological surveys, clinical trials and capital projects are prohibited. E. CARE ACT funds shall not be used to provide items or services for which payment already had been made or reasonably can be expected to be made, by third party payers, including Medicaid, Medicare, and/or other state or local entitlement programs, prepaid health plans, or private insurance. F. PROVIDER is encouraged to seek other funding sources to supplement CARE ACT funding. G. Use of Ryan White funds for travel is restricted to local travel (within the Las Vegas EMA) and must be program specific. 6 . . Mohave County Department of Health & Social Services 8. PROGRAMMA TIC REQUIREMENTS: A. Continuous Quality Management: PROVIDER shall adhere to DISTRICT'S quality management program guidelines to assess the extent to which HIV health services provided are consistent with the Public Health Service's guidelines for the treatment of HIV disease and related opportunistic infection. PROVIDER shall develop strategies for ensuring that the services it provides are consistent with the guidelines for improving access to and quality of HIV health services. PROVIDER shall work with DISTRICT staff in defining statistically valid service related populations for determining client satisfaction. These guidelines are required by the Continuous Quality Management mandate contained in the Ryan White CARE ACT. To insure adherence to DISTRICT'S quality management program guidelines, PROVIDER shall also complete and submit Quarterly Progress Reports as specified in Exhibit B to DISTRICT on the following dates: 1 st Quarter - July 15, 2003 2nd Quarter - October 15, 2003 3rd Quarter ~ January 15, 2004 Final Report - March 15, 2004 B. Medical and Financial Eligibility Criteria: Provider shall follow medical and financial eligibility criteria as determined by the COUNCIL. C. Fee Schedules: Any fees and charges for service must be published and made available to the public at the time of service. Funds collected by PROVIDER in the form of fees, charges, and/or donations for the delivery of the services provided herein shall be accounted for separately and provided to the DISTRICT. Such fees, charges and/or donations must be used for providing additional services or to defray the costs of providing services consistent with the Scope of Work in Exhibit A. Documentation of assessment of client charges must be consistent with Exhibit E, Income Eligibility Guidelines which is incorporated by reference and made a part of this Agreement as though fully set forth herein. 7 Mohave County Department of Health & Social Services E. Grievance Procedures - Clients: PROVIDER shall maintain on file its current grievance procedures in English and in Spanish for clients not satisfied with services received from PROVIDER. PROVIDER shall submit any revised grievance procedures to DISTRICT. F. Special Provisions: Special emphasis shall be placed on previously neglected, under-represented populations and those who can no longer care for themselves or have no other alternatives. Pursuant to the Ryan White CARE Act Title I "Plan and Guidelines for Implementing the Expenditure Requirement to Provide Services to Women, Infant, Children and Youth" (WICY), PROVIDER shall provide a summary report and demonstrate a percentage of services to this population of not less than 16%. PROVIDER shall capture and report to DISTRICT service output data to assess service needs for the special population "Men of Color who have Sex with Men". CARE ACT funds are to be used as dollars of last resort for each client. 9. REPORTING. MONITORING AND EVALUATION: A. Reporting: PROVIDER shall submit reports in accordance with Exhibit B and other supporting documentation as requested to DISTRICT or its duly authorized representative(s) as determined by the DISTRICT. PROVIDER shall use only DISTRICT approved forms/formats provided in this Agreement. DISTRICT will notify PROVIDER in a subsequent letter(s) of any additional reports that must be submitted and the forms/formats required. PROVIDER shall also report and maintain in the Nevada CARE Information Management System all data relating to Ryan White funded services provided to clients. B. Monitoring: PROVIDER shall allow DISTRICT or its duly authorized representatives to perform reviews, audits and onsite monitoring of this program as may be necessary to determine: (1 ) Whether objectives of this program are being achieved; (2) Whether this program is being conducted in an effective manner; 8 Mohave County Department of Health & Social Services (3) Whether management control systems and internal procedures have been established to meet the objectives of this program; (4) Whether the financial operations of this program are being conducted properly; (5) Whether the reports to DISTRICT contain accurate and reliable information; (6) Whether adequate financial and accounting procedures are in place; (7) Whether technical assistance is needed. DISTRICT personnel and/or duly authorized representatives shall monitor the entire program under this Agreement. DISTRICT will advise PROVIDER in advance of the monitoring procedures which will be used. All information obtained by monitors will be kept confidential within DISTRICT, except as otherwise required by federal or state statutes or regulations. PROVIDER shall maintain discrete client files for all individuals served and shall secure the necessary consents to releases of information to allow for periodic review of all pertinent client information by DISTRICT personnel and/or designated representatives. PROVIDER shall not remove or blackout names or other personal identifying characteristics on client records furnished to DISTRICT. PROVIDER shall provide additional information as requested in writing by DISTRICT. Whenever practical, DISTRICT will allow a minimum of three (3) business days for PROVIDER to respond to requests for records. C. On-Site Visits: DISTRICT or its duly authorized representative{s) will conduct site visits during the Agreement term. DISTRICT will notify PROVIDER when and what type of site visit will be conducted. PROVIDER shall cooperate fully with DISTRICT personnel and/or its duly authorized representatives by providing information upon request concerning client services provided, financial transactions and/or program operations. PROVIDER shall make available for inspection and/or copying by DISTRICT, all records and accounts relating to the work performed or the services provided under this Agreement, or for similar work and/or service provided under other grants and contracts. PROVIDER shall also make available for inspection client grievances received, peer reviews and/or quality assurance reviews performed in-house. 9 Mohave County Department of Health & Social Services D. Evaluation: If DISTRICT discovers any practice, procedure, or policy of PROVIDER which materially deviates from the terms or requirements of this Agreement, which violates state, federal, or county laws or regulations, which threatens the success of the services provided pursuant to this Agreement, or which jeopardizes the fiscal integrity of said services, DISTRICT may notify PROVIDER in writing that corrective action is required. PROVIDER shall correct any and all discrepancies, violations, or deficiencies to the satisfaction of the DISTRICT within ten (10) calendar days of such written notification unless corrective action reasonably requires additional time, in which case PROVIDER shall have a reasonable period of time to make corrections, but in no case not more than (45) calendar days. E. Confidentiality of Client Information: This Agreement is subject to all state and federal laws protecting confidentiality of client medical, behavioral health, and drug treatment information. If PROVIDER falls under Health Insurance Portability and Accountability Act (HIPAA) definition of covered entities, PROVIDER shall designate a Compliance Officer and submit a compliance plan to DISTRICT by April 14, 2003. PROVIDER shall be required to attend DISTRICT sponsored HIPAA training during the term of this Agreement. HIPAA regulations will become effective April 14, 2003 and apply to medical information that contains patient identifiers including name, Social Security number, telephone number, medical record number and ZIP code. The regulations protect all individually identifiable health information in any form (electronic, paper-based, oral) that is stored or transmitted by a covered entity. DISTRICT may amend this Agreement at a later date to conform to HIPAA regulations as they relate to client confidentiality forms. PROVIDER shall establish and maintain written procedures and controls regarding disclosure of confidential medical information and records. Disclosure to DISTRICT is deemed essential to the performance of duties under this Agreement. PROVIDER shall secure from all clients any and all consents to releases of information or other authorization requested by DISTRICT. Each client file documenting the provision of CARE ACT services must contain a release form signed by the client. This release form must consent to the release of named confidential file information to representatives of the DISTRICT and/or its designees for the purpose of the CARE ACT administration and Agreement monitoring for a period of five (5) years from date of execution of this Agreement. Failure to secure consents to releases from clients may result in delay or disallowance of claims to DISTRICT for services covered under this Agreement. 10 Mohave County Department of Health & Social Services The use or disclosure by PROVIDER to any party of information concerning an eligible individual served under this Agreement is expressly limited to the performance of this Agreement. 10. AUDIT REQUIREMENTS: Procedures: All payments made under this Agreement shall be subject to an audit and shall be adjusted in accordance with said audit. PROVIDER shall schedule an annual financial audit to be submitted to DISTRICT for review within six (6) months following the close of the PROVIDER'S fiscal year. Failure to meet this requirement may result in loss of current funding and disqualification from consideration for further DISTRICT administered funding. This audit shall be made by an independent auditor in accordance with generally accepted accounting principles. This requirement applies equally to any and all subcontractors of PROVIDER that receive CARE ACT funds. PROVIDER shall include this requirement in all subcontractor agreements. PROVIDER must make appropriate corrections within six (6) months after receipt of an audit report to remedy any material weaknesses identified by the audit report. DISTRICT may terminate this Agreement and/or withhold payment for non- correction of material weaknesses identified by the audit report. If PROVIDER receives a combined total of $300,000 or more annually from all contracts funded under the CARE ACT, and/or receives $300,000 or more annually from any combination of Federal Funding sources, PROVIDER may be subject to Federal audit requirements per Public Law 98-502, "The Single Audit Act". PROVIDER shall comply with OMB Circulars A-122, A-110, and A-133 as applicable. The single audit report shall be submitted to DISTRICT for review within the six (6) months following the close of the fiscal year. PROVIDER shall permit DISTRICT, state and/or federal representatives access to any pertinent books, documents, papers, client records and other records and materials related to this Agreement. 11 NON-COMPLIANCE: If PROVIDER fails to substantially comply with any material provisions of this Agreement, DISTRICT reserves the right to withhold payment in an amount that corresponds to the harm caused by PROVIDER, and/or to immediately suspend, modify or terminate this Agreement for cause. Events that may lead to withholding of funds, and/or suspension, modification or termination for cause include, but are not limited to: 11 Mohave County Department of Health & Social Services (1 ) PROVIDER materially breaches this Agreement or is in material violation of any applicable county ordinance or state or federal law in conducting activities under this Agreement. (2) PROVIDER fails to maintain any license, registration, or permit required to provide the services specified in this Agreement or fails to utilize licensed personnel, where required by law; (3) PROVIDER, either knowingly or unknowingly, misrepresents, in any way, information or data furnished to the DISTRICT, or submits reports that are materially incorrect or incomplete or delinquent; (4 ) PROVIDER makes improper use of funds; (5) PROVIDER fails to resolve to the reasonable satisfaction of DISTRICT any disallowed or questionable costs and/or operating practices identified in any prior year program monitoring, site visit or audit reports; (6) PROVIDER engages in unlawful discrimination; (7) PROVIDER fails to take timely corrective action in response to written notification by the DISTRICT; (8) PROVIDER is indebted to the United States Government; (9) PROVIDER fails to collaborate and cooperate with other CARE ACT funded or non-funded agencies when deemed necessary to provide efficient and effective services to the HIV infected/affected population. This includes failing to attend or send a representative to meetings scheduled by the DISTRICT and other agencies; (10) PROVIDER fails to accomplish Scope of Work, Exhibit A or fails to meet deliverable due dates indicated in Exhibit B. (11 ) PROVIDER uses CARE ACT funds for lobbying purposes or fails to submit to DISTRICT "Disclosure of Lobbying Activities with Non-Federal Funds" Statement. (12) DISTRICT reasonably deems PROVIDER'S performance is unsatisfactory; Any withheld funding may be released upon written documentation received by DISTRICT and DISTRICT concurrence that compliance has been achieved. 12 GENERAL PROVISIONS: A. Record Retention: PROVIDER agrees to maintain and preserve all books, documents, paper, audit reports, contracts, and other records relating to this Agreement for a period of five (5) years after termination of this Agreement, or if any litigation, claim, negotiation, audit or other action involving the records has been started before the expiration of the five 12 Mohave County Department of Health & Social Services year period, the records shall be retained until completion of the action and resolution of all issues which arise from it or for five (5) years from the start of the action whichever is later. B. Compliance with Laws, Regulations and Guidelines: PROVIDER shall comply with all applicable state, federal and county laws and regulations relating to its performance under this Agreement as they now exist and as hereafter amended or otherwise modified. PROVIDER shall perform all services under this Agreement in compliance with the US Office of Management and Budget (OMB) cost principles and uniform administrative requirements as promulgated in its published circulars as well as US Department of Health and Human Services Public Health Service Grants Policy Statements, all HRSA CARE ACT program guidelines, policies and practices and comply with the Universal Health Records Standards issued by H RSA. PROVIDER shall also be in compliance with the Civil Rights Act of 1964, Equal Employment Opportunity Act, Anti-Kickback Act, the Davis-Bacon Act, OSHA regulations, Clean Air and Clean Water Acts, EPA regulations and mandatory standards and policies related to energy efficiency. In accordance with the Immigration Reform and Control Act of 1986, PROVIDER shall not employ unauthorized or illegal aliens in the performance of this Agreement. PROVIDER in connection with any service or other activity under this Agreement, shall not in any way discriminate against any client on the grounds of age, race, color, national origin, ancestry, religion, sex/gender, sexual orientation, mental disability, physical disability, medical condition, political beliefs, organizational affiliations or marital status. PROVIDER shall include this non-discrimination clause in all subcontracts/agreements inuring to the benefit of PROVIDER and/or DISTRICT. PROVIDER shall also fully comply with all applicable provisions of the Americans with Disabilities Act of 1990. PROVIDER shall, without limitation, obtain and maintain all licenses, permits, and authority legally required to do business, render services, and/or perform work under this Agreement. C. Insurance: PROVIDER shall carry Commercial General Liability Insurance, the amount of one million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000) aggregate, during the term of the Agreement, unless PROVIDER has equivalent self- 13 .. Mohave County Department of Health & Social Services insurance liability coverage through a government agency. Proof of such insurance or coverage must be provided by PROVIDER and on file with DISTRICT upon execution of this Agreement. PROVIDER understands and further agrees that regardless of the coverage provided by any insurance policy, to indemnify, defend and hold DISTRICT harmless from any and all claims, demands, actions, attorneys fees, costs, and expenses based upon or arising out of any acts, errors, omissions, fault or negligence of PROVIDER or its principals, employees, subcontractors or other agents while performing services under this Agreement. PROVIDER shall indemnify, defend and hold harmless DISTRICT for any attorney fees or other costs or defense, even if the allegations of the claim are groundless, false or fraudulent. PROVIDER shall promptly inform DISTRICT of any litigation filed against it in conjunction with any activity undertaken pursuant to this Agreement. D. Required Information: All statements, press releases, flyers, posters, brochures and other documents promoting programs and services funded in whole or in part with CARE ACT funds shall specifically reference that funding has been made available through a grant from the US Department of Health and Human Services, HRSA and the Clark County Health District under the CARE ACT. When issuing statements, press releases and other documents describing projects or programs funded in whole or in part with CARE ACT funds, PROVIDER shall clearly state (1) the percentage of the total costs of the program or project financed with these funds; (2) the dollar amount of these funds awarded in support of the project or program, and (3) percentage and dollar amount of the total costs of the project or program that will be financed by other sources. E. Relationship of the Parties No employer-employee relationship between the DISTRICT and PROVIDER is established by this Agreement. PROVIDER is and shall serve as a professional independent contractor. PROVIDER shall not assign, transfer, conveyor otherwise dispose of this Agreement or its rights, title, or interest in the same, or any part thereof, unless authorized as a part of this Agreement or by the prior written consent of DISTRICT and any sureties of the PROVIDER pursuant to the insurance requirements of this Agreement. F. Notices: All administrative or program notices prescribed by this Agreement shall be in writing and deemed effective upon personal service or upon receipt from United States Certified Mail, Federal Express Mail, or other equivalent delivery system. Such 14 Mohave County Department of Health & Social Services notices shall be postage prepaid with return receipt requested, addressed to the appropriate parties at the addresses set forth below or at such other addresses as the party may designate in writing in accordance with this Section: CLARK COUNTY HEALTH DISTRICT CLARK COUNTY HEALTH DISTRICT Karl Munninger Mary Ellen Harrell, PHN Manager Director Administrative Services Program Director Ryan White Title I 625 Shadow Lane 625 Shadow Lane Las Vegas, NV 89106 Las Vegas, NV 89106 P. O. Box 3902 P. O. Box 3902 Las Vegas, NV 89127 Las, Vegas, NV 89127 Telephone: (702) 383-1204 Telephone: (702) 383-1444 Fax: (702) 383-6341 Fax: (702) 383-1446 E-mail: karl@cchd.org E-mail: Harrell@cchd.org PROVIDER: MOHAVE COUNTY DEPARTMENT OF HEALTH & SOCIAL SERVICES Patty Mead, R.N., M.S., Heath Director P. O. Box 7000 318 N. 5th Street Kingman, AZ 86402-7000 Telephone: (520) 753-0743 Fax: (520) 718-5547 G. Authority and Responsibility: Unless otherwise indicated in writing, the following person has primary authority and responsibility to carry out this Agreement on behalf of PROVIDER: Name and Title: Patty Mead, R.N., M.S., Health Director Agency Tax ID Number: 86-6000539 Agency Name: Mohave County Department of Health & Social Services H. Modifications This document represents the entire Agreement between the parties with respect to the subject matter hereof. All prior negotiations and written and/or oral agreements between the parties with respect to the subject matter of this Agreement are superseded by this Agreement. No alteration, modification, or variation of the terms of this Agreement shall be valid unless made in writing and signed by the parties hereto, and no oral understanding or agreement not incorporated herein shall be binding on either party hereto. 15 . Mohave County Department of Health & Social Services I. Severability: If any provision of this Agreement is found by a court of competent jurisdiction to be void, invalid or unenforceable, the same will either be reformed to comply with applicable law or stricken if not so conformable, so as not to affect the validity or enforceability of the remainder of this Agreement. Any provision of this Agreement which is determined to be invalid, void or illegal shall in no way affect, impair or otherwise invalidate any other provision hereof, and remaining provisions shall remain in full force and effect. J. Waivers: No delay or failure to enforce any provision of this Agreement shall constitute a waiver of that provision as to that or any other instance. Any waiver granted by a party must be in writing, and shall apply to the specific instance expressly stated. K. Internal Review: At the conclusion of this Agreement, DISTRICT will conduct an internal review of PROVIDER'S performance during the term of this Agreement. This review will include, but not be limited to, site visits, PROVIDER'S participation in DISTRICT sponsored training and contractor meetings, timeliness of deliverables and grantee sponsored projects through the COUNCIL. Results of this review may be considered when evaluating PROVIDER'S performance for the FY 2004 Request for Proposal process. L. Dispute Resolution: In the event that a dispute arises under the terms of this Agreement and the dispute involves the parties to the Agreement or providers within the Las Vegas EMA, it is understood that the parties to the dispute shall meet and confer in an effort to resolve the dispute. In the event that such efforts to resolve the dispute are not successful, the parties shall submit the dispute to non-binding mediation before a mutually agreed upon and acceptable person who will act as the mediator. In the event that such non-binding mediation efforts are not able to resolve the dispute, the parties shall submit the matter to binding arbitration before a mutually agreeable arbitrator who serves as such with the Eighth Judicial District Court. M. Signature: By signature of this Agreement, PROVIDER agrees to all terms and conditions as outlined in this Agreement except as may be otherwise stated herein. 16 . " Mohave County Department of Health & Social Services N. This Agreement shall be construed and enforced in accordance with the laws of the State of Nevada. The venue for any legal action regarding this Agreement shall be Clark County, Nevada. CLARK COUNTY HEALTH DISTRICT MOHAVE COUNTY DEPARTMENT OF HEAL TH & SOCIAL SERVICES II II . .. . . . ill II I 011 ill III .. . 11II II . . III .. . . II II . " .. I " . III . . . .. II . . II II . " III .. III .. ~j(fJ~~ . II . . III .. .. " . . . " III II . . III III .. ~. II . II . " . .. . . ,. . III II III .. .. . III I". . . II . . . . . oil to .. . III II . . . I . . . .. . . '" II . . ill II III . III .. II . '.................. Donald S. Kwalick, MD, MPH Tom Sockwell, Chairman I II II . . .. .. . . .. Chief Health Officer or Designee Mohave County Board of Supervisors Date: ~ /; /03 Date: APPROVED AS TO FORM: ~5rif\~ '2=f2- Stephen R. Minagil, Esq. . Attorney for DISTRICT 17 Mohave County Department of Health and Social Services BudiJet Preparation Worksheet 2002-2003 Grant Year Mar - Feb Ryan White Title I Grant 272-04-5185 04/15/20039:21 g :\heal thde\admshare\budaet03\RWBud .xls FY02/03 FY02/03 Requested Total Acct Adopted Revised Adjustment Adjustment Number Description Budget Budget New Contract To Base 331.40 Federal Grants ($201,750.00) ($201,750.00) ($158,313.00) $43,437.00 390.00 Miscellaneous Revenues $0.00 390.50 Miscellaneous Revenues $0.00 399.00 Transfer from General Fund $0.00 Total Revenues ($201,750.00) ($201,750.00) ($158,313.00) $43,437.00 401.10 SalarieslWages $38,231.00 $38,231.00 $38,987.00 $756.00 401.20 Overtime $0.00 401.30 Temporary Employees $22,885.00 $22,885.00 $15,990.00 ($6,895.00) 401.40 Short Term Disability $0.00 401.90 Market Study Adjustment $0.00 401.95 Split Fund Salary Allocation ($5,152.00) ($7,925.00) ($9,329.00) ($1,404.00) 402.00 Employee Benefits $0.00 402.10 FICA $4,675.00 $4,675.00 $4,14300 ($532.00) 402.20 Unemployment Compensation $0.00 402.30 Health Insurance $4,206.00 $4,206.00 $8,057.00 53,851.00 402.40 Workers Compensation $336.00 $336.00 $257.00 ($79.00) 402.60 State Retirement $1,267.00 $1,267.00 $1,100.00 ($ 167.00) 402.95 Split Fund Benefit Allocation ($1,201.00 ($3,115.00\ ($2,890.00\ $225.00 PERSONAL $65,247.00 $60,560.00 $56,315.00 ($4,245.00) 411.00 Office Supplies $1,100.00 $700.00 $231.00 ($469.00) 411.40 Copies Duplicating Supplies $400.00 $284.00 ($116.00) 411.50 Data Processing Supplies $0.00 412.20 Food Supplies $14,673.00 $14,673.00 $20,379.00 $5,706.00 412.30 Drugs & Chemicals $49,600.00 $49,600.00 $41,310.00 ($8,290.00) 412.60 Fuel, Oil & Lubricants $100.00 $50.00 ($50.00) 412.90 Misc. Operating Supplies $491.00 $391.00 $94.00 ($297.00) 413.90 Miscellaneous Repair Supplies 50.00 414.00 Minor Small Tools $1,000.00 $1,000.00 5116.00 ($884.00) 419.70 Housing Assistance Payments 50.00 SUPPLIES $66,864.00 $66,864.00 $62,464.00 ($4,400.00) 431.00 Professional Services $0.00 50.00 $0.00 $0.00 431.20 Data Processing Services $684.00 $684.00 $684.00 50.00 431.48 Health Insurance Claims 511,368.00 $21,368.00 $14,30000 (57,068.00) 431.50 Health Services Exams 537,530.00 532,217.00 $16,539.00 (515,678.00) 431.55 Mental Health Service Exams