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HomeMy WebLinkAbout19-Fire Department CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION From: Larry R. Pitzer, Fire Chief Subject: Resolution authorizing the City of San Bernardino to enter into standard agreements with the Department of Mental Health-Patton State Hospital. Dept: Fire Date: June 29, 2006 MC/C Meeting Date: July 24, 2006 Synopsis of Previous Council Action: ORIGINAL RECOMMENDATION: I. Adopt resolution. 2. Authorize the Finance Director to amend the FY 2006-2007 Budget and increase General Fund revenue number account 001-000-4880 (EMS user Fee) by $20,000 from $450,000 to a new total of $470,000. R Contact Person: Larry R. Pitzer. Fire Chief Phone: (909) 384-5286 Supporting data attached: StaffReoort. Resolution. and Agreementt Ward: Citv Wide FUNDING REQUIREMENTS: Amount: The proiected revenue of$20.000 should be collected in FY 06/07. Source: (Acct No.) 001-000-4880 (Acct Description) EMS User Fee Finance: Council Notes: 'ReS/') J-DD6 - ~[a (0 7 J i1 q/!J ltJ Agenda Item No. 1'1 e e e STAFF REPORT SUBJECT: Resolution authorizing the City of San Bernardino to enter into standard agreements with the Department of Mental Health-Patton State Hospital. BACKGROUND: The Fire Department responds to emergency medical incidents and renders emergency medical care and lifesaving measures in accordance with emergency medical standards established by the San Bernardino County Health Officer. For EMS services rendered, the city charges a user fee. The City of San Bernardino Municipal Code Chapter 3.72 authorizes the city to charge the EMS user fee to recover costs associated with the delivery of paramedic services for basic and advanced life support services. The California Department of Mental Health requires that state mental hospitals enter into agreements to reimburse local agencies for services provided to patients. Therefore, Patton State Hospital, the local care and treatment facility within our community is required to establish an agreement with the city. The agreement will allow Patton State Hospital to reimburse the city for emergency medical services rendered. The Fire Department is requesting authorization to enter into standard agreements with the Department of Mental Health-Patton State Hospital to compensate the city for billable EMS services at their facility. There are two separate agreements that require action for the city to receive compensation for services provided to Patton State Hospital from July 1, 2005 through June 30, 2006 and July 1, 2006 through June 30, 2008 (respectively, attachment A and B). The agreements outline mutual expectations, rights and responsibilities of the Department of Mental Health-Patton State Hospital and the Fire Department. Since the implementation date of agreements has passed, the resolution ratifies any action taken from July 1, 2005 through the date that the agreements are executed. The delay in finalizing the terms and conditions of the agreements, was a result of the 2005-2006 agreement budgeted amount not being adequate to cover the actual Fire Department response costs thus requiring re-negotiation. FINANCIAL IMP ACT: There is no cost to the City to enter into these standard agreements with the Department of Mental Health-Patton State Hospital. Services are being provided with or without the agreement in place. However, this will allow Patton State Hospital to compensate the City for all emergency medical services rendered to their patients. e e e All approved invoices by Patton State Hospital will compensate the City for EMS services and funds will be deposited into the City's revenue account number 001-000-4880 (EMS user fee). Agreement number 05-30099 and 06-30099 will allow us to receive compensation for billable services in the amount not-to-exceed $74,999.99; retro from July I, 2005 through June 30, 2008. The amount of compensation provided for in these agreements is considered adequate by all parties. Therefore, the projected revenue to be received for services rendered per the agreements is estimated between $10,000 and $20,000 per year, based on the assumption that all billable calls are for patient related calls. Fire anticipates additional EMS user fee revenue in the amount of$20,000 per year. RECOMMENDATION: 1. Adopt resolution. 2. Authorize the Finance Director to amend the FY 2006-2007 Budget and increase General Fund revenue number account 001-000-4880 (EMS user Fee) by $20,000 from $450,000 to a new total of $470,000. 2 1 e 2 3 4 5 6 7 8 9 10 11 12 13 e 14 15 16 17 18 19 20 21 22 23 24 25 26 e 27 28 RESOLUTION NO. RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE CITY OF SAN BERNARDINO TO ENTER INTO STANDARD AGREEMENTS ~TH THE DEPARTMENT OF MENTAL HEALTH- PATTON STATE HOSPITAL. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: SECTION 1. The City of San Bernardino and the Department of Mental Health-Patton State Hospital wish to enter into standard agreements for emergency medical services reimbursement to the City of San Bernardino; SECTION 2. The Mayor or his designee is hereby authorized and directed to execute said agreements, a copy of which is attached and incorporated herein as Attachment A and Attachment B' , SECTION 3. The terms ofthe Standard Agreements are from July 1,2005 through June 30, 2008; therefore, any action taken between July 1, 2005 and the date that the agreement is executed is hereby ratified. SECTION 5. The authorization to execute the above referenced Agreements are rescinded if they are not executed within sixty (60) days of the passage of this resolution. IIII IIII IIII IIII IIII IIII IIII IIII IIII IIII IIII 1 22 23 24 Approved as to Form: 25 JAMES F. PENMAN, 26 City Attorney e 27 28 2 1 e 2 3 4 5 6 7 8 9 10 11 12 13 e 14 15 16 17 18 19 20 21 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE CITY OF SAN BERNARDINO TO ENTER INTO STANDARD AGREEMENTS WITH THE DEPARTMENT OF MENTAL HEALTH- PATTON STATE HOSPITAL. I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and Common Council of the City of San Bernardino at a meeting thereof, held on the day of , 2006, by the following vote, to wit: Council Members: ABSTAIN ABSENT AYES NAYS ESTRADA BAXTER MCGINNIS DERRY KELLEY JOHNSON MCCAMMACK Rachel G. Clark, City Clerk The foregoing resolution is hereby approved this day of ,2006. Patrick J. Morris, Mayor City of San Bernardino Attachment "A" STATE OF CALIFORNIA STANDARD AGREEMENT TO. 213 (Rev 06103) AGREEMENT NUMBER: 05-30099 REGISTRATION NUMBER: This Agreement is entered into between the State Agency and the Contractor named below STATE AGENCY'S NAME DEPARTMENT OF MENTAL HEALTH (Patton State Hospital) CONTRACTOR'S NAME CITY OF SAN BERNARDINO - FIRE DEPARTMENT 2. The term of this Agreement is: July 01, 2005 through June 30, 2006 3. The maximum amount of this $ 25,000.00 Agreement is: Twenty-Five Thousand and Zero Cents 4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made a part of the Agreement: Exhibit A Statement of Work 3 pages Exhibit B Budget Detail and Payment Provisions 2 pages Exhibit C* General Terms and Conditions GTC 306 Check mark one item below as Exhibit 0: [8:1 Exhibit 0 - Special Terms and Conditions (Attached hereto as part of this agreement) o Exhibit 0 - Special Terms and Conditions 2 pages pages Exhibit E HIPAA Business Associate Addendum 6 Exhibit F Commercial General And Automobile Liability Insurance Requirements pages Items shown with an Asterisk ("), are hereby incorporated by reference and made part of/his agreement as if attached reto. These documents can be view at: http://www.ols.dgs.ca.gov/Standard+Language WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CALIFORNIA CONTRACTOR'S NAME (If other than an individual, state whether a corporation, partnership, etc.) Department of General Services CITY OF SAN BERNARDINO - FIRE DEPARTMENT Use Only BY (Authorized Signafure) I DATE SIGNED (do not type) 2S PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS 200 E. Third Street San Bernardino, CA -92410-4889 STATE OF CALIFORNIA AGENCY NAME DEPARTMENT OF MENTAL HEALTH - Patton State Hospital BY (Aufhorized Signature) I DATE SIGNED (do not type) LS PRINTED NAME AND TITLE OF PERSON SIGNING OCTAVIO C. LUNA, EXECUTIVE DIRECTOR ADDRESS CONTRACTS UNIT 3102 EAST HIGHLAND AVENUE PATTON, CA 92369-0999 ~ Exempt Per: SCM 4.04 5.b. e e City of San Bernardino - Fire Department Agreement 05-30099 Page 2 of 15 EXHIBIT "A" (Standard Agreement) SCOPE OF WORK 1. Contractor agrees to provide to the Department of Mental Health, Patton State Hospital (PSH), paramedic services, on as-needed basis, as described herein. 2. The services shail be performed for Patton State Hospital, Medical Services Department, 3102 E. Highland Avenue, Patton, CA 92369-0999 3. The Contractor's professional, technical, and administrative personnel shail provide the necessary covered services (on-cail), 24 hours per day, 7 days per week. 4. The project representative during the term of this agreement will be: State Agency: PATTON STATE HOSPITAL Contractor: CITY OF SAN BERNARDINO Name: Darryl Brown, Administrator Name: Rolf Lindblom, Captain Phone: 909/425-7960 Phone: 909/384-5286 e Fax: 909/425-6589 Fax: 909/384-5281 E-Mail: Lindblom_ Ro@ci.san-bernardino.ca.us Direct All Inquiries To State Agency: PATTON STATE HOSPITAL Contractor: CITY OF SAN BERNARDINO Section/Unit Contracts Office Section/Unit: EMS Coordinator Attention: Connie C. Dodd Attention: Rolf Lindblom, Captain Address: 3102 E. Highland Avenue Address: 200 E. Third Street Patton, CA 92369-0999 San Bernardino, CA 92410 Phone: 909/425-7332 Phone: 909/384-5286 Fax: 909/425-6243 Fax: 909/384-5281 e e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 3 of 15 SCOPE OF WORK (continued) 5. Contractor shall supply all personnel, labor, tools, supplies, materials, equipment, licenses, permits, insurance, and a properly equipped service vehicle to provide paramedic services, on as-needed basis. A. Contractor shall assure that qualified personnel will provide Paramedic and Emergency Medical Technician (EMT-1) service. Contractor's vehicle will arrive with the Advanced Cardiac Life Support. (ACLS) and other equipment for life-saving measures. B. Paramedic services shall be for emergency care to stabilize the patient on-site at PSH. C. Upon arrival at a PSH medical emergency, if a PSH physician is already attending and directing emergency care, the Paramedic shall acquire authorization from the attending physician (on- site) to commence emergency procedures. D. The PSH attending physician shall transfer control to Contractor's paramedic at an appropriate point of care. If there is no PSH physician on-site directing emergency care when Contractor's paramedic reaches the patient, Contractor's paramedic shall assume control immediately. PSH staff shall supply relevant patient medical information to Paramedic and EMT, as available. E. Exchange of monitoring equipment (from PSH's to Contractor's) shall be done at an appropriate time that does not interfere with medical treatment in progress. F. Contractor shall respond in a timely manner, to PSH calls, for emergency or non-emergency calls, as requested and/or as appropriate. G. Contractor shall provide a liaison for discussion of questions or problems related to cases in which the Contractor is involved. PSH's liaison shall be the Chief Physician and Surgeon or designee. H. PSH shall provide opportunities for Contractor to participate in drills or practice/mock runs on the hospital's property, upon Contractor's request or voiuntarily if invited by PSH, to enhance readiness for emergency or disaster response. e City of San Bernardino - Fire Department Agreement 05-30099 Page 4 of 15 SCOPE OF WORK (continued) 6. PSH REQUIREMENTS: A. Contractor shall abide by PSH bylaws, policies, and procedures. B. All patient care services must comply with applicable Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. C. Contractor is advised that tan, brown, and khaki clothing may prevent entry to patient areas of the hospital. D. Contractor shall maintain in effect at all times, during the term of the Agreement, a valid certificate of Commerciai General and Automobiie Liabiiity Insurance in accordance with State of Caiifornia requirements E. Contractor shall maintain in effect at all times, during the term of the Agreement, current iicenses, certifications, and permits in accordance with Federal, State, and locai government requirements. F. G. e H. I. J. Contractor's representatives shall present proper identification in order to be admitted into all secured compounds. (Vaiid Pictured 1.0., Certification Cards, Etc.) Contractor shall cooperate with Hospitai security procedures. In the event additional work is required, Contractor shall provide the Project Coordinator with a written estimate for review and approval prior to commencing the work. Contractor's service staff must be prepared to display a list of tools in their possession, when entering locked compounds. All work shall be coordinated and approved by the Project Coordinator. e e City of San Bernardino - Fire Department Agreement 05-30099 Page 5 of 15 THIS PAGE HAS BEEN INTENTIONALLY BLANK e e e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 6 of 15 EXHIBIT B (Standard Agreement) BUDGET DETAIL AND PAYMENT PROVISIONS 1. Invoicina and Pavment A. For services satisfactorily rendered, and upon receipt and approval of the invoices, the State agrees to compensate the Contractor for actual expenditures incurred in accordance with the rates specified herein, which is attached hereto and made a part of this Agreement. B. Invoices shall include the Agreement Number and shall be submitted in triplicate, not more frequently than monthly in arrears to: Patton State Hospital ATTN: ACCOUNTING/BILLING 3102 E. Highland Avenue Patton, CA 92369-0999 2. Budaet Continaencv Clause A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement. B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to Contractor to reflect the reduced amount. 3. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in Government Code Chapter 4.5, commencing with Section 927. Chargeslrates shall be computed in accordance with the following budget on page 2 of Exhibit B. The cost of each major budget category may vary up to 15% within each Fiscal Year (FY) without DMH approval so long as the total amount budgeted for the FY is not exceeded. 4. Additional Provisions A. This Agreement must be fully executed and approved by the State before any payments for services can be made. B. Invoices to be submitted within ninety (90) days after the services were performed and shall include the PSH Agreement Number, Patient Name, Date of Services Performed, Description of Services/Procedures Provided, the Usual and Customary Rate, Itemization of Costs, and Total Amount Due. C. In the event additional work is required, contractor shall provide the project coordinator with a written estimate for review and approval prior to commencing the work e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 7 of 15 BUDGET DETAIL AND PAYMENT PROVISIONS (continued) D. MUTUAL INDEMNIFICATION Each party, to this contract, shall defend, indemnify, hold free and harmless the other party, its elected officials, its officers and employees, from and against any and all liability, claims, losses and demands, including attorney's fees and other reasonable costs incurred in defending any such claim, whether resulting from court action or otherwise, arising out of the acts, errors or omissions of the indemnifying party, its employees and/or authorized subcontractors, whether intentional or negligent, in the performance of this Agreement. E. SELF-INSURED STATUS Contractor is self-insured through the Big Independent Cities Excess Pool Joint Powers Authority ("BICEP") pursuant to Government Code sections 990.8 and 6500, et seq. Rates are established by the City of San Bernardino Resolution #2004-252 # SERVICES RATE 1. Advanced Life Support (ALS) $ 250.00 /call 2. Basic Life Support (BLS) $ 250.00 /call e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 8 of 15 EXHIBIT D (Standard Agreement) SPECIAL TERMS AND CONDITIONS 1. Client Confidentialitv: A. Contractor shall protect from unauthorized disclosure, names and other identifying information concerning persons receiving services pursuant to this contract, except for statistical information not identifying any client. Ciient is defined as "those persons receiving services pursuant to a Department of Mental Health funded program". Contractor shall not use such identifying information for any purpose other than carrying out the Contractor's obligations under this contract. B. Contractor shall promptly transmit to the State all requests for disclosure of such identifying information not emanating from the client. C. Contractor shall not disciose, except as otherwise specifically permitted by this contract or authorized by the client, any such identifying information to anyone other than the State without prior written authorization from the State. D. For purposes of this section, identity shall include but not be limited to name, identifying number, symbol or other identifying particular assigned to the individual, such as finger or voice print or a photograph. 2. Excise Tax The State of California is exempt from federal excise taxes, and no payment will be made for any taxes levied on employees' wages. The State will pay for any applicable State of California or local sales or use taxes on the services rendered or equipment or parts supplied pursuant to this Agreement. California may pay any applicable sales and use tax imposed by another state. 3. INSURANCE: Contractor hereby warrants that it is self-insured and Contractor may, at its option, (i) satisfy any of its insurance obligations under this Agreement with any blanket policy or policies of insurance or self- insurance program now or hereafter carried or maintained by City and/or (ii) provide for reasonable deductibles with respect to all such insurance. 4. Potentiai Subcontractors Nothing contained in this Agreement or otherwise, shall create any contractual relation between the State and any subcontractors, and no subcontract shall relieve the Contractor of his responsibilities and obligations hereunder. The Contractor agrees to be as fully responsible to the State for the acts and omissions of its subcontractors and of persons either directly or indirectly employed by any of them as it is for the acts and omissions of persons directly employed by the Contractor. The Contractor's obligation to pay its subcontractors is an independent obligation from the State's obligation to make payments to the Contractor. As a result, the State shall have no obligation to pay or to enforce the payment of any moneys to any subcontractor. e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 9 of 15 SPECIAL TERMS AND CONDITIONS (continued) 5. Richt to Terminate: A. The State reserves the right to terminate this agreement subject to 30 days written notice to the Contractor. Contractor may submit a written request to terminate this agreement only if the State should substantially fail to perform its responsibilities as provided herein. B. However, the agreement can be immediately terminated for cause. The term "for cause" shall mean that the Contractor fails to meet the terms, conditions, and/or responsibilities of the contract. In this instance, the contract termination shall be effective as of the date indicated on the State's notification to the Contractor. C. This agreement may be suspended or cancelled without notice, at the option of the Contractor, if the Contractor or State's premises or equipment are destroyed by fire or other catastrophe, or so substantially damaged that it is impractical to continue service, or in the event the Contractor is unable to render service as a result of any action by any governmental authority. 6. Security: A. Contractor understands that services may be performed in a secured area and agrees that Contractor and his/her representatives shall follow any and all rules, regulations and requirements in force at Patton State Hospital. Failure to comply shall constitute grounds for immediate termination of the contract. Contractor shall provide the Project Coordinator with a list of employees/subcontractors within 14 days of requesting access to the secured area. B. Contractor agrees to review and comply with Patton State Hospital's Contraband and Security Policy and Procedures. These documents may be requested through the Project Coordinator or Patton State Hospital Contracts Coordinator. C. Contractor certifies that he is fully knowledgeable of the terms and conditions of the contract documents, the location and site conditions of the project, and the conditions under which the work is to be performed, and that he enters into this contract based upon his investigation of all such matters and is not relying on any opinions or representation of Patton State Hospital. This contract represents the entire agreement. 7. Settlement of DisDutes A. In the event of a dispute, Contractor shall file a "Notice of Dispute" with Patton State Hospital, Executive Director or Designee, within ten (10) days of discovery of the problem. Within ten (10) days, the Executive Director or Designee shall meet with the Contractor and Project Coordinator for purposes of resoiving the dispute. The decision of the Executive Director or Designee shall be final. B. In the event of a dispute, the language contained within this Agreement shall prevail over any other language including that of the bid proposal. e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 10 of 15 EXHIBIT E (Standard Agreement) HIPAA Business Associate Provisions 1. Recitals A. It has been determined that a business associate relationship exists between the Department of Mental Health (DMH) and the Contractor under the Health Insurance Portability and Accountability Act (HIPAA) and its implementing privacy and security regulations at 45 CFR Parts 160 and 164 (the HIPAA regulations:). B. The DMH may wish to disclose to Business Associate certain information pursuant to the terms of this Agreement, some of which may constitute Protected Health Information (PHI). C. The PHI means any information, whether oral or recorded in any form or medium that relates to the past, present, or future physical or mental condition of an individual, the provision of health and dental care to an individual, or the past, present, or future payment for the provision of health and dental care to an individual; and that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual. The PHI shall have the meaning given to such term under HIPAA and HIPAA regulations, as the same may be amended from time to time. D. Under this Agreement, Contractor is the Business Associate of DMH and provides services, arranges, performs or assists in the performance of functions or activities on behalf of DMH and uses or discloses PHI. E. The DMH and Business Associate desire to protect the privacy and provide for the security of PHI disclosed pursuant to this Agreement, in compliance with HIPAA and HIPAA regulations and other applicable laws. F. The purpose of these Provisions is to satisfy certain standards and requirements of HIPAA and the HIPAA regulations. G. The terms used in these Provisions, but not otherwise defined, shall have the same meanings as those terms in the HIPAA regulations. In exchanging information pursuant to this Agreement, the parties agree as follows: 2. Permitted Uses and Disclosures of PHI by Business Associate A. Permitted Uses and Disclosures Except as otherwise indicated in these Provisions, Business Associate may use or disclose PHI only to perform functions, activities or services specified in this Agreement, for, or on behalf of DMH, provided that such use or disclosure would not violate the HIPAA regulations, if done by DMH. B. Specific Use and Disciosure Provisions Except as otherwise indicated in these Provisions, Business Associate may: e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 11 of 15 HIPAA Business Associate Provisions (continued) 1. Use and disclose for management and administration. Use and disclose PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate, provided that disclosures are required by law, or the Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and wiil be used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware that the confidentiaiity of the information has been breached. 2. Provision of Data Aggregation Services Use PHI to provide data aggregation services to DMH. Data aggregation means the combining of PH I created or received by the Business Associate on behaif of DMH with PHI received by the Business Associate in its capacity as the Business Associate of another covered entity, to permit data analyses that relate to the health care operations of DMH. 3. Responsibilities of Business Associate Business Associate agrees: A. Nondisclosure Not to use or disclose Protected Heaith Information (PHI) other than as permitted or required by this Agreement or as required by law. B. Safeguards To implement administrative, physical, and technical safeguards that reasonabiy and appropriately protect the confidentiaiity, integrity, and availability of the protected health information, including electronic PHI, that it creates, receives, maintains or transmits on behalf of DMH; and to prevent use or disclosure of PHI other than as provided for by this Agreement. Business Associate shall develop and maintain a written information privacy and security program that includes administrative, technical and physical safeguards appropriate to the size and complexity of the Business Associate's operations and the nature and scope of its activities. Business Associate will provide DMH with information concerning such safeguards as DMH may reasonably request from time to time. C. Mitigation of Harmful Effects To mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate or its subcontractors in violation of the requirements of these Provisions. D. Reporting of Improper Disclosures To report to the DMH Privacy Officer within one business day, (916) 654-0497, of discovery by Business Associate that PHI has been used or disclosed other than as provided for by this Agreement and these Provisions. e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 12 of 15 HIPAA Business Associate Provisions (continued) E. Notification of Electronic Breach During the term of this Agreement, to notify DMH immediately upon discovery of any breach of security of PHI in computerized form if the PHI was, or is reasonably believed to have been acquired by an unauthorized person. Notification shall be made to the DMH Privacy Officer within one business day at (916) 654-0497. Written notice shall be provided to the DMH Privacy Officer within two (2) business days of discovery. Business Associate shall take (i) prompt corrective action to cure any deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable Federal and State laws and regulations. Business Associate shall investigate such breach and provide a written report of the investigation to the DMH Privacy Officer within thirty (30) working days of the discovery of the breach at the address below: Privacy Officer C/o Office of HIPAA Compliance California Dep,artment of Mental Health 1600 9 h Street, Room 150 Sacramento, CA 95814 F. Business Associate's Contractors To ensure that any contractors, including subcontractors, to whom Business Associate provides PHI received from or created or received by Business Associate on behalf of DMH, agree to the same restrictions and conditions that apply to Business Associate with respect to such PHI; and to incorporate, when applicable, the relevant provisions of these Provisions into each subcontract or subaward to such agents or subcontractors. G. Availability of Information to DMH and Individuals To provide access as DMH may require, and in the time and manner designated by DMH (upon reasonable notice and during Business Associate's normal business hours) to PHI in a Designated Record Set, to DMH (or, as directed by DMH), in accordance with Health & Safety Code 123110 and 45 CFR Section 164.524. Designated Record Set means the group of records maintained for DMH that includes medical, dental and billing records about individuals; enrollment, payment, claims adjudication, and case or medical management systems maintained for DMH health plans; or those records used to make decisions about individuals on behalf of DMH. Business Associate shall use the forms and processes developed by DMH for this purpose and shall respond to requests for access to records transmitted by DMH within 5 days of receipt of the request by producing the records or verifying that there are none within 15 days. H. Amendment of PHI To make any amendment(s) to PHI that DMH directs or agrees to pursuant to 45 CFR Section 164.526, In the time and manner designated by DMH. I. Internal Practices To make Business Associate's internal practices, books and records relating to the use and disclosure of PHI received from DMH, or created or received by Business Associate on behalf of DMH, available to DMH or to the Secretary of the U.S. Department of Health and Human Services in a time and manner designated by DMH or by the Secretary, for purposes of determining DMH's compliance with the HIPAA regulations. e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 13 of 15 HIPAA Business Associate Provisions (continued) J. Documentation of Disclosures To document and make available to DMH or (at the direction of DMH) to an Individuai such disclosures of PHI, and information related to such disciosures, necessary to respond to a proper request by the subject Individual for an accounting of disclosures of PHI, in accordance with 45 CFR 164.528. K. Employee Training and Discipline To train and use reasonable measures to ensure compliance with the requirements of these Provisions by employees who assist in the performance of functions or activities on behalf of DMH under this Agreement and use or disclose PHI; and discipline such employees who intentionally violate any provisions of these Provisions, including termination of employment. 4. Obligations of DMH DMH agrees to: A. Notice of Privacy Practices Provide Business Associate with the Notice of Privacy Practices that DMH produces in accordance with 45 CFR 164.520, as well as any changes to such notice. The most current Notice of Privacy Practices can be viewed at: http://www.DMH.ca.Qov/hipaa. B. Permission by Individuals for Use and Disclosure of PHI Provide the Business Associate with any changes in, or revocation of, permission by an Individual to use or disclose PHI, if such changes affect the Business Associate's permitted or required uses and disclosures. C. Notification of Restrictions Notify the Business Associate of any restriction to the use or disclosure of PHI that DMH has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect the Business Associate's use or disclosure of PHI. 5. Audits, Inspection and Enforcement From time to time, DMH may inspect the facilities, systems, books and records of Business Associate to monitor compliance with this Agreement and these Provisions. Business Associate shall promptly remedy any violation of any provision of these Provisions and shall certify the same to the DMH Privacy Officer in writing. The fact that DMH inspects, or fails to inspect, or has the right to inspect, Business Associate's facilities, systems and procedures does not relieve Business Associate of its responsibility to comply with this Agreement and these Provisions, nor does DMH's: A. failure to detect; or B. detection, but failure to notify Business Associate, or e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 14 of 15 HIPAA Business Associate Provisions (continued) C. require Business Associate's remediation of any unsatisfactory practices, constitute acceptance of such practice or a waiver of DMH enforcement rights under this Agreement and these Provisions. 6. Termination A. Termination for Cause Upon DMH's knowledge of a material breach of these Provisions by Business Associate, DMH shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this Agreement if Business Associate does not cure the breach or end the violation within the time specified by DMH; or 2. Immediateiy terminate this Agreement if Business Associate has breached a material term of these Provisions and cure is not possible. 3. If neither cure nor termination is feasible, the DMH Privacy Officer shall report the violation to the Secretary of the U.S. Department of Health and Human Services. B. Judicial or Administrative Proceedings The DMH may terminate this Agreement, effective immediately, if (i) Business Associate is found guilty in a criminal proceeding for a violation of the HIPAA Privacy or Security Rule or (ii) a finding or stipulation that the Business Associate has violated a privacy or security standard or requirement of HIPAA, or (Hi) other security or privacy laws is made in an administrative or civil proceeding in which the Business Associate is a party. C. Effect of Termination Upon termination or expiration of this Agreement for any reason, Business Associate shall return or destroy all PHI received from DMH (or created or received by Business Associate on behalf of DMH) that Business Associate still maintains in any form, and shall retain no copies of such PHI or, if return or destruction is not feasible, it shall continue to extend the protections of these Provisions to such information, and limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. This provision shall apply to PHI that is in the possession of subcontractors or agents of Business Associate. 7. Miscellaneous Provisions A. Disclaimer The DMH makes no warranty or representation that compliance by Business Associate with these Provisions, HIPAA or the HIPAA regulations will be adequate or satisfactory for Business Associate's own purposes or that any information in Business Associate's possession or control, or transmitted or received by Business Associate, is or will be secure from unauthorized use or disciosure. Business Associate is solely responsible for all decisions made by Business Associate regarding the safeguarding of PHI. e e e City of San Bernardino - Fire Department Agreement 05-30099 Page 15 of 15 HIPAA Business Associate Provisions (continued) B. Amendment The parties acknowledge that Federal and State laws relating to electronic data security and privacy are rapidly evolving and that amendment of these Provisions may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of HIPAA, the HIPAA regulations and other applicable laws relating to the security or privacy of PHI. Upon DMH's request, Business Associate agrees to promptly enter into negotiations with DMH concerning an amendment to these Provisions embodying written assurances consistent with the standards and requirements of HIPAA, the HIPAA regulations or other applicable laws. DMH may terminate this Agreement upon thirty (30) days written notice in the event (i) Business Associate does not promptly enter into negotiations to amend these Provisions when requested by DMH pursuant to this Section or (ii) Business Associate does not enter into an amendment providing assurances regarding the safeguarding of PHI that DMH in its sole discretion, deems sufficient to satisfy the standards and requirements of HIPAA and the HIPAA regulations. C. No Third-Party Beneficiaries Nothing express or implied in the terms and conditions of these Provisions is intended to confer, nor shall anything herein confer, upon any person other than DMH or Business Associate and their respective successors or assignees, any rights, remedies, obligations or liabilities whatsoever. D. Interpretation The terms and conditions in these Provisions shall be interpreted as broadly as necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws. The parties agree that any ambiguity in the terms and conditions of these Provisions shall be resolved in favor of a meaning that complies and is consistent with HIPAA and the HIPAA regulations. E. Regulatory References A reference in the terms and conditions of these Provisions to a section in the HIPAA reguiations means the section as in effect or as amended. F. Survival The respective rights and obiigations of Business Associate under Section 6.C of these Provisions shall survive the termination or expiration of this Agreement. G. No Waiver of Obiigations No change, waiver or discharge of any liability or obligation hereunder on anyone or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall prohibit enforcement of any obligation, on any other occasion. Attachment "B" STATE OF CALIFORNIA STANDARD AGREEMENT TD. 213 (Rev 06103) AGREEMENT NUMBER: 06-30099 REGISTRATION NUMBER: This Agreement is entered into between the State Agency and the Contractor named below STATE AGENCY'S NAME DEPARTMENT OF MENTAL HEALTH (Patton State Hospital) CONTRACTOR'S NAME CITY OF SAN BERNARDINO - FIRE DEPARTMENT 2. The term of this Agreement is: July 01, 2006 through June 30, 2008 3. The maximum amount of this $ 49,999.99 Agreement is: Forty-Nine Thousand, Nine Hundred Ninety-Nine and Ninety-Nine Cents 4. The parties agree to comply with the tenns and conditions of the following exhibits which are by this reference made a part of the Agreement: Exhibit A Statement of Work 3 pages Exhibit B Budget Detail and Payment Provisions 2 pages Exhibit C* General T arms and Conditions GTC 306 Check mark one item below as Exhibit D: 181 Exhibit D - Special Terms and Conditions (Attached hereto as part of this agreement) D Exhibit D-Special Terms and Conditions 2 pages pages Exhibit E HIPAA Business Associate Addendum 6 Exhibit F Commercial General And Automobile Liability Insurance Requirements pages Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached eto. These documents can be view at: http://www.o/s.dgs.ca.gov/Standard+Language WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CALIFORNIA CONTRACTOR'S NAME (If other than an individual, state whether a corporation, partnership, etc.) Department of General Services CITY OF SAN BERNARDINO - FIRE DEPARTMENT Use Only BY (Authorized Signature) I DATE SIGNED (do not type) .€S PRINTED NAME AND TITLE OF PERSON SIGNiNG ADDRESS 200 E. Third Street San Bernardino, CA -92410-4889 STATE OF CALIFORNIA AGENCY NAME DEPARTMENT OF MENTAL HEALTH - Patton State Hosoital BY (Authorized Signature) I DATE SIGNED (do not type) .<'f PRINTED NAME AND TITLE OF PERSON SIGNING OCTAVIO C. LUNA, EXECUTIVE DIRECTOR ADDRESS CONTRACTS UNIT 3102 EAST HIGHLAND AVENUE PATTON, CA 92369-0999 [8J Exempt Per: SCM 4.04 S.b. e e e e SCOPE OF WORK EXHIBIT "A" (Standard Agreement) City of San Bernardino - Fire Department Agreement 06-30099 Page 2 of 15 1. Contractor agrees to provide to the Department of Mental Health, Patton State Hospital (PSH), paramedic services, on as-needed basis, as described herein. 2. The services shall be performed for Patton State Hospital, Medical Services Department, 3102 E. Highland Avenue, Patton, CA 92369-0999 3. The Contractor's professional, technical, and administrative personnel shall provide the necessary covered services (on-call), 24 hours per day, 7 days per week. 4. The project representative during the term of this agreement will be: State Agency: Name: Phone: Fax: PATTON STATE HOSPITAL Darryl Brown, Administrator 909/425-7960 909/425-6589 Contractor: Name: Phone: Fax: E-Mail: Direct All Inquiries To State Agency: Section/Unit Attention: Address: Phone: Fax: PATTON STATE HOSPITAL Contracts Office Connie C. Dodd 3102 E. Highland Avenue Patton, CA 92369-0999 909/425-7332 909/425-6243 Contractor: Section/Unit: Attention: Address: Phone: Fax: CITY OF SAN BERNARDINO Rolf Lindblom, Captain 909/384-5286 909/384-5281 Lindblom _ Ro@ci.san-bernardino.ca.us CITY OF SAN BERNARDINO EMS Coordinator Rolf Lindblom, Captain 200 E. Third Street San Bernardino, CA 92410 909/384-5286 909/384-5281 e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 3 of 15 SCOPE OF WORK (continued) 5. Contractor shall supply all personnel, labor, tools, supplies, materials, equipment, licenses, permits, insurance, and a properly equipped service vehicle to provide paramedic services, on as-needed basis. A. Contractor shall assure that qualified personnel will provide Paramedic and Emergency Medical Technician (EMT-1) service. Contractor's vehicle will arrive with the Advanced Cardiac Life Support. (ACLS) and other equipment for life-saving measures. B. Paramedic services shall be for emergency care to stabilize the patient on-site at PSH. C. Upon arrival at a PSH medical emergency, if a PSH physician is already attending and directing emergency care, the Paramedic shall acquire authorization from the attending physician (on- site) to commence emergency procedures. D. The PSH attending physician shall transfer control to Contractor's paramedic at an appropriate point of care. If there is no PSH physician on-site directing emergency care when Contractor's paramedic reaches the patient, Contractor's paramedic shall assume control immediately. PSH staff shall supply relevant patient medical information to Paramedic and EMT, as available. E. Exchange of monitoring equipment (from PSH's to Contractor's) shall be done at an appropriate time that does not interfere with medical treatment in progress. F. Contractor shall respond in a timely manner, to PSH calls, for emergency or non-emergency calls, as requested and/or as appropriate. G. Contractor shall provide a liaison for discussion of questions or problems related to cases in which the Contractor is involved. PSH's iiaison shall be the Chief Physician and Surgeon or designee. H. PSH shall provide opportunities for Contractor to participate in drills or practice/mock runs on the hospital's property, upon Contractor's request or voluntarily if invited by PSH, to enhance readiness for emergency or disaster response. e City of San Bernardino - Fire Department Agreement 06-30099 Page 4 of 15 SCOPE OF WORK (continued) 6. PSH REQUIREMENTS: A. Contractor shall abide by PSH byiaws, policies, and procedures. B. All patient care services must comply with applicable Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. C. Contractor is advised that tan, brown, and khaki ciothing may prevent entry to patient areas of the hospital. D. Contractor shall maintain in effect at all times, during the term of the Agreement, a valid certificate of Commercial General and Automobiie Liability Insurance in accordance with State of California requirements E. Contractor shall maintain in effect at all times, during the term of the Agreement, current licenses, certifications, and permits in accordance with Federal, State, and local government requirements. F. G. e H. I. J. Contractor's representatives shall present proper identification in order to be admitted into all secured compounds. (Valid Pictured 1.0., Certification Cards, Etc.) Contractor shall cooperate with Hospital security procedures. In the event additional work is required, Contractor shall provide the Project Coordinator with a written estimate for review and approval prior to commencing the work. Contractor's service staff must be prepared to display a list of tools in their possession, when entering locked compounds. All work shall be coordinated and approved by the Project Coordinator. e e City of San Bernardino - Fire Department Agreement 06-30099 Page 5 of 15 THIS PAGE HAS BEEN INTENTIONALLY BLANK e e e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 6 of 15 EXHIBIT B (Standard Agreement) BUDGET DETAIL AND PAYMENT PROVISIONS 1. Invoicina and Payment A. For services satisfactorily rendered, and upon receipt and approval of the invoices, the Slate agrees to compensate the Contractor for actual expenditures incurred in accordance with the rates specified herein, which is attached hereto and made a part of this Agreement. B. Invoices shall include the Agreement Number and shall be submitted in triplicate, not more frequently than monthly in arrears to: Patton State Hospital ATTN: ACCOUNTING/BILLING 3102 E. Highland Avenue Patton, CA 92369-0999 2. Budaet Continaencv Clause A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement. B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to Contractor to reflect the reduced amount. 3. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in Government Code Chapter 4.5, commencing with Section 927. Charges/rates shall be computed in accordance with the following budget on page 2 of Exhibit B. The cost of each major budget category may vary up to 15% within each Fiscal Year (FY) without DMH approval so long as the total amount budgeted for the FY is not exceeded. 4. Additional Provisions A. This Agreement must be fully executed and approved by the State before any payments for services can be made. B. Invoices to be submitted within ninety (90) days after the services were performed and shall include the PSH Agreement Number, Patient Name, Date of Services Perfonmed, Description of Services/Procedures Provided, the Usual and Customary Rate, Itemization of Costs, and Total Amount Due. C. In the event additional work is required, contractor shall provide the project coordinator with a written estimate for review and approval prior to commencing the work e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 7 of 15 BUDGET DETAIL AND PAYMENT PROVISIONS (continued) D. MUTUAL INDEMNIFICATION Each party, to this contract, shall defend, indemnify, hold free and harmless the other party, its elected officials, its officers and employees, from and against any and all liability, claims, losses and demands, including attorney's fees and other reasonable costs incurred in defending any such claim, whether resulting from court action or otherwise, arising out of the acts, errors or omissions of the indemnifying party, its employees and/or authorized subcontractors, whether intentional or negligent, in the perfonmance of this Agreement. E. SELF-INSURED STATUS Contractor Is self-insured through the Big Independent Cities Excess Pool Joint Powers Authority ("BICEP") pursuant to Government Code sections 990.8 and 6500, et seq. Rates are established by the City of San Bernardino Resolution #2004-252 # SERVICES RATE 1. Advanced Life Support (ALS) $ 250.00 /call 2. Basic Life Support (BLS) $ 250.00 /call r- e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 8 of 15 EXHIBIT D (Standard Agreement) SPECIAL TERMS AND CONDITIONS 1. Client Confidentialitv: A. Contractor shall protect from unauthorized disclosure, names and other identifying information concerning persons receiving services pursuant to this contract, except for statistical information not identifying any client. Client Is defined as "those persons receiving services pursuant to a Department of Mental Health funded program". Contractor shall not use such identifying information for any purpose other than carrying out the Contractor's obligations under this contract. B. Contractor shall promptly transmit to the State all requests for disclosure of such identifying information not emanating from the client. C. Contractor shall not disclose, except as otherwise specifically permitted by this contract or authorized by the client, any such identifying information to anyone other than the State without prior written authorization from the State. D. For purposes of this section, identity shall include but not be limited to name, identifying number, symbol or other identifying particular assigned to the individual, such as finger or voice print or a photograph. 2. Excise Tax The State of California is exempt from federal excise taxes, and no payment will be made for any taxes levied on employees' wages. The State will pay for any applicable State of California or local sales or use taxes on the services rendered or equipment or parts supplied pursuant to this Agreement. California may pay any applicable sales and use tax imposed by another state. 3. INSURANCE: Contractor hereby warrants that it is self-insured and Contractor may, at its option, (i) satisfy any of its insurance obligations under this Agreement with any blanket policy or policies of insurance or self- insurance program now or hereafter carried or maintained by City and/or (ii) provide for reasonable deductibles with respect to all such insurance. 4. Potential Subcontractors Nothing contained in this Agreement or otherwise, shall create any contractual relation between the State and any subcontractors, and no subcontract shall relieve the Contractor of his responsibilities and obligations hereunder. The Contractor agrees to be as fully responsible to the State for the acts and omissions of its subcontractors and of persons either directly or indirectly employed by any of them as it is for the acts and omissions of persons directly employed by the Contractor. The Contractor's obligation to pay its subcontractors is an independent obligation from the State's obligation to make payments to the Contractor. As a result, the State shall have no obligation to pay or to enforce the payment of any moneys to any subcontractor. e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 9 of 15 SPECIAL TERMS AND CONDITIONS (continued) 5. Riaht to Terminate: A. The State reserves the right to terminate this agreement subject to 30 days written notice to the Contractor. Contractor may submit a written request to terminate this agreement only if the State should substantially fail to perform its responsibilities as provided herein. B. However, the agreement can be immediately terminated for cause. The term "for cause" shall mean that the Contractor fails to meet the terms, conditions, and/or responsibilities of the contract. In this instance, the contract termination shall be effective as of the date indicated on the State's notification to the Contractor. C. This agreement may be suspended or cancelled without notice, at the option of the Contractor, if the Contractor or State's premises or equipment are destroyed by fire or other catastrophe, or so substantially damaged that it is impracticai to continue service, or in the event the Contractor is unabie to render service as a result of any action by any governmental authority. 6. Securitv: A. Contractor understands that services may be performed in a secured area and agrees that Contractor and his/her representatives shall follow any and all rules, regulations and requirements in force at Patlon State HospitaL Failure to comply shall constitute grounds for immediate termination of the contract. Contractor shall provide the Project Coordinator with a list of employees/subcontractors within 14 days of requesting access to the secured area. B. Contractor agrees to review and comply with Patton State Hospital's Contraband and Security Policy and Procedures. These documents may be requested through the Project Coordinator or Patlon State Hospital Contracts Coordinator. C. Contractor certifies that he is fully knowledgeabie of the terms and conditions of the contract documents, the location and site conditions of the project, and the conditions under which the work is to be performed, and that he enters into this contract based upon his investigation of all such matters and is not reiying on any opinions or representation of Patlon State HospitaL This contract represents the entire agreement. 7. Settlement of Disputes A. In the event of a dispute, Contractor shall file a "Notice of Dispute" with Patlon State Hospital, Executive Director or Designee, within ten (10) days of discovery of the problem. Within ten (10) days, the Executive Director or Designee shall meet with the Contractor and Project Coordinator for purposes of resolving the dispute. The decision of the Executive Director or Designee shall be finaL B. In the event of a dispute, the ianguage contained within this Agreement shall prevail over any other ianguage including that of the bid proposaL e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 10 of 15 EXHIBIT E (Standard Agreement) HIPAA Business Associate Provisions 1 . Recitals A. It has been determined that a business associate relationship exists between the Department of Mental Health (DMH) and the Contractor under the Health Insurance Portability and Accountability Act (HIPAA) and its implementing privacy and security regulations at45 CFR Parts 160 and 164 (the HIPAA regulations:). B. The DMH may wish to disclose to Business Associate certain information pursuant to the terms of this Agreement, some of which may constitute Protected Health Information (PHI). C. The PHI means any information, whether oral or recorded In any form or medium that reiates to the past, present, or future physical or mental condition of an individual, the provision of health and dental care to an individual, or the past, present, or future payment for the provision of health and dental care to an individual; and that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual. The PHI shall have the meaning given to such term under HIPAA and HIPAA regulations, as the same may be amended from time to time. D. Under this Agreement, Contractor is the Business Associate of DMH and provides services, arranges, performs or assists in the performance of functions or activities on behalf of DMH and uses or discloses PHI. E. The DMH and Business Associate desire to protect the privacy and provide for the security of PHI disclosed pursuant to this Agreement, in compliance with HIPAA and HIPAA regulations and other applicable laws. F. The purpose of these Provisions is to satisfy certain standards and requirements of HIPAA and the HIPAA regulations. G. The terms used in these Provisions, but not otherwise defined, shali have the same meanings as those terms in the HIPAA regulations. In exchanging information pursuant to this Agreement, the parties agree as follows: 2. Permitted Uses and Disciosures of PHI by Business Associate A. Permitted Uses and Disciosures Except as otherwise indicated in these Provisions, Business Associate may use or disclose PHI only to perform functions, activities or services specified in this Agreement, for, or on behalf of DMH, provided that such use or disclosure would not violate the HIPAA regulations, if done by DMH. B. Specific Use and Disclosure Provisions Except as otherwise indicated in these Provisions, Business Associate may: e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 11 of15 HIPAA Business Associate Provisions (continued) 1. Use and disclose for management and administration. Use and disclose PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate, provided that disclosures are required by law, or the Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and will be used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware that the confidentiality of the information has been breached. 2. Provision of Data Aggregation Services Use PHI to provide data aggregation services to DMH. Data aggregation means the combining of PHI created or received by the Business Associate on behalf of DMH with PHI received by the Business Associate in its capacity as the Business Associate of another covered entity, to permit data analyses that relate to the health care operations of DMH. 3. Responsibilities of Business Associate Business Associate agrees: A. Nondisclosure Not to use or disclose Protected Health Information (PHI) other than as permitted or required by this Agreement or as required by law. B. Safeguards To implement administrative, physical, and technicai safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the protected health information, including electronic PHI, that it creates, receives, maintains or transmits on behalf of DMH; and to prevent use or disclosure of PHI other than as provided for by this Agreement. Business Associate shall develop and maintain a written information privacy and security program that includes administrative, technical and physical safeguards appropriate to the size and complexity of the Business Associate's operations and the nature and scope of its activities. Business Associate will provide DMH with information concerning such safeguards as DMH may reasonably request from time to time. C. Mitigation of Harmful Effects To mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate or its subcontractors in violation of the requirements of these Provisions. D. Reporting of Improper Disclosures To report to the DMH Privacy Officer within one business day, (916) 654-0497, of discovery by Business Associate that PHI has been used or disclosed other than as provided for by this Agreement and these Provisions. e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 12 of 15 HIPAA Business Associate Provisions (continued) E. Notification of Electronic Breach During the term of this Agreement, to notify DMH immediately upon discovery of any breach of security of PHI in computerized form if the PHI was, or is reasonably believed to have been acquired by an unauthorized person. Notification shall be made to the DMH Privacy Officer within one business day at (916) 654-0497. Written notice shall be provided to the DMH Privacy Officer within two (2) business days of discovery. Business Associate shall take (i) prompt corrective action to cure any deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable Federal and State laws and regulations. Business Associate shall investigate such breach and provide a written report of the investigation to the DMH Privacy Officer within thirty (30) working days of the discovery of the breach at the address below: Privacy Officer C/o Office of HIPAA Compliance California Dep,artment of Mental Health 1600 9 h Street, Room 150 Sacramento, CA 95814 F. Business Associate's Contractors To ensure that any contractors, including subcontractors, to whom Business Associate provides PHI received from or created or received by Business Associate on behalf of DMH, agree to the same restrictions and conditions that apply to Business Associate with respect to such PHI; and to incorporate, when applicable, the relevant provisions of these Provisions into each subcontract or subaward to such agents or subcontractors. G. Availability of Information to DMH and Individuals To provide access as DMH may require, and in the time and manner designated by DMH (upon reasonable notice and during Business Associate's normal business hours) to PHI in a Designated Record Set, to DMH (or, as directed by DMH), in accordance with Health & Safety Code 123110 and 45 CFR Section 164.524. Designated Record Set means the group of records maintained for DMH that includes medical, dental and billing records about individuals; enrollment, payment, claims adjudication, and case or medical management systems maintained for DMH health plans; or those records used to make decisions about individuals on behalf of DMH. Business Associate shall use the forms and processes developed by DMH for this purpose and shall respond to requests for access to records transmitted by DMH within 5 days of receipt of the request by producing the records or verifying that there are none within 15 days. H. Amendment of PHI To make any amendment(s) to PHI that DMH directs or agrees to pursuant to 45 CFR Section 164.526, in the time and manner designated by DMH. I. Internal Practices To make Business Associate's internal practices, books and records reiating to the use and disclosure of PHI received from DMH, or created or received by Business Associate on behalf of DMH, available to DMH or to the Secretary of the U.S. Department of Health and Human Services in a time and manner designated by DMH or by the Secretary, for purposes of determining DMH's compliance with the HIPAA regulations. e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 13 of 15 HIPAA Business Associate Provisions (continued) J. Documentation of Disclosures To document and make available to DMH or (at the direction of DMH) to an Individual such disclosures of PHI, and information related to such disclosures, necessary to respond to a proper request by the subject Individual for an accounting of disclosures of PHI, in accordance with 45 CFR 164.528. K. Employee Training and Discipline To train and use reasonable measures to ensure compliance with the requirements of these Provisions by employees who assist in the performance of functions or activities on behalf of DMH under this Agreement and use or disclose PHI; and discipline such employees who intentionaliy violate any provisions of these Provisions, including termination of employment. 4. Obligations of DMH DMH agrees to: A. Notice of Privacy Practices Provide Business Associate with the Notice of Privacy Practices that DMH produces in accordance with 45 CFR 164.520, as weli as any changes to such notice. The most current Notice of Privacy Practices can be viewed at: httD://www.DMH.ca.aov/hiDaa. B. Permission by Individuals for Use and Disclosure of PHI Provide the Business Associate with any changes in, or revocation of, permission by an Individual to use or disclose PHI, if such changes affect the Business Associate's permitted or required uses and disclosures. C. Notification of Restrictions Notify the Business Associate of any restriction to the use or disclosure of PHI that DMH has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect the Business Associate's use or disclosure of PHI. 5. Audits, Inspection and Enforcement From time to time, DMH may inspect the facilities, systems, books and records of Business Associate to monitor compliance with this Agreement and these Provisions. Business Associate shali promptly remedy any violation of any provision of these Provisions and shali certify the same to the DMH Privacy Officer in writing. The fact that DMH inspects, or fails to inspect, or has the right to inspect, Business Associate's facilities, systems and procedures does not relieve Business Associate of its responsibility to compiy with this Agreement and these Provisions, nor does DMH's: A. failure to detect; or B. detection, but failure to notify Business Associate, or e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 14 of 15 HIPAA Business Associate Provisions (continued) C. require Business Associate's remediation of any unsatisfactory practices, constitute acceptance of such practice or a waiver of DMH enforcement rights under this Agreement and these Provisions. 6. Termination A. Termination for Cause Upon DMH's knowledge of a material breach of these Provisions by Business Associate, DMH shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this Agreement if Business Associate does not cure the breach or end the violation within the time specified by DMH; or 2. Immediately terminate this Agreement if Business Associate has breached a material term of these Provisions and cure is not possible. 3. If neither cure nor termination is feasible, the DMH Privacy Officer shall report the violation to the Secretary of the U.S. Department of Health and Human Services. B. Judiciai or Administrative Proceedings The DMH may terminate this Agreement, effective immediately, if (i) Business Associate is found guilty in a criminal proceeding for a violation of the HIPAA Privacy or Security Rule or (ii) a finding or stipulation that the Business Associate has violated a privacy or security standard or requirement of HIPAA, or (Iii) other security or privacy laws is made in an administrative or civil proceeding in which the Business Associate is a party. C. Effect of Termination Upon termination or expiration of this Agreement for any reason, Business Associate shall return or destroy all PHI received from DMH (or created or received by Business Associate on behalf of DMH) that Business Associate still maintains in any form, and shall retain no copies of such PHI or, if return or destruction is not feasible, it shall continue to extend the protections of these Provisions to such information, and limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. This provision shall apply to PHI that is in the possession of subcontractors or agents of Business Associate. 7. Miscellaneous Provisions A. Disclaimer The DMH makes no warranty or representation that compliance by Business Associate with these Provisions, HIPAA or the HIPAA regulations will be adequate or satisfactory for Business Associate's own purposes or that any information in Business Associate's possession or control, or transmitted or received by Business Associate, is or will be secure from unauthorized use or disclosure. Business Associate is solely responsible for all decisions made by Business Associate regarding the safeguarding of PHI. e e e City of San Bernardino - Fire Department Agreement 06-30099 Page 15 of 15 HIPAA Business Associate Provisions (continued) B. Amendment The parties acknowledge that Federal and State laws relating to electronic data security and privacy are rapidly evolving and that amendment of these Provisions may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to lake such action as is necessary to implement the standards and requirements of HIPAA, the HIPAA regulations and other applicable laws relating to the security or privacy of PHI. Upon DMH's request, Business Associate agrees to promptly enter into negotiations with DMH concerning an amendment to these Provisions embodying written assurances consistent with the standards and requirements of HIPAA, the HIPAA regulations or other applicable laws. DMH may terminate this Agreement upon thirty (30) days written notice in the event (i) Business Associate does not promptiy enter into negotiations to amend these Provisions when requested by DMH pursuant to this Section or (i1) Business Associate does not enter into an amendment providing assurances regarding the safeguarding of PHI that DMH in its sole discretion, deems sufficient to satisfy the standards and requirements of HIPAA and the HIPAA regulations. C. No Third-Party Beneficiaries Nothing express or implied in the terms and conditions of these Provisions is intended to confer, nor shall anything herein confer, upon any person other than DMH or Business Associate and their respective successors or assignees, any rights, remedies, obligations or liabilities whatsoever. D. Interpretation The terms and conditions in these Provisions shall be interpreted as broadly as necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws. The parties agree that any ambiguity in the terms and conditions of these Provisions shall be resolved in favor of a meaning that complies and is consistent with HIPAA and the HIPAA regulations. E. Regulatory References A reference in the terms and conditions of these Provisions to a section in the HIPAA regulations means the section as in effect or as amended. F. Survival The respective rights and obligations of Business Associate under Section 6.C of these Provisions shall survive the termination or expiration of this Agreement. G. No Waiver of Obligations No change, waiver or discharge of any liability or obligation hereunder on anyone or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall prohibit enforcement of any obligation, on any other occasion. ** FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT ** RESOLUTION AGENDA ITEM TRACKING FORM Meeting Date (Date Adopted): ~~ Item # ~ \ ~ Resolution # Vote: Ayes~'ll Nays ~ Abstain %- Change to motion to amend original documents 0 Companion Resolutions ;}.()()6 , d-.l..alQ Absent6-- Null/Void After: (0 D days / ~ Resolution # On Attachments: 0 Note on Resolution of attachment stored separately: 0 PUBLISH 0 POST 0 RECORD W/COUNTY 0 By: Date Sent to Mayor: ~ ~~ Date of Mayor's Signature: 7 ~1, t, Date of Clerk/CDC Signature: 7 pi D ~ Reso. Log Updated: tlQ Seal Impressed: Ji\I Reso. # on Staff Report ~ Date Memo/Letter Sent for Signature: 1" Reminder Letter Sent: g- I;:) - Ofo g-';>/-OONotReturned: 0 Date Returned: 2"d Reminder Letter Sent: Request for Council Action & Staff Report Attached: Updated Prior Resolutions (Other Than Below): Updated CITY Personnel Folders (6413,6429,6433,10584,10585,12634): Updated CDC Personnel Folders (5557): Updated Traffic Folders (3985, 8234, 655, 92-389): Yes 4- No-t- NoJt- NoL N04- No Yes Yes Yes Yes Copies Distributed to: Animal Control 0 City Administrator 0 City Attorney JSf' Code Compliance 0 Development Services 0 Others: EDA 0 Information Services 0 Facilities 0 Parks & Recreation 0 Finance g' Police Department 0 Fire Department GJ~ Public Services 0 <Y o?-fJ1P..-- Human Resources 0 Water Department 0 By_ By_ By_ By_ By_ Notes: Ready to File: _ Date: Revised 12/18/03 Camarena No From: Sent: To: Subject: CONSUELa DODD [CDODD@dmhpsh.state.ca.us] Monday, June 26,200611 :14 AM Camarena No; Lindblom Ro RE: Paramedic Service Contract Importance: High u u 05-30099 CON .doc 06-30099 CON.doc '1'* High Priority ** Norma: attached is the revised contract for FY 2005/06 and the upcoming 2-year contract starting 7/01/06. Please print, sign, and return (5) hardcopies of Page 1 for each contract. Upon approval by your City Council, please OVERNIGHT DELIVERY all (10) pages to my attention for further processing. Thank You, CONNIE Consuelo C. Dodd, M.B.A., A.G.P.A. Contracts Coordinator Patton State Hospital 3102 E. Highland Avenue Patton, CA 92369-0999 (909) 425-7332 - Office (909) 425-6243 - fax cdodd@dmhpsh.state.ca.us >>> "Lindblom_Ro" <Lindblom_Ro@ci.san-bernardino.ca.us> 6/20/2006 11:08 AM >>> Connie, Of Southern California The Best ,C'\ 1'0 Hopefully this will be the last change to the contract. It was pointed out to me that on page three, section five, in the main paragraph, it states "Contractor shall supply all personnel, labor, tools, supplies, materials, equipment, licenses, permits, insurance, and a properly equipped service vehicle to provide paramedic and ambulance transport services, on as-needed basis." You must have a separate contract with American Medical Response for actual transport. We will however coordinate ambulance transport in the application of this contract. D 5 o S 'tv J~~ (JJf,dJJ }-!5ltf Could you please make this minor change and send it back. We will then have to send it to the City Council for final approval. ostamesa<a.com SOO_W9-5499 www.c 1 OFFICE OF THE CITY CLERK RACHEL G. CLARK, C.M.C. . CITY CLERK 300 North "D" Street. San Bernardino' CA 92418-0001 909.384.5002' Fax: 909.384.5158 www.sbcity.org ~ August 2, 2006 Connie C. Dodd Patton State Hospital Contracts Office 3102 E. Highland Avenue Patton, CA 92369-0999 Dear Ms. Dodd: At the Mayor and Common Council meeting of July 24, 2006, the City of San Bernardino adopted Resolution No. 2006-266 - Resolution authorizing the City of San Bernardino to enter into standard agreements with the Department of Mental Health - Patton State Hospital. Enclosed are two (2) original sets of the standard agreement along with seven (7) signature pages of the agreement to be executed by the Patton State Hospital. Please obtain signatures in the appropriate locations and forward two sets of each original agreement to the City of San Bernardino. Please retain the five (5) executed signature pages for your records. Please be advised that the agreement will be null and void if not executed within sixty (60) days or by Friday, September 22, 2006. If you have any questions, please contact Dodie Otterbein, Records Management Coordinator, at (909) 384-5002. Sincerely, -)JYldlv;J'yw dtYll,,-- Sandra Medina Assistant to the City Clerk Enclosure Cc: Norma Camarena, Administrative Analyst II, Fire Department CITY OF SAN BERNARDINO AooYfED SHARED VALUES: Integrity' Accountability' Respect for Human Dignity' Honesty .:) () c (f) '.0 -i 0 '" s: I m ~. :JJ i"';> () '-" , 0 '-' '1J v" -< !"J) '0 I (f) m m :JJ m < m :JJ (f) m (f) 0 m -1:t: 0 :JJ -i m :JJ s: (f) ,_d '.' .. j.; 0;' ~, ,-;- " -, " ~J: _., ..~, ,.....' " ,-or ;~ - '.-~.. - ';;0- <~ ;C; : ." ~ -y::. :; -r~' '-J r'TI CL[ ~~ , D E P A R , M E N , ii-v:..i'i [, -l.\ I I - 0;;; 11 H a1 "'J I" I c, - en thAW s I I-.i', I' 0 :.'> e .~ J ... I.' " .:: M' ;;j ." ...., >-' t'<: ~ " ~ .'~ ~, () tate H os p i ta I .' I Avenue, Patton, CA 92369 ,., (') '" :>- '" &? 9) 425-7000 " ':-r 'il '" 0 >, c.c ;v ~ .1>0 w to ~ cr- t,; ~ Co> '" c3 ;') 00 0 0 0000 ,; . ~ i 5~oo' y~ 11? ffi ~ ~ '0_ 'Ill:: 352:l:> Z Z 000 ~a" 3~ <::o:u "Tl9:r., ~ ",~~u;(J) 013 ~or)l<mm~ ~:gg ~~ ~~ G5 8 co ~ o(;.a 2:;:6 m :::t:,-< ~. ^.!l~ ~ ~-;!o----" C~ =. * . ::? IIl""C ~m COW ~ x -<~ ai' iif 9?s:: -< (') g. 'l. or >- ~ <<3 s:: E m . l !a~R~~ t5" '" ;! '" I,,;; a: = ~ m m ~ ~ - ~ x " I m I W ~ 11 + ~ 0" =r ~ E' ti: ~ ~ r ~ i ~ r :D <n m = Q. -6' ~ ~ CP' ~ a VI >- n n o c '" <n o ~ -? o ~ ~o ~ r 1> !!1 ~~f'" ~"l ,6 .t [ ~*cn ~i~[llI ~ .i~s. ~-!ll,~~(') ~i@'llI ~~ ~~.g ;lrf'C HH~ ~ g. UJ .~ !!1=- ~ ~3' .,< .- ~,.o aI gi"'ll':: ,<~3 =: ;;j~m :J ~-"'=(Q: '0 i:s =e. CD cO; ::1': . ..... o :::J - -. :::J CI) ;;t Qi (") :?S :::J' (Q Q) - ::!E ~ ~ 0- ~ ="" (") ~ 0> ex> U> o CO ex> CO .....L .....L /} (', L IrU./JL~ Consuelo C. Dodd, M.BA, A.G.P.A. Contracts Coordinator Enclosures oved agreements to you for your records. Inical questions about the work) I . of payment on your invoices) 169 Jestions of a contractual nature) 2 lle at (909) 425-7332. C A L I F 0 I N I A D E P A I T MEN T 0 F RECEIVEJ-G!TY CLE,,/ Mental HealtnOfiAUG21 f1,illl:17 Patton State Hospital 3102 East Highland Avenue, Patton, CA 92369 (909) 425-7000 August 17, 2006 CITY OF SAN BERNARDINO-FIRE DEPT. ATTN: Sandra Medina, Ass!. City Clerk 300 No. "0" Street San Bernardino, CA 92418-0001 RE: CONTRACT #06-30099 Dear Contractor: We are sending the enclosed (2) fully approved agreements to you for your records. Your contacts here are: Project Coordinator (to answer technical questions about the work) . Darryl Brown, 909/425-7960 Accounting (To check on the status of payment on your invoices) . Trish Thompson, 909/425-7169 Contract Coordinator (To answer questions of a contractual nature) . Connie Dodd - 909/425-7332 If you have any questions, please contact me at (909) 425-7332. Sincerely, C~ Consuelo C. Dodd, M.BA, A.G.P.A. Contracts Coordinator Enclosures CITY OF SAN BERNARDINO Interoffice Memorandum CITY CLERK'S OFFICE Records and Information Management (RIM) Program DATE: August 23, 2006 TO: Norma Camarena, Administrative Analyst II Fire Department FROM: Sandra Medina, City Clerk RE: Duplicate Signed Agreement Please find enclosed one duplicate original executed copy of the agreement attached to Resolution No. 2006-266, authorizing the City of San Bernardino to enter into standard agreements with the Department of Mental Health - Patton State Hospital. If you have any questions, please call Dodie Otterbein at ex!. 3215.